Paperwork is 31% of U.S. Health Care Costs

. . . ,  a large part of America’s health care spending goes into paperwork.  A 2003 study in The New England Journal of Medicine estimated that administrative costs took 31 cents out of every dollar the United States spent on health care, compared with only 17 cents in Canada.

For the full commentary, see:

PAUL KRUGMAN.  "The Medical Money Pit."   The New York Times   (Friday, April 15, 2005):  A19.

 

Canada may beat the U.S. in this dimension of health care, but they lose in many other important dimensions–for example the wait time to receive ‘elective’ surgeries.  And anyway, isn’t 17 percent still too high?

“Everybody wants to be like Bill Gates”

Vietnamese university students hoping to see Bill Gates.  Source of image:  http://www.nytimes.com/2006/04/27/world/asia/27vietnam.html?ex=1303790400&en=255d4d4996b1a9a6&ei=5088&partner=rssnyt&emc=rss

 

HANOI, Vietnam, April 26 — It was Lenin’s birthday.  The most important Communist Party meeting in five years was under way. And the star of the show was the world’s most famous capitalist, Bill Gates.

The president, the prime minister and the deputy prime minister all excused themselves from the party meeting on Saturday to have their pictures taken with Mr. Gates, who has more star power in Vietnam than any of them.

When people heard he was in town, hundreds climbed trees and pushed through police lines to get a glimpse of him.  He was the subject of the lead article in the next day’s newspapers.

This is where Vietnam stands today, moving cautiously toward a new version of communism while the people and their leaders lunge eagerly for the brass ring of capitalist development.

"That was very symbolic," said Le Dang Doanh, an official in the Ministry of Planning, speaking of the reception for Mr. Gates.  "It is a very clear sign of the new mood of society and the people.  Everybody wants to be like Bill Gates."

 

For the full story, see:

SETH MYDANS.  "Communist Vietnam Lunges for Capitalism’s Brass Ring."  The New York Times (Thurs., April 27, 2006):  A3.

Note:  the version of the article above corrects an error in the print version that had misidentified the day of Lenin’s birth, and Gates visit as a Sunday (it was a Saturday).

Reagan on the Bureau of Indian Affairs

Source of book image:  http://www.amazon.com/gp/product/0060957573/ref=ed_oe_p/104-5180402-9681554?%5Fencoding=UTF8

 

Michael Deaver, longtime aide to Ronald Reagan, has written an interesting memoir that documents that in most important respects, Reagan was his own boss, worked hard, and had a focused intellect.  

He also documents what most grant:  Reagan was a great communicator.  One element in his success as a communicator is illustrated below:

 

(p. 71)  . . . he would often recount a fictitious yarn of a sobbing bureaucrat he encountered at the Bureau of Indian Affairs.  The man was at his desk, crying into his folded arms when Reagan touched him on the shoulder and asked him what was wrong.  "My Indian died, that’s what’s wrong," came the response.  "What the hell am I supposed to do now?"

 

The citation for Deaver’s book is:

Deaver, Michael K.  A Different Drummer:  My Thirty Years with Ronald Reagan.  Reprint ed:  Harper Paperbacks, 2003.

 

Kenyan Lawmakers Nearly Double Their Mercedes Mileage Allowances: More on Why Africa is Poor

  The relatively modest vehicle of Francis Ole Kaparo, the speaker of Kenya’s National Assembly, contrasts with other Kenyan lawmakers’ "Mercedeses, Land Rovers and other typically sleek rides."   Source of photo:   the online version of the NYT article cited below.

 

NAIROBI, Kenya, May 21  —  It has been a trying year in Kenya, one of the worst in decades, as a severe drought killed off crops and cattle and left millions with empty stomachs and uncertain futures.

In such suffering, members of Parliament have been roused to action as seldom before, finding common ground on an issue so pressing that they threatened to stonewall the budget until it was addressed: another big increase in their compensation.

