Deep question. And you might think completely out of reach of economics. But economics is fundamentally about how to allocate scarce resources in world of seemingly unlimited wants. Many would say life is invaluable. But health research, among others, forces us to think deeper. Suppose a drug extends life of cancer patients by a month on average but costs around 30 thousand dollars. Is it worth it? Assuming there are no other alternative drugs for simplicity, the question behind is how much is a month of life worth? This is not a hypothetical philosophical question. It was actually a case made public by doctors from the Memorial Sloan-Kettering Cancer Center.
If you think life is invaluable, you should then think that one month of life is worth those 30 thousand dollars. But think again. Resources are scarce. There isn't an infinite amount of money available. Suppose that money is coming from public funds, what if that money were used to help other people with simpler/cheaper health issues, which can also extend or improve life? What if that money were used in education? Now suppose that money is coming from your own pocket. Would you rather use it to go travel around the world instead? Or maybe buy a house for your children? Or, even, would you be willing to leave a 30 thousand dollar debt to your family for that extra month of life? If life is thought as invaluable, none of these comparisons can be done.
Doctors from the Sloan-Ketterin Cancer Center pondered about this due to a combination of new treatments available for cancer that were estimated to cost around 600 thousand dollars per year of life extended. Having been approved by the FDA, most insurers had to cover these treatments. But doctors at that hospital decided those drugs were not worth the price, other alternatives were better. If those new treatments were used by everyone, resources available for health would run out very fast. That money could be better used elsewhere. And so they decided to boycott them by going publicly against some of these treatments.
Avastin, $5,000/month; Zaltrap, $11,000/month; Yervoy, $39,000/month; Provenge, $93,000/course of treatment; Erbitux, $8,400/month; Gleevec, $92,000/year; Tasigna, $115,000/year; Sprycel, $123,000/year. (Photo: NYMag, Illustrations by Remie Geoffroi)
OK, so those treatments may not have been very good. Other alternatives were available. But what if the drug in question is really good and no alternatives are available? One such drug has been suggested to be SOVALDI for hepatitis C. Let me clarify that I know nothing about this drug, so let's approach the example more as a thinking process to understand how life sometimes needs to be given a dollar value, instead of a health study. SOVALDI is suggested to have smaller side effects and as much as 95% rate of cure in the US, hence an impressive drug. Its alternatives were suggested to perform much worse, possibly not curing Hepatitis C, just dealing with it temporarily. However, SOVALDI costs one thousand dollars a pill and is to be taken daily for 12 weeks, or around 84 thousand dollars per treatment. This has been taken by around 75 thousand people last year, totaling a cost of around 5 billion dollars in the US.
Given the costs, states have limited the coverage to some special cases. But the bigger picture is that this drug might actually cure you, reducing future costs and allowing patients to get back to their lives faster and with less problems in the future. So it might not be fare to just compare the price tags among the different Hepatitis C treatments. Assume away all other possible life improvements beside work and just suppose that the average patient is able to produce for one more year of life than those that take other cheaper drugs. Moreover, say this person produces the average GDP per Capita of the US: over 50 thousand dollars. This extra year of production can be considered to reduced the actual "cost" of this drug by more than half. Then add all other aspects of life that may improve with such a drug: not taking any more medicine later on in life, enjoying more time with family and friends, and so on.
The first drug was too expensive for what it provided. (Suppose it actually works) second might be worth the price. What is the cut-off? In other words, we return to the same question: what is a month of life worth? Neither zero, nor infinite. Many numbers are actually out there. For example, The World Health Organization typically places the value one year of life between one and three times the GDP per capita of the country, i.e. one to three times of what is produced by the average person in that country. I believe this number should depend on the person, determining the quality of that month (e.g. age, other possible health issues, general happiness): a month of life for an average 20 year old person should be worth more than an extra month of an average 90 year old one. But it gets very complicated to go into these details. However abstract this may seem, this number that values life is supposed to start being used to evaluate cardiology treatments. Independently of the final number, if you thought life was invaluable, think again.
Based on Radiolab's podcast.
A funnier example of scarcity, to finish off laughing...
How much are we investing in our industries? Most Argentinians nowadays complain that the government's policies are affecting their investments as they cannot import these goods. This idea can be exploited to evaluate the capital investments of most countries. Even though direct measures of equipment installed in a country by type are not available, Eaton and Kortum have shown that most of the world’s capital is produced in a small number of R&D intensive countries. The rest of the world generally imports its equipment. Two other economists, Caselli and Wilson, then have concluded that, for most countries, imports of capital of a certain type are an adequate proxy for overall investment in that type of equipment. Before leaving Argentina, I thought it was a good time to test how capital imports (and hence investments) compare over a selection of Latin American countries.
