Lead Article

    The American Health Care Market Just Became Less Opaque

    How much a plate of spaghetti is going to cost you isn’t usually a mystery. Sure, the price can vary quite a bit–from a few cents if you’re making the plate yourself from groceries, to dozens of dollars at a fancy restaurant. You shouldn’t be too surprised by the bill at the end; the price […]

The American Health Care Market Just Became Less Opaque May 8th, 2013 | By | Category: Featured Articles, Lead Article, Medicine

How much a plate of spaghetti is going to cost you isn’t usually a mystery. Sure, the price can vary quite a bit–from a few cents if you’re making the plate yourself from groceries, to dozens of dollars at a fancy restaurant. You shouldn’t be too surprised by the bill at the end; the price is right there on the menu, or on the box–same for you as anyone else.

The American healthcare system remains remarkably opaque–particularly if you are among the uninsured. The cost of a hospitalization for a heart attack varies tremendously depending upon the hospital giving the treatment. And, unlike a restaurant, hospitals generally refuse to state the price up front.

To reduce healthcare costs, the plan for the past few decades has been to pass on costs to the consumer. The idea here is to use the market (in the Adam Smith sense of the word) to force down prices–expecting patients to find the most efficient, cheapest, hospital for a given problem. (Spoiler: It hasn’t worked.)

But, how can you decide which hospital is most efficient, if you have no idea what they’re charging? The net result is most Americans understand that getting sick–thanks to a lack of insurance, or tremendous copayments–is a good way to end up bankrupt, without any real sense of how to pick a more efficient provider.

Something exciting has happened this week, possibly changing this dynamic: The Center for Medicare Services, for the first time, has published the list prices charged by hospitals around the country (to Medicare) for the top one hundred reasons patients end up in the hospital.

Let’s look at what hospitals are charging, and receiving, in the Seattle area. In each of these charts, the blue bars is the bill charged to Medicare by the hospital, the red the payment the hospital actually received from Medicare as well as all copayments or deductibles paid by the patient. You’ll note, like almost all insurers in the US, Medicare pays a significant discount from the billed cost. A patient without insurance can expect the full, undiscounted rate.

First up, the charge for a pneumonia admission:
Pneumonia

For a COPD (rotten lungs, usually after a lifetime of smoking) flare:
COPD

Coronary artery disease, requiring a stent (either a heart attack or a heart-attack-to-be):
CAD-DES

The overbilling is (in part) a negotiation tactic between the hospitals and the insurers–a way of amplifying the percentage discount to a prospective insurer while maintaining revenues. The side effect is to leave the uninsured or underinsured as road-kill–charged two or three times the total bill payed from an insured person.

If nothing else, the Affordable Care Act (i.g. Obamacare) will make this better by shifting a majority of people from the uninsured into the insured group–paying the discounted rate, with insurance picking up most of the total tab.

The Fukushima Disaster Mar 17th, 2011 | By | Category: Featured Articles, Lead Article, Nukes

Like many of you, I’ve been closely following the developments at the Fukushima reactor complex. Below is a set of links to articles I’ve written for the Stranger, as the events have unfolded.

3/12/2011
Explosion at Fukushima Nuclear Plant, Cesium Detected

3/14/2011
Don’t Panic

Geiger Counter Readings Rise in Tokyo

3/15/2011
What’s on Fire at the Fukushima Reactor?

Will Radioactive Particles from the Leaking Reactor Reach Washington State?

The Fukushima Fifty

3/16/2011
“We believe that radiation levels are extremely high” (A discussion of acute radiation injury)

3/17/2011
Video from a Helicopter Flyover of the Fukushima Plant

The Health Effects of Radioactive Isotopes from Fukushima

3/20/2011:
Radiation from Fukushima, in Seattle

3/24/2011:
How Radiation Is Measured

3/27/2011:
Radiation From Fukushima, in Seattle, Tells the Story

The Gold Standard: Inflation, Wealth and Economic Growth Oct 12th, 2010 | By | Category: Economics, Featured Articles, Lead Article

Conservative commentators have been riling up their audiences recently with lots of talk about America ‘devaluing our money’ and expressing the horrors that befell us after the United States left the Gold Standard in 1972. Beck, as always, provides the well-crafted prototype of this line of reasoning.

What’s going on here? Let’s talk macroeconomic theory!

Money, as an abstraction, represents a sliver of the total productive ability of the economy. So, the value of the $20 bill in your pocket is ultimately determined by the productive ability of the economy divided by the total amount of money available at the moment.

