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01 / 05
What Cosmetic Surgery Innovation Can Teach Us About Healthcare Costs

Blog Post | Cost of Services

What Cosmetic Surgery Innovation Can Teach Us About Healthcare Costs

The average time price of 19 procedures has fallen by 50 percent since 1998.

Summary: Hospital services costs have surged, raising questions about the effectiveness of regulation and government intervention in the healthcare industry. To investigate the potential impact of free markets on cost trends, we examined the time prices of common cosmetic surgery procedures, which are elective and typically not covered by insurance. Our analysis reveals a significant decline in the relative time prices of these procedures, indicating increased abundance driven by innovation and market competition.


The Bureau of Labor Statistics reports that since 1998, hospital services costs have increased 61 percent faster than average wages and far outpaced consumer price index inflation. This industry is highly regulated, and government restricts supply and subsidizes demand.

Would free markets help to reverse these cost trends? To answer this question, we looked at the time prices of 19 common cosmetic surgery procedures. These procedures are elective, and insurance companies typically don’t provide reimbursements. Cosmetic surgeons also have been relatively free to innovate, and cosmetic surgery centers are globally competitive.

The American Society of Plastic Surgeons annually publishes prices for a variety of procedures. We compared the nominal prices from 1998 to 2022 against the average hourly wage rates of unskilled and blue-collar workers. This gave us relative time prices over time.

The average time price fell by 50.3 percent over this 24-year period. For the time it took to earn the money to pay for one procedure in 1998, you could get over two procedures today. Procedure abundance has increased by over 100 percent. The time price of chemical peels and laser hair removal fell the fastest by 87.7 percent and 80.1 percent, respectively. However, two procedure costs increased: upper arm lifts increased by 6.7 percent and facelifts by 1.6 percent.

Bar chart displaying Nominal hourly wage rates from 1998 to 2022

The above analysis compares categories of wage earners over time, but what about individuals? We typically start as unskilled workers and then advance as we acquire more productive skills, knowledge, and experience. Categories remain constant while individuals are upwardly mobile. If we look at an unskilled worker who “upskilled” to a blue-collar worker, cosmetic surgery procedures have become dramatically more abundant.

Graph showing nominal hourly wage rates for different groups of workers, with all groups showing increases from 1998 to 2022.

From 1998 to 2022, nominal unskilled hourly wages increased by 102.8 percent, while blue-collar hourly compensation increased by 91.2 percent. The average between these two categories is 94.7 percent. If you started out in 1998 as an unskilled worker and moved up to a blue-collar worker, your nominal hourly compensation increased by 348.5 percent.

Comparing an upskilling worker’s hourly compensation to the prices of cosmetic procedures indicates that the average time price fell by 78.4 percent. These workers could get 4.63 procedures in 2022 for the time price of one in 1998. Personal cosmetic surgery abundance increased by 363.5 percent for upskilling workers, growing at a 6.6 percent compound annual rate, doubling every 11 years or so.

This article was published at Gale Winds on 2/21/2024.

Blog Post | Cost of Living

We’re All Billionaires Now (Thanks to New Knowledge)

We may not have a billion dollars in the bank, but we enjoy the benefits of many billions of dollars invested on our behalf.

Summary: Modern society enjoys immense wealth through access to products created with high fixed costs but low marginal costs, thanks to mass markets. By leveraging technology and innovation, products from smartphones to streaming music and affordable medicine provide people with benefits once unimaginable. This abundance illustrates capitalism’s ability to generate shared prosperity, contrary to the views of critics who focus solely on the relative distribution of wealth.


Sen. Bernie Sanders (I-VT) has tweeted “There should be no billionaires.” Compared to 100 years ago, the United States is a country where everyone is a billionaire. We may not have a billion dollars in the bank, but we enjoy the benefits of many billions of dollars invested on our behalf in the products and services we use every day. Let me explain.

