Category: Ideas

The ROI Payback of Tossing Incandescents For CFLs

After moving into my current home, I discovered that the previous owners had left dozens of light bulbs for the various fixtures in the house. I was happy to know that I wouldn’t have to restock for a while. In the interim, compact fluorescent light bulbs have become inexpensive, and LED bulbs have begun to become economical as well. While I have realized for some time that CFLs are a good investment with a short payback period, I have yet to replace my bulbs. At some level, it feels wrong to throw out all those light bulbs. What is the real return on throwing out a working bulb and replacing it with a CFL?

I calculated the payback period in days when replacing a 60W bulb with a CFL, assuming $0.1 per kWh electricity and $0.97 per CFL, which is what I paid at Home Depot last weekend [1]. I performed the calculation for a variety of usage assumptions, and this graph shows the results:

CFL Payback Period In Days

The payback on moving to CFLs is quite fast, a few weeks for high usage bulbs, and several months for bulbs used only one hour per day.

The first graph begs the question – how frequently does a light bulb need to be used to justify replacing it with an incandescent? Assuming that a 10% return on investment is desired, that the CFL will last 5 years [2], and that electricity costs $0.10 per kWh, I calculate that you should replace any bulb used more than 9 minutes per day [3].

That’s a pretty low bar, lower than I expected. As CFL prices have dropped, and light quality has improved [4], there aren’t many arguments left for sticking with incandescents. And for the lazy, switching to CFLs will decrease the frequency of light bulb changes, resulting in lower effort as well.

Conclusion: Throw out your light bulbs and replace them with CFLs today. The quality of CFL light output is now pretty close to incandescent, and you are burning money every day you wait!

I replaced roughly 40 light bulbs last weekend, in the middle of writing this post. For the most part it’s worked out – the light quality is decent, but the CFLs still take some time to get to full intensity, and I may have to replace a few that flicker due to dimmers on the switches.

Here is my calculations spreadsheet on Google Docs.

[1] While this was a sale price, CFL prices have been falling steadily and the standard price at HomeDepot.com is still only $1.25 per bulb (see the 12 pack of 60W-equivalent TCP brand bulbs available at this writing).

[2] Many CFLs are warrantied for 7-9 years, and claim 8000-12,000 hours of working life. Five years is thus a conservative estimate, but takes into account the fact that CFL quality control is still an issue, so that some percentage of bulbs will be defective.

[3] The calculations in my spreadsheet are linear with respect to purchase price – if you pay $2 for a CFL instead of $1, then you should replace all bulbs used for more than 18 minutes a day, and so on.

[4] That CFL light quality has improved is my personal opinion – look around on the web, and you will find hundreds of articles disparaging CFL light quality. I think they’ve come a long way, however, and the soft-white (2700K) bulbs available now do an acceptable job imitating incandescent soft-white bulbs.

Posted on by praveenghanta 5

List of Foods By Environmental Impact and Energy Efficiency

Which foods have the smallest (and largest) energy footprint, thereby having the most environmental impact? While most people probably realize that meat products have a larger energy and environmental impact, the degree of difference isn’t immediately clear. How much difference does it make if you’re a vegetarian, or if you’re almost entirely carnivorous? The following list provides a rough estimate of the energy required to produce different kinds of foods, in order from least to most energy intensive:

Table 1: List of Foods By Energy Required to Produce One Pound

Food Energy (kWh) to Produce 1 Lb
Corn [1] 0.43
Milk [2] 0.75
Apples [3] 1.67
Eggs [4] 4
Chicken [5] 4.4
Cheese [2] 6.75
Pork [6] 12.6
Beef [7] 31.5

Table 2: Energy Efficiency of Various Foods (Measured as Food Calories / Energy Used in Production) [8]

Food Calories / Lb Energy Efficiency
Corn 390 102%
Milk 291 45%
Cheese 1824 31%
Eggs 650 19%
Apples 216 15%
Chicken 573 15%
Pork 480 8.5%
Beef 1176 4.3%

The data above indicate the huge difference in energy required from one end of the food spectrum to the other. Roughly twenty-five times more energy is required to produce one calorie of beef than to produce one calorie of corn for human consumption. Dairy products are actually fairly energy efficient, as they are very dense in calories. Vegans may indeed be able to boast that their diets use 90% less energy than the average American’s, and even those who eat only eggs and dairy can lay claim to significant energy efficiency.

