President Obama talks about the importance of prevention in a way that suggests that when people have heart attacks it's their own fault. But my wife, a longtime vegetarian and marathon runner, had a freak heart attack at the age of 37.
It wasn't from too many Big Macs. After some rough patches, she's now doing well, thanks to an obscure and expensive anti-arrhythmic drug called Tikosyn, and an implantable cardioverter/defibrillator. Not too long ago, she'd have been largely bedridden. These medical innovations made the difference between the life of a near-invalid and a life that's close to normal.
My mother had a hip replacement. Her hip didn't break - she basically wore it out with exercise. When the pain got too bad, she got it replaced, and now she's moving around like before, only painlessly. Not too long ago, she would have been chairbound.
My father had prostate cancer; his doctor suggested waiting but on biopsy it turned out to be pretty aggressive. It was treated with radioactive "seed" implants. He's now been cancer-free for several years, without the side effects of earlier treatments -- or, worse, of cancer.
My daughter had endoscopic sinus surgery this spring. She had been sickly and listless, complaining of constant migraine headaches, missing a lot of school, and generally looking more like a zombie than a teenager. Several doctors dismissed her problems, or prescribed antibiotics that didn't help much, until we found one who took the extra step.
A head CT scan done on a fancy new in-office machine showed a nasty festering infection, the surgeon cleaned it out, and now she's like a normal kid again. Before laparoscopy, her condition
would probably have remained untreated, and she would have been another "sickly" kid. Better to be well.
The normal critique of socialized medicine is to point out that people have to wait a long time for these kinds of treatments in places like Britain. And that's certainly a valid critique. I'm sure my mom and daughter would still be waiting for their treatments, while my father and wife would probably be dead.
The key point, though, is that these treatments didn't just come out out of the blue. They were developed by drug companies and device makers who thought they had a good market for things that would make people feel better.
This is something I've been saying for a while. But it touches on something else I've been thinking about--the way in which our attempts to measure health care innovation are going to bias our health care output towards things that can be measured.
The death of Dr. Helen would have shown up in any system's statistics. It's a hard fact which is easy to measure, hard to game. But if she had merely been bedridden, the loss that represents would be hard to measure, and easy for the system to "improve" by deciding that being bedridden wasn't so bad, after all. An old woman waiting for a hip replacement (or not getting it at all?) A daughter whose health was sort of permanently dragged down by a lingering infection? The system rarely looks for ways to fix things that the system doesn't measure.
Meanwhile, The Enterprise blog has one of the more fascinating health care charts I've seen in a while:
Veterinary spending is rising just about in line with human medical spending. Kudoes to AEI for publishing a graph that seriously undercuts one of the major conservative arguments about health care: that the main problem is consumers who don't bear their own costs. Veterinary spending is subject to few of the perversities that either left or right suppose to be the main problems afflicting health care spending. Consumers pay full frieght most of the time. They are price sensitive, and will let the patient die if keeping him alive costs too much. There is no adverse selection. There is no free riding on mandatory care. Government regulation is minimal. Malpractice suits are minimal, and have low payouts. So why is vet spending rising along with human spending?
Two reasons, presumably: technological change and rising income. As we get wealthier, we spend more of our income on former luxuries, like keeping our pets healthy--nineteenth century veterinary care for sick cats consisted of a sack and some stones to weight it down with. And improvements in health care technology are giving us more things to spend that money on. With the help of my family, I bought my dog five extra years of life with an MRI that diagnosed his slipped disk; without it, we'd have had to put him to sleep when he was three. Worth it? I think so. But in 1950, I couldn't have afforded it, even if it had been available.
That is a truly fascinating graph that should change the way a lot of people think about this issue, including me.
Hat tip.
Holy crap, Megan, did you even look at that graph? They aren't scaled the same! You can make any two lines look the same if you change both the y-intercept AND THE SLOPE! Dear lord, you're ridiculous.
Yes, but this isn't the case. The y-intercept is the same, and the slope too. If can check it out by performing a quick-and-dirty ratio.
The graph is indeed very nice. My question is: who questioned the assertion that the rise of prices was mainly driven by technological pressures?
The slopes ARE the same, but not because the scales are different. Remember, slope is dy/dx, and the dx is the same for both.
The slopes are the same, huh? Try plotting the data on a common y scale and see if you still think that.
A polynomial fit would be better, but linear fits are close enough to indicate how vastly different the slopes are.
slope_vet = (11-5.2) billion / 22 yrs = 0.264 billion/yr
slope_hc = (2100-800) billion / 22 yrs = 59.09 billion/yr
I think you meant to say that the percentage change slopes are similar.
That's right. Not dy/dx, but (dy/y)/dx.
To be precise, the plots would not look the same in a linear scale, but they would look the same on a logarithmic scale.
No, I meant what I said (this is not rocket science). The slope is the change in y divided by the change in x, or dy/dx. Or if you prefer high school algebra, it is m (or dy/dx) in the equation of y = mx + b. Slope is also dimensionless; therefore, no common scale is required to compare the slopes of two different trends.
And as for Nimed's comment below: I have no idea what you are talking about.
I don't need a log scale to compare these two trends. My eyes can see that a linear fit is just fine.
Right. dx is constant, while dy is much greater for human expenditure. To repeat what solarlux said, the slope of human health expenditures is much steeper, which would be apparent if you used only one y axis for both curves in the plot.
Also, slopes are not generally dimensionless. They have the dimensions of the axes. The slopes in this graphic have the dimensions money/time - (billions of dollars)/year. If you had, for instance, a measure of time in the x axis and of distance in the y axis, the slope could by interpreted as distance/time, or instant speed.
But the point of the plot is to make apparent similar changes in percentage of expenditure, not absolute value. So, if you would transform the y axis in log(y), you could then interpret the curve slopes as increments in proportion, and both lines would have the same slope in a common y scale (but would be shifted by a constant).