Fixed costs and marginal costs. In economics, we consider the cost to create a new product and then the cost to manufacture each additional unit. Many products have high fixed costs but low per unit costs when manufactured at scale. This per unit cost is also called marginal cost. The marginal costs on some products can reach zero.

More people mean we are all richer. We can enjoy products with such high fixed costs and low marginal costs because there are so many of us. Creators of these high fixed costs products can recoup these costs from millions, if not billions, of customers. The Scottish economist Adam Smith understood that in 1776. If you want to get rich, have lots of potential customers. Large markets also allow people to develop their skills and specialize in such things as drug and software development. The bigger the population and the more we specialize, the more variety and lower costs we enjoy in the marketplace.

Here are five examples:

Movie billionaires. The top 10 highest-grossing films cost a total of $2.8 billion to create. You can now stream those movies at home on your $250, 55-inch large-screen high-definition TV along with 1,900 other movies for around $9.99 a month on Disney+. Unskilled workers earn around $17.17 an hour today, so it takes around 14.5 hours to buy the TV and 35 minutes of work each month to enjoy this multibillion-dollar benefit.

iPhone billionaires. It’s estimated that Apple spent $150 million over three years to develop the first iPhone, which was released in 2007. It sold for $499. How could it be sold so cheap if it cost so much? According to CNBC, Apple has sold over 2.3 billion iPhones and has over 1.5 billion active users. That’s how.

In 2009, Apple spent $1.33 billion on research and development. This year, it will have risen to $32 billion. The company has spent $208 billion on developing new products over the past 16 years. About half of Apple’s revenue comes from iPhone sales. Assuming half of its research and development investment has gone into the iPhone, we are enjoying a product that costs over $100 billion for about $30 a month, or around an hour and 45 minutes of work for a typical unskilled worker.

Note: In 2009, Amazon spent $1.24 billion on research and development, similar to Apple. This year, it expects to spend over $85 billion. In the past 16 years, Amazon has spent $485 billion.

Medicine billionaires. The cost to develop a new drug is estimated to range from less than $1 billion to more than $2 billion. The U.S. Congressional Budget Office notes, “Those estimates include the costs of both laboratory research and clinical trials of successful new drugs as well as expenditures on drugs that do not make it past the laboratory-development stage, that enter clinical trials but fail in those trials or are withdrawn by the drugmaker for business reasons, or that are not approved by the FDA.” Once a drug is approved, the marginal cost can be very low, maybe under a dollar.

If it costs $1 billion to develop a new drug, but each new unit of the pill only costs a dollar, how much should you charge the customer for it? The answer depends on the size of the market. If the market is 1,000 people, your costs will be $1 billion plus $1,000. You would have to sell each pill for $1 million plus $1 to break even. If your market was a million people, the breakeven price would drop to $1,001. If your market was a billion potential customers, the price per pill drops to $2.00. This is why new drugs are typically developed for widespread medical conditions. The fixed costs must be spread across a sufficiently extensive market. This is amazing when you think about it. You get a pill that required $1 billion to develop for $2.00 if a billion other people have the same medical problem.

Book billionaires. The Harry Ransom Center estimates that before the invention of the printing press, the total number of books in Europe was around 30,000. The United Nations Educational, Scientific and Cultural Organization estimates there are roughly 158,464,880 unique books in the world as of 2023.

When Gutenberg innovated printing in 1440, an average book cost around 135 days of labor, ranging from 15 days for a short book to 256 days for a major work. If workers put in eight hours a day, they’d have to work 1,080 hours to afford an average book. Today, blue-collar compensation (wages and benefits) is around $37 an hour. If there had been no printing innovation, it would cost about $40,000 to buy a book today.

Google has become the new Gutenberg. It has a library of more than 10 million free books available for users to read and download. Assuming the average book is around 250 pages and a half inch thick, you would need a bookshelf around 80 miles long to hold this library.

