Jack

If you don't believe that health care has market failure, you are impervious to all evidence.

Fifty years ago America spent about 8% of GDP on "national defense" and 0% of GDP on Medicaid. By 2015 spending on both programs is forecast to be about 3% of GDP (roughly $540 billion--including the state portion of the program.) That's a big change in priorities. On the whole I'd say it's a welcome change, but mostly because we were spending much too much on national defense. (That does not include other big government health programs; Medicare, the VA, public employees, etc.)

Now dial back the clock to 1964 and ask yourself what sort of outcome people expected from the Medicaid program. What would have been viewed as a success? Recall that 1964 was "the liberal hour," a time of boundless optimism about the ability of government programs to solve problems. Suppose you told people that by 2015 Medicaid would be spending as much as the military. They would obviously have thought you were insane. But suppose you convinced them otherwise, what would they have expected for that money? It seems clear that there were two goals:

1. Helping low income people pay for healthcare.
2. Better health outcomes for low income Americans.

We've done a pretty good job on the first goal, and ObamaCare will fill some of the remaining gaps. And that may well be a huge success. But I can't help thinking the second goal would also have been viewed as being very, very important.

Morgan Warstler directed me to an interesting discussion of Thomas Piketty's book by Larry Summers and Balaji Srinivasan. Both made some excellent points. But I was particularly struck by how Larry Summers responded to Srinivasan's claim that consumption inequality is becoming less of a problem. Summers pointed out that while this is true for many consumer goods, the gap in life expectancy between those in the bottom and top 10% of income has widened by 3 or 4 years since the 1970s, comparable to a doubling of cancer mortality. Indeed he seemed to view this as the great failure of American society in terms of equality. Perhaps it is.

He did not mention Medicaid, but I couldn't help thinking of the program. Here are two questions:

1. Has Medicaid improved the health care for the poor relative to the rich?
2. Has the US healthcare regime improved health outcomes by more than European healthcare regimes have improved health outcomes?

It seems to me that the answer to both questions is probably "no." I concede that in theory there are counterfactuals that make these two claims less than ironclad. Yes, we live shorter lives than Western Europeans, but without our policy of spending almost 18% of GDP on healthcare the gap might be even wider. And yes, the health outcomes of the poor relative to the affluent have deteriorated dramatically since the enactment of Medicaid, but the deterioration might have been even worse without Medicaid.

I'm skeptical of both claims.

Here's my question. Do American liberals believe the answer to the first question is yes, and the answer to the second question is no? If so, what evidence do they have for holding those two beliefs?

My hunch is that the increasing gap between the longevity of the poor and rich reflects lifestyle. When I was very young the stereotypical rich man was a fat banker who smoked a cigar, ate lots of steaks and drank martinis. The stereotypical low-income person ate much less, and got lots of exercise picking crops, or working in mining or manufacturing. Obviously things have changed. And yet low-income people in the Great Plains states still live pretty long. So it's not just income.

If (as Robin Hanson would say) healthcare isn't about health, maybe we don't need to spend 3% of GDP of Medicaid. Morgan Warstler suggested providing a low cost single-payer option for the poor---similar to the Cuban system that Michael Moore likes so much. Instead of thinking about how to pay for CAT scans and MRIs for the poor, perhaps we should think about whether poor actually need CAT scans or MRIs. Singapore's government spends 1.2% of GDP on healthcare (vs. close to 8% in the US) and has universal coverage. Obviously we could not hope to achieve those efficiencies in a country of 320 million, but then that raises the question of whether these ought to be federal programs, or whether (as in Scandinavia) healthcare might be more effectively managed at the local level, with local taxes.

(17 COMMENTS)

Kudos to Senator Mike Lee and Representative Matt Salmon for proposing a new approach to early-education policy on the home page yesterday. The lawmakers recognize that the nation’s largest preschool program, Head Start, has failed to demonstrate any persistent impacts when subjected to rigorous evaluation. They propose to cancel federal funding for Head Start and send the money to the states for pre-K education. “It’s time to distribute [Head Start’s] funds to the states and let them experiment,” they write.Any proposal that eliminates spending on Head Start is a positive step. But is it wise to simply give the money
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According to Ryan Avent of The Economist, the U.S. dollar's rapid appreciation in the early 2000s, the result of mercantilist currency manipulation on the part of several of America's trading partners, led to a steep increase in the relative cost of American tradable goods. This in turn did a great deal of damage to the U.S. economy:What would we expect to happen in such a circumstance? Well, we would expect a big blow to industries that were cost-sensitive and highly exposed to foreign markets. We would expect to see large current-account deficits and for net trade to be a substantial
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Or any minimum wage, for that matter.