One trivial example is f(x)=exp(x) (or any other function a^(bx) ). This function's slope evidently not constant (i.e. not a straight line), but its growth rate is. Therefore, its slope varies in a linear plot, but is constant in a logarithmic plot.
And your eyes are serving you well. Growth in both expenditure are roughly linear. They just don't have the same slope. The clever use of 2 y-axis hides that from you, to show more clearly the point of the graph - they have the same rate of growth.
NoT,
You're not helping my stereotype of the innumerate liberal.
I'm a physical chemist, you ass. I've forgotten more math than you've heard of.
no one changed the slope (you can't do that without changing the data).
However, using a different axis for veterinary spending is misleading. You could have used a single axis if they used percentage change in spending for both.
Just eyeballing the graph, it seems veterinary spending goes from about 4.2-10.1 billion, while health care spending for humans goes from about 750 billion to 2.1 trillion over the same time period. Those numbers give us, about 140% and 180% changes, respectively. That is a large difference you do not get just from looking at the graph.
10.1 is a bad number; that looks a hair over 11 to me, giving 162%.
(don't want to argue any side, just pointing out that 10.1 is not a plausible interpretation of the graph)
are there any raw numbers for this?
You must be looking at the wrong graph. "Over 11" is the vet one, but gauged on the human axis. The human one is red with square dots, and ends slightly over 10 bn.
Uh, I'm pretty sure that the point is that the magnitude of change (in percentage terms) is similar over a given period of time. General health expenditures go from a bit less than 700 billion to just over 2100, for a 200% increase over the given period.
Vet expenditures go from 4.5 billion to 11 billion which is more like 150%, but close enough for Megan's point to be totally valid.
Growth of both types of medical expense vastly outpace inflation + population growth, and in the case if vet expenses it's clear it's because people are choosing to spend more on their pet's health.
I'd be very interested in seeing similar charts for dental health and eye care as a much larger fraction of those costs are also born by people themselves than is typical for normal medical care.
Nutella, the point you are missing here is that the starting points of the two curves are approximately at the same place on the graph (although, annoyingly, not exactly the same place, a fact that I put down to sloppiness). This plus the fact that the zeros are aligned (and the fact that both scales are linear) implies that if the two curves line up the two quantities must in fact exhibit the same rate of change.
It's a slightly subtle point, but--given that you called the author "ridiculous" and boasted about your superior math skills--one you should be embarrassed about overlooking.
Vet care = 4.25 billion to 11 billion an increase of 258%
Human care = 750 billion to 2,000 billion = 266%
Nutella - what did I miss? Human healthcare inflation and pet healthcare inflation are almost identical.
Bad math.
(11-4.25)/4.25= 1.588235294
(2000-750)/750=1.666666667
They aren't scaled the same!
I checked the numbers, and vet care has gone up about 2.7x, while human care has gone up about 2.8x (based on my crude reading), so the slopes are actually pretty close (although of course it was necessary to scale things differently to fit).
That graph is entirely reasonable. The important point is that the graphs are rising at very similar rates, even if on different scales. And they appear to to both be growing much faster than population/or US Income growth. Implying of course that the reasons for their growth are similar. This is a common charting technique when you want to interpose to related data sets.
Now, personally, I would have wanted some kind of correction for population/pet growth. That is I can imagine the growth of the pet population is either slower or faster than the general growth of the population.
But their is nothing disingenious about the data.
Good questions. All I can turn up right now is that, according to Discovery, 57% of US households own a dog or a cat as compared to 44% in 1956. So the proportion of households owning pets definitely has increased, and the average number of pets per household is 1.5 (dogs) and 2.1 (cats).
http://www.petfinder.com/for-shelters/facts-pet-ownership.html?printer_friendly=1
The precise meaning of these numbers is still subject to some interpretation, although according to that same source, apparently the population of veterinarians has also increased rapidly in the past fifteen years, suggesting a proportionate demand increase for their services.
Of course the number of people receiving health care is also growing, so you'd really need to know the *relative* difference in rates of growth between animals receiving health care and humans receiving health care.
Good point. Are we spending more to keep our pets alive, or are we keeping more pets while spending the same per pet? The second possibility undercuts a few arguments
Or, having more humans while spending the same per? I'd think the population of humans would grow at about the same rate as the population of pets...
I can see at least one scenario where pet population might go up.
Pets are an (imperfect) substitute for children. Since the US fertility rate has gone down (population growth is holding up only due to immigration), I'd guess pet ownership went up.
My grandfather died of smoking and yet never inhaled directly. I won't make that mistake I've decided.
To me the subject of better prevention does not necessarily relate to better treatment and the two are not mutually exclusive. For example: When heart disease, diabetes and cancer increase due to too much saturated fats - the solution will never be: private vs public health care. Getting rid of our insanely high annual subsidies of saturated fats would be good prevention. It would provides us with billions for either tax cuts or medical research - treatment.
PS: Most of so called veterinary spending happens on livestock factory farms where most animals in the US try to survive. We are talking about roughly 25 billion animals and not merely 350 million.
I don't know, it says "pets." Either the title is misleading or they've controlled for non-pets.
OK, it says it's "Consumer Expenditure." I don't know for sure, but it seems likely farms are considered businesses and farm vets business expenditures.
Where does it say so? And in any case - what about business vets expenditures? What if they have gone down per head? Does that mean that our tax subsidies do work when compared to no public support?
The vet chart is mostly a reflection of the fact many people can afford medical for their pets instead of leting them die. $10,000 operations for pets were almost unheard of thirty years ago, but I know more than one person who has paid that or more recently.
This tends to argue the same forces are driving health care: innovation and increasing disposable income to purchase new medical care.
(I'm tempted to argue it also reflects the increasing role of pets as surrogate children, but I'm not sure how much birthrates have really changed since 1984.)
