Estimating County Health Care Costs in Washington State

Besides state and higher-level health care expenditures, county level HCE are useful, integral really. For example, to promote the Triple Aim (the best care for the whole population at the lowest cost) you need per capita HCE. And knowing those costs at the county level would help a lot. However, county estimates generally don’t exist. They didn’t in Washington State until a client needed cost estimates for our 39 counties. To supply those estimates I used a regression approach resulting in this model:

percaphce = +0.1*percapinc + 247*pctage65 + 0.71*percapmedaid + 10.5*pctrural – 1349 Continue reading

Risk Pushed Down onto Us

Within a day I was twice alerted to Bruce Schneier’s recent essay, “Our Newfound Fear of Risk.” Schneier meaningfully and regularly contributes on security issues. He deserves our appreciation. However, I disagree with his connotation that “Our Newfound Fear of Risk” is our fault, for that’s how the essay reads: “We’re afraid of risk”, “We’re bad at accurately assessing risk”, “We need to relearn how to accept risk.” The examples given about our implied overreaction to risk are policing, control and, terrorism. Continue reading

On Refusing to Expand Medicaid

Robert Pear wrote in the Times that the refusal by “states to expand Medicaid will leave millions of poor people ineligible for government-subsidized health insurance…” 1 Indeed, the refusals will do that, as well as worsen what instead should be remedied. In the following I present a graph of two chronic diseases over the 50 states. Those states which have opted out of the Medicaid expansion are identified. Additionally each state’s poverty rate is indicated. The take-away is that populations in greater need are being further disadvantaged. A conjecture is presented as to why. Continue reading


A Fresh Look at Health Care Cost Growth

In this post I recast the visual display of international health care expenditures. For select OECD countries, this clearly shows the growth of average costs has been moderating while U.S. cost-growth has been accelerating. The graph methodology is discussed along with a caution about marginal thinking. A conjecture is presented as to why the OECD cost-growth is moderating followed by a couple thoughts for action. Continue reading

Hold that Health Care Shibboleth

“We spend far more on health care than other peer countries yet have worse outcomes. Why is U.S. health care so expensive?” I’m sure you’ve encountered similar statements, maybe even expressed it yourself. It occurs often, including by knowledgeable people and health-related institutions. However, it’s a fallacy because it confuses health care with population health. Continue reading

Unemployment Statistics: A Closer Look

The context here is unemployment and educational attainment statistics, while the themes include the importance of a degree, how aggregating data can misinform, and trusting your lying eyes.

Street Level
What unemployment statistics convey can be different than what you witness at street level. For example: my daughter, Linda, has a bachelor’s in education and can’t find work. Anna, a barista at the local cafe has a BA in Psychology; Candice who works the bakery counter next door to the cafe has a BA in Journalism. These three young women are educated, articulate, and dependable. They want challenging creative work but their capacities are not anywhere near taxed. Those are just three examples. I’m sure you encounter many similar. Wait, please allow me one more. Continue reading

A Helpful Graph Related to the Federal Budget

A couple days ago Mike Konczal posted a Congressional Budget Office graph of Federal receipts and outlays relative to GDP, a graph, he wrote, we should “keep in mind about the current budget situation.”[i] I found the graph insightful but thought I’d like to see a longer timeline.

The revised graph, given here, starts with 1929, goes through the Great


Depression and World War II, and on to September 30, 2012. Looking at those 84 years, my first observations are: there are far more outlays greater than receipts than going the other way, over 80% of the years we spent more than we took in; from the end of WWII through 1974, outlays and receipts were tightly coupled; a persistent divergence begins with 1975 and except for the final bubble years continues to the present; after the peak in 2000, average receipts trend downward and outlays trend up; and the Great Recession, which we’re still experiencing regarding jobs, foreclosures, and debt, has the second highest deficit spending, though that’s improving.

This extended display of receipts and outlays gave me a better sense of context for where we’re at now (the deficit has been worse—I knew that but it helps to see it—and deficit spending has been the rule, especially for 34 out of the last 38 years). It added to my understanding. Hopefully it will also add to yours.

Notes: All of the data came from FRED[ii] except the 2012 estimates, which are from the November 2012 CBO Monthly Budget Review.[iii]

A PDF of this post is here.

Added on Jan 26: There’s a similar chart at the Tax Policy Center but it includes state and local receipts and expenditures. The graph given above is just federal. So if your interest is, e.g., the Federal deficit, then the above graph is germane.