Archive for category The Intersection of Economics and Technology

Health Care Shift to Electronic Medical Records Led to Rent-Seeking

“We called it the Sunny von Bülow bill. These companies that should have been dead were being put on machines and kept alive for another few years,” said Jonathan Bush, co-founder of the cloud-based firm Athenahealth and a first cousin to former President George W. Bush. “The biggest players drew this incredible huddle around the rule-makers and the rules are ridiculously favorable to these companies and ridiculously unfavorable to society.”

Part of the American Recovery and Redevelopment Act (ARRA) was incentives for the health care industry to switch to electronic medical records.  A recent New York Times article (Feb. 19, 2013) looked at what went into this $19 billion pie.  They concluded that the health care shift to electronics medical records led to rent-seeking behavior by the “big three” suppliers of electronic medical records. The three companies were  Cerner Corp., Allscripts and Epic Systems of Verona, Wis. The three lobbied heavily to have the $19 billion included in the bill.  And, of course, the requirements for suppliers were oriented toward systems produced by these three.  No problem?  Oh, wait, these companies are old and produce what should be legacy systems.  I’ve written before about Jonathan Bush of Athenahealthcare.  Here’s what he has to say about this clause in ARRA →

But if the customers are happy, who cares?  Well, it turns out the customers are not all that happy.  Again, from the Times article:

The records systems sold by the biggest vendors have their fans, who argue that, among other things, the systems ease prescribing medications electronically. But these systems also have many critics, who contend that they can be difficult to use, cannot share patient information with other systems and are sometimes adding hours to the time physicians spend documenting patient care.

“On a really good day, you might be able to call the system mediocre, but most of the time, it’s lousy,” said Michael Callaham, the chairman of the department of emergency medicine at the University of California, San Francisco Medical Center, which eight months ago turned on its $160 million digital records system from Epic. Michael Blum, the hospital’s chief medical information officer, said a majority of doctors there like the Epic system.

And, naturally, all that rent-seeking paid off:

Four years later, in December 2008, H. Stephen Lieber, chief executive of the group, wrote an open letter to President-elect Obama calling for a minimum government investment of $25 billion to help hospitals and physicians adopt electronic records. The industry ultimately got at least $19 billion in federal and state money.

In the months after that windfall arrived, sales climbed for leading vendors as hospitals and physicians scrambled to buy systems to meet tight timetables to collect the incentive dollars. At Allscripts, Mr. Tullman soon announced what looked like a game-changing deal: the acquisition of another records company, Eclipsys, for $1.3 billion.

“We are at the beginning of what we believe will be the fastest transformation of any industry in U.S. history,” Mr. Tullman said when the deal was announced.

Last spring, some of the Eclipsys board members left after a power struggle; Mr. Tullman left in December. He is now at a company he co-founded that focuses on solar energy — another area that, after Obama administration and Congress expanded government incentives in the 2009 stimulus bill, has been swept by a gold-rush mentality, too.

But Has It Paid Off For the Stockholders?

As a good economist, I believe that corporations should act in the best interests of their owners, the stockholders.  And it appears that Cerner has done pretty well.  Let’s look at stock prices and financial summaries. It happens, however, that Epic is privately owned.  No financials from them. If you’re looking for information about them, their name is just Epic, not Epic Systems as they are called in the Times article. (Those who want the financial statements as Excel workbooks should click here to download a zip file containing three workbooks. Also, data and charts shown in this section are from Yahoo Finance.)

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The FRED Widget

I just added the FRED widget to this site.  FRED is the well-known economic database at the Federal Reserve Bank of St. Louis.  I’ve been using their add-on for Excel that lets you easily search for and download data.  I meant to install the widget, but only got around to it today.  (The widget’s output is clearly visible at the top right of this blog.)

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Time to Sell Netflix and Buy Amazon and Apple

Netflix, Amazon, and Apple logos

Netflix, Amazon, and Apple logos

Disclaimer: I am not an investment adviser of any kind.  Over my long career I have picked some winners and some losers.  But most of my portfolio is in mutual funds with low expense ratios.  The advice I’m giving here is my opinion only.  If you choose to act on it, you’re on your own.