As many have pointed out here before me, there's no reason why we shouldn't be spending more on health care if we can afford it.
Note: Despite the fact that pets are an emotional business and hence pet owners cut veterinary spending last in a down economy - this is not quite true overall. Pets remain a product and not a subject industry. More like car or IT maintenance than health care. Otherwise we would not be killing 4-6 million unwanted dogs and cats per year while breeding more by the hour.
Well, that gets into a slightly different issue - breeders turn out a higher quality dog than Fifi and Spot down the street. Some of the cats and dogs are vicious. Once a cat goes feral, it ain't turning back into a housecat.
Most of all, the foster care system for human children, while woefully inadequate, barely exists (very limited quantities) for pets.
Angel
Breeders turn out a higher quality dog than Fifi and Spot down the street? You could not be further from the truth than that. On average the heathy DNA mix of a mutt by far outstrips the incest of purebreds - it is common sense actually.
That is why the BBC has stopped broadcasting the world's largest and most prestigious dog show Crufts for the first time in decades. The term breeding will hopefully soon be equated with this, quite funny.
If you want to reduce the suffering of your loved one while also reducing your medical bills - get a mutt. Stop breedism!
In contrast to human adoption - there is too much supply and not demand when it comes to cats and dogs. It is not about more or better adoption shelters - treatment. Breeding is why we kill these animals - prevention.
Hugo - I'd rather stop bailing out irresponsible pet owners and breeders by cleaning up their messes. Why is that option never part of the purebred/purposely bred vs shelter dog equation? I will admit I am apparently a "breedist," and not to be trusted, as I have two purebreds.
Rich. As John McEnroe would say, you can't be serious. Why do you believe that I would have something against you or your dogs merely because they are purebreds. My first guess is - it was not your dog's fault that they are purebred and I am sure they are wonderful and that I would get along just fine with them. My second guess is that you, please don't get it wrong, have not heard much about breeding in every context and did not know better than to get purebreds. It could also be that you got your purebreds at a shelter where more than 25% are, I don't like the term, purely bred.
I could only judge and hence like or dislike your dogs or yourself based on conscious decisions? And frankly - I don't know enough about you yet for that. I don't form lasting opinions easily I'd like to believe. Sorry if I gave that impression. Here - I am merely stating what I have learned to be facts about breeding and hence breeders. I was not born with this knowledge or awareness etc and hope that I could be "trusted" before gaining it myself.
Hugo - I'm terrible with written sarcasm b/c I'm too dry. I really need verbal communication to convey my intent. I do, however, prefer known quantities in regards to dogs b/c I have a toddler and another baby on the way. I knew I was getting predictable dogs that aren't prone to aggression or other behavior that doesn't mix with small, grabby humans. I bought one dog and got another from an ad in the Sunday paper. The purchased dog came from a farm. I visited months before I got her and saw her Mom, the farm, lots of healthy adult dogs, etc. Met her dad when I picked her up, though I had info on him well before she was born. Also gained access to a whole network of people who breed that specific breed and work to diversify the gene pool, nationally and internationally. (For example, my dog's parents were paired based on temperment and not markings and her dad was freshly imported from Austria.) She's almost 3 and I can still email or call with any questions I have.
I personally think we conflate puppy mills with responsible breeders and don't send enough shame toward those who don't spay/neuter the household pet. If we eliminated two out of the preceding three, we wouldn't have problems with overpopulation or inbreeding.
Good lord rich,
How did you pick your wife and children? ;)
For the wife, I made her provide me with a family tree, I spent time with her parents, talked to her grandparents, checked out where she lived. You know, the usual. For the kids I just have to roll the dice. That's where the focus on my wifes stock comes in. :-)
The dog thing sounds excessive, but I wanted a specific breed and I didn't want one bred by people who choose appearance over health or who engage in unethical practices.
Rich - thanks for the family insights. Sounds like a fun bunch.
Not to lose the breeding point out of sight - here a last long one. If your wife had been bred over generations to look and behave as she did when you first met her - there would be some generic health issues involved no matter how one twists it. Maybe minor - maybe not - see the BBC list below. In reality - your wife's parents probably also had a choice regarding who to mate with? What if this wasn't the case?
I respect your good intentions regarding finding the right dogs for your kids and looking out for as much genetic variety as possible. But I hope you can also you see that you can find all this even better and healthier and more natural in mutts. Of course there are more playful and more fearful and more anything type of dogs out there. I am sure personalties differ somewhat in your own family too? Good nutrition, good socializing and good education is what makes great dogs overall. Not the careful yet involuntarily pairing of their not completely but somewhat related parents.
Watch it here.