At the same time, food production and consumption amounts to only about 10% of first-world energy consumption, so even the most parsimonious eater can reduce their total energy footprint by around 9% through diet alone. The big culprits remain transportation, heating, and cooling, and while diet modification can help, energy conservation efforts should focus most heavily on these areas.

[1] It’s possible to estimate the energy involved in corn production very accurately, since corn energy intensity has been closely scrutinized by both proponents and critics of the corn ethanol industry. This Berkeley study compares energy intensity estimates from two sources, one pro and one anti-ethanol. Using an average of the two studies’ data yields an estimate of 30,000 BTU energy consumed per gallon of ethanol produced. From the same study, about 2.75 gallons of ethanol are produced per bushel of corn, which means that one bushel of corn required 82,500 BTU. One bushel of corn is 56 pounds of corn kernels, so one pound of corn kernels requires 1473 BTU for production. This is equivalent to 0.43 kWh.

[2] For milk, the estimates provided in Without The Hot Air Chapter 13 are utilized, with this conversion used for fluid ounces of milk to weight. The estimates for cheese are also taken from the above chapter, with the numbers simply proportionally adjusted from kg to pounds.

[3] From Table 3 in this study in Nature, we see that the annual energy input for a hectare of apple trees is 500,000 MJ, or 56,230 kWh at 3.6 MJ per kWh and 2.47 acres per hectare. According to this article, 800 bushels of apples per acre appears normal, which is 33600 lb of apples at 42 lb of apples per bushel. This equals 1.67 kWh per pound of apples.

[4] Here are the estimates for eggs, taken from Without The Hot Air page 77. Using a standard of eight eggs to a pound, convert from metric to English measures and arrive at the 4kWh estimate.

[5] Chicken is examined in detail on Without The Hot Air page 79, and I use that estimate, converted to kWh per pound.

[6] For Pork, I use McKay’s estimates from page 77, and convert them for each animal. McKay estimates that a 65kg human burns 3kWh per day, or 0.0462 kWh / kg / day = 0.021 kWh / pound / day. McKay uses a pig lifespan of 400 days, and thus notes that if you want to eat a pound of pork every day, 400 lb of pig must be alive at any given time (one pound for each day, so that the rate of pig production matches the rate of consumption). McKay further estimates that only two-thirds of an animal can be used for meat, so we actually need 600 lb of pig to generate one pound of meat per day. 600lb * 1 day * 0.021 kWh / pound /day = 12.6 kWh for a pound of pork.

[7] Beef is calculated exactly as for Pork above, except that a cow lives for 1000 days instead of 400 days. 1000 lb / 0.66 (wastage factor) * 1 day * 0.021 kWh / pound / day = 31.5 kWh for a pound of beef.

[8] Calorie data was taken from caloriecount.about.com, and kcal (food calories) were converted to kWh for energy efficiency calcs. We simply convert the calories in one pound of each food into kWh, and then divide that number by the energy required for production of one pound of that food.

[9] How can corn have an energy efficiency higher than 100%? This means that the energy that human beings put into the process of growing, distributing, and eating corn is less than theenergy provided to the human body by the corn. The hidden factor here is sunlight – corn plants are drawing energy from the sun for free, and storing that energy, which humans later consume.

Posted on by praveenghanta 16

How Do We Limit Bank Risk?

President Obama recently proposed a tax on some of major banks’ liabilities to pay for TARP-related (bank bailout) losses, and to reduce risk taking by big banks. While the proposed tax might accomplish the former goal, analysts have opined that it is unlikely to decrease financial risk-taking. Regulation might decrease risk-taking, but it doesn’t resolve the issue of paying for past losses, nor does it establish a reserve for any future risks. Is there a better way to reduce risk taking while simultaneously paying for losses past, present, and future?

Why not consider a financial leverage tax on all corporations? The US has historically encouraged debt, which helped fuel the recent credit crisis. A tax on leverage would help penalize excess risk taking by taxing the very fuel that feeds the fire. While it’s perfectly acceptable for any company to gamble with their own equity, systemic risks are created when institutions bet in the trillions by borrowing dozens of times their own capital. That’s precisely what Lehman Brothers and other investment banks did during the boom years, with leverage ratios well over 40 times their own capital. A tax on financial leverage that increases taxation as a function of leverage would allow companies to take on risk while penalizing the Lehmans that took excessive risk with borrowed money.

