Plugin Hybrid List

http://www.pluginamerica.org/plug-in-vehicle-tracker.html
Plugin America, an organization devoted to promoting electric and plugin hybrid vehicles, has put together an excellent list of plugin vehicles (linked above). Most major auto manufacturers now have a plugin model targeted for 2011 or earlier.

Continuing advances in battery technology mean that by 2011 plugin hybrids will be cost effective at today’s gas prices ($2.50 per gallon), and by 2013 hybrids may be cost effective at $2 a gallon.

Posted on by praveenghanta 0

US Doctors Are Overeducated

US medical students study for 8 years prior to residency, compared to 5-6 years of study in the rest of the world. This discrepancy increases health care costs by $25 Billion annually without contributing to quality.

In the UK, medical students study for five years after high school before beginning residency. They can expect to become practicing doctors by their late 20’s. This is true in Australia as well, where it’s possible to become a practicing doctor after less than 10 years of post-secondary education.

In much of Europe, medical students study for 4-6 years before beginning vocational training, and this process is slowly being standardized throughout the EU. Finally, in Japan, Brazil, China, India, and many other countries, medical education involves a 5-6 year degree followed by optional specialty training.

Since medical students in the US have a career path two years longer than in most other countries, their initial salary requirements must inevitably be higher to compensate for two years of extra tuition and lost salary. Using a career ROI calculation, it’s possible to estimate that US doctors must be paid an additional $30,000 per year as a result of this additional schooling [1]. With roughly 800,000 physicians in the US, that amounts to $25 Billion per year in additional compensation!

Why does the US stand almost alone in requiring aspiring doctors to study for eight years before training for another 3-8 years prior to practicing medicine? Is it possible that American doctors are better at their profession as a result? In fact, a small number of accelerated six-year medical programs exist in the US, and these programs have extremely competitive admissions. In a 6 year program, typical Bachelors-level general college education is curtailed while still accommodating a full four years of medical school. This model should become the norm rather than the exception, enabling medical students to enter careers more quickly and with less, thereby saving the entire health care system money!

[1] Using the spreadsheet used to perform Career ROI calculations, we can first adjust the medical student’s career path to shorten it by two years. This will raise the NPV and rate of return. We can then lower the expected salary to the point that the NPV is equivalent to the original NPV – the difference in salary is the salary amount made necessary by the extra schooling.

Posted on by praveenghanta 2

How Long Until Greenland Melts?

It would take 7400 years to melt Greenland at currently observed ice melting rates, and many hundreds of years even with a non-linear increase in melting rates.

Numerous studies and direct observation show that Greenland’s ice sheet is melting, and the latest studies show that snowfall on Greenland is not sufficient to offset this loss. If the entirety of Greenland’s ice sheet were to melt, sea levels worldwide would rise by roughly 20 feet. This rise would severely damage or wipe out many of the world’s major cities, and accordingly the threat of catastrophic sea level increase is listed among the primary threats of global warming.

This brings to light an important question: how long do we have until Greenland’s ice sheet melts, or until its melting causes a significant amount of sea level rise?

Greenland’s ice sheet has a total volume of 2.6 million kilometers cubed, and according to a recent study, lost an average of 222 km cubed of ice in the last couple of years. In 2007, the year that Arctic ice cover set a new summertime minimum, 350 km cubed of ice was lost. Assuming this extreme rate continues, Greenland will be fully melted in 7400 years. Of course, ice melt rates are non-linear, and so this rate could increase considerably as temperatures rise.

Assume for a moment that the rate of ice melt rises by an order of magnitude (10x) beyond the 2007 record. 740 years of melting would still be required to melt all of Greenland, and even at that rate sea levels would rise only 2 feet by 2100! If the ice immediately begins melting at 100 times the record rate, then a real catastrophe would ensue, as sea levels would rise by the full twenty feet before the end of the century.

What would it take to trigger a catastrophic increase in Greenland’s ice melt rate? Unfortunately, this isn’t yet well understood, with some research showing that Greenland’s ice sheet could tolerate significantly higher temperatures. This is based in part on research showing that during the last interglacial period, 125,000 years ago, about half of the Greenland ice sheet persisted despite temperatures 5C higher than today. It’s a good idea to keep this and the melt rate calculations in mind when weighing the threat of AGW-induced sea level rise against potential solutions.