BBC: The Top 10 Most Over-Bred Dogs and Their Ailments
1. Labrador Retriever
Hip dysplasia—a hip disease that can lead to crippling, lameness, or painful arthritis
Progressive retinal atrophy—degeneration of the retina, which can lead to blindness
Cataracts
Eye abnormalities
Bloat—a life-threatening condition in which the stomach becomes overly filled with food, water, and air and may twist, cutting off access to the esophagus and small intestines; can lead to circulatory failure and death within hours
Elbow dysplasia—a degenerative elbow disease which can lead to lameness or crippling
2. Yorkshire Terrier
Bronchitis
Early tooth decay
Poor digestion
Paralysis in the hindquarters caused by herniated disks and other spine problems
Fragile bones can easily be fractured
Poor tolerance of anesthetics
Abnormal skull formations in Yorkshire terriers measuring less than 8 inches (20cm)
Birthing complications
“Teacup” Yorkshire terriers often have serious health and behavioral problems
Slipped stifle—a condition in which the knee-like joint above the hock in a dog’s hind leg slips; may require surgery
Eye infections
Gum weaknesses
3. German Shepherd
Hip dysplasia
Elbow dysplasia
Blood disorders
Digestive problems
Epilepsy
Chronic eczema
Keratitis—an inflammation of the cornea
Dwarfism
Flea allergies
Bloat
Gastric disorders
Panosteitis—a painful bone disease that causes periods of sudden pain and lameness
Spinal paralysis
Eye disease
Skin conditions
4. Golden Retriever
Heart problems
Epilepsy
Von Willebrand disease—a blood disorder that can cause prolonged bleeding from simple injuries
Progressive retinal atrophy
Cataracts
Congenital eye defects
Hip dysplasia
Skin allergies
5. Beagle
Hypothyroidism
Demodectic mange—a skin condition that occurs when a dog’s immune system can’t regulate the number of mites living in the skin and mites proliferate, causing hair loss and open, crusty sores
Umbilical hernia
Epilepsy
Eye and eyelid problems
Cryptorchidism—absent or undescended testicles, which increases the risk of testicular cancer
Dwarfism
Hip dysplasia
Intervertebral disk disease—slipped or ruptured spinal disks, which can cause pain and paralysis
Luxating patella—a condition in which the kneecap moves out of place, can cause limping, difficulty walking and osteoarthritis, and may require surgery to correct
6. Boxer
Cardiomyopathy—a heart disease that causes abnormal heat beat, which reduces blood flow to the body and can lead to unconsciousness, collapse, and death
Heart problems
Subaortic stenosis—a narrowing of the outflow valve beneath the heart’s aortic valve, can lead to heart failure
Epilepsy
Tumors
Hip dysplasia
Allergies
Deafness (in white boxers)
7. Dachshund
Heart disease
Diabetes
Urinary stones
Spinal disc problems
Eye disorders
Skin conditions
8. Poodle
Cataracts
Progressive retinal atrophy
Allergies
Severe skin disease
Hip dysplasia
Eye problems, especially runny eyes
Ear infections
Von Willebrand disease
Bloat
Addison's disease—an adrenal gland deficiency which requires lifelong medication and monitoring
9. Shih Tzu
Spinal disc disease
Respiratory problems
Obesity
Early tooth loss
Eye problems
Ear problems
10. Bulldog
Cherry Eye
Conjunctivitis
Entropia
Dermatitis
Heart Problems
Demodectic Mange
Gastric Torsion and/or bloat
Hip Dysplasia
Please compare this to the average mutt. Can we cure the symptoms without the cause? Do we want to? It's the animals who suffer - we pay. In any case - I do not wish for an arranged marriage and do not wish it on anybody else. Glad you could chose the partner of your liking - maybe we should one day allow animals the same right?
Lots of mutts have health problems, but they are not tracked in the same way as purebreds. I am in no way advocating the over-breeding puppy mills, but responsible breeders serve an important function - it would truly be a shame if unique breeds that are hundreds of years old and bred for very specific purposes were allowed to fade into a general muttdom.
To back up what Holdfast said, I have a Greater Swiss Mountain Dog (purchased) and an Entlebucher Mountain Dog (adopted). The Greater Swiss is the largest and oldest of the Sennenhunds and the Entlebucher is the smallest. The origins of the Greater Swiss are unclear, but the most popular theory is that some of Alexander the Great's men stayed in the alps and kept with them an early mastiff-like dog. They wanted to farm, haul stuff, etc. and didn't have traditional farm animals. They bred their mastiffs with local dogs into a very sturdy animal which could pull their plows, etc.
Though uncommon and not well-known, the Greater Swiss served in WWII as cart dogs for munitions and other items. (Each dog can pull around a ton of weight when fully grown and trained for drafting.) Though once the most popular dog in Switzerland, the advent of mechanized farm equipment led to a lessening of their popularity. The breed hung around and is now being revived. One doesn't have to like or condone dog breeding to admit that's a long and very interesting history.
Insofar as health is concerned, I'm not a purebred. I have English, French, Scots-Irish, and Cherokee blood, all mixed up in a thoroughly American and not at all blue-blood lineage. I have pretty severe allergies, I sunburn easily, and have other hereditary "weaknesses." Such is life.
Again - my grandfather never smoked and yet died of lung cancer. There are always exceptions but the core of the argument stands. No matter how well one manages bloodlines - if your own wives and partners had been bred for generations against their free will. That is why many breeds (and mutilations such as ear cropping) have become illegal in Europe. No matter how "responsible" the breeder might be. A petition against the proposed laws of making the worst breeds illegal ends with: "This isn't right. its racism! we have to stop this now." What beautiful projection? The racists screams racism?
Guys I am sorry. But just visit your local dog park and open your eyes. I have yet to see a German Shepard - no matter who his breeders and parents were - who does not have a hip problem after the age of 7.
First - mutts are tracked by both shelters and vets. Second - I have personally worked and still am with enough different dogs so that the statistic does not surprise me. In my world - the stats and the overall experience are the same on this obvious one. The BBC has also not quit dog shows for fun.
Puppy mills are awful for many obvious reasons. Most bitches there are so stressed that they stop giving milk to their puppies prematurely. That means that the pups don't get their colostrum - much like calves on animal farms. Starting from here - no health and good behavior can be expected.
I have written above: "I could only judge and hence like or dislike your dogs or yourself based on conscious decisions? And frankly - I don't know enough about you yet for that. I don't form lasting opinions easily I'd like to believe."
I am slowly getting there ;) I hope that you feel that I've taken your concerns regarding dog temperament and children seriously. I hope that you see that just like with smoking and cancer - I am not talking about absolutes. Have you even understood any of my points? Again - last question: what do you think of arranged marriages that can involve only cousins? Even rich and well-meaning parents like the Habsburg have done it to their children - but was it and is it good?