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Switzerland has consistently resisted some of the more blatantly progressive-populist-socialist impulses that have gripped many of their continental neighbors — joining the 28-members of the European Union and their unified currency system springs immediately to mind — and the Swiss once again just declined the growing trend to implement their own top-down minimum wage in […]

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One major difference between being insured and uninsured is easy to see in new graphs from a government report.

When compared to those without insurance, working-age adults with insurance are far less likely to go without prescription drugs because they can't afford them, according to the National Center for Health Statistics.  You can also see in this chart how people struggle to afford insurance as their incomes approach and fall below the federal poverty line.

Over the last decade, as you can see in the chart to the left, those without insurance were about four times as likely to skip a needed prescription drug.

The results aren't all that surprising, but the graphs are a helpful visualization of how people put off necessary care because they can't afford it. And ultimately, delaying care could lead to poorer health and the use of even more services, the NCHS report points out.

The charts come from the NCHS's massive 511-page report from Wednesday that provided a wide-ranging checkup on how our country is performing on numerous health-care measures. The above results come from the National Health Interview Survey, in which people were simply asked, “During the past 12 months, was there any time when you needed prescription medicine but did not get it because [person] couldn’t afford it?”

A similar correlation was found between people's income and their decision to skip medical and dental care because of cost.

 

The latest World Values Survey was released last month, polling 80,000 respondents in 56 countries on hundreds of social, economic and political questions. Read on for some of the most interesting findings about Americans and our place in the world.

Americans don't fully trust their family members

69 percent of Americans report that they trust their family members "completely," which puts us close to the bottom of the list of countries surveyed. Middle Eastern and central European countries are at the top, while the Netherlands ranks dead last, with only 59 percent of respondents trusting their families completely.

Work is low on the list of American priorities

While we have a reputation for being a country of workaholics, we actually rank the importance of work quite low (36 percent) compared to other countries. Ghanians, Filipinos and Ecuadorians are the biggest workaholics, while again the Dutch are at the bottom of the list.

The most important thing, according to Americans? Family. Sure, we may not fully trust that one sketchy uncle, but we love him anyway.

No Robin Hood governing, please...

The survey asked a battery of questions on the essential ingredients of democracy. These questions asked respondents to choose how important various characteristics (free and fair elections, civil rights, etc) were on a 1-to-10 scale. Americans were middle-of-the-pack on most of these measures, but we stood out on the question of whether the government should tax the rich and give to the poor--spreading the wealth, if you will. Only 7 percent of us ranked this as a 10, or absolutely essential to democracy. This put us near the bottom of the list, just behind--you guessed--the Netherlands.

... and while we're at it, keep the government out of business

On a similar 1-to-10 scale the survey asked whether it was better to increase private or public ownership of business. The U.S. was among the countries least likely to say that government ownership of business and industry should be increased.

The U.S. is middle-of-the-pack when it comes to how safe we feel...

83 percent of us say we feel "very" or "quite" safe in our neighborhoods, which is a healthy number, but nothing compared to Slovenia, where 99 percent of respondents report feeling secure. Egypt is a notable outlier at the bottom of the list, which isn't surprising given the political turmoil in that country.

... which might explain why we're more likely to pack heat than almost anyone else

One reason why Americans might report feeling safe is we are third on the list for percentage of respondents who report carrying a weapon for security reasons, at 16 percent. While this is high compared to other countries, it actually seems quite low relative to how much you hear about self-defense in debates over gun safety laws. In 2013, "protection" was the top reason cited by gun owners for why they own a gun, according to a Pew Research Center survey.

Americans are big into the notion of a "just war"...

Nearly three-quarters of Americans say that war is sometimes necessary in order to "obtain justice." This puts us behind only Pakistan on that measure. There's a lesson for politicians here. Need to convince a war-weary public to engage in yet another military escapade? Just tell them it's in the service of justice.