Recent technological developments have led me to wonder whether this might be the right time to sell Netflix and buy Amazon and Apple. The two technological developments I’ve seen recently are included in Apple OS X Mountain Lion and iOS 5.x. Both, however, work only with Apple TV, a small box that will set you back all of $100. Read on.

Apple OS X Mountain Lion (10.8)

Mountain Lion includes a brand new feature that lets you seamlessly and easily mirror your Mac’s screen onto your flatscreen using Apple TV.  We’ve been using it to watch streaming video from Amazon.com.  Get this: Amazon Prime costs $80 per year and allows unlimited streaming of many titles at a price of zero.  Caveat emptor: some videos that show up as available for streaming are not free.  Read carefully and make your decisions before you have that second beer.

Compare that to Netflix streaming: about $96 per year but, frankly, with a crappy title list.  It looks to me like the major studios have decided Netflix is not paying them enough for content and are signing on with Amazon instead.  And Amazon has struck a deal with IMDB.com (the internet movie database site) to place click-through links on IMDB when a title is available for streaming on Amazon.

So let’s spell it out.  Amazon’s deal is cheaper, has higher-quality titles, offers the opportunity for pay-per-view for newer releases, and will work with any flatscreen that supports Apple TV.  Which is all of them.  (Our homemade home theater system is a Vizio 40 inch flatscreen, a Sony amplifier/tuner, a couple of speakers, and Apple TV.  We also have an HD DVD player which we don’t use much any more.)

Apple Airplay

The second option is streaming video wirelessly from your iPhone or iPad to Apple TV via Airplay.  This does not work with Amazon’s mobile streaming app.  However, you can mirror pretty much anything you can put on the iPad screen onto the flatscreen.  The setup can be tricky (click here for a lengthy discussion with many tips), but once it’s working, it works very well.  And the cost of this option is zero — whatever video you can download and put on the iPad you can play on your flatscreen.  (Disclaimer: our tests have not been exhaustive.  We welcome comments about what works and what doesn’t.)

What’s Reed Hastings Up To?

With all that in mind, Netflix CEO and serial entrepreneur Reed Hastings has done something astounding.  The two paragraphs below are from a Wall Street Journal article:

“Reed Hastings, chief executive of Netflix Inc. and a Facebook Inc. board member, disclosed on Thursday a purchase of roughly $1 million in Facebook stock.

In a filing with the U.S. Securities and Exchange Commission, Mr. Hastings disclosed buying 47,846 Facebook Class A shares on Wednesday at a weighted average price of $21.03 each. Facebook’s stock closed trading Wednesday at $20.72.”

Mr. Hastings is on Facebook’s board and apparently didn’t own much FB stock before this.  Perhaps he was under pressure to join the other directors and make a commitment to the company.  Maybe Facebook wants to buy Netflix.  The only reason I can think of for a move like that is Netflix’s one viable asset: their huge inventory of DVD disks.  Their pioneering video streaming technology is probably worth quite a bit, too — to the right buyer.

So maybe I’m wrong.  The downside risk of selling Netflix right now is that some other company might buy them.  Probably not Google because they own Youtube.  But Facebook?  Your guess is as good as mine.

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Crowdfunding or Government Grants?

Crowdfunding or government grants?  That’s the question raised by two disparate articles that passed before our eyes today.  The crowdfunding idea was produced by a Tweet from @lalahpolitico. Crowdfunding is analogous to microlending.  Small investors ($1,000 or less) would be allowed to contribute to a startup, presumably in exchange for some sort of claim on future equity, earnings, revenue, or other financial variable.  To say that the various models of crowdsourcing differ is a vast understatement.

Bart Cats Patch

Bart Cats Patch

To get some idea of the breadth of crowdfunding, check out some of the offers on KickStarter.com.  For example, Slurricane is a zine self-published by Will Laren.  If you donate $25 to help him upgrade his zine, you are promised “You get Slurricane III, the scans of my other zines, and the Bart cats patch.”  In other words, donors are not equity owners.  Instead they get the promise of stuff.  In Will’s case, the amount of stuff varies with the size of the contribution.  (Donate $1 and you get “a very nice thank you e-mail.”)