Hugo, your mistake is in thinking that mutts are magically free of the genetic diseases of their composite breeds. If a given disease is dominant, the mixed-breed is likely to inherit it regardless, especially if the composite breeds both have a tendency to have it. A labrador-standard poodle mix might be a mutt, but both lineages carry the risk of hip dysplasia, bloat, and PRA.
When you responsibly breed purebreds, you KNOW what's floating around the genetic tree, and you take steps to avoid it. I have standard poodles, and bred one litter. I had three generations of hip dysplasia x-rays, blood tests on both for von Willebrand's, CERF testing for PRA, two generations of skin punch tests for sebaceous adenitis, and a five-generation pedigree to run the coefficient of inbreeding on the prospective match. (Several hundred dollars' worth of health/genetic testing -- I do my part to contribute to that vet-spending curve.) The breeder who bred my first standard poodle did the same, as do all serious breeder/showers, and I would never buy a puppy from someone who didn't. When the littermate of that first poodle got bloat, we *spayed* her and her puppy and her littermates, and cut that branch of the genetic line right off.
That's what responsible breeding should be, and I would never buy a dog (purebred or mixed) from someone who didn't adhere to those standards. I might adopt a mix from a shelter, but I'd never pay money for one and encourage an irresponsible breeder. Since responsible breeders don't mix breeds, that is by definition what you're doing when you purchase a mutt. It's about the worst thing you can do if you really care about dogs' health.
Emma
I am talking about real mutts. Of course once you have gone too far with breeding, and it is only a question of time that one gets there, crossing two purebreds with genetic problems is not the final solution. It would take many generations of random, also known as voluntary, couplings to clean up the genetic Frankenstein mess.
I think this is my last post here. Pity that nobody could tell me what they think about forced sex. Pity that nobody would tell me how they would feel if their partner was purposely bred for generations, against the will of his parents, to look and behave as she or he does.
I would prefer that cats get 19th century veterinary treatment today. Vicious little animals.
Love dog MRIs and everything that helps keep man's best friend alive and functional. Honestly we need better doggie prozac - side effects are rather unpleasant and prevent patients from being treated appropriately (on prozac they sh*t everywhere, so the choice is a neurotic/scared dog who's hard to keep inside, or one that can't be kept inside). My old golden became ridiculously afraid of thunder in his old age so spring and summer freaked him out. He would have been better medicated if he'd been able to control his bowels on prozac.
My friend had a miniature dachshund that needed 1/2 a xanax when company came over. I'm like....giving a 15lb dog 1/2 a xanax is like giving a person 5 xanax... oh well he sure was relaxed when company came over.
Although there are a number of drugs that can be taken by both dogs and humans, the pharmacokinetics of the two species are not the same. There are some drugs that must be dosed at a higher amount per pound in dogs than they are in people. Xanax may very well be one of these.
Vicious little animals.
They don't hold a candle to people.
You show me a dog that cleans itself, uses a litter box, and keeps the house free of spiders and insects, and I'll show you a dog that has finally figured out how to be as useful as any ordinary cat.
http://www.youtube.com/watch?v=nPV9SwCecTQ
I've got 2 cats and 2 dogs. I find the litter box argument to be an argument against, rather than for, cats. No amount of scooping, changing, and cleaning prevents those from smelling like a box in which cats shit. Thoroughly disgusting. And my dogs eat as many bugs as my cats. Moths tremble in fear of my main dog!
To the point raised by Hugo Pottisch: are we talking about veterinary service just for domestic pets, or for farm animals as well ?
It always bugs me when someone begins an article on health care with a throwaway line that shows a fairly deep lack of understanding of medicine. While it doesn't affect the argument, it does predispose me against it.
Honestly we need better doggie prozac
I think we need doggie Requip, but mostly because I want to see what a dog with increased gambling urges does with his time.
Come on, Rob, make 'em harder.
http://en.wikipedia.org/wiki/Dogs_Playing_Poker
Chase cars on the freeway?
Sniff grizzly-bear butts?
Eat out of the dumpster at Denny's?
It is a good and thought provoking chart. What I take away from it is that the inflation in vet medical care has been kept to roughly the same level as inflation in human medicine.
The vet costs have been kept in control only though the free market, while the same has been achieved with humans with a tangled mass of competing interests, only one of which is the market.
Sources:
http://www.avma.org/reference/marketstats/ownership.asp
http://www.avma.org/reference/marketstats/2001/ownership_2001.asp
Which isn't enough for a comprehensive analysis, but enough for a guesstimate.
In five years we went from 147,580,000 to 172,329,000 pets, a 16% increase
Pet care went from 8b in 2001 to what looks like will be 10.5b in 2007. So, per pet, care costs were $54.21 per pet in '01 and $60.93 in '07, a 12% increase
Meanwhile, human population in 2001 was 278,058,881 and in '07 it was 301,621,157 which is only a 8.5% increase
Meanwhile costs went from 1600b to 2400b based on my poor reading of the graph.
So, per person costs were $5,754 per person in '01 and $7,957 in '07 a 38% increase.
So, 12% more spending per pet, vs 38% per human in the same time frame, so much for cost control.
I hate to say this, Megan, but you might have been duped by a pretty graphic.
However, this does show that we get more pets when we can afford them, which makes me think that we wont use any less fuel with more efficient cars. But that's another topic entirely.
Nice work!
Agree, nice work.
Instead of per capita, though, should it be "per household" or maybe "per wage earner?"
In other words, should we look at spending per animal or spending per household or as a proportion of average income?
It seems to me that if the household size if relatively constant, and the household to pet ratio is decreasing (i.e., more pets per household), then the portion of available funds (e.g., annual income for most of us) going to pet health care is rising at the same rate as the portion of income going to human health care.
Thoughts?
Thoughts? I think it's a good idea ... I think it's funny that someone who would write ... "It's a hard fact which is easy to measure, hard to game." ... wouldn't spend any time pointing out the issues with the graph; especially when all this data is so readily available.