... as long as somebody else is doing the fighting

While our enthusiasm for a just war is nearly unmatched, many of us get skittish when it comes to actually carrying it out. Only 58 percent of Americans say they would be willing to fight for their country. This puts us in the bottom-middle of the pack on that measure. Apparently it's time to update Kennedy's famous dictate: ask not what your country can do for you; ask what someone else can do for your country.

Xbox maker Microsoft was among the interested parties in acquiring video game streaming service Twitch, according to sources speaking to The Verge. YouTube, which is owned by Google, eventually finalized its billion-dollar deal and is currently working with Twitch to determine how independent the company will remain, the site's sources went on to say.

The Verge's sources said Microsoft, and other unspecified companies, made "serious" bids for Twitch, but the streaming service sided with Google/YouTube because they were deemed the company that would allow Twitch to realize its potential. Another source said Twitch had "plenty" of offers from venture capitalists for more money, but Twitch needed a stronger infrastructure to help it handle its technical processes, something Google was capable of providing.

Neither Twitch nor Google have commented in an official capacity regarding the rumored buyout. We will of course continue to monitor the story as new information becomes available.

Google's rumored buyout of Twitch is not a done deal and it's possible that the United States Justice Department could see the acquisition as anticompetitive in the online video market. That's because YouTube is already the most popular platform for Internet videos.

Twitch may not be a household name, but it has a massive reach. A report from February showed that Twitch ranked fourth in peak Internet traffic in the United States, ahead of major companies like Facebook, Hulu, and Valve.

Eddie Makuch is a news editor at GameSpot, and you can follow him on Twitter @EddieMakuch
Got a news tip or want to contact us directly? Email news@gamespot.com

Action game Blades of Excalibur will be making its way to the Western market this year, but players can try the game out for free on YouTube.

Developer and publisher Kabam announced today that a working preview of Blades of Excalibur is currently being hosted on YouTube.

According to Kabam, the game will be "the first Web-based fighting game that has the speed, responsiveness and graphical sophistication of a console."

Blades of Excalibur will be free-to-play upon release. The game is set in medieval England and centres on the trials of King Arthur, aided by Merlin the wizard and the Knights of the Round Table. Head on over to the YouTube page to try the game out.

Zorine Te is an associate editor at GameSpot, and you can follow her on Twitter @ztharli
Got a news tip or want to contact us directly? Email news@gamespot.com

Comic by Noitego.

(via Pleated Jeans)

Game of Thrones is a ridiculously complicated show. Explaining it all to someone could easily take hours and would likely require the help of some flowcharts and family trees and maybe even a Powerpoint presentation, unless you’re Peter Dinklage. In this interview during the press junket for X-Men: Days of Future Past, Dinklage is asked to sum it all up in less than a minute, and he actually pulls it off.

See the video after the break.

(Pajiba via The Mary Sue)

There’s nothing quite so sweet as that moment when you discover something new and completely fall in love with a fandom. It could be a comic, a movie, or a book, but it’s a wonderful moment that’s something to treasure. The only problem is that, no matter the fandom, some guy out there is going to try and ruin it for you within minutes. Whatever you do, don’t be that guy.

See the full comic after the break.

(Dorkly via Geeks are Sexy)

Not content with attacking the sanctity of America’s highly regarded car dealers via direct sales of his annoyingly successful Tesla electric vehicle, Mr. Musk’s Space Exploration Technologies is now threatening to undermine the renowned efficiency of America’s Military-Industrial-Complex.

Trulia's Chief Economist Jed Kolko identifies where the middle class struggles to find housing.  Where can the middle class afford to buy a home today? Affordability has worsened in the past year, as home prices have climbed faster than incomes and mortgage rates have risen. But compared with the longer-term past, [...]

Nearly two-thirds of Americans polled by NBC News said they'd favor a return to death by gas, electric chair, firing squad or hanging if lethal injection was found impractical. What's your preference? Personally, I'd like to have seen polling numbers for garroting and breaking on the wheel.

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As I write this post in my godforsaken part of North Carolina, it's a comfortable 61°F outside. The weather report also tells me that the relative humidity is 55% . For all intents and purposes, that means nothing. It's crap. Let me tell you why.

