Sinking SCHIP: A First Step toward Stopping the Growth of Government Health Programs

Federal lawmakers are considering legislation that could result in millions more middle income families obtaining health insurance from government. Unfortunately, the debate over expansion of the State Children's Health Insurance Program is divorced from the reality of who truly needs assistance and the forces that are making health insurance increasingly unaffordable. SCHIP and its larger sibling Medicaid currently enroll many people who do not need government assistance, including some families of four earning up to $72,000 per year. That is a direct result of federal funding rules that reward states for making more Americans dependent on government for their health care. Rather than expand SCHIP, Congress should (1) make private health insurance more affordable by allowing consumers and employers to purchase less expensive policies from other states, and (2) fold federal Medicaid and SCHIP funding into block grants that no longer encourage states to open taxpayer-financed health care to nonneedy families. With more Americans able to afford private insurance and no incentive for states to expand government programs beyond the truly needy, federal and state governments could reduce spending on those programs

Does Barack Obama Support Socialized Medicine?

Democratic presidential nominee Sen. Barack Obama (IL) has proposed an ambitious plan to restructure America's health care sector. Rather than engage in a detailed critique of Obama's health care plan, many critics prefer to label it "socialized medicine." Is that a fair description of the Obama plan and similar plans? Over the past year, prominent media outlets and respectable think tanks have investigated that question and come to a unanimous answer: no. Those investigations leave much to be desired. Indeed, they are little more than attempts to convince the public that policies generally considered socialist really aren't. A reasonable definition of socialized medicine is possible. Socialized medicine exists to the extent that government controls medical resources and socializes the costs. Notice that under this definition, it is irrelevant whether we describe medical resources (e.g., hospitals, employees) as "public" or "private." What matters-what determines real as opposed to nominal ownership-is who controls the resources. By that definition, America's health sector is already more than half socialized, and Obama's health care plan would socialize medicine even further. Reasonable people can disagree over whether Obama's health plan would be good or bad. But to suggest that it is not a step toward socialized medicine is absurd

A Better Way to Generate and Use Comparative-Effectiveness Research

President Barack Obama, former U.S. Senate majority leader Tom Daschle, and others propose a new government agency that would evaluate the relative effectiveness of medical treatments. The need for "comparative-effectiveness research" is great. Evidence suggests Americans spend $700 billion annually on medical care that provides no value. Yet patients, providers, and purchasers typically lack the necessary information to distinguish between high- and low-value services. Advocates of such an agency argue that comparative- effectiveness information has characteristics of a "public good," therefore markets will not generate the efficiency-maximizing quantity. While that is correct, economic theory does not conclude that government should provide comparative-effectiveness research, nor that government provision would increase social welfare. Conservatives warn that a federal comparative- effectiveness agency would lead to government rationing of medical care -- indeed, that's the whole idea. If history is any guide, the more likely outcome is that the agency would be completely ineffective: political pressure from the industry will prevent the agency from conducting useful research and prevent purchasers from using such research to eliminate low-value care. The current lack of comparative-effectiveness research is due more to government failure than to market failure. Federal tax and entitlement policies reduce consumer demand for such research. Those policies, as well as state licensing of health insurance and medical professionals, inhibit the types of health plans best equipped to generate comparative-effectiveness information. A better way to generate comparative-effectiveness information would be for Congress to eliminate government activities that suppress private production. Congress should let workers and Medicare enrollees control the money that purchases their health insurance. Further, Congress should require states to recognize other states' licenses for medical professionals and insurance products. That laissez-faire approach would both increase comparative-effectiveness research and increase the likelihood that patients and providers would use it

Does the Doctor Need a Boss?

The traditional model of medical delivery, in which the doctor is trained, respected, and compensated as an independent craftsman, is anachronistic. When a patient has multiple ailments, there is no longer a simple doctor-patient or doctor-patient-specialist relationship. Instead, there are multiple specialists who have an impact on the patient, each with a set of interdependencies and difficult coordination issues that increase exponentially with the number of ailments involved. Patients with multiple diagnoses require someone who can organize the efforts of multiple medical professionals. It is not unreasonable to imagine that delivering health care effectively, particularly for complex patients, could require a corporate model of organization. At least two forces stand in the way of robust competition from corporate health care providers. First is the regime of third-party fee-for-service payment, which is heavily entrenched by Medicare, Medicaid, and the regulatory and tax distortions that tilt private health insurance in the same direction. Consumers should control the money that purchases their health insurance, and should be free to choose their insurer and health care providers. Second, state licensing regulations make it difficult for corporations to design optimal work flows for health care delivery. Under institutional licensing, regulators would instead evaluate how well a corporation treats its patients, not the credentials of the corporation's employees. Alternatively, states could recognize clinician licenses issued by other states. That would let corporations operate in multiple states under a single set of rules and put pressure on states to eliminate unnecessarily restrictive regulations

Interpolating compact binary waveforms using the singular value decomposition

Compact binary systems with total masses between tens and hundreds of solar masses will produce gravitational waves during their merger phase that are detectable by second-generation ground-based gravitational-wave detectors. In order to model the gravitational waveform of the merger epoch of compact binary coalescence, the full Einstein equations must be solved numerically for the entire mass and spin parameter space. However, this is computationally expensive. Several models have been proposed to interpolate the results of numerical relativity simulations. In this paper we propose a numerical interpolation scheme that stems from the singular value decomposition. This algorithm shows promise in allowing one to construct arbitrary waveforms within a certain parameter space given a sufficient density of numerical simulations covering the same parameter space. We also investigate how similar approaches could be used to interpolate waveforms in the context of parameter estimation.Comment: 5 pages, 3 figures, presented at the joint 9th Edoardo Amaldi Conference on Gravitational Waves and 2011 Numerical Relativity - Data Analysis (NRDA) meetin

Pay-for-Performance: Is Medicare a Good Candidate?

According to one prominent study, adults in the United States receive the generally accepted standard of preventive, acute, and chronic care only about 55% of the time. The likelihood that patients will receive recommended care varie[s] substantially according to the particular medical condition, ranging from 78.7 percent of recommended care . . . for senile cataract to 10.5 percent of recommended care ... for alcohol dependence. Evidence of low-quality care appears in Medicare, the federal health program for the elderly and disabled. Quality of care does not appear to be higher in areas where Medicare spending is higher. In fact, some studies point to the somewhat paradoxical conclusion that Medicare patients are often less likely to receive recommended care in regions where Medicare expenditures are highest. Third-party payment is a potential contributor to the under-provision of quality health care. Most health care payments in the United States are made by third parties, usually employers, insurers, or government. Those purchasers typically reimburse health care providers on the basis of the volume and intensity of the services provided, rather than the quality or cost-effectiveness of those services. The result is a financing system akin to paying academics on the basis of the volume and intensity of footnotes

The composition and quantity of milk produced by cows on pasture and dry feed

The object of this study was to determine the quantity and composition of milk produced by cows on pasture and dry feed

Invariant Peano curves of expanding Thurston maps

We consider Thurston maps, i.e., branched covering maps $f\colon S^2\to S^2$ that are postcritically finite. In addition, we assume that $f$ is expanding in a suitable sense. It is shown that each sufficiently high iterate $F=f^n$ of $f$ is semi-conjugate to $z^d\colon S^1\to S^1$, where $d$ is equal to the degree of $F$. More precisely, for such an $F$ we construct a Peano curve $\gamma\colon S^1\to S^2$ (onto), such that $F\circ \gamma(z) = \gamma(z^d)$ (for all $z\in S^1$).Comment: 63 pages, 12 figure