The United Nations has a dataset COMTRADE which holds information on all trade for each country, in a quite disaggregated way. (Notice that for some countries one big benefit of this source is that the information collection is independent of their governments). For example, we can check the number, price and weight of male suits made of linen that are exported from Egypt to Germany each year. And this happens for almost any good, year and set of countries you can imagine. Then, by identifying which of these imports are capital, we can identify the value of capital imports every Latin American country has done over the last 20 years. Figure 1 shows this as a share of GDP. It is clear that Bolivia (really Evo?), Chile and Paraguay are some of the highest capital investors/importers. On the other hand, the rest of Latin America seems to be pretty similar, importing/investing below 10% of GDP (I was surprised by Brazil's low numbers as well). Just to get an idea Asia has had a stable average ratio of capital imports to GDP of close to 16% over the same period.
But not all capital is the same when looking at investments. Aircraft or computers are not the same as cars or even more basic electrical equipment. Hence, we can even use COMTRADE data and evaluate the uses of capital investments of each of these countries. For the sake of clarity, in Figures 2, High R&D refers mainly to aircraft, computers and communication equipment; Medium R&D refers to other electrical and non-electrical equipment (includes professional goods like photographic ones); and Low R&D refers to motor vehicles and fabricated metal products. And now we can see how each Latin American country has invested in the last two decades.
Figure 1: Capital Imports as a share of GDP.
Figures 2: Capital Imports Composition, by country.
Let me start with my own country. Argentina has seen a big switch in the early 2000s from High R&D towards Low R&D. Imports of motor vehicles and fabricated metals seem to have taken place over equipment with more advanced uses like computers and other office goods. (This seems to go against what the Argentinean government keeps saying about building our own motor industry.) A similar pattern can be seen in Chile, though in much milder terms. Paraguay is on the opposite end, switching away from Low R&D towards more Medium and High R&D goods. Interestingly, some of the countries with the best recent reputation (like Brazil, Peru or Uruguay) have had a much more stable path. Figures 2 have many stories to tell and probably depend a lot on each country's policies, which I am most likely unaware of. Nevertheless, they do let us test whether the comments our politicians make on industrial and other forms of investment hold in the data. So pick your favorite country and check it out!
As I spend my vacations back home in Argentina, I am being asked by many people what do I think about the Argentinean economy? My answer to most of these people was that, on top of what the newspapers say, it is very hard to comment. Data is necessary to properly evaluate the state of an economy. And reliable data on my country's situation is hard to get.
A lot has been said about the inflation index in Argentina. The figure published by the INDEC, the national statistics agency, has been accused by almost every media source as unreliable. The government is accused of cherry picking the stores and goods it follows such that inflation is reported to be low. But every Argentinean you meet on the streets will tell you the index is a lie. They go to the supermarket or any store and they can "estimate" the index on their own heads. And things do not add up to what is published. MIT's billion dollar project includes an index where they follow a - albeit smaller - selection of goods online and report on them. This MIT inflation index is not perfect and probably would not exist if people trusted the official inflation. The orange line in Figure 1 shows their index, while the blue one is official inflation. Clearly, the official one is usually below half of the one built from online prices.
Figure 1: Argentina's official versus independent inflation indices.
Figure 2: Argentina's life cycle of income (monthly), 2012.
This will not come as a surprise to any Argentinean. They all know they cannot trust the official inflation index. However, I am always surprised to notice that do not comment on the reliability of other reports. It is relatively easy for everyone in the street to partially check the inflation index while going to the supermarket. But it is absolutely impossible for a regular person on the street to check if GDP has grown. If the government or the statistics agency is willing to lie on inflation - which we can all easily check - imagine what they can be doing with reports on things like GDP, unemployment, reserves or government spending/revenue - which are very hard to measure.
What can we do about it? Probably not much. But in order to try to reduce some of these issues I decided to look at the micro data available. The Encuesta Permanente de Hogares is a regular household survey (also held by the INDEC) where people are asked several questions on their education and economic status among others. My hope was that looking at something that is not directly published from this, maybe I can extract some more reliable information. I am not certain about this but here we go.
Looking at the life cycle of income the pattern found is surprinsingly similar to that of the US in the 1970s. (Are we really 40 years behind?) Using the EPH for 2012, the shape observed is very similar. The peak is observed around the age 40, a lot earlier than currently in the US, but similar to them in the 1970s. But the level of income is shockingly low, with an average monthly income at the peak age of below 4000 Argentinean pesos (between 300 and 500 dollars, depending on the dollar exchange rate used). Similar calculations for 1995 give a similar shape but an average monthly income at the peak of twice as much, around 900 dollars.
Going from the average, at the peak age, of say 500 dollars a month to the published value of GDP per capita of over 14 thousand dollars seems a bit complicated to me (12 months x 500 = 6000 dollars a year, which is a lot less than 14 thousand...). Remember that the average of 500 dollars was based on people who have jobs. Unemployed people were not included. The sample is small and results may not be very accurate due to that. But even then, you still need to add all the people who are not working but still count for the "per capita" part of those 14 thousand dollars. This is the issue with Argentinean data nowadays. We cannot trust them and is hard to find out if we researchers are making a mistake in our calculations or if things simply just do not add up.
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