Posted on by praveenghanta 6

The Hidden Trucking Industry Subsidy

Freight trucks cause 99% of wear-and-tear on US roads, but only pay for 35% of the maintenance. This $60B subsidy causes extra congestion and pollution, and taxpayers pay the bill.

It seems obvious that the heavier the vehicle, the more damage it does to roads over time. A 40,000 pound big rig probably does a bit more damage than your average 3500 pound consumer vehicle, right? It turns out that vehicle road damage doesn’t rise linearly with weight. Road damage rises with the fourth power of weight, and this means that a 40,000 pound truck does roughly 10,000 times more damage to roadways than the average car [1]!

In other words, one fully loaded 18-wheeler does the same damage to a road as 9600 cars. According to the American Trucking Associations (ATA), the trucking industry represents 11% of all vehicles on the road in the US, while paying 35% of all highway taxes. But if trucks represent 11% of vehicles, their heavy loads cause them to do 99% of all road damage! [2] The trucking industry paid $35 Billion in highway taxes in 2005, according to the ATA. Since most of the $100 Billion in highway taxes paid goes to maintenance (and US infrastructure maintenance is far behind), this implies that the trucking industry receives a $60 Billion annual subsidy from other drivers.

What are the negative effects of this subsidy? Since the trucking industry doesn’t pay the true cost of its road usage, it benefits relative to rail and other forms of transport. Freight rail lines are privately owned and maintained in the US, so they don’t receive a similar subsidy. As a result, more truck traffic ends up on highways than the market would dictate, leaving the taxpayers poorer, the air dirtier, and the roads more congested.

[1] Here’s some information on US pavement equations, including the statement of the fourth power law. Here’s another statement of the same, which also shows that on weaker surfaces, damage rises with the 6th power of the load.

[2] In order to calculate the damage done by trucks versus other vehicles, let’s assume that a fully loaded truck does the same damage to the roadway as 9600 cars, as mentioned above. In that case, then 11%, or 0.11 * 9600 = 1056. This is a measure of total damage done by truck traffic. Meanwhile, car traffic does 89% * 1 or 0.89 in damage. So the total damage is 1056 + 0.89 or 1056.89, of which 1056, or 99.9%, is done by trucks.

Perhaps half of all trucks are actually traveling empty. If an empty truck weighs 20,000 pounds, then it puts 4000 pounds onto each of its five axles, versus 2000 pounds on each axle for a car. The truck will do 2^4 more damage than the car, or 16 times more damage. So let’s add the totals back up: 5.5% * 9600 + 5.5% * 16 = 529. 529 / 529.89 = 99%. In fact, even if all big rigs in the US traveled empty, they would still do two-thirds of all damage to US roads!

Posted on by praveenghanta 50

How Much Would Universal Healthcare Cost?

Universal health care would cost $70 Billion for 2009 if enacted using a market-based approach, but this cost will grow rapidly if overall health care inflation is not tamed.

How much would health coverage for all uninsured Americans really cost? Critics maintain that covering all Americans would break the US budget (which is already overstretched), while advocates maintain that covering all Americans can be done affordably. But how much would universal coverage really cost?

The Commonwealth Fund provides a great summary of the costs of proposals under consideration, including Medicare for all, a Building Blocks extension of the current system, and other proposals. Proponents of universal Medicare claim that it will save the US $58 Billion in 2010, since Medicare operates more efficiently than private insurers [1]. Providing universal coverage through incremental changes could cost anywhere between $48B and $120B, according to analyses by the Urban Institute and the Lewin Group, a private health care consultancy. And while Medicare for all would lower total health care spending, it would raise the Federal government’s share of spending by almost $200 Billion per year.

With numbers all over the map, is it possible to come up with a plausible estimate for comparison purposes? Sites like ehealthinsurance.com now make it much easier to get estimates for insurance coverage. Using this data, we can estimate how much basic health insurance coverage would cost for the 45 million uninsured Americans. The experience of Massachusetts, which has implemented universal health care, can also be used to project an estimate for the rest of the country. Since Massachusetts’ health care costs are above US average, this provides a high-side estimate.