David Bernstein has a similar post where he details the value of medical innovation for his family:
http://volokh.com/posts/1242703131.shtml
The main difficulty I have with the graph is that it's not per-capita. How do we know that the number of pets hasn't tripled in the past three years?
Also, pet insurance is getting more and more popular, though by no means is the market large.
Otherwise, I find the comparison ingenious. If the population growth rates are similar, I think this could be a great graph to show certain politicians...
Oh, see Ken's post above. Great work!
Has anyone been to a vet lately? In 2007 we took our 11-year old dog for her annual checkup. She was in good shape, but the blood work indicated possible liver issues (not unusual for the breed at that age). To provide a more precise diagnosis, the vet wanted to do $4000 worth of tests.
$4000. Just for the tests. For a dog. We got the full "You're being bad owners" guilt trip when we declined.
I'm convinced part of the reason for the rising spending (and thus cost) of vet care is the cost of vet school. It's actually harder to become a vet than a physician, and the start-up costs of a practice are huge. I'm sure these vets are ordering up a bunch of unnecessary and cost-inflated procedures in order to service their student loans and the debts they incurred opening up shop.
The dog was (and is) fine, though slowing down considerably.
It's nice to hear Chauncey spout inflated figures about the under-insured without having a real clue about what he's talking about.
Where are the morbidity/mortality statistics about our "uninsured?" Since every "uninsured" American - and illegal alien - can already walk into a hospital and get treated, I'd really like to see some unbiased statistics around morbidity/mortality of the most threatened group.
And then I'd like to see someone do an analysis similar to what the opening of this post alludes to. Specifically: how many medical innovations go to market in the USA first, and require the US model to even make them viable?
How many pharmaceuticals make their debut in the UK, or Greece, or Spain, or Brazil, or any of the other nations where "universal health care" is the rule?
Worse, other than IT (Intel, AMD, TI, software), what other major industries can the USA still claim at least parity on the world stage? Automobiles? Steel? Large or small appliances? Garments? Clearly not.
There aren't many industries left here like Pharma, Medical Devices, etc.
Nobody is saying that the cost of healthcare doesn't need to be curtailed, but if there was ever an industry that we should be doing everything we can to hold onto - and perhaps induce to re-patriate some of their production lines - it is medicine.
The sheer ignorance of the US populace here, including Chauncey, is staggering.
Actually, when I think about it some more. A straight population/pet growth correction is probably not accurate. Pet owners I know tend to fall into 2 categories. A fair number are basically willing to spend whatever it costs to keep their pets alive, and others will simply let their pets die if costs exceed a threshold.
This would also be based on type of pet. I would pay a lot to keep my dog alive, if my goldfish passed away I would not really be that broken up.
This is different from people in that no one I know with the money will willingly let themselves die if they have the money to pay for their own treatment. The optimal solution would be to determine the number of pets in society that actively receieve lots of healthcare, and then track the spending just in that cohort.
I would like to think I would not spend my daughter's college money to keep myself alive. Judging by the AARP I'm in the minority.
While your sentiment is noble, your daughter may feel otherwise.
I think that's the point--the motivations and constraints are all different, but the rate of increase is roughly the same.
That is a scary graph. If that trend continues, we will be spending 30% of GDP taking care of our pets. We need pet control ASAP.
Megan, you and Glenn bring up a good point that I often argue myself (but I rarely convince anyone). The reason some treatments in countries with socalized medicine after a year's wait is that the U.S. invented the treatments. Otherwise, the treatments wouldn't be available at all.
Americans complain about our drugs being more expensive than Canada's drugs. That's because we finance the drug development in the first place. Their drugs aren't cheaper while ours are more expensive, their drugs are cheaper BECAUSE ours are more expensive. It's no coincidence that the one industrialized nation that doesn't have socialized medicine is responsible for a vast majority of medical advances.
Socialized countries free ride off the United States in medical care and if we go socialized too, they won't be able to anymore--those creaky barely functioning systems will simply collapse because they'll lose our subsidies.
In the end, bringing socalized medicine to the U.S. may not only degrade medical care everywhere, it may also end it everywhere else. I'd feel worse about that if we got the credit we deserve for what we give the world, but still...
If that turns out to be the case than the rest of the world can pony up to help fund innovation when they decide that not enough drug/devices are being developed.
So I read the article and it appears the graph is plotting consumer vet spending which I suppose means pets. I wonder if any statistician among us can opine on the significance of the correlation between the growth in people healthcare spending and pet healthcare spending. The idea that one factor (improved tech) is driving both is an interesting hypothesis but I don't have the expertise to know whether it has any support.
Does anyone disagree with Ken's analysis? Do most people agree that the AEI should have caught this (assuming they missed it in the first place)? This is precisely why I don't accept cites like the AEI. Note that this has nothing to do with partisanship and everything to do with numerical accuracy.
I disagree with some points, though his conclusion may be correct. I haven't decided yet.
For one, he made a mistake reading the graph. Veterinary expenses go from $7.9 billion in 2001 to $11.0 billion in 2006. The graph doesn't have 2007 data but, if it stays the same, that's a change of 39%.
Human expenses go from $1.6 trillion in 2001 to about $2.1 trillion in 2006, which is an increase of 31%.
1.39/1.16 = 1.2 -> 20%
1.31/1.085 = 1.21 -> 21%
So it's about the same on a per-pet basis as on a per-human basis. But even that may be incorrect for the following reasons.
1) The median age of the human population increased from 35.3 in 2000 to 36.6 in 2007, and medical costs should increase commensurately. Although I don't have any specific data on the median age of the pet population, the fact that the population is growing quickly suggests that the median age is shrinking.
