Tag Archives: economy

Our Failed Health-care System

The bad idea behind our failed health-care system by Malcolm Gladwell

One of the great mysteries of political life in the United States is why Americans are so devoted to their health-care system.

Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the extra spending comes to hundreds of billions of dollars a year. What does that extra spending buy us? Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average.

Health Savings Accounts represent the final, irrevocable step in the actuarial direction. If you are preoccupied with moral hazard, then you want people to pay for care with their own money, and, when you do that, the sick inevitably end up paying more than the healthy. And when you make people choose an insurance plan that fits their individual needs, those with significant medical problems will choose expensive health plans that cover lots of things, while those with few health problems will choose cheaper, bare-bones plans.

In the rest of the industrialized world, it is assumed that the more equally and widely the burdens of illness are shared, the better off the population as a whole is likely to be. The reason the United States has forty-five million people without coverage is that its health-care policy is in the hands of people who disagree, and who regard health insurance not as the solution but as the problem.

This is another article with an interesting take on the problems with the broken health care system in the USA. I don’t totally agree with the conclusion. I think the failure of the system and refusal to make substantial change have multiple causes including: smart lobbyists paying politicians lots of money to support their interest in keeping the current system, people being fearful about change, false perceptions about the system performance (thankfully an understanding of the poor performance is becoming more widespread recently), that the system works least poorly for the wealthy who have more influence than those without insurance, that the benefits of spending huge amounts today are going to specific companies and people and thus are available for buying political support (not just paying politicians but also funding marketing campaigns, experts to provide journalists the position of those in favor of the existing system…) while the benefits of changing are much more distributed. Luckily companies are increasingly – decades after Deming noted this health care costs are a huge problem for companies in the USA – focusing on the need for improving what is often one of the largest expenses for companies. The issue many fail to understand is how much the excessive costs of health care in the USA harm the ability of companies in the USA to compete – many even fail to appreciate the human cost of tens of millions of people without health insurance.

Related: Drug Prices in the USAMeasuring the Health of NationsOverview of 5 Nations Health Care SystemsFixing Health CareImproving the Health Care System

California Uses More Gas than China

Amazing Stat: California Uses More Gas than China:

California alone uses more gasoline than any country in the world (except the US as a whole, of course). That means California’s 20 billion gallon gasoline and diesel habit is greater than China’s! (Or Russia’s. Or India’s. Or Brazil’s. Or Germany’s.)

That’s according to the California Energy Commission’s State Alternative Fuels Plan, which was posted online last Christmas Eve (pdf). The whole report makes for some fascinating reading because it’s a blueprint for a low-carbon and renewable transportation fuel future. The dominant takeaway: it ain’t going to be easy.

One more choice statistic: gasoline usage in California has increased 50 percent, that’s 10 6.7 billion gallons, since 1988.

But China’s oil thirst is growing — to almost 20 billion gallons in 2007 — and perhaps as early as this year, China’s 1.3 billion people will overtake California’s 37 million people in total gasoline and diesel usage.

Interesting data. The Curious Cat Economics Blog recently posted on the top oil consuming countries.

Related: Car Powered Using Compressed AirFailure to Increase Gas TaxCurious Cat Science and Engineering Blog – Energy posts

Manufacturing Employee Shortage in Utah

Utah scrambling to meet need for technical workers [the broken link was removed]

The state faces challenges in generating necessary interest to fill available manufacturing jobs for what Utah’s governor has called the state’s “Aerospace Hub,” both immediately and in the future, the report said.

The situation continues to worsen, with jobs being created and unemployment remaining low in the state. And as the current work force ages, the supply of skilled workers is diminishing, forcing employers to recruit outside of Utah and sometimes leave Utah altogether, the report said.

The college’s Lean Manufacturing Center [the broken link was removed] was built from an old warehouse with state funds and $30 million from rocket-booster manufacturer Williams International. Williams provides the college with equipment and mentors to train students with practical, real-world applications, said Lloyd McCaffrey, the Lean Center’s director.

Related: Engineering Innovation for Manufacturing and the EconomyApplied Quality Engineering EducationWisconsin ManufacturingTop 10 Manufacturing CountriesHelp Wanted: Lean Manufacturing ExpertsThe Lean MBA

Drug Price Crisis

In 2005 I posted about some of the problems with drug pricing. It is nice to find at least a couple of people at MIT that want to have MIT focus research on the public good instead of private profit. As I have mentioned too many universities now act like they are for-profit drug or research companies. That is wrong. Drug companies can do so, institutions with purported higher purposes should not be driven to place advancing science below profiting the institution.

Solving the drug price crisis

The mounting U.S. drug price crisis can be contained and eventually reversed by separating drug discovery from drug marketing and by establishing a non-profit company to oversee funding for new medicines, according to two MIT experts on the pharmaceutical industry.