Using market insurance quotes, the cost of providing a health insurance with a $1000 deductible and prescription coverage would amount to $2500 per person annually, or roughly $115B per year [2]. This calculation uses different insurance rates for different age groups among the uninsured, based on this demographic breakdown of the uninsured provided by the Kaiser Foundation. In Massachusetts’ experience, covering each uninsured individual costs roughly $3400 per year. Covering all 45 million uninsured Americans at this rate would cost $150 Billion per year.

The midpoint of these estimates is around $130 Billion per year. To get a final estimate, money currently spent on uncompensated care must be subtracted out, since there is no uncompensated care in a universal health care system. Approximately $58 Billion will be spent on uncompensated care in 2009 [3], and subtracting this figure out leaves roughly $70 Billion in annual expenditure required for universal health care.

While $70 Billion per year sounds like a lot of money, it’s actually less than many estimates. It looks increasingly likely that some kind of health care reform will be passed in 2009, and that money will be found to pay for it for the moment. The bigger question is, how will it be paid for tomorrow? Unless health care cost growth is pulled into line with inflation, no one has that answer.

[1] Medicare doesn’t have to perform medical underwriting, and it doesn’t have to spend money on advertising, sales, or shareholder dividends, so its overhead should be lower than private competitors, if it can maintain efficiency. Critics counter that Medicare suffers from high fraud rates precisely because it is a government bureaucracy without competition to force it to raise efficiency and tighten controls.

[2] Here is the rough cost estimate for each demographic group, taken from quotes on ehealthinsurance.com:

0-19: $100/month  (20% of all uninsured)

20-29: $150/month (29% of all uninsured)

30-44: $200/month (27% of all uninsured)

45-64: $400/month (24% of all uninsured)

Using these numbers, we calculate a weighted average cost per person of $213 per month, or $2556 per year. That’s $115 Billion for 45 million people.

[3] In 2004, uncompensated care expense was estimated at $40.7 Billion. Since health care spending (in nominal dollars) has grown at 7.5% per year during this decade, the adjusted number for 2009 is approximately $58 Billion. This assumes that uncompensated care is growing in line with health care costs as a whole.

Posted on by praveenghanta 16

The True Cost of Gun Ownership

The gun industry generates a total economic loss of $15B per year in the United States.

Guns are a part of American culture, and guns are also a part of the economy in the US. While not a large industry, the small arms and hunting industries contribute roughly $29B annually to the US economy [1]. While many industries have externalities (think pollution), the gun industry’s externalities are particularly damaging: 31,000 deaths and 70,000 injuries per year [2].  From an economic standpoint, the cost-benefit of US gun ownership and the gun industry can be measured by weighing the economic benefit of the gun industry against the economic loss caused by premature deaths and injuries.

What is the annual economic loss associated with 31,000 deaths and 70,000 injuries? By looking at loss of income alone, each gun death can be valued at roughly $1.4M, or $43 Billion in total lost income [3]. A 1994 study published in JAMA concluded that medical costs from gun injuries cost another $2.3B, or $4B today including inflation [4]. The total economic costs of $47 Billion per year from gun industry externalities thus greatly exceed the economic benefit of the industry!

Perhaps this is not surprising. Guns were invented as military weapons, and while hunting and recreation are part of today’s industry, guns’ primary use remains human combat. In the 20th century, the arms industry split into two industries: a hugely profitable defense industry which sells only to the government, and a tiny small arms industry accessible to ordinary American citizens. Despite causing a $15B loss every year to the American economy, the American small arms industry exists because it is protected from its liabilities by the Second Amendment and its political allies.

Can this situation can be improved? The gun industry has thus far successfully resisted efforts at further regulation, and the NRA and other organizations have created a potent political alliance to prevent a change in the status quo. Eventually, an industry with huge negative externalities has to improve its behavior as attitudes shift, or public sentiment and politicians will force the issue (the oil and tobacco industries come to mind). The gun industry would do well to cooperate with reasonable regulations that decrease its negative side effects, or it risks harsher regulations down the road.

[1] The gun industry’s estimated total value in 1999 was $24B, or $29B today when adjusted for inflation.

[2] According to the CDC, there were roughly 31,000 deaths involving firearms (including homicides, suicides, and accidents), and  70,000 non-fatal injuries related to guns annually.

