Deadly Medicine and Youthful Rebellion

Some areas of modern medicine have been successful in saving (or more correctly prolonging) lives.

From 1992 to 2002 death rates from CVD [CardioVascular Disease] declined 18.0 percent.

From 1992 to 2002 the death rate from coronary heart disease declined 26.5 percent.

The AHA's 2005 Statistical Fact Sheets (PDF) should be required reading for anyone trying to understand the economics of health care. Cardiovascular Disease is well studied, well understood and "accounted for 38.0 percent of all deaths or 1 of every 2.6 deaths in the United States in 2002."

Cardiovascular disease is also instructive because several of the risk factors (overweight and obesity, physical inactivity and smoking) can be controlled at no cost (or negative cost if you quit buying cigarettes).

The question before us is: should we be spending more on medical care? If the documented net effect of spending on medical care at the current margin seems to be nil, then the answer to that question is "no". The hypothesis that there are some positives and some negatives that sum to zero rather than every individual treatment being zero isn't a useful contribution unless we have a good way to tell good parts from the bad parts. Which we apparently don't. So it's not clear that you're actually disagreeing with the contrarians in terms of the policy implications.

Second point: shouldn't we expect to see a declining marginal utility for medical spending? Suppose the first third of spending tends to do something very useful, the next third is marginal or zero effect, and the last third is of negative effect, somewhat masked by placebo effects. In that case, we could cut national health spending by 2/3rds and have a hugely healthier nation!

Robin's paper says that medical spending doesn't matter on the margin, and that seems to be true regardless of whether "all health spending doesn't matter", "health spending has various effects, some good and others bad", or "health spending has declining marginal utility."

Related to your comment about pliable kids balancing out rebellious kids is the "good enough parenting" concept.

These days it's mostly used to ease parental guilt or to push for goverment policy changes.

But as I understand it, the concept is an example of an 80/20 rule, with the 20 split. That is, 10% are wonderful parents who make a positive difference in their children's lives. Another 10% are terrible parents, who really screw their kids up. Then there are the 80% who are "good enough" parents, who do some good and some bad and whose children turn out more or less according to their potential.

I do think that society's views on what constitutes "good enough" parenting change over time, and (being an optimist) I think overall for the better. For instance, pulling a kid's britches down and beating him with a willow switch would have been "good enough" 100 years ago in America, but not today.

Bryan, I am curious: Were their any sports that your father wasnt that interested in (say Hockey, or Golf, or Jai-Lai) that you now may enjoy. I only ask because my older brother loved sports and beat me at all of them except hockey, he wasnt that interested in it, so it was the only non-monopoly that I could compete in.

Bryan, think of how devastated you'll be when your twins hate AD&D when they grow up...