How would a financial leverage tax work? The tax rate would be based on the debt-equity leverage of the company, so that the tax rate would rise with leverage. The tax might not apply to the first billion dollars in liabilities, so that it would affect only larger corporations. Assume the base tax rate is 0.03% of liabilities. A large non-financial company with $10B in debt and a debt-equity ratio of 1 would have to pay $3 million in taxes [1]. A bank with $10B in liabilities and $1B in equity would have to pay ten times that amount as a result of its 10x leverage, resulting in a tax bill of $30 million. If the bank lends out 10 Billion with a 3% interest margin, it would earn $300 million in net interest. For this bank, the leverage tax would effectively be 10% of net interest income [2].  On the other extreme, under this tax regime a company like Lehman would have had to pay 1.2% of its gross liabilities, which were in the neighborhood of $700 Billion. This would amount to $8B per year, double Lehman’s 4B net income in 2007 [3]!

The financial leverage tax would make it impossible for banks, corporations, and hedge funds to create the kind of credit bubble they created in the mid 2000s. Funds raised by such a tax could be used to pay off the TARP bailout, and also to fund the SEC and other enforcement agencies. The benefit of this approach is that it could be applied across the economy in a uniform way. Current proposals don’t apply to hedge funds and other highly leveraged non-bank institutions, leaving pockets of risk to grow. Excess financial leverage has fueled almost every major financial collapse in history, and a tax on leverage would directly address this issue.

[1] 0.03% of $10 Billion is 10 Billion * 0.0003, or $3,000,000. In the case of the bank with 10x leverage, this figure goes up by a factor of 10, to $30 million

[2] The St. Louis Fed tracks net interest margins of US banks, and they have been above 3% over the last 30 years, making this a very conservative estimate. A leverage tax of $30 Million would be 10% of the bank’s net interest of $300 Million.

[3] At 40x leverage, the leverage tax in the example given would be 1.2% of gross liabilities. With net interest margins around 3.5%, a 1.2% tax would consume about 1/3 of a bank’s interest. Since a bank’s operating expenses and loan losses often consume more than 50% of net interest, this tax rate would likely cause a bank with this kind of leverage to be unprofitable – which is precisely the point.

Posted on by praveenghanta 2

HiddenLevers.com – Scenario Analysis For Investors

I’d like to announce  a new project that I’ve been working on called HiddenLevers.

What happens to your portfolio if interest rates rise to 10%? What about if oil prices spike up to $150 per barrel? Do know what impact health care reform could have on your portfolio?

HiddenLevers.com will help you answer those questions and more, by making Scenario Analysis easy for investors. By connecting big-picture economic factors (levers) with stocks and industries, HiddenLevers helps investors to understand how different economic scenarios can impact their investments.

You can use HiddenLevers to:

Try HiddenLevers out – we think it will add another valuable angle to your investment planning and research! HiddenLevers is currently in beta mode, so don’t hesitate to leave feedback to help improve it.

Posted on by praveenghanta 1

List of Metro Areas By Cost Effectiveness (Adjusted Income)

How cost-effective is your city? More precisely, how well does your hometown rank in median income when incomes are adjusted for the local cost of living? This combination of qualities can be thought of as the “cost-effectiveness” of a city, as measured by adjusting income for cost of living. A number of news sources produce “best cities” lists, and Kiplinger Magazine’s list enables a simple calculation of cost-effectiveness, since it publishes both median income and a cost-of-living index for each city [1]. The ranking of the 50 largest cities in the US by cost-effectiveness (median income / cost of living) is provided below:

Metro Area Cost of Living Index [2]
 Median Household Income Adjusted Income [3]
1. Atlanta-Sandy Springs-Marietta, GA 0.94 57307 60965
2. Indianapolis-Carmel, IN 0.88 52607 59781
3. St. Louis, MO-IL 0.87 51713 59440
4. Washington-Arlington-Alexandria, DC-VA-MD-WV 1.38 81163 58814
5. Dallas-Fort Worth-Arlington, TX 0.92 53748 58422
6. Austin-Round Rock, TX 0.94 54827 58327
7. Houston-Sugar Land-Baytown, TX 0.89 51685 58073
8. Cincinnati-Middletown, OH-KY-IN 0.9 51926 57696
9. Denver-Aurora, CO 1.01 58039 57464
10. Nashville-Davidson–Murfreesboro–Franklin, TN 0.88 49979 56794
11. Kansas City, MO-KS 0.95 53564 56383
12. Charlotte-Gastonia-Concord, NC-SC 0.92 51702 56198
13. Salt Lake City, UT 0.98 55064 56188
14. Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 1.03 57831 56147
15. Minneapolis-St. Paul-Bloomington, MN-WI 1.14 63866 56023
16. Columbus, OH 0.94 51687 54986
17. Hartford-West Hartford-East Hartford, CT 1.19 64989 54613
18. Jacksonville, FL 0.94 51269 54541
19. Las Vegas-Paradise, NV 1 54299 54299
20. Seattle-Tacoma-Bellevue, WA 1.14 61740 54158
21. Richmond, VA 1.05 56277 53597
22. Detroit-Warren-Livonia, MI 1 53593 53593
23. Phoenix-Mesa-Scottsdale, AZ 1 52857 52857
24. San Francisco-Oakland-Fremont, CA 1.37 72059 52598
25. San Jose-Sunnyvale-Santa Clara, CA 1.58 82664 52319
26. Chicago-Naperville-Joliet, IL-IN-WI 1.13 58946 52165
27. Birmingham-Hoover, AL 0.9 46667 51852
28. Boston-Cambridge-Quincy, MA-NH 1.29 66870 51837
29. Louisville-Jefferson County, KY-IN 0.89 46095 51792
30. Memphis, TN-MS-AR 0.86 44495 51738
31. Baltimore-Towson, MD 1.21 62524 51673
32. Sacramento–Arden-Arcade–Roseville, CA 1.15 58480 50852
33. Orlando-Kissimmee, FL 0.98 49789 50805
34. Milwaukee-Waukesha-West Allis, WI 1.02 51669 50656
35. New York-Northern New Jersey-Long Island, NY-NJ-PA 1.21 60964 50383
36. Rochester, NY 0.99 49508 50008
37. San Antonio, TX 0.93 46203 49681
38. Virginia Beach-Norfolk-Newport News, VA-NC 1.1 54442 49493
39. Oklahoma City, OK 0.89 43652 49047
40. Pittsburgh, PA 0.92 44814 48711
41. Buffalo-Niagara Falls, NY 0.93 44747 48115
42. Cleveland-Elyria-Mentor, OH 0.99 47600 48081
43. Providence-New Bedford-Fall River, RI-MA 1.16 54064 46607
44. San Diego-Carlsbad-San Marcos, CA 1.32 60970 46189
45. Portland-Vancouver-Beaverton, OR-WA 1.17 53935 46098
46. Tampa-St. Petersburg-Clearwater, FL 0.99 45243 45700
47. Riverside-San Bernardino-Ontario, CA 1.23 54991 44708
48. New Orleans-Metairie-Kenner, LA 1.06 45802 43209
49. Los Angeles-Long Beach-Santa Ana, CA 1.42 56680 39915
50. Miami-Fort Lauderdale-Pompano Beach, FL 1.2 47527 39606

Atlanta tops the list, followed by Indianapolis, St. Louis, Washington D.C., and Dallas. Rounding out the top 10 are Austin, Houston, Cincinnati, Denver, and Nashville. What city holds the unfortunate designation of being least cost-effective? Miami/Ft. Lauderdale is dead last, with Los Angeles, New Orleans, Orange County (California), and Tampa/St. Petersburg all in the bottom 5.

It clearly pays to live in Atlanta or the other top cities, as higher incomes and lower costs translate into a higher quality of life or simply greater net savings. The cities at the bottom of the list generally suffer from high real estate prices and rental costs coupled with lower median incomes.

[1] Here’s the full spreadsheet of data from Kiplinger.com including 300+ metro areas.

http://www.kiplinger.com/tools/bestcities_sort/index.php?sortby=hhi&sortorder=DESC

[2] The Cost of Living Index in Kiplinger.com’s original list is set so that the average cost of living in the US is 100. Here I have divided the Kiplinger index by 100 so that it can be more easily used in the Adjusted Income calculation.

[3] The Adjusted Income, or cost-effectiveness, is calculated by simply dividing a city’s median income by its cost of living (when the cost of living is a ratio centered around 1 as discussed above).

Posted on by praveenghanta 8

How to Balance the Federal Budget

Can the US federal budget be balanced? It is obviously physically possible to balance the budget by either lowering spending, raising taxes, or a bit of both. But can the budget be balanced in a manner that is fiscally prudent while maintaining adequate funding for government’s most important operations?