2) He treats all pets the same, which they are not. Dogs and cats are the most common, dogs and horses consume the most health dollars per animal. A complete analysis would look at the costs animal-by-animal, instead of in total. I'm not asking anyone to do it; it would be a pain, and would present little reward. But if you want to have an informed opinion on the matter, that's what needs to be done.
While the second point is valid, (I had to work with what data I had, but there are so few horses out there that I think they would average out) the first point is most certainly not.
Increase is calculated as (new amount-original amount)/original amount. This is high school stuff.
http://www.onemathematicalcat.org/algebra_book/online_problems/calc_percent_inc_dec.htm
OK, so we're measuring the % change in $/dog (or whatever) from t = 0 to t = 1.
That's equal to [$/dog (at t = 1)] / [$/dog (at t = 0)] - 1. (like you said)
So imagine I have an equation, x= (a/b)/(c/d). That's equivalent to x = (ad)/(bc), or (a/c)*(d/b), or x = (a/c)/(b/d).
You can rearrange this equation so that it says [$(t=1) /$(t=0)]/[dog(t=1)/dog(t=0)] - 1.
That's exactly what I did.
For animals, dollars went from 7.9 -> 11 11/7.9 = 1.39
For animals, animals went from 147.6 -> 172.3 172.3/147.6 = 1.16
So the total % change in $/animal is 1.39/1.16 -1 = 20%
No, I did not say that, because its wrong. What I said was (in your terms) {[$/dog (at t = 1)] - [$/dog (at t = 0)]}/[$/dog (at t = 0) which is not really the same thing.
In other words:
x=(a-b)/a
is not
x=a/b-1
You said "Increase = (new amount-original amount)/original amount."
New amount = amount at [t = 1] = A
Original amount = amount at [t = 0] = B
Increase = (A-B)/B = (A/B - 1) = [t=1]/[t=0] - 1 = What I said = What you said.
I'm sick of this. You either don't want to admit you made an honest mistake or you're purposely baiting me. I've given you enough evidence if it's the former and I have no patience for the latter.
You are absolutely correct, I fudged up my math and should have double checked. I assumed, wrongly, that you started with the same numbers as I, but reached different conclusion, which led me to believe, wrongly, that you math has to be wrong, which in turn resulted in me saying things that I now regret.
Can someone else dig up the data and do some per capita calculations?
I am not sure that the increase in vet spending tells us much except that people are willing to spend more on pets. In fact, total spending on pets has basically doubled in the past ten years.
(see e.g., http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/10/10/MNNFS8O0V.DTL)
So the amount of vet spending as a percentage of pet spending is not really increasing. Health care spending as a percentage of GDP is rising.
That is only true if GDP has doubled over the past ten years as well. Alas, it has not.
I would point out that one reason we spend more on people over time is that we have more old people relatively, just like we have more pets.
And that except for some birds and turtles, people generally live substantially longer.
And there's also the different aspects of end-of-life care; my dog is 11, has a fast-growing cancer, and I'll have her put to sleep soon. My kids won't necessarily (qualified for unknown future events; I'm expecting baby-boomer kids to revolt and pass euthanasia laws,) have that option with me, however much both they and I might want it.
Sure there are a ton of reasons why human health care is rising at thrice the rate of pet health care, and all they prove is that you can't compare the two. In this way, the original article is unfalsifiable, like some religious dogma.
Ken,
I agree you can't compare the two directly, and the implied arguments were kind of silly, but there is a deeper point that is almost always lost when we have this discussion- that spending on lots of things are growing faster than GDP. What really amazes me is that people take seriously the proposition that we will eventually spend more on healthcare than we can afford if the free market is allowed to function in this area. That argument is silly on its face.
I wish you had broken this into two articles, because most people are ignoring the first section, and commenting on the second section.
Anyway, my comment is that the discussion of innovation holds for a lot more than just the field of medicine. After working for 32 years in industrial R&D, I have learned from repeated experience that when times are tough, R&D is one of the first areas to be cut. And the Engineering function probably isn't far behind. R&D doesn't immediately contribute to the bottom line, so you can cut it without having an immediate impact on manufacturing, sales, etc. Besides, most bean counters are suspicious of R&D anyway, because they don't really understand it, and think all of the R&D guys live in the proverbial ivory tower somewhere.
So if, for example, you tax the living daylights out of the oil companies, you can absolutely guarantee that you will kill some innovations that allow us to wring another BTU out of a gallon of oil, and no one will ever know what we are missing.
Uncle Bill,
I agree that people are ignoring the first section. But that is easy to do - especially given the ridiculous start:
President Obama talks about the importance of prevention in a way that suggests that when people have heart attacks it's their own fault. But my wife, a longtime vegetarian and marathon runner, had a freak heart attack at the age of 37.
We have almost no prevention in place compared to treatment and people start bashing more prevention with the logic of 5 year olds? Our health care costs are skyrocketing due to more and more heart disease, diabetes, obesity etc. Consumers want for a risk-free cigarette to be invented or for a cheap 30 minute lung cancer procedure to come along. Eh.. no, today it is saturated fats - which we also subsidize by much much more than any medical research on an annual basis. The solution for eating too much saturated fat does not depend on public vs private health care or on more R&D.
The same is true for pets - especially dogs. They are overbred, underexcerised and malnourished. Better R&D and treatment will ease the symptoms but will not get rid of the cause. As I have said before - on the positive side and thanks to us - Sisyphus is starting to feel really good about his day job.
"I'm sure my mom and daughter would still be waiting for their treatments, while my father and wife would probably be dead."
Surely such an assertion could be backed up by data.