[3] Gun death rates peek in the 18-24 age range, and fall sharply after 30, according to the CDC (select Age under Output Group). Assume that the average person killed by a gun loses 35 years of productive life (from 35-70) . 35 years * US per capita income of roughly $40,000 equals $1.4 Million per person. No NPV adjustment is needed, because gun deaths are cumulative over time – last year’s gun deaths contribute to this year’s losses as well.

[4] This study concludes that the medical costs associated with firearms injuries were roughly $2.3B per year in 1994. Assuming a health care rate of inflation of 4% over the last 15 years (lower than the real rate!), this $2.3B equals $4B in 2009 dollars.

Posted on by praveenghanta 32

US debt to exceed GDP by 2010!

In Febuary, I predicted that US federal debt would exceed US GDP by 2015. It appears that I was too optimistic at that time.

The Obama Administration’s latest budget projections now show that the debt may exceed GDP as soon as 2010! This year’s deficit is expected to rise to $1.75 Trillion, raising the total debt from the current 11.2 trillion (4/9/09) to almost 13 trillion by year end. Next year’s deficit is projected to be in the trillion dollar range, driving the debt up to 14 trillion [1], which is roughly equivalent to 2008 GDP. Since GDP growth will be negative in 2009 and modest in 2010, it’s not unlikely that GDP and gross federal debt will be equal at the end of 2010 [2].

It looks like the budget situation may force decisions on big government programs like Medicare, Social Security, and Defense sooner than most expected – and likely sooner than the Administration would prefer. Here’s to the return (or beginning?)  of fiscal discipline!

[1] See Table S-9 in the White House Budget for FY 2010, showing gross debt of 14.078 Trillion for 2010.

[2] Table S-8 shows the White House’s economic growth assumptions, which are more optimistic than many mainstream economists’ assumptions. In fact, the table itself shows that both the CBO and private economists have lower growth projections than the White House (kudos for the honesty). The CBO estimates GDP at 14.6 Trillion for 2010, meaning that any further slippage in the budget cause the debt to surpass GDP.

Posted on by praveenghanta 6

Lowering Healthcare Costs: Supply and Demand

Most discussions around healthcare these days focus on covering all Americans, and on lowering healthcare costs. President Obama has recently focused on the second issue, noting that ballooning healthcare costs could cripple the federal government’s finances and kill economic growth. But how can healthcare costs be reined in? In the partially private US healthcare system, prices are still somewhat subject to the law of supply and demand. Healthcare prices (and therefore costs) can thus be lowered by either reducing demand or increasing supply. Here’s a quick list of ideas:

Increasing Supply:

1. Increase the number of medical professionals. Unemployment among healthcare professionals remains near 1%, far lower than any other field. Increasing the number of medical, dental, and nursing school seats in the US will increase supply over time, creating more balance in the healthcare work force and driving down wage increases.

2. Shorten the length of medical school. Doctors in the UK and other countries finish their medical education in six years or less before going on to training programs (residency), while US doctors spend eight years between college and medical school. Accelerated six year medical programs exist in the US, and there is no evidence that their doctors’ education suffers as a result. Shortening medical, dental, and pharmaceutical programs to six years will increase the supply of practitioners, and decrease the starting salaries they demand since their schooling and debt burden are lower.

3. Doctors aren’t needed for routine healthcare. Nurse practicioners, midwives, pharmacists, and other medical providers can provide much of the routine care needed. National laws (or at least guidelines) making it easier for these practitioners to do their jobs will further increase the supply of qualified medical professionals, driving down prices.

4. Warranties on Medical Care. While pay for quality has been heavily discussed, it is quite difficult to measure and implement in practice. It’s far easier to require warranties on procedures, so that medical providers must provide care free of charge when issues as a result of mistakes during a procedure. Medicare could put this in place, incentivizing the industry to move towards higher quality.

Decreasing Demand:

1. Measure cost effectiveness of treatments within Medicare. As long as Medicare pays for healthcare by quantity, without any regard for cost-effectiveness, expensive and marginally effective treatments will continue to drive health care inflation. Patients should be given the option to pay for treatments that are not cost-effective, should they desire.

2. End employer health care tax deduction. As I’ve previously discussed, this $250B+ subsidy inflates demand, causing price increases for all, including those without insurance. Removing this subsidy would decrease health care spending by up to 10% [1], and could provide funding for other initiatives including universal health care or deficit reduction.