I have attempted to balance the 2008 budget below while obeying the following constraints:

  1. No tax increases
  2. No spending shifts between departments, only spending cuts
  3. All spending, including entitlements spending, is fair game

The actual federal deficit for 2008 was $459 Billion, which forms the goal for the cost cutting exercise outlined in the table below [1].

Category 2008 Spending ($Billions) Proposed Cuts Proposed Spending
Defense 612 Cut by $150 Billion, maintaining US defense spending at a level that exceeds the entire World excluding NATO. [2] 462
Social Security 612 Phase out social security benefits for upper income seniors, cutting roughly $110 Billion annually. [3] 500
Medicare + Medicaid 587 Introduce 20% coinsurance for medical spending above $40,000 per year for Medicare and Medicaid recipients, saving $110 Billion. End Medicare Advantage subsidies, saving $17 Billion. [4] 460
Non-defense Discretionary 508 Make an across-the-board 9% cut in non-defense discretionary spending, saving $46 Billion. [5] 462
Other Mandatory Programs [5] 411 End agricultural commodity subsidies and crop insurance subsidies, saving $15 Billion. Modify student loan programs to cut out private middlemen, saving $9 Billion. [6] 387
Interest Payments 253 This cannot be cut without a US government default. 253
Totals 2,983 459 2523

As the table shows, the US federal budget cannot be balanced without deep cuts in Medicare/Medicaid, Social Security, and the Department of Defense. Roughly 60% of the budget is allocated to these major programs, making a balanced budget impossible without reductions here.

A rationale for each major budget cut is provided in the footnotes below. I invite readers to share their balanced budgets as well, or to suggest changes in the cuts that I’ve suggested. Just make sure that the numbers add up, as cutting $459 Billion from the federal budget is harder than it looks!

[1] The core budget data for the table comes from Table S-3 of the US Budget Summary Tables. The 2010 budget document is used, as actual spending for 2008 is not available in earlier versions. The 2009 fiscal year data is incomplete, and also has significant one-time items like TARP and Stimulus package spending, so I chose to focus on the finalized 2008 numbers instead.

[2] The US defense budget represents almost 50% of the entire world’s defense spending, leaving ample room for cuts without jeopardizing US security. Over time the US defense apparatus has become particularly bloated, and cuts may actually improve the DoD’s efficiency over time. It’s worth noting that the US won the Cold War with much lower defense budgets than today.

[3] Social Security was enacted to ensure that American seniors did not starve in their last years, but later grew into a mandatory retirement program. Cutting Social Security payments to upper income seniors would bring the program closer to its original goal. There are 5 million senior households with income greater than $50,000, and they represent the top 20% of all seniors in income terms. These seniors likely draw maximum social security benefits, around 30k annually if there is slightly more than one senior per household on average.  Phasing out these benefits for the wealthiest 20% of seniors would save around $110 Billion. Gross benefits reductions would be around $150 Billion (5 million * 30,000), with an offsetting loss of tax revenue from the reduction in benefits.

[4] Along with defense spending, Medicare and Medicaid are the fastest growing parts of the federal budget.  Since government resources are limited, government benefits must also be limited. Medicare and Medicaid spending can be contained by requiring individuals to pay 20% of their own health care bills beyond $40,000 per year. This change would affect only 5% of Medicare recipients, but would yield huge savings as many patients would decline expensive treatments once cost became a consideration. 32% of all Medicare spending occurs above the $40,000 line; if requiring coinsurance cut this in half, roughly $110 Billion would be saved. This analysis assumes that the breakdown in Medicaid spending is similar to that of Medicare.  An additional $17 Billion annually could be saved by ending subsidies to Medicare Advantage, which is part of current health care reform proposals under debate.

[5] Non-defense discretionary spending includes almost all other federal departments. A 10% across-the-board cut would force all departments to shrink and increase efficiency. Alternately, targeted cuts could be used to shrink certain programs, but these cuts would still have to total $51 Billion annually. Health care cost growth could be reined in through heavy cuts at the NIH, which heavily subsidizes health care and pharmaceutical research. Cutting NIH’s $30 Billion budget in half would enable other departments to get by with a 6% cut instead. One more alternative would involve eliminating Congressional earmarks, which would reduce spending by $20 Billion.