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Lee Chingyu, an anchor for Taiwan's Next TV News, choked back tears as she discovered live on air that a friend and colleague at another network had been found dead in an apparent suicide.

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Hackers in San Francisco (let's imagine this as a real group of people and not key characters in an Aaron Sorkin pilot pitch) provided the new Godzilla movie with unsolicited viral marketing earlier this week by hacking an electronic road sign to read "GODZILLA ATTACK!"

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After lawmakers in New Jersey and Missouri both recently proposed regulations that would prohibit car companies like Tesla Motors from selling vehicles directly to consumers instead of through independent dealers, the Federal Trade Commission is weighing in with comments for legislators in those states, urging them to consider abandoning existing laws and change things up a bit. .

The agency already laid out why it thinks Tesla should be allowed to sell directly to consumers, but today’s missive outlining the subject of its comments to New Jersey and Missouri lays out exactly how each state’s proposed law would harm consumers.

Staff from the FTC’s Office of Policy Planning, Bureau of Competition, and Bureau of Economics note in the comments that current laws in both jurisdictions “operate as a special protection for [independent motor vehicle dealers] – a protection that is likely harming both competition and consumers.”

It’s not like the FTC wants to pick on N.J. or Missouri, of course — any state law that would mandate a single method of “distributing automobiles to consumers” is one that the staff would oppose.

Specifically in Missouri, the FTC feels that the proposed amendments to current law — which the staff says already dampens innovation in manufacturers’ ability to sell to customers in what could be a more cost-effective and responsive manner — would only serve to “amplify the adverse effects of the current prohibition” and “discourage innovation.”

And while in New Jersey the legislative proposals currently on the table simply provide a strict set of exceptions to the laws banning direct sales and could possibly increase competition, the bills don’t go far enough.

“New Jersey’s consumers would more fully benefit from a complete repeal of the prohibition on direct sales by all manufacturers, rather than any limited, selective set of exceptions,” the staff comment states, noting that “current New Jersey law . . . is very likely anticompetitive and harmful to consumers.”

The FTC notes that of course, all of these proposals bring Tesla’s efforts to mind. But it’s not just about that one company — it’s about the bigger picture of giving consumers more choice about how they spend their money, and who they buy products from.

“FTC staff offer no opinion on whether automobile distribution through independent dealerships is superior or inferior to direct distribution by manufacturers,” the comments note. “Consumers are the ones best situated to choose for themselves both the cars they want to buy and how they want to buy them.”

FTC Staff: Missouri and New Jersey Should Repeal Their Prohibitions on Direct-to-Consumer Auto Sales by Manufacturers [FTC.gov]

The grim truth about pay and living standards in some the regions of the UK has also been highlighted by official EU figures showing that parts of Britain are effectively poorer that countries from  former communist countries in Eastern Europe.

People in Cornwall and the Welsh Valleys are worse off than residents of Estonia and Lithuania, according to Eurostat figures comparing wealth across the EU using a measure known as “purchasing power standards” – which takes into account GDP per person and cost of living.

In addition, Durham and the Tees Valley, in the north east of England, are poorer than those in the wealthiest regions of Bulgaria and Romania, the two most deprived countries in the EU.

By contrast, the Eurostat figures show that London is the richest place in Europe.

There is more here.

Jason Kottke blogs:

A Japanese TV show took three expert fencers and pitted them against 50 amateurs.

I honestly didn’t think this would be that interesting and expected the Musketeers to easily get taken out right away or, if they survived more than 30 seconds, to handily finish off the rest of the crowd…nothing in between. But it’s fascinating what happens. The crowd, being a crowd, does not initially do what it should, which is rush the experts and take them out right away with little regard for individual survival. But pretty much every person fights for themselves. And instead of getting easier for the Musketeers near the end, it gets more difficult. The few remaining crowd members start working together more effectively. The survival of the fittest effect kicks in. The remaining experts get sloppy, tired, and perhaps a little overconfident. The ending was a genuine shock.

In 2011, Peter Gibson, a professor of gastroenterology at Monash University and director of the GI Unit at The Alfred Hospital in Melbourne, Australia, published a study that found gluten, a protein found in grains like wheat, rye, and barley, to cause gastrointestinal distress in patients without celiac disease, an [...]

