Happy July 4 to the Americans reading this. As we eat our cheeseburgers and hot dogs, here’s a robot designed to drill through your blocked arteries, modeled after…the bacteria that causes Lyme disease. The article says it’s about 5 years out, so given my age and health I should be able to start eating all the junk food I want right now, and this technology should be available well before my arteries start to get into serious trouble.
New technology may deliver vaccines without needles. Actually, there are needles but they are so small and short you can’t feel them.
But with if a vaccine could be delivered by simply applying a patch? That’s Mark Prausnitz’s goal: creating a nickel-sized bandage-like device covered with 100 microscopic needles that would puncture the skin, then dissolve to get the vaccine into the body.
Maybe that sounds scary — 100 needles instead of one. But Prausnitz says you can’t really feel the needles. “It wouldn’t be like sandpaper or scratching,” he says. “You would have a hard time feeling a difference between the needles being there or not being there.”
In a poll of U.S. taxpayers, 95% of respondents had no idea how much the country spends on foreign aid, which is much less than 1%. It just shows that although rational people can disagree on how our tax money should be spent, we are not having a rational debate because most of us have no clue what it is really being spent on. A taxpayer receipt is a simple idea to help cure this problem. Ideally this should be done by the IRS or Treasury Department, but the White House has stepped in to do it since nobody else will.
I picked a hypothetical married couple with children making an income of $80,000 per year. There are a million different ways you can slice it. But no matter what you do, the biggest categories jump out at you. Income tax is only about 40% of what the government takes in from this family, with Social Security and Medicare taxes making up the other 60%. Pensions for retired people make up the majority of how the money is spent, with Social Security alone making up almost half. Even without an offical public health care system, the federal government spends a lot on health care – almost 20% of all the money spent between Medicare (for older people) and programs to help lower-income people (Medicaid and children’s health insurance programs mostly). Of course, state and local governments also tax and spend on health care, which is not reflected here.
The military makes up around 10% of all federal spending. If you add veteran’s benefits (I’m double counting here, since these include retirement and health care) and homeland security, that number comes to more like 13%.
So however you slice it, the big numbers are retirement, health care, and defense. If we want to make significant changes in either the amount of tax, or the outcomes of government programs, we should focus most of our debating energies in these areas.
Robot-assisted surgery is here, and this BBC video has some real footage of it. Warning, it’s a little graphic. It looks like the surgeon operating the robot is in the same room, and I assume he could jump in with an old-fashioned scalpel if he needed to. But in the future, I suppose there is no reason why surgery couldn’t be done by a surgeon far away, or even without direct human assistance at all.
Here is an interesting blog post on the “forbidden topic” of health care cost-effectiveness. It’s hard because at the personal, human level life and health are of course priceless. But at the scale of a country or civilization with limited resources, there are choices to make, and better information should allow better choices.
Research in this area can be difficult to perform. One of the reasons is that it’s not always easy to measure health outcomes. Some things, like death, can be relatively easy to define, but how do you quantify having diabetes,asthma or a seizure disorder?
A robust methodology exists for doing so, based upon the expected utility theory of John von Neumann and Oskar Morgenstern. Asking people to consider what risks they will take to avoid certain health states, a technique known as the “standard gamble,” can yield what we call a utility value. Another method, which asks people to think about the trade-off between a shorter life in perfect health and a longer life in an unhealthy state (this is a “time-trade-off”) can also be used to determine a utility value.
When you take a utility value and multiply it by a number of years, you can calculate “quality-adjusted life years,” or QALYs. So if interventions improve quality or add years of life (or both), the number of QALYs goes up. Taking the cost of a therapy and dividing it by the number of QALYs gained results in a measurement of cost effectiveness.
I said recently that I didn’t think oil prices would continue to decline much below $100 a barrel. Well, today (October 10 as I write) West Texas Intermediate is at $85.82 and Brent Crude at $90.21. An article I linked to recently said that fracking is cost-effective right now when oil stays above about $60.
In other economic news, U.S. health care cost growth is significantly down and it seems like that trend might continue. And France’s economy might be in trouble.
What do all these trends mean taken together? I have no idea, but I can speculate as well as anyone. Europe has been stagnant and is staying that way. Growth and energy demand are slowing in Asia too, exactly when U.S. oil and gas production are booming. Maybe solar panels are starting to take a bite out of the natural gas market? Probably not yet, but that will happen.
The U.S. health care system is an extraordinarily complex and inefficient market that nobody truly understands. There are some signs it may finally be getting a little more efficient. I think this may be one reason the U.S. looks like a bright spot in the overall lackluster world economy right now.