3. End tax breaks on medical goods and services. Sales taxes are generally not levied on healthcare products like the $285B pharmaceutical industry, providing them with a $20B subsidy relative to other goods [2]. Property taxes and income taxes are not collected on many not-for-profit hospitals, though some generate significant income and serve very few uninsured patients. Ending these subsidies would further reduce demand and prices.

4. Enact consistent end-of-life guidelines for Medicare. 27% of Medicare spending (almost $100B) is incurred for patients in their last year of life. While higher costs towards the end of life are expected, there are wide variations in spending in different regions of the US. Enacting a consistent set of guidelines which emphasizes palliative care would help decrease end-of-life healthcare demand.

Why doesn’t this list mention the approaches typically touted like electronic medical records, administrative efficiencies, and the like? Unfortunately, while efficiency improvements would result in one-time reductions in cost, they would not change the supply-demand fundamentals of the US healthcare delivery system. The solutions mentioned above would address these issues, creating permanent decreases in healthcare costs while potentially expanding availability.

[1] $250B is slightly more than 10% of healthcare spending in the US today, so eliminating this subsidy would reduce spending by that amount at most. In practice, the reduction would be somewhat less, since falling prices would cause some offsetting increase in healthcare consumption.

[2] Assuming a 7% sales tax (most states’ sales tax is higher), 7% of $285B is roughly $20B.

Posted on by praveenghanta 1

Limits on the Health Care Deduction?

The Obama administration is open to the idea of limiting the deduction on employer-based health care coverage. This would be a tremendous step in the right direction in limiting health care cost growth, as I’ve previously discussed (here as well).

While President Obama campaigned against this proposal initially, his advisers now indicate that he will not oppose a reduction in this subsidy if Congress passes it. Let’s hope that this particular initiative survives the Congressional melee and emerges as part of health care reform!

Posted on by praveenghanta 0

US Defense Spending Is Out Of Control

In the federal budget, there are three untouchable categories of spending: Medicare, Social Security, and Defense. Which of these expenditures has grown fastest over the past decade? While the media is constantly pointing to runaway healthcare spending, defense spending has grown at 10% per year in the past decade, faster than any part of the budget. The Korean and Vietnam Wars were fought on 2/3 the current defense budget, and those were much larger conflicts than Iraq and Afghanistan! In his proposed budget, President Obama has indicated that he will attempt to make defense spending more efficient. Nonetheless, the budget shows defense spending rising from $600 Billion this year to nearly $700 Billion by 2019.

US defense spending during the Cold War (1946-1991) averaged $400 Billion per year in 2008 dollars, including both the Korean and Vietnam wars. By comparison, the 2008 defense budget including the Iraq War and troop surge was $676 Billion. It’s absurd enough that we defeated the Soviets with a much smaller military budget, but proposed budgets increase spending further, when the winding down of the Iraq war should enable a $100 Billion dollar decrease.

Winslow Wheeler at the Center for Defense Information notes that the military budget has doubled while the quantity of weaponry and quality of military readiness has actually declined. Department of Defense accounting is so poor (perhaps intentionally?) that the DoD has no idea how much money is really spent on its weapons programs. Rather than increasing the defense budget, President Obama should consider freezing it at the 2007 level for the balance of his presidency. This would eliminate almost $1 trillion in deficit spending, and would finally force the DoD to focus on accountability and efficiency. A $600 Billion defense budget is still triple that of our potential adversaries’ defense budgets combined, and would ensure our safety while forcing fiscal discipline on an untamed federal department.

Sources:

[1] $258 Billion in 1998, $676 Billion in 2008 = 10% growth per year. Health care spending and social security also rise rapidly over the same period, but neither grew at this rate. See the following links for data:

http://www.defenselink.mil/comptroller/afr/fy2008/Fiscal_Year_2008_Department_of_Defense_Agency_Wide_Financial_Statements_and_Notes.pdf – Figure 1-5 and 1-6 show actual expenditures for 2008

Click to access tables.pdf

Click to access budget.pdf

[2] $676 Billion in 2008 vs. $400 Billion per year in 2008 dollars during the Cold War including Vietnam and Korea

http://www.cdi.org/Issues/milspend.html

Posted on by praveenghanta 3