Before Gutenberg and his press, Google and the internet, Amazon and its digital tablet, and the manufacture of computer memory chips, it would have cost $400 billion to have a library of 10 million volumes. It would have taken 5.4 million people working full time for a year to create this library in 1439.

Today, you can have this library for around $43. That’s $35 for the tablet and $8 for the 2 TB memory stick. Another valuable feature we enjoy today is being able to search for a word or phrase in any of these books.

Music billionaires. Thomas Edison developed the original phonograph record in 1877. Suddenly people did not have to be present at a live performance to hear music. In 1949, RCA Victor became the first label to roll out 45 RPM vinyl records, and by the 1950s, the price was around 65 cents each. Unskilled workers at the time were earning around 97 cents an hour. This put the time price of a song at 40 minutes.

Steve Jobs introduced the iTunes Store on April 28, 2003, and sold songs for 99 cents. By this time, unskilled wages had increased to $9.25 an hour. The time price of a song had dropped 84 percent to 6.42 minutes. Listeners in 2003 got six songs for the price of one in 1955.

Apple Music was launched on June 30, 2015. Today, a student can access 90 million songs for $5.99 a month. Soundcloud is another popular music streaming service with over 320 million songs priced at $4.99 a month, or 18 minutes of time for an unskilled worker.

In 1955, the time to earn the money for an unskilled worker to buy the Soundcloud catalog of 320 million songs on 45 RPM records would have taken 106,666,667 hours. At today’s rate of $17.17 an hour, it would have cost $1,831,466,666.

Capitalist billionaires. Under capitalism, the only way wealth can grow is if entrepreneurs create it in the form of new products and services. Becoming a billionaire is a by-product of how successful a person is at creating and producing. When someone creates a product based on knowledge, it is non-rivalrous. (Paul Romer won a Nobel prize economics in part for explaining this truth.) Non-rivalry means we can all use a product at the same time. It’s as if we all own the product. Knowledge products make us all billionaires.

Bernie Sanders’s does not seem to understand or appreciate these economic truths. He wants to expropriate capital from Elon Musk and other innovators and give the money to his fellow politicians and bureaucrats to enrich their friends and supporters. Once this capital is seized, however, entrepreneurs will be much less motivated to create more. Ask all the entrepreneurs who lived in the former Soviet Union, and those in China under Mao Zedong, how 100 percent taxation disincentivized them from creating and taking risks.

This article was published at Gale Winds on 11/7/2024.

Blog Post | Human Development

Superabundance Cuts Through Pessimism

The introduction to the Polish translation of Superabundance.

Summary: Superabundance by Marian Tupy and Gale Pooley counters the pessimistic outlook on resource scarcity, arguing that resources have become more accessible over time thanks to human innovation. Through “time prices” the authors demonstrate that abundance is achievable even as the global population grows. The book underscores the importance of free markets, freedom of speech, and economic freedom as pillars for sustaining prosperity and refuting outdated Malthusian fears.


In a world full of popular media headlines warning of resource exhaustion, ecological crises, and overpopulation, it’s worth picking up a book that explains why there’s no need to be afraid. Superabundance by Marian Tupy and Gale Pooley, based on data and compelling arguments, shows that the availability of a wide range of resources has been steadily increasing over the past 150 years. This is possible thanks to progress and the people behind it—their creativity and innovation.

Depending on the selection of goods and the period of analysis, abundance—understood as the number of work hours required to acquire a certain product or service—has improved over recent decades by an average of 2-4% per year, effectively doubling every 20 to 35 years. To understand the phenomenon of abundance, time itself is key, treated by the authors as a measure of wealth. This approach provides an interesting alternative to the useful yet imperfect metric of GDP (Gross Domestic Product). The so-called “time prices” used by Tupy and Pooley address some of GDP’s weaknesses, such as the difficulties in measuring changes in product quality and innovation.