[6] Other Mandatory Programs includes federal funding for food stamps, unemployment insurance, farm subsidies, student loans, veterans’ benefits, and other miscellaneous programs written into law with automatic spending formulas. Farm subsidies in particular deserve heavy cuts, as they distort the economy while worsening Americans’ health. Eliminating commodity crop payment programs and crop insurance subsidies would save $15 Billion annually (see page 4). An additional $9 Billion in savings is possible through the removal of middlemen in federally-backed student loans. Since the federal government assumes all risk on these loans, there’s no reason to compensate private banks to issue the loans.

Posted on by praveenghanta 16

The Mystery of Health Care Pricing

Many economists, think tanks, and politicians have been agitating for more consumer-driven health care in the US. They argue that if consumers have to spend their own money for care, they will tend not to waste health care resources, and they will shop around for cost-effective care. The first part of this argument appears valid, as individuals will always spend their own money most carefully. Studies have validated this hypothesis, showing that individuals with high-deductible insurance and health savings accounts (HSAs) tend to spend less than those on traditional insurance.

But are individuals able to shop for health care in a competitive marketplace? Personal experience and numerous reports indicate otherwise. In the US, most health care providers can’t tell you the price of any particular health care service until after it’s been performed! I recently shopped around for a health care service, and called four doctors’ offices in total. One office told me that they “aren’t allowed to provide that sort of information.” Two more offices were flabbergasted, and attempted to ease their way out of the conversation. Only one office was able to answer with an actual price quote.

Why is this so difficult for medical providers? Virtually all chargeable medical services have associated CPT Codes, which are defined by the American Medical Association [1]. Hospitals, labs, and most medical practices have a chargemaster, which is essentially a price list. Even small practices without explicit chargemasters know the rate their doctor charges for his time. When insurers and medical providers negotiate payment structures, they negotiate using the chargemaster rates (and usually Medicare rates) as starting points for negotiation.

The currently proposed health care reform plans have missed this essential element: require all health care providers to publish standardized price lists, and market competition can begin [2]. For doctors, a simple hourly rate should be enough to satisfy this requirement. Hospitals and labs should be required to initially publish online price lists for their most common charges, with the list expanding over time. While this information is irrelevant to patients in emergency situations, the great majority of health care spending is pre-planned [3].

Put another way, why not include a mandate on medical price lists as part reform? The cost of the mandate to providers is extremely low, as the information is available, and publishing the information online eliminates distribution costs. While price transparency is making slow progress, Congress has an opportunity to make this happen, and should do so as part of the health care reform package.

[1] The AMA would likely be a primary opponent of free publishing of CPT code-based price lists, since it derives signicant ($70M per year) income from its copyright on CPT codes. If the government is to open up the pricing market, it may have to break this monopoly by buying the copyright at fair value and putting it in the public domain.

[2] Consider a scenario in which all doctors are required to provide price lists. Since most small practices would find this difficult, they might just quote a maximum hourly charge. One surgeon might quote $1000 per hour, and another $2000 per hour. And there you have it, competition on price can begin, just as it occurs for plastic surgery, Lasik, and other out-of-pocket services today!

[3] According to the Kaiser Family Foundation, roughly 70% of health care expenditures are non-hospital expenses. Since many hospital expenses are planned, it appears that significantly less than 30% of health care expenses are emergencies in which consumers have no choice of provider. According to ACEP, only 3% of health care costs are emergency-related.

Posted on by praveenghanta 0

The Failure of Healthcare IT

You can track a package down to the hour online. You can order a pizza online. You probably manage your finances online as well. You can even pay your taxes online! Why can’t you do almost anything with regard to your healthcare online? Why has the IT revolution failed so miserably in the health care industry?

A 2008 nationwide survey found that only 4% of physicians used a fully functional electronic medical records system (EMR). Health care information is certainly complex, but not any more so than information in many other industries. Integrating medical systems and ensuring seamless transfer of patients’ medical information would yield huge benefits, including fewer medical errors, few repeated tests, and less time spent filling forms. The security of modern IT systems has been tested by hackers again and again, but if it’s safe enough for trillions of dollars of financial transactions, it’s safe enough for medical records as well. So why haven’t EMR and health care IT progressed further?