One problem: current SEC regulations say no more than 35 unaccredited investors that can own stock in the startup.  (There is no limit to the number of accredited investors, often called sophisticated investors even though many of them are not particularly knowledgeable about finance.) But another alternative – direct government grants – is hinted at in the cover story of EE Times.  “Money, cleantech, and what comes next” was the title (free registration required to view complete article).  Here’s a worrying sentence from near the end of the article: “Indeed, ARPA-E is replacing some Series A venture capital, …”  ARPA-E is the federal government’s Advanced Research Projects Agency Energy program.  With Small Business Innovation Research (SBIR), these two agencies routinely make government grants to fund startups.  While the article focuses on cleantech, the National Defense Authorization Act of 2012 allows these grants to be made to companies “that are majority-owned by VC firms.”

Crowdfunding

Now crowdfunding has its problems.  An article in Bloomberg Businessweek discusses some of these issues.  (If you read the article, be sure to also read the comments.  Unlike comments on most online articles, the discussion here is intelligent and adds considerably to the article’s content.)  Among the problems: who actually owns the equity in the startup?  If the shares are voting shares, will each contributor get 0.01 of a vote?  As the Businessweek.com article puts it, “Companies that want to raise big chunks of money later on will run into trouble if they already have lots of investors who own tiny pieces of equity, says Catherine Mott, chair of the Angel Capital Association. She supports the idea for businesses that don’t plan to raise further money, such as a retail store trying to expand or even a social media startup that needs a relatively small amount to launch a product.”  At the end of the article, there’s this: “Chicago angel investor Bob Okabe told me he doubts most venture firms will bother. ‘Do the VCs really want to mess with 75 crowdfunding investors? They have enough heartburn when there’s 10 angels on the table. That to me is the big risk for entrepreneurs.’ Says Okabe: ‘You’ve just hung a dead, leaden anchor on the end of your boat.’”

Proposals to overcome these objections usually have the crowdfunding intermediary act as a representative of all the investors, similar to a mutual fund that holds stocks and/or bonds on behalf of individual owners. The most prominent intermediary (or at least the outfit lobbying hardest for these bills) is WeFunder.com.  Their website has a petition supporting the laws and asking the senate to get moving. The fund gets to vote the shares at the annual meeting, presumably acting on behalf of the owners.  Without going into details, there is a potential principal-agent issue here in which the fund manager may not have the correct incentive to accurately represent the actual owners.  That will be just as true for crowdfunding as it is for mutual funds.

Crowdfunding is moving along.  The House of Representatives recently passed four new pieces of legislation whose combined effect would to legalize crowdfunding. Reflecting an unusual consensus, the largest number of votes against any of the four bills was 17, with all four bills garnering over 400 votes in favor. The Senate sponsor, Scott Brown (R-MA) has not been able to persuade the Democrat majority to move the bill forward.  As attorney Scott Edward Walker puts it, “The crowdfunding bill that was passed in the House by a 407-17 vote (and is enthusiastically supported by the Obama Administration) is stuck in the Senate.  Why?  Because of effective lobbying by the NASAA and two hearings designed to highlight the potential of fraud.”  The NASAA is the North American Securities Administrators Association, a trade association for state securities regulators.  They are concerned that these laws will preempt state laws and (possibly) cost them their jobs.  This is, of course, completely rational and consistent with the economic theory of bureaucracy.  Let’s hear the testimony from Jack Herstein, President of NASAA: “Main Street investors should not be treated as the easiest source of funds for the most speculative business ventures.  The law should not provide lesser protections to the investors who can least afford to lose their money.”

The rebuttal by AOL founder Steve Case is illuminating: “It seems a little crazy to me that you have to be an accredited investor to invest in a company, but you can go to Las Vegas and lose $10,000 at the table in an hour and you don’t have to be an accredited gambler to do that.”

Government Grants

As noted earlier, there is at least some belief that ARPA-E and SBIR grants are replacing some Series A venture capital.  And no wonder.  Entrepreneurs who accept venture capital or angel funding must give up a huge chunk of equity.  But the government funds are grants – not loans, not equity purchases, but outright gifts.  As has been said many times, “it’s hard to compete with a price of zero.”  But don’t cry for the venture capitalists because they can now accept those funds on behalf of startups whose equity they own.  In public finance, we call this regressive taxation.  Your tax dollars are being sent to people who already are so wealthy that they can put large chunks of capital at very high risk in a startup.