From a historical perspective, the accumulated knowledge at the end of the 18th century, along with liberal ideas, enabled a shift from chronic shortages to the construction of a world of increasing abundance in various fields and regions of the globe. A significant advantage of the book is the data and charts that illustrate how humanity’s situation has improved over the decades. Furthermore, in the case of many goods and resources, abundance has increased faster than the population, which Tupy and Pooley call the titular “superabundance.”

The authors debunk the myth of overpopulation and refute the ideas of Malthusian proponents who argue that, given the planet’s finite resources, population growth is unsustainable. A larger population means more minds capable of generating innovative solutions to our shared problems. As George Gilder states in the book’s foreword, “people are not a burden on resources—they are a source of resources.”

Superabundance challenges the pessimistic beliefs about the world’s worsening condition, arguing that humanity’s future can be not only bearable but also filled with prosperity. The Foundation for Economic Freedom supported the Polish edition of the book, not only to show readers that the state of the world today is much better than in the past but also better than we might believe. More importantly, the book leaves us with a key question: will superabundance continue?

Tupy and Pooley highlight the conditions necessary for this continuation. Firstly, it will depend on people and the freedom of thought leading to ideas that can undergo market testing and ultimately drive progress. Secondly, freedom of speech is crucial for the growth of abundance, a freedom that today faces strong challenges—from both authoritarian regimes in poorer countries and from universities in wealthier nations. Thirdly, the continuation of progress requires the defense and strengthening of a free market, where the true value of human ideas is tested.

The authors note that human psychological traits, shaped by hundreds of thousands of years of evolution, are not conducive to institutional solutions that promote progress. The biologically driven “craving for a daily dose of fear and anxiety” creates fertile ground for various populist forces in politics, which promise equality and security, promote tribalism (us versus them), and view the economy as a zero-sum game—where one person’s gain is another’s loss. However, most phenomena in a free economy are positive-sum games, benefiting various parties involved in transactions, often strangers to each other. The arguments in Tupy and Pooley’s book offer a rational counterpoint to strong tendencies in the human psyche, which were beneficial for survival in prehistoric times but hinder development and quality of life improvement in today’s economy, based on trade, services, peaceful cooperation, and globalization.

Poland embarked on a path of accelerated development after its successful transformation in 1989, and despite many economic challenges, it has the potential for further growth and even greater prosperity in the future. The lessons from Superabundance can be valuable to anyone who wants to create more favorable conditions for economic freedom, private enterprise, innovation, and, consequently, economic growth. I encourage you to read it and to engage as citizens in the pursuit of continued progress.

This article was translated from original Polish using ChatGPT 4o. It appears as the introduction to the Polish edition of Superabundance.

Axios | Manufacturing

Rings Get Bigger as Lab-Grown Diamonds Catch up to Naturals

“If you bought a diamond this year, there’s a roughly 50% chance it was manufactured in a laboratory.

Why it matters: Lab-grown diamonds have radically transformed the jewelry market. But despite the cheaper alternative, the amount being paid for diamonds is actually rising — and the stones are larger than ever.

The big picture: Two things are happening at once: Lab-grown diamonds are getting more popular as they get cheaper, while people are spending more than ever on natural diamonds.”

From Axios.

NBC News | Air Transport

Drone Deliveries, Slow to Take Flight, Come to Silicon Valley

“The hype around drones may finally be starting to deliver.

Drone deliveries, first touted by Amazon more than a decade ago, are slowly taking off in some parts of the U.S. On Thursday, Matternet, a drone delivery startup, launched its service to Silicon Valley…

The announcement adds to signs of growth for drone delivery. In Fort Worth, Texas, which recently became the first major city in the United States to offer commercial drone deliveries, they’re being used to deliver groceries from WalMart.

In College Station, Texas, Amazon’s drone delivery service has become common enough for residents to see the service as a noisy nuisance. And, with recent FAA approval, the company seems set to expand drone delivery operations across the city and beyond. 

Experts say many of the obstacles to drone delivery, most notably the technology and regulations, have been hurdled.”

From NBC News.