Let’s assume that the productive capacity of the United States is stable. If North Korea manufactured a million $20 bills and handed them out to people on the street, the value of your twenty dollar bill would decrease. The term for this–when the growth in the supply of money exceeds the growth in the productive capacity of the economy–is inflation. If you have a wallet thick with $20 bills (you have lots of savings), inflation is working against you. If you owe money, inflation is great. Paying off the same debt (in dollar terms) requires less productive effort.

Assuming again the intrinsic productive capability of the economy is stable, let’s think through what would happen if trillions of dollars were suddenly evaporated–say by a gigantic retail bank failure obliterating checking accounts. Now, the $20 in your pocket represents a larger share of the economic output. That’s deflation. The winners and losers are opposite from inflation. The more savings you have, the better deflation is for you. If you’re indebted, you’re doomed.

Borrowing and saving are both critical for the health of the economy. Inflation discourages saving, deflation strongly discourages borrowing. Therefore, keeping a stable relationship between the productive output of the economy and the total money supply in the economy is the goal.

Here’s the rub: The productive capability of the economy is constantly in flux, and affected by an astonishing multitude of factors: New technologies, the availability of resources, monopolization of supplier companies for other companies, the weather, the overall enthusiasm of entrepreneurs, the number of work-capable people, the amount of labor each person can produce, the number of new ideas worth investing in, the state of infrastructure and on and on and on. Observing this, objectively, is beyond a difficult task; predicting the future productive state of the economy is even more difficult.

The old way to deal with this problem was to ignore it. Under the gold standard, the amount of money is fixed to be equal to the amount of gold in reserve. You could, at any time, exchange your crumpled dollar bill for a fixed amount of shiny metal. Therefore, the growth in amount of money was determined by how fast this one metal could be mined and refined from the earth. You can’t eat gold. You can’t make a home out of gold. And gold clothing is just tacky. The gold production rate is a poor correlate for the growth of the overall economy. The result–particularly during periods of rapid technological advancement in areas beyond metallurgy–were repeated cycles of catastrophic crashes. When an advancement dramatically increased the productive capacity of the economy, the money supply stayed relatively fixed–resulting in sharp, rapid deflation. The deflation stopped borrowing, stopping investment in new endeavors, crashing the economy over and over again. It was a terrible system, whose success depended almost entirely upon luck and faith in divine providence. Of course, Beck loves it.

Instead, we now attempt to measure as well as we can the state of the economy, and forecast how fast it is growing, and then ‘print’ enough new money (or, in theory subtract enough money) so that the ratio of the two stays roughly the same. While not perfect, it’s the far more rational way of dealing with the problem–harnessing mathematics, economic theory and plain-old empiric data.

Assessing and predicting the current and future state of the dollar-based economy is the primary mission of the Federal Reserve. Based on these predictions, the Federal Reserve adds (and theoretically subtracts) from the total money supply–in an attempt to keep the ratio of productive capability to money stable. Hence, the Beckian feverish repetition of, “…. how much money we’re printing at the Federal Reserve.” They (the Fed) are ‘printing’ money to replace that lost by catastrophic (entirely abstract) investments and reflect growth in the productive capability of the nation.

In it’s arsenal–to accomplish this herculean task–the Fed collects data on almost every aspect of the economy. Among all this data is a calculation of the inflation rate of the economy. A basket of goods (representing a cross section of productive output of the economy) is priced out in dollar terms on a regular basis. The rate of change in the price for the collection of goods is used as a measure of the inflation rate. This measure is probably the best sign of how well the Fed has done their matching job. High inflation rates mean too much money supply, low rates of inflation (or negative rates, reflecting deflation) represent too little money is being ‘printed’. Since the economic crisis that started in 2008, the rate of increase in this measure has been historically low–despite the historically large increases in the money supply by the Fed. Based on this measure, the Federal Reserve hasn’t printed enough money, to replace that lost by bankers in their spreadsheets.

There are reasons to be concerned about run away printing of dollars by the Fed–but it’s worth noting that the Fed is a quite conservative organization. At a baseline, the Federal Reserve tends to err on the side of too little growth in the money supply–fitting with the catering to the needs of the wealthy before the needs of the working that dominates US leadership generally. For now, there is no reason underlying the hysteria of the right-wing commentators.

Take Your Generosity and Shove It, Buddy Sep 3rd, 2010 | By | Category: Lit Round-up

Who would you vote off the island: the selfish ass or the generous spirit? The selfish ass, right? Rational.