Give me crowdfunding any day compared to government grants.

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Apple Moves Into Textbooks

Apple's e-text model

Apple's e-text model

Apple has decided to move into the textbook publishing market.  The platform will, of course, be iOS devices, primarily the iPad.  Students will be able to search the textbook, add notes, and use hyperlinks.  Those are all nice features, but not particularly new. The pricing is low.  In fact, Apple has stated that they would like a number of textbooks to carry a price of zero.   Most critics have focused on the EULA which essentially says that if you sell something you’ve written through the Apple store, you give Apple the exclusive right to distribute that content.  The purpose of this blog entry is to point out some potential issues not addressed by other critics.

I have a rather unique perspective on this whole situation.  I’ve worked on any number of textbook projects over the years including Aplia’s online platform (now part of Cengage, Thompson, South-Western, or whatever name they’re using this year).  I’ve written instructor’s manuals for several textbooks, including four consecutive editions of Principles of Economics by Karl Case, Ray Fair and Sharon Oster.  I’ve written countless reviews, online study guides, and participated in focus groups.  I’ve also taught information economics several times and am pretty sure I know something about information goods.  And, of course, I’ve been teaching university economics for over three decades.

Here’s what I’ve learned.  Writing a good textbook is a lot of work.  A whole lot of work.  And writing the textbook is only the first step.  There are instructor’s guides, the solutions manual for the end-of-chapter questions, PowerPoint slides, test-banks, a companion web site, and inevitable comments from reviewers and editors.  In some respects writing a textbook is closer to writing a screenplay than writing a book.  There are so many people with the textbook equivalent of “notes” that I’m amazed the authors can keep track of it all.  Anyone who thinks that writing a textbook means converting lecture notes into a book format is just plain wrong.

Which brings me to some of the most troubling parts of Apple’s proposal.  The intent of the platform is to facilitate collaborative learning, allowing teachers and perhaps even students to alter the course materials to suit their style.  That will work well in English, art, and other subjects in which the content is, shall we say, fluid.  But in other subjects — physics, chemistry, and even economics — there is a fairly standard set of ideas that must be taught, especially at the principles level. For those subjects, collaborative learning has serious limitations.

I speak as one who tried the Socratic method when I first began teaching.  It worked well, until I realized that I had only 36.67 hours of actual class time.  What I could cover in an hour of lecture took two or three times as long using discussion.  This is also the reason experimental learning hasn’t caught on in economics, despite the availability of some excellent materials.  It just takes two darn long to complete the experiment, with no guarantee that the students are taking away the correct lessons.  (Yes, I have tried economic experiments in class.)

Coursesmart textbook page

Coursesmart textbook page

Coursesmart bookshelf

Coursesmart bookshelf

Textbooks, especially electronic textbooks, present the usual problems of information goods.  Marginal cost of distributing one more copy is virtually zero.  Efficiency implies price equals marginal cost, setting the price at zero.  But at a price of zero no one will write good textbooks.  Existing competition, particularly CourseSmart.com, is pretty darn good.  Coursesmart allows students and teachers access to electronic versions of many textbooks over the web.  Pricing for a student 180 day license for a textbook is half the suggested retail price.  I’ve added some screen shots so you can see what Coursesmart looks like.  One further advantage: Coursesmart mobile apps are available for iPad, iPhone, Kindle Fire, and Android devices.  iTextbooks are unlikely to be available for non-iOS devices any time soon.

We can see this today in the blogosphere, newspapers, and magazines.  The quality of writing has deteriorated incredibly over the last ten years.  To an economist, this is just a reflection of the principle of diminishing returns.  As more and more people are writing, we expect marginal productivity (quality corrected) to decline precipitously.  And so it is.  To a certain extent, bad writing has driven out good writing simply because there is so much bad writing out there.  It doesn’t help that bad writers will often do their writing at a very low price, perhaps zero.  Consider, for example, the recent acquisition of the Huffington Post by AOL.  Arianna Huffington walked away with $315 million, while her army of volunteer writers ended up with nothing.