Following the utility model, Finkelstein and Temin propose establishing an independent, public, non-profit Drug Development Corporation (DDC), which would act as an intermediary between the two new industry segments — just as the electric grid acts as an intermediary between energy generators and distributors.

The DDC also would serve as a mechanism for prioritizing drugs for development, noted Finkelstein. “It is a two-level program in which scientists and other experts would recommend to decision-makers which kinds of drugs to fund the most. This would insulate development decisions from the political winds,” he said.

I see their idea as one worth trying. Lets see how it works. Their book: Reasonable Rx – Solving the Drug Price Crisis by Stan Finkelstein and Peter Temin

Related: USA Spent $2.1 Trillion on Health Care in 2006Measuring the Health of NationsAntibiotics Too Often Prescribed for Sinus Woes$600 Million for Basic Biomedical Researcharticles on improving the health care system

Management Advice from Warren Buffet

As usual, Warren Buffett’s letter to shareholders is packed with wisdom. He is best know for his investing genius but his writing provides great thoughts for managers also: Berkshire Hathaway 2007 Letter to Shareholders:

We will soon purchase 60% of Marmon and will acquire virtually all of the balance within six years. Our initial outlay will be $4.5 billion, and the price of our later purchases will be based on a formula tied to earnings.

This deal was done in the way Jay would have liked. We arrived at a price using only Marmon’s financial statements, employing no advisors and engaging in no nit-picking. I knew that the business would be exactly as the Pritzkers represented, and they knew that we would close on the dot, however chaotic financial markets might be. During the past year, many large deals have been renegotiated or killed entirely. With the Pritzkers, as with Berkshire, a deal is a deal.

Charlie and I look for companies that have a) a business we understand; b) favorable long-term economics; c) able and trustworthy management; and d) a sensible price tag. We like to buy the whole business or, if management is our partner, at least 80%

A truly great business must have an enduring “moat” that protects excellent returns on invested capital. The dynamics of capitalism guarantee that competitors will repeatedly assault any business “castle” that is earning high returns.

Susan came to Borsheims 25 years ago as a $4-an-hour saleswoman. Though she lacked a managerial background, I did not hesitate to make her CEO in 1994. She’s smart, she loves the business, and she loves her associates. That beats having an MBA degree any time. (An aside: Charlie and I are not big fans of resumes. Instead, we focus on brains, passion and integrity.

I should emphasize that we do not measure the progress of our investments by what their market prices do during any given year. Rather, we evaluate their performance by the two methods we apply to the businesses we own. The first test is improvement in earnings’ with our making due allowance for industry conditions. The second test, more subjective, is whether their “moats” – a metaphor for the superiorities they possess that make life difficult for their competitors – have widened during the year.

You will recall that in our catastrophe insurance business, we are always ready to trade increased volatility in reported earnings in the short run for greater gains in net worth in the long run.

What is no puzzle, however, is why CEOs opt for a high investment assumption: It lets them report higher earnings. And if they are wrong, as I believe they are, the chickens won’t come home to roost until long after they retire.

Related: Buffett’s Letter to Shareholders (from last year)Buffett’s Shareholder Letter (2006)Overview of Warren BuffettAnnual Report by Warren Buffett (2005)Hiring the Right People
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Creating Jobs

Do Lean Companies Create Fewer Jobs?

No, they create more. If you assume the lean company grows sales at the same rate as some poorly management company then it may well be that the lean company creates fewer jobs. However that is not a valid assumption. Deming provided the reason in his presentations to Japan in the 1950’s with his chain reaction. From page 3 of Out of the Crisis

  • Improve Quality —>
  • Costs decrease because of less rework, fewer mistakes, fewer delays, snags, better use of machine-time and materials —>
  • Productivity Improves —>
  • Capture the market with better quality and lower price —>
  • Stay in Business —>
  • Provide jobs and more jobs

For an example of this process at work see GM, Ford and Toyota. Toyota defines lean (Toyota’s management system is what was called lean manufacturing by Jim Womack and Dan Jones). Toyota continues to add employees while Ford and GM have been shedding jobs.

It is true, for lean (and un-lean) companies alike, productivity is improving (it just improves more at lean companies) which means that fewer people are needed to produce the same amount as we have in the past. We have posted previously about the mistaken belief that jobs are moving overseas.
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Measuring the Health of Nations

Measuring the Health of Nations: Updating an Earlier Analysis

In a Commonwealth Fund-supported study comparing preventable deaths in 19 industrialized countries, researchers found that the United States placed last. While the other nations improved dramatically between the two study periods (1997–98 and 2002–03) the U.S. improved only slightly on the measure.