WSU scientist Craig Parks along with Asako Stone set out to figure out exactly how much loutish behavior a group will tolerate before throwing the selfish out. What they discovered is far more interesting:

…we also observed a completely unanticipated and, we argue, more interesting result: Those who give much to the group effort yet take little of its subsequent reward are not applauded but rather targeted for expulsion. The effect was replicated across three subsequent studies. Two of these studies ruled out some rather mundane explanations for the finding (lack of understanding of the task by the benevolent other, the other behaving unpredictably), and a third suggested that people are motivated to expel the benevolent other either for self-image reasons or because the other is not adhering to common rules of behavior. In this article, we report on this series of studies.

What the hell. The authors go on to attempt to explain why:

These data, then, provide potential explanations for why people want to remove a benevolent individual from the group. In some cases, the individual makes others feel they look bad in comparison, and, in other cases, the person is seen as violating rules of social interaction for mixed-motive situations. As we solicited these explanations after the expulsion preference had been stated, it is certainly possible that they represent not motivations for removing a benevolent other but rather rationalizations for why subjects want the benevolent person removed.

If you were looking for an empiric basis for the “Keep the government’s hands off my Medicare” red state, federal subsidy dependent elderly white teapartier, this is a good place to start.

The HIV Vaccine…. Success Oct 21st, 2009 | By | Category: Public Health

Sixteen thousand people volunteered for the study; unlike most, these weren’t people engaging in high risk behaviors like sex work or IV drug abuse. All received condoms, HIV prevention counseling, and an offer for HAART therapy if they became positive. Eight thousand received a placebo shot, the other half six doses of two distinct (and previously failed) HIV vaccines. About five years later, 74 of the placebo recipients were newly HIV positive. Twenty-three fewer, 51 total, among the vaccine recipients were now HIV positive.

After years of struggle, and some truly distressing failures, this is the one and only successful HIV vaccine trial.

It was definitely took an odd approach. Take two failed vaccines, combine them together, and see if they’ll work. The first vaccine stuffed into a tamed Canarypox virus some of the critical functional proteins of the HIV virus. (Canarypox is in the same broad family of viruses that includes Smallpox. Birds are the desired home of Canarypox; it’s capable of getting into human cells, but not properly replicating itself once in. As such, it has the ideal vaccine combination of really pissing off the human immune system while being incapable of causing injury.) The second, booster, vaccine was simply some of the purified and isolated surface protein (gp120) from the HIV virus. (This booster vaccine is a bit like going around the human immune system with a mugshot of the HIV virus. The isolated protein is incapable of causing disease, but gives the whiff of what the real deal is like.) When the study was first proposed, parts of the scientific community were non-plussed. Isn’t zero times zero still zero?

Nope, it’s one third. What do you do with a vaccine that only works sometimes, or only for some? For a vaccine to be considered clinically useful (i.e, after the shots are done, you can feel confident in telling someone they are vaccinated and protected against the infection), you’d hope to have at least 70-80% of those vaccinated to be protected. (Herd immunity takes care of the rest of the risk, eventually.) Further, this vaccine combination (bizarrely) failed to produce neutralizing antibodies even in the successfully vaccinated.

For the next few months and years, the results of this study will be torn into, trying to answer some of these questions. In the meantime, this is an extremely heartening sign–indicating a real potential to salvage other failed vaccines into successful combination therapies.

Featured Articles

The American Health Care Market Just Became Less Opaque

How much a plate of spaghetti is going to cost you isn’t usually a mystery. Sure, the price can vary quite a bit–from a few cents if you’re making the plate yourself from groceries, to dozens of dollars at a fancy restaurant. You shouldn’t be too surprised by the bill at the end; the price […]

The Fukushima Disaster

Like many of you, I’ve been closely following the developments at the Fukushima reactor complex. Below is a set of links to articles I’ve written for the Stranger, as the events have unfolded. 3/12/2011 Explosion at Fukushima Nuclear Plant, Cesium Detected 3/14/2011 Don’t Panic Geiger Counter Readings Rise in Tokyo 3/15/2011 What’s on Fire at […]

The Gold Standard: Inflation, Wealth and Economic Growth

Conservative commentators have been riling up their audiences recently with lots of talk about America ‘devaluing our money’ and expressing the horrors that befell us after the United States left the Gold Standard in 1972.

Let’s talk macroeconomic theory, and see why they’re wrong.

featuredimage The Health Care Debate

The US healthcare system, in its present state, is a failure. It fails those with and without coverage. We spend more, care for fewer and are sicker than the citizens of any other industrialized nation.