Apple, of course, cannot tell authors the price to set for their work.  Apple will take a 30% cut off the top and demand exclusive distribution rights.  This will, of course, encourage teachers to engage in the worst form of conflict-of-interest behavior: writing material for a course, then selling that material to students. Monopoly pricing will undoubtedly occur in some cases.  Where’s the efficiency gain again?

So, in a nutshell, if Apple really expects to hand out e-texts at a price of zero, they must not be expecting much in the way of good content. There are powerful incentives for monopoly pricing and badly-prepared materials. There are a number of subject areas in which excessive instructor and/or student editing of the material could be detrimental to the material that needs to be learned. And many authors of good textbooks are likely to abandon the market entirely.  Is that really the future of education we want?

Coursesmart annotations

Coursesmart annotations

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Move to New Host

Well, that was excruciating.  For the last week we’ve been trying to move to a new hosting company.  The journey has been long and difficult, but we seem to be back online as of Dec. 22.  Stay  tuned for more ravings.  (By the way, our piece on the New York Times magazine article on leading indicators has garnered a number of “likes” in the comments section of that article.)

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Serious Problem for the Scientific Method

From The New Yorker December 13, 2010, “The Truth Wears Off.”   This is a 4.8 mb file, so be patient.

“But now all sorts of well-established, multiply confirmed findings have started to look increasingly uncertain. It’s as if our facts were losing their truth: claims that have been enshrined in textbooks are suddenly unprovable. This phenomenon doesn’t yet have an official name, but it’s occurring across a wide range of fields, from psychology to ecology.”

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A Great New Plugin for WordPress

WP-Touch converts your site into a mobile version compatible with the iPhone, Blackberry, or Android.  I just tested it with an iPhone and it works great.  Highly recommended.

http://www.bravenewcode.com/products/wptouch/

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PayPal v. India: Money Laundering?

Speculation about PayPal’s suspension of personal money transfers into India is rife on the blogosphere.  The most intriguing idea came from PC Magazine.  They noted that the Reserve Bank of India has recently cracked down on money laundering.  India’s central bank may be worrying that people are using PayPal for nefarious purposes.  In his PayPal blog, Anuj Nayar makes the following statements:

1. Why did you suspend local bank transfers and personal payments to and from India?

We temporarily suspended these services to respond to enquiries from the Indian regulators, specifically questions on whether personal payments constitute remittances into India.

We’re working with the regulators and our bank processing partners in India to get this resolved as quickly as we can. We realize that this is causing considerable inconvenience to our customers and I want to reassure you that this is a top priority for the leadership at PayPal

2. When will personal payments be turned back on?

The regulators recently let PayPal know about revised licensing rules that we are now actively engaged in securing. Personal payments to and from India will be suspended for at least a few months until we fully resolve the questions from the Indian regulators.”

For those who don’t want to click the link above, remittances are simply transfers of income, usually from foreign nationals working in a country to family or friends in their home country.

Again, the mystery deepens.  Remittances are generally good for an economy.  Why would the Indian government worry about them?  Interestingly, the Economic Times (part of IndiaTimes.com) also speculates that money laundering is the real problem.  Stay tuned.

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Weird: Paypal stops India money transfers

PayPal, the online payment system owned by eBay Inc., has reportedly stopped allowing personal money transfers to and from India.

TechCrunch and Moneylife report that the move has suddenly cut off the preferred payment method of thousands of Indian users, including man IT software coders working for companies in Silicon Valley and elsewhere around the world.” (Source: Silicon Valley/San Jose Business Journal.)

Here are three plausible hypotheses about the reason for this move:

  1. There’s a technical issue.  For example, the volume of personal transfers may have been slowing the speed of commercial transactions.
  2. Some customers may be using personal transfers as a form of disintermediation, bypassing traditional financial intermediaries to handle foreign exchange conversions themselves.
  3. Arbitrage is another possibility.  Paypal may have been offering lower foreign exchange transaction fees or the Paypal exchange rate may have been misaligned with market exchange rates.

I”m sure my readers will come up with other possibilities.  I suspect we’ll know the actual reason by Tuesday or Wednesday (Feb. 9 – 10).

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