Tuesday, September 17, 2013

Wellness, again

Austin Frakt and Aaron Carrol had a nice column in Bloomberg on Wellness programs and the PSU program in particular. They point out that, 

Whether wellness programs work as intended or not, let’s recognize what they also do: They increase the cost of coverage for some employees. That saves employers money but by shifting costs to workers. Those who bear the brunt of this increase are the less healthy employees, who also tend to be those of lower socioeconomic status. 
Now let’s consider what wellness programs might do: reduce health-care spending and improve health. In general, the evidence is weak that they will. Why? Conceptually, factors within workers’ control make only a small contribution to rising health-care costs, so there’s only so much such a program can do, even if it works perfectly. Empirically, the track record of wellness programs’ efficacy is mixed at best.
They do not point to the irony of our self-financing system directly. But they note the fact that the research shows that they are ineffective. And they answer the question of why they are so popular with employers.
More rigorous studies find that wellness programs in general don’t save money. With few exceptions, they often don’t improve health, either. The additional screenings that such programs encourage can lead to overuse of care, pushing spending higher without improving health. 
Given all of this, why are wellness programs so pervasive? Our hypothesis is that it’s a form of supplier-induced demand: The wellness industry is doing a good job of pushing its product. Understanding research is challenging, and it’s relatively easy for a marketing representative to cite glorious-sounding results.
Clearly the suppliers of these programs benefit, as PSU employees could see when we took our biometric testing and saw how many people the wellness program hired. I think that PSU is just counting on a lot of dropped spousal coverage. As they conclude, 

Penn State’s plan would hardly be the first time Americans bought something that may not work as well as advertised. Companies should reconsider the reasons that they are so eager to have them and whether they’re really worth the investment.

So Much for Energy Independence

With all the talk about US shale production there is a lot of talk about the US becoming energy independent. But as this report from the FT makes clear, the whole world is still highly dependent on Saudi Arabia, Kuwait, and the UAE. 
The US might be drowning in oil, but the world is still dependent on Saudi Arabia.
Indeed, Saudi Arabia is pumping out more crude than at any time since at least the 1970s. In neighbouring Kuwait and the United Arab Emirates meanwhile, oil production levels hit record highs. 
These numbers reflect a profound but easily overlooked trend in the global oil market. In spite of the shale oil revolution in the US, the world has become, if anything, more dependent on a handful of Gulf producers to fill supply shortfalls elsewhere. 
This  is of course great news for Russia. In July, Russian output reached 10.4 million barrels per day, a post-Soviet high. 

The problem is uncertainty of supplies elsewhere. Libyan production is down almost 1 million barrels per day due to turmoil. Iran still faces sanctions, and Nigeria has its own problems. As the world oil market is like a bathtub these are shocks we cannot escape, so Saudi behavior still matters.

Hard to disagree with this conclusion.
The consequences for the global economy – and the world’s biggest oil consuming nations – are significant. Saudi Arabia is already the single largest supplier to many of the large importing countries, including China. But it only sells crude to existing customers, and does not allow buyers to sell on their cargoes. 

For all the talk about the shale boom, then, it is business as usual for the rest of the world in terms of supply. The market will be watching those output data closely.