Why I am bullish on America in one simple picture

Its demography, the X-factor that everyone always seems to forget when looking at the past and the future:

France was a dominant world power in part because it used to be the third most populous nation on earth (after China and India). Its population growth stagnated in the 19th and 20th centuries and it was overtaken by Germany, among others. Europe as a whole used to count for 20%+ of the world population, now they are barely 5%. Fears in 1989 were that Japan would overtake America economically. But the Japanese population growth stopped, and reversed, while Americas steamed ahead (we've added another 50 million people, IE, the entirety of England, while Japan has added essentially none). Or think of historical antagonists. In 1900 Britain had 40 million people to Iran's 7 million. Today, Britain has 60 million to Iran's 70.

Anyone who thinks China is destined to overtake America has not learned the lessons of demography. We Americans right now are haggling over debts and austerity, but at the end of the day, we're going to add another 150 million people by the year 2050, which is almost a 50% increase. China is going to start shrinking in population. Their ratio of workers to retirees will dramatically worsen, while ours will stay about the same (hence the oft repeated phrase that "China will get old before it gets rich").

If it was up to me we would encourage this even more, instead of turning into a xenophobic cocoon. A huge advantage that we still have is that most people would rather immigrate to the United States instead of China. Why not open our doors to skilled or driven foreigners from around the world? Every immigrant is a taxpayer. Immigrants are hard workers. They start business, and since they often have big families, they buy houses. Every immigrant is another ambassador to their home country, increasing the soft power of America around the world.

To an America with 500 million people, the debts of today are entirely manageable (assuming we can slow the growth of the debt to some extent). In contrast, the crushing burden of supporting retirees with the waning of the demographic dividend that China is now experiencing is a recipe for stagnation or worse.

America will probably be the second largest economy in the world by mid century. Rather than China that overtakes us, my bet is that it will be India. By 2050 demographers are projecting population growth of another 400 million people on the subcontinent.

on PSA screening

The US Preventive Service Task Force (USPSTF) recently recommended that primary care physicians not screen men for prostate cancer. The question I have is, why were primary care physicians ever screening for prostate cancer with PSA levels in the first place if it hasn't been proven to be effective at reducing mortality?

And what of the contentious debate? I don't think anybody is saying don't screen for prostate cancer. There is an appropriate context in which to do it: a randomized, controlled clinical trial. Outside of research, it is ethically and economically* inappropriate to advocate for treatments that have no proven benefit. Am I missing something?

*I suspect that economics will increasingly play a major role in our clinical decision making. We might as well embrace it now and do the leg work early. We need to stop doing things that don't help so there is money to keep doing the things that do help. Physicians have the ability to trim the excess fat from our health care system with a scalpel. If we wait for the government to do it for us, its going to be with a guillotine.

Djerejian on Occupy Wall Street

Christmas for me only comes a few times per year. I found the insights into the behind-the-scenes strategy and tactics of the parties in play to be particularly interesting.

What's wrong with this picture?

This patient has situs inversus. It is a mistake in embryogenesis where the major organs in the body end up in a mirror-image position from where they should be.

On medical images, the right is on the left and the left is on the right. So what you see in this chest x-ray is a heart that extends to the patient's right side. It is normally the opposite, of course.

Little America.

Just when I started to think we bottomed out in the "reprehensible reactionary regressive politiking" department:  a new immigration law in Alabama:

"School superintendents and principals across the state confirm that attendance of Hispanic children has dropped noticeably since the word went out that school officials are now required to check the immigration status of newly enrolled students and their parents."

So small.

Republicans and taxes: winning the battle, losing the war.

From one of my favorite economists:

http://www.nytimes.com/2011/10/02/business/economy/antitax-ideas-could-have-unintended-results.html?_r=1

I've said this before:  the problem with the sort of scorched-earth policy that the GOP has been operating with is that in absence of reform, big government wins by default.  The current crop of GOP leaders took power and could have cut all sorts of deals to drastically reduce the size of the government.  They've taken advantage of precisely zero of those opportunities (its already obvious that the debt ceiling deal won't result in any actual spending cuts).

The Economist on Palestinian Statehood

"In truth, Israel will be safer when a proper Palestinian state has been consolidated. That is a point that too few Israelis and their American supporters appreciate. This newspaper has argued steadfastly for the right of Israel to exist. We abhor the creeping delegitimisation and demonisation of Israel. But we also believe that the Palestinians deserve a state of their own. These two beliefs are entirely compatible. By his intransigence, Mr Netanyahu has played into the hands of those who would destroy Israel. In blocking any Palestinian aspirations at the UN, America is helping extremists on both sides."

Apparently all it takes to be a NYT Columnist is a poorly considered opinion

This was such a weak article:

NYT: Is junk food really cheaper?

The column starts off with an argument that fast food is actually more expensive than natural food. As proof, the author picks an anecdote completely out of thin air. In his hypothetical case, for a family of four, fast food is more expensive than healthy food. Take that, statisticians! He goes on to make the really insightful point that there are lots of things people could do to live cheaper - like drink water instead of soft drinks. He then goes on to talk a lot about how the problem here is really cultural: people are lazy, and don't like to cook. His solutions include changing said culture. The column ends with a complete 180, culminating in vague references to statist political solutions to curb consumption of processed food.

The only useful thing he does is bring up the analogy with the anti-smoking campaign. Consider for a second: what would you say if, instead of taxing cigarettes to $ 8.00 per pack where they are now, the government was subsidizing them to $ 1.50 per pack? And then imagine some jackass wrote a NYT column about how we just have a crisis of culture and that the OBVIOUS solution was for people to just get some willpower and quit smoking. Never mind stopping government hand-outs to tobacco companies (in this hypothetical case).

This is the reality of the nation that we live in: the government essentially pays people to eat fast food and drink soda. That is the 100% truth. We can talk about culture, paternalism, and lots of other things but it really comes down to incentives. Whether or not fast food is cheaper than natural food is really irrelevant - thanks to subsidies, fast food is cheaper than it would otherwise be. Period. People would consume less processed food it it was appropriately priced. Food industry subsidies are an example of big-government corporate socialism at its worst.

Once we all agree that we shouldn't be paying people to eat unhealthy food, we can wade into the area of whether or not we should tax unhealthy food. I think reasonable people can BEGIN to disagree on that point. That being said, taxes have to come from somewhere. Why not tax things that we shouldn't be doing (smoking, eating unhealthy food) instead of taxing things that we should be doing (working hard / income taxation)? Especially when people expect the government to pay for their health care at the end of life, its not unreasonable for that government to try to discourage the most unhealthy behaviors. Whatever; like I said, taxing fast food is an issue we can debate; that we subsidize fast food is not a point for debate - its a travesty.

Medical images blogging

Kid comes in w/ abdominal pain and bilious emesis. Whats going on?