IT Advance Who Benefits? Who Pays?
Electronic Medical Records Patients Doctors and Hospitals pay for installation, and could lose some revenue due to loss of additional tests, checkups, etc
Medical Record Portability Patients Doctors pay to upgrade systems, could lose revenue as above
Billing System Integration Doctors and Insurers Doctors and Insurers
Online Appointment Scheduling, Email Patients Doctors pay for website and systems, lose time spent on email if not reimbursed

Looking at the table above, it becomes obvious why America’s health care system practically guarantees IT will fail! In almost every case, information technology will cost health care providers money, while primarily benefiting patients (and perhaps payers). Why would any sane business invest in an IT system that has low or negative ROI? If health care were a truly free market, then in some areas IT might flourish, as patients demand conveniences like online appointments and control of their medical records. If US health care were dominated by a single payer, that system would enforce health care IT compliance and integration. But the bizarre no-man’s land of American health care reimbursement makes it difficult to advance IT beyond billing integration between providers and payers.

Can this situation be improved? The Obama administration has decided to get involved by offering carrots initially, followed by sticks later. Time will tell if this approach is sufficient to bring health care into the 21st century.

Posted on by praveenghanta 8

How Much Should the US Spend on Defense?

In this time of fiscal constraints and global insecurity, how much should the United States spend on national defense? US defense spending hit $710 Billion in 2008 when foreign wars are included [1], amounting to roughly half of all worldwide defense spending [2]. The table below compares US defense spending with US GDP, with our adversaries’ defense budgets, and with the rest of the world.

Category Amount (2008 USD) Comparison
US Defense Spending $710B 4.98% of 2008 US GDP [3]
World Defense Spending $1470B US share is 48.3% of world defense spending [2]
US Adversaries’ Defense Spending – China, Russia, Iran, Myanmar, Venezuela, Cuba, North Korea $217B US Defense spending is 3.3 times that of our adversaries [4]
World Minus NATO $442B US Spends 1.6 times the World minus NATO [5]
World Minus Major US Allies – UK, France, Japan, Germany, Italy, South Korea, Australia, Canada, Israel $473.3B US Spends 1.5 times the World minus major allies [6]

Defense hawks have advocated that the US spend at minimum 4% of GDP on defense annually. This would equate to a defense budget of roughly $570 Billion in 2010, roughly in line with President Obama’s FY10 budget. But aligning defense spending with GDP is somewhat arbitrary, as US defense spending as a percentage of GDP has varied significantly over time.

A more rigorous approach would involve comparing US defense spending to world defense spending, and to its adversaries’ defense spending. The US could match the defense spending of the entire non-NATO world for roughly $450 Billion. With NATO members as long standing allies, the US could match the defense spending of all its theoretical adversaries combined for 37% less than it spends today. The combined defense spending of credible adversaries (China, Russia, North Korea, Iran, and some Arab nations) would still amount to less than half of America’s defense budget!

As the US begins to contemplate fiscal discipline (as lenders slowly run out), cutting the military budget will be unavoidable. Gradually cutting $200B annually from the US defense budget would make a huge impact on the deficit. Thankfully, it appears that cuts of this size can be made without jeopardizing the defense of America itself.

[1] From the US DOD Green Book, FY2009 defense spending appropriations total $709.58 Billion – see pdf page 14 (page 6 as marked on the document) for the FY2009 constant dollars figure.

[2] There are a number of estimates of total worldwide military expenditure. The Center for Arms Control and Non-Proliferation and SIPRI both estimate that total worldwide defense spending equaled roughly $1.47 Trillion in 2008. US spending of $710B equals 48.3% of this total. The Center for Arms Control’s numbers match the US DOD numbers and NATO numbers, lending credibility to these estimates.

[3] The US BEA provides its estimate of 2008 US GDP on page 8 here – $14.264 Trillion.

[4] This estimate includes all potential US adversaries that spent more than $1B on defense in 2008, per the Center for Arms Control. The 2007 estimate for North Korea was used.

[5] NATO countries excluding the US spent $318 Billion on defense in 2007 (see page 4 of the pdf). This number was not inflation adjusted, making it a very conservative estimate for 2008.

[6] All US allies with defense budgets greater than $10B are included here, per the 2008 Center for Arms Control estimates. Saudi Arabia, Turkey, Brazil, and Spain are not counted as major allies here, making this a conservative list of major allies. All countries included on this list are secular democracies with almost no likelihood of engaging in future conflict with the US. Collectively, the UK, France, Japan, Germany, Italy, South Korea, Australia, Canada, and Israel spent $287 Billion on defense in 2008.

Posted on by praveenghanta 6