Drugs and Devices

Why are prescription drugs so damn expensive? Or that test your doctor ordered–requiring you to be contorted into some ornate machine–that costs thousands of dollars?

Why Are American Doctors So Damn Expensive?

The salaries of American doctors are huge, terrifying, for anyone trying to bring down health care costs in the United States. Why are American doctors so damn expensive? Medical school is a big part of the answer.

Extraterrestrial Saltwater Ocean on Saturn Moon

Enceladus, a moon of Saturn, probably has a saltwater ocean under it’s surface, at least per an analysis of data from the Cassini probe. Take it away NASA and JPL: For the first time, scientists working on NASA’s Cassini mission have detected sodium salts in ice grains of Saturn’s outermost ring. Detecting salty ice indicates […]

Good Work Dendreon

Dendreon, a Seattle-based biotech startup, just completed a successful phase III trial on an entirely new kind of cancer treatment.

The Carbon Impact of Reading On Paper or Online

Is reading The Stranger online actually any greener than reading the printed-in-Yakima hard copy? It was time to roll up my sleeves and do some real, primary, research on the question. Allow me to show my work.

Evolution on Darwin’s 200th Birthday

Human understanding of life has come in spurts, separated by decades of consolidation and grappling with new data or new ways of thinking about biology. We’re, right now, in midst of another spurt in our understanding of life.

It’s Difficult to Say Nice Things About NDs

A recent column of mine responded to a question/rant about naturopathic medicine: A dear friend of mine is about to enter a prestigious program of naturopathic medicine. There—in exchange for hundreds of thousands of dollars and five years of his life—he will study homeopathy, osteopathy, water therapy, etc. Apparently, after gaining his ND credential, he […]

The HIV Vaccine…. Success

Sixteen thousand people volunteered for the study; unlike most, these weren’t people engaging in high risk behaviors like sex work or IV drug abuse. All received condoms, HIV prevention counseling, and an offer for HAART therapy if they became positive. Eight thousand received a placebo shot, the other half six doses of two distinct (and […]

The American Health Care Market Just Became Less Opaque

How much a plate of spaghetti is going to cost you isn’t usually a mystery. Sure, the price can vary quite a bit–from a few cents if you’re making the plate yourself from groceries, to dozens of dollars at a fancy restaurant. You shouldn’t be too surprised by the bill at the end; the price […]

The Fukushima Disaster

Like many of you, I’ve been closely following the developments at the Fukushima reactor complex. Below is a set of links to articles I’ve written for the Stranger, as the events have unfolded. 3/12/2011 Explosion at Fukushima Nuclear Plant, Cesium Detected 3/14/2011 Don’t Panic Geiger Counter Readings Rise in Tokyo 3/15/2011 What’s on Fire at […]

Yet Another Reason to Dislike CFLs: Horrible Power Factors

Many of you already know of my skepticism of compact fluorescent lightbulbs. Now utilities are joining in the hate: CFLs use about twice as much energy than previously claimed. Lightbulbs, TVs, ovens, baseboard heaters–whatever–draw energy from alternating current with varying degrees of efficiency, due to the funkiness of alternating current. Allow me to explain, by […]

Take Your Generosity and Shove It, Buddy

Who would you vote off the island: the selfish ass or the generous spirit? The selfish ass, right? Rational. WSU scientist Craig Parks along with Asako Stone set out to figure out exactly how much loutish behavior a group will tolerate before throwing the selfish out. What they discovered is far more interesting: …we also […]

The Gold Standard: Inflation, Wealth and Economic Growth

Conservative commentators have been riling up their audiences recently with lots of talk about America ‘devaluing our money’ and expressing the horrors that befell us after the United States left the Gold Standard in 1972.

Let’s talk macroeconomic theory, and see why they’re wrong.

The Apollo Guidance Computer

Let’s say you’re a NASA engineer in the 1960s, wearing your snazzy black plastic glasses, thinking of landing a man on the Moon and returning him safely to the Earth. You start thinking navigation. Getting into the right orbits is going to take a fair bit of computation–plus some fine control of rocket engines and […]

Every Visit to the Seattle Central Library Reminds Me of the Cheese Shop Sketch

“Customer: It’s not much of a cheese shop, is it? Owner: Finest in the district! Customer: (annoyed) Explain the logic underlying that conclusion, please. Owner: Well, it’s so clean, sir! Customer: It’s certainly uncontaminated by cheese….”