Rankings: 1) France 2) Japan 3) Australia 4) Spain 5) Italy 6) Canada… 18) Portugal 19) USA. Maybe the United States is last but still not significantly behind?

According to the authors, if the U.S. had been able reduce amenable mortality to the average rate achieved by the three top-performing countries, there would have been 101,000 fewer deaths annually by the end of the study period.

It might seem like a stretch to compare the lowest ranked country to the average of the top 3, but, for all those that feel the USA is the best health care system it raises the questions of why they don’t think 100,000 annual deaths is a significant enough problem to lower their opinion of the current system. And remember the USA system costs something like twice as much as the average system: up to 16% of GNP in 2006.

I must say I would rather have the Toyota mindset shown by those talking about the USA health system instead of the claims of how the current USA health system is number 1. In Toyota’s horrible last year they still had a profit of about $14 billion (I believe something like 20 companies have every made that much). The United States health system sure has some things to point to positively but the system seems to be losing ground to the rest of the world more and more quickly while many cling to a belief it is the best system around.

Related: Evidence-based Managementposts on improving health careImproving Hospital Performancearticles on improvement health careBest Research University RankingsTop 10 Manufacturing CountriesDr. Deming’s Seven Deadly Diseases of Western Management

Top 10 Manufacturing Countries

The newest data from the UN* confirms most of the recent trends in manufacturing output – most notably that China continues to grow dramatically. The data also shows a stagnation in USA manufacturing output over the last several years, though the USA remains by far the largest manufacturer. The most significant news from this latest data, I believe, is that that manufacturing output growth in the USA has been slower than global manufacturing output growth from 2002-2005. This was not the case prior to 2002. I will be writing more on this data in the Curious Cat Investing and Economics Blog. UN Data, in billions of current US dollars:

Country 1990 1995 2000 2001 2002 2003 2004 2005
USA 1,040 1,289 1,543 1,460 1,471 1,488 1,545 1,493
Japan 809 1,217 1,033 857 807 886 962 964
China 143 299 484 527 573 664 788 895
Germany 437 517 392 389 407 490 566 594
United Kingdom 207 221 230 218 222 239 283 no data
Italy 240 226 206 205 218 259 295 291
France 200 233 190 185 192 228 256 253
Korea 200 233 190 185 192 228 256 253
Canada 92 100 129 119 120 149 170 196
Brazil 117 149 120 102 95 109 130 171
Spain 108 107 98 100 108 134 153 160
Mexico 50 55 107 110 111 104 111 122
Russia 201 104 73 77 54 64 92 117
India 50 60 67 68 72 84 100 116

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Applied Quality Engineering Education

Classroom projects translate into immediate workplace gains for working professionals in engineering [the broken link was removed]

In the final semester of his UW–Madison master’s degree, Bob Aloisi didn’t just earn a letter grade in his quality engineering class: He saved his company $50,000. It wasn’t the typical classroom outcome — but it wasn’t a typical classroom. As a student in “Quality Engineering and Quality Management,” Aloisi accomplished a major class project in quality improvement at his own workplace.

The project is the capstone experience in the College of Engineering’s award-winning distance-education program, the Master of Engineering in Professional Practice (MEPP) [the broken link was removed]. Designed for mid-career engineers who live and work all over the country, MEPP’s Internet-based curriculum strives to provide knowledge students can apply immediately at their companies.

“Our project was a very good example of the Kaizen approach,” says Aloisi. “It wasn’t one specific thing, a home run type of thing, that we changed to make our improvements.” Instead, his team met its targets through many small steps, including adjustments to equipment settings and better training for machine operators.

Good news. Related: Wisconsin ManufacturingImproving Engineering Education – Teaching Quality Improvement by Quality Improvement in Teaching [the broken link was removed] – The Lean MBA

Global Manufacturing Data by Country

I am still looking for a good source for manufacturing data by country and year. Today I found some data from the United Nations Statistics Division. The data for the top five manufacturing economies: China, Germany, Japan, United Kingdom and United States. Figures are in current $US billion. The data used is for Mining, Manufacturing and Utilities (because China and Germany do not have manufacturing data separated out).

Country 2001 2002 2003 2004
United States 1,781 1,779 1,876 2,012
Japan 991 929 1017
China 507 551 638 754
Germany 421 449 545 613
United Kingdom 280 283 322 378

For manufacturing output only:

Country 2001 2002 2003 2004
United States 1,460 1,463 1,523 1,623
Japan 866 812 894
United Kingdom 220 223 254 298

This data shows the United States manufacturing economy is continuing to grow and is solidly the largest manufacturing economy: which contradicts what many believe. It is true manufacturing jobs are decreasing in the United States and worldwide – China is losing far more manufacturing jobs than the USA.
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