Earlier this week, one of my readers, Meshack Vallesillas, sent me a link to an article he posted on his own blog. It took my breath away. Writing about his own struggles to be creative, Meshack said, "(I finally) understood that anything you might consider ‘art’ is made up of two parts; [...]

As regular readers know, I occasionally like to dig into the recent box office past and see how films performed over the long run. The news that caught my eye and inspired this update is the fact that Walt Disney's Need For Speed has crossed $200 million at the worldwide box office. [...]

Entrepreneur Marc Bell's resume includes FriendFinder and Penthouse. But judging by his pad, his passion is "Star Trek."

The 4-year-old on-demand car service could be joining the big-players club with a possible new round of funding.

Following Microsoft's announcement of a cheaper, Kinect-less Xbox One, NPD Group reports that Sony's PlayStation 4 yet again claimed the hardware crown.

People whose training regimens include intense endurance workouts might actually be at increased risk for heart damage, according to a couple of big new studies released yesterday — but researchers caution that they don't want people to take that as an excuse to skip the gym.

Instead, these results might help doctors figure out why certain people develop irregular heartbeats and how exercise might affect someone who already has heart problems.

How healthy people might end up with faulty hearts later in life

Some people who train intensely more than five hours a week at age 30 are more likely to develop an irregular heartbeat later on in life, especially if they seriously cut back on exercise by the time they turn approximately 60, according to one of the two studies published in Heart, a British Medical Journal publication.

Researchers looked at a group of approximately 44,000 Swedish men, with an age range between 45 and 79 and an average age of 60. In 1997, they asked them how frequently they exercised at ages 15, 30, 50, and their current age.

At the end of 2009, they followed up on the group to see if any had developed atrial fibrillation, an irregular heartbeat, which can increase the risk of stroke, cause chest pain, and even lead to heart failure. In the general population, atrial fibrillation affects almost 8% of people between 65 and 74, with the risk increasing further as people age.

In the group of Swedish men, those who exercised more than five hours a week when they were 30 but less than one hour a week when they were 60 were significantly more likely to have developed an irregular heartbeat than those doing almost no exercise the whole time.

This increased risk held even after researchers controlled for other diseases, body mass index, smoking history, aspirin use, and alcohol consumption. 

The results seem to suggest that being sedentary in middle age may be more problematic in some ways for those who were super active at 30 than for those who were lazy all along.

But before you let your running sneakers gather dust, consider that moderate levels of exercise were universally beneficial, and that even intense exercise had protective effects for those in middle age.

Moderate exercise is best for those already with heart disease

In the second study, researchers looked at a group of just over 1,000 Germans who were receiving medical rehabilitation for issues related to heart disease. They followed up with them repeatedly over the next 10 years, checking their heart health and seeing how frequently they exercised.

In this group, about 40% said they hiked, cycled, played sports, or gardened two to four times a week. About 30% said they worked out more frequently than that, and 30% did less, including 10% who said they almost never did anything physical.

Those who did no exercise were the most likely to die of a cardiovascular event, and working out only once a week was also tied to increased mortality. However, the group that was least likely to die or suffer a heart attack or stroke wasn't those who got the most exercise, it was those who worked out a moderate amount: two to four times a week.

Once people started working out five times a week or more, their likelihood of death and other problems rose again, though it didn't get as high as for those who did nothing.

Why this doesn't mean you should cut down on exercise

Both of these studies do match some previous data that says athletes are more likely to develop irregular heartbeats than the general population and that exercise-induced inflammation could overstress a burdened heart. But both come with an important note of caution, which is that they rely on people accurately reporting how much exercise they get.

In the one that looked at the Swedish men, participants may not have accurately remembered how much they worked out at age 30. Perceptions of intensity might also vary greatly from person to person, making it hard to draw solid conclusions from the findings. Plus, the study only looked at men, and women could have different outcomes.

In the German study that looked at those who already had heart disease, researchers relied on participants' accounts of both how frequently and how intensely they worked out. Those self-reports might not be completely accurate.

The researchers mention the caution required when relying on self-reports, which is echoed alongside other concerns in an editorial also published in Heart.

Physicians Eduard Guasch and Lluís Mont argue that these results are helpful for researchers and for doctors advising individual patients, but less important for general workout guidelines. They say that even though being aware of potential adverse effects is useful, there is "no other known therapy" as beneficial as physical exercise for preventing or recovering from heart issues.