But let us not forget that this statement also presupposes that one has insurance and/or that one can afford to have the procedure done. Those are non-issues in countries with universal health care. And let us also not forget that in many of those countries one also has the option of paying for a private surgeon if one does not want to wait for their "free" procedure
Having lived under both the Canadian and the American systems I personally miss living under the Canadian health care system. My three doctor's visits this year have cost me $400 and a whole lot of wasted time filling out about a dozen forms mailed to me by claims departments. Add in the insurance costs deducted from my paycheck and the forgone pay from what my employer contributes to my plan and the $600 a year I had to pay into the Ontario system looks like an absolute steal. And having witnessed a dear friend start chemo the day she was diagnosed with breast cancer, I hardly felt like we were being subjected to third world care.
I remember when I first moved to Canada and meeting someone pissed to all hell because they got a $40 bill for their ambulance ride. I couldn't help but laugh.
Aside from sharing similar slopes, it is not at all clear what the chart is supposed to mean.
It may simply be that the animal healthcare providers use the human system as a proxy for their own price increases, while accepting that human repair fetches an absolute premium. It may be that humans have subconsciously decided that an animal life is worth some fixed fraction of a human one, and budget accordingly. It may be something else entirely, or the correlation may be dumb luck.
The only clear conclusions here are that health care costs outpace inflation, and that animals don't get nearly as much of the cash. Otherwise, this doesn't take you very far.
The chart says to me: If we treat humans like pets, we'd save a lot of money.
Isn't Glenn Reynolds a government employee (Univ. of Tenn.)? As such doesn't he and his his family quite likely have employer/taxpayer subsidized health insurance?
I always enjoy government employees talking about the virtues of libertarianism and free markets in health care (or anything else really).
This argument is very tired. The University of Tennessee dates to at least 1807. As in, the time when the Founders were still alive and running the show. You can be awfully damn libertarian --- at least as libertarian as Thomas Jefferson, who founded the University of Virginia --- and still think that flagship public universities are well within the legitimate functions of a state government. Are libertarian or pro-market military officers hypocrites, too?
While I agree this is interesting, that the graph is reasonable, that there may be more here than meets the eye and that Megan may have discovered the solution to our entire national health care debate, I think the real answer might be simpler.
When I was in college (graduated in 1983) Michelob was our beer of choice, and I remember well being able to buy a six pack for $1.99. Today that same six pack of Michelob is $5.99. That's a threefold increase, slightly more than is at issue in the health care/vet care graph, but close enough to illustrate my point.
So I looked up some other stuff. The average price of a loaf of white bread from 1984 to 2009 went up about 2.54x
http://data.bls.gov/PDQ/servlet/SurveyOutputServlet
They stopped recording chocolate cupcake data in 1986, but Oreos are up about 2.4x since 1984. http://www.foodtimeline.org/foodfaq5.html
And finally, while I can't confirm its price back to 1984, a Big Mac is up about 1.5X since just 1996 (via The Economist's Big Mac Index)so I think it would fit the pattern, too.
Which is to say that maybe there isn't any pattern at all, but rather simply a comparison of two things that we think should be closely related but maybe have very little in common. Lies, damned lies and statistics once again.
Thus I think it's a stretch to say that the graph undercuts one of the primary critiques of health care spending. Maybe it does, but I doubt it.
Mr. Reynold's comments miss the point entirely: I'm thrilled that he and his family had coverage and/or money to pay for all of these treatments, but millions of Americans don't even have the option of considering these treatments. We must decide if we as a society want all of our citizens to have the option of getting these types of treatments, or do we think that only the wealthy and those who have access to comprehensive coverage are entitled to these treatments. The reality is that as the cost of innovative treatments and technology goes up, fewer and fewer people will be able to access this level of care. Are the "haves" willing to wait a few extra months for that hip replacement so that someone else's daughter can have endoscopic sinus surgery and the improvement in quality of life as Mr. Reynold's daughter has experienced?
@broken_quanta asks:
" Are libertarian or pro-market military officers hypocrites, too?
"
Which military officers - the ones that serve a few years and then go out into the free market and perhaps start a business or the ones who retire after 20 or 30 years and then go directly to work for a defense contractor whose sole existence is dependent upon government contracts all the while talking about a free unfettered marketplace and the wonders of competition while they enjoy sole source or no bid contracts?
I couldn't care less whether UofT is a public uni or not that is an irrelevancy. Glenn is free to spout whatever libertarian (and he's a semi-libertarian at best) mantras he wants. The point is that as a government employee he is not responsible for operating in the real world, meeting a payroll, etc., etc. Perhaps if he had to buy his and his family and perhaps his employees health insurance on the open market during boom and bust business cycles he might have a different experience and opinion on the subject of health care in the US.
Despite his Instapundit pretensions he has a cushy lifetime government job so..yeah...his opinions on matters affecting millions of Americans
in the real world are well...at the least oftentimes ironic.
Beyond that I'm glad his family had a positive health care experience and outcome. Shouldn't we be trying to see to it that everyone - not just cushy government job holders - have the same shot at that?
I strongly disagree with making a comparison between veterinary costs and human medical costs. You can definitely argue that people choose to pay more for veterinary care when the increase is still quite manageable and within most American household's discretionary budget. Many Americans would be willing and able to cough up a few hundred extra dollars to enable their dog to live longer. Not so easy when you're trying to extend Grandma's life for a few extra months at a cost of $50K.
The scale is so vastly different and the cost differential so huge that it really is not a good comparison.
Megan, interesting graph, but there's a serious (potential) flaw. The spending needs to be normalized per capita in order for you to drawm the conclusions you are drawing.
It might very well be that spending per pet has increased as much as spending per person, in which case your points are relevant and accurate.
If that's not the case, however, then the explanation might be mundane and unreleated: for example, it might simply be because people have more pets that they take to the vet. That might be because we own more pets, period, or that rising prosperity has motivated more people to take their pets to the vet, etc.
Regards,
SchmidtyPhi
Flint of wood.
The thorn
of a red rose
appears in the
light of
September, and
there, in the
care of the
darkness, a little
chamois discovers
a fate....
Francesco Sinibaldi