Make no mistake: Regular physical activity is absolutely crucial to your health.

"A thin line separates accurate information and unnecessary alarmism leading to inactivity and consequent heart disease," the editorial argues. "The beneficial effects of exercise are definitely not to be questioned; on the contrary, they should be reinforced."

SEE ALSO: 11 Scientifically Proven Reasons You Should Go Outside

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Smartphones have changed a lot since they began to creep into the industry about seven years ago, but researchers are working with a material that could once again shake up the way our phones look and feel.

And today's biggest tech companies can't wait to get their hands on it. 

Graphene is a super thin, flexible material that's capable of conducting electricity. In a sense, it's sort of like a high-tech version of cling wrap, as Bloomberg describes it. Graphene is particularly valuable in the tech industry because it solves a lot of the design problems electronics makers struggle with.

So far, graphene has been flaunted as a "wonder material" that could make  far-fetched concepts such as foldable phones a reality. 

Since the material is 1 million times thinner than a sheet of paper, it could easily be used to make smartphones much sleeker than they are today. It's flexible nature also makes it an attractive option for wearable computing devices. Reports have also suggested that it could even deliver internet 100 times faster on your smartphone.

Samsung has already locked in 38 patents pertaining to the use of graphene in the United States, with 17 other applications pending, according to Bloomberg. Apple has at least two pending patent applications involving graphene.

How Thin Can You Make Something?

The sheer number of patents, however, isn't always indicative of whether or not one company will succeed over another in a given area. Samsung typically invests in new display and component technologies, while Apple is known for commercializing new technology, as Avi Greengart, research director for consumer platforms and devices at Current Analysis, points out.

Graphene could be particularly valuable to Apple since the company is always focused on making its products thinner.

"Any technology that will enable you to shave even a portion of a millimeter off a phone will be very useful for Apple's designers," Greengart said in an interview with Business Insider. "This is an element of design that's very important to them—how thin can you make something?"

If a material like graphene is commercialized for use in smartphones, manufacturers such as Apple wouldn't have to cut corners on other internal components to keep devices slimmer. 

"You could increase the battery size and have the same overall product thickness," Greengart said. "Anything that gives design more flexibility is something that Apple is going to want."

For Samsung, the value in commercializing graphene is a bit clearer. The company has been flaunting its flexible smartphone displays for years, but has yet to produce them at high enough quantities for mainstream products.

Graphene could potentially change that, making the company's rough product timeline of releasing fully foldable gadgets by 2016 a reality.

Both Samsung and LG have already released their first consumer-ready device with a curved display—the Galaxy Round and G Flex respectively. The benefits of these devices, however, aren't immediately clear.

"The curved screen we've seen on smartphones haven't added much to the smartphone other than the novelty factor," Greengart said. 

Displays that are curved or flexible are the useful when they're implemented in devices that couldn't exist without being rounded, such as wearable devices. Greengart cited Samsung's newest fitness tracker, the Gear Fit, as an example. 

"The Gear Fit's display curves around your wrist in a way that flat displays don't," he said. "If Apple is indeed working on wearable tech, then [graphene] would definitely be interesting to them."

The Challenges

Graphene hasn't been used in mobile devices yet because it still hasn't been commercialized. So far, it's been difficult to manufacture on such a large scale, leaving researchers with the choice of producing high-quality batches in small quantities or lower-grade graphene in large amounts, as the AFP reported. 

This could all change very soon as scientists and researchers are discovering new ways to commercialize graphene.

Last month, Samsung announced that it had made a breakthrough in using the material at a larger scale in electronics.

The company said that it had found a way to enable a single crystal of graphene to retain its electrical and mechanical properties across a large area.

A team of researchers from England and Ireland have also said they uncovered a way to create graphene using a blender and powdered graphite.

It's unclear exactly how valuable graphene will be to the smartphone industry until it's actually produced on a massive scale. But if it's the "wonder material" that people believe it is, the substance could be a game changer.

"It depends on how well it works and whether or not it can be commercialized in volume," Greengart said. "Once those are proven, I think this definitely looks like a promising technology that could enable more wearables or simply thinner and better smartphones." 

SEE ALSO: This Mind-Blowing Prototype Shows How Crazy Smartphones Could Look In The Future

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