The move last month to reward themselves in a time of crisis infuriated Kenyan voters, most of whom eke out a living on a fraction of what their elected officials earn.  It also reinforced the notion that this was a political drought, one that owed its origins as much to mismanagement in a country that should be able to feed itself as to the vagaries of nature.

. . .

. . . , some say legislators have lost touch with the poor districts they represent.  Per capita income is about $463 a year, which nobody here would expect a lawmaker to survive on.  Minimum wage is $924 a year, still far too little, in most Kenyans’ view, for someone taking care of the nation’s business.

But the base compensation that legislators earn is about $81,000 a year, tax free, plus a variety of allowances and perks, which can effectively double their take-home pay.  That means those public servants earn more than most Kenyan corporate executives and outstrip the salaries of many of their counterparts in the developed world.

"They are behaving like we are rich and as if there’s no famine and poverty in the country," Maina Kiai, the chairman of the Kenya National Commission of Human Rights, complained recently to the newspaper The Daily Nation.  "They want to make as much money as they can."

The latest increase, which cost the country $2.78 million, nearly doubled the mileage allowances that lawmakers receive for their Mercedeses, Land Rovers and other typically sleek rides.

 

For the full story, see:

MARC LACEY. "Nairobi Journal; Crisis Swirls in Kenya, and Politicians Reward Themselves." The New York Times (Mon., May 22, 2006):

 

Charles Koch Participates in Schumpeter’s Process of Creative Destruction

 

KochClharles.gif Charles Koch.  Source of image:  online version of WSJ article cited below.

 

I heard Charles Koch speak at the April 2005 Orlando meetings of the Association of Private Enterprise Education.  Part of his speech involved how he has tried to apply in his own business, Schumpeter’s process of creative destruction.  For a long time Koch has been a stalwart defender of the free market in word and deed.

Ideas seem to exhilarate him.  This no doubt explains in part why this professorial CEO delivers "dozens and dozens" of lectures around the country to his employees on these very topics.  But what does any of this have to do with explaining his company’s prodigious profitability?  Well, everything — he believes.  Mr. Koch contends that the key insight of his business career was melding these philosophical insights about the way the wealth-creation process works into a business operating system called "Market Based Management."  This system, which he has trademarked, enables every division of his business empire to operate as a separate, autonomous, profit-maximizing unit.  It is intended to reward employees who think like entrepreneurs.

"Long-term success entails constantly discovering new ways to create value for customers and building new capabilities to capture new opportunities," he instructs.  "In this sense, maintaining a business is, in reality, liquidating a business."  Mr. Koch likens the cycle to Schumpeter’s "creative destruction" — where the old and inefficient are ruthlessly swept away by the new.

 

For the full commentary, see: 

STEPHEN MOORE. "THE WEEKEND INTERVIEW with Charles Koch; Private Enterprise." The Wall Street Journal (Sat., May 6, 2006): A8.

 

If Bush’s spirit breaks “evil will indeed triumph”

Natan Sharansky was a political prisoner for nine years in the Soviet Union.  He is articulate and passionate.  But I am not so sure he is right in almost equating freedom and democracy.

While I was an undergraduate at Wabash College, Ben Rogge arranged for Erik Maria Ritter von Kuehnelt-Leddihn to visit campus for a week.  Kuehnelt-Leddihn was an improbable walras of a man.  On my first encounter with him, I was stunned to hear him arguing that a monarchy embued with noblese oblige would be more likely to defend freedom, than would a democracy.  At first I thought the conclusion was patently absurd.  But over time, I gradually came to believe that although it was probably a false conclusion, it was not an absurd one. 

History, and modern experience, provide us many examples of democracies that severely restrict the freedom of their citizens.  And perhaps, for a time, freedom can thrive under enlightened monarchs, or dictators?

I hope, and still believe, that democracy is the system of government most likely, most of the time, to promote freedom.  If so, then what Bush is trying to do, may eventually leave the world safer, and more free:

 

Critics rail against every step on the new and difficult road on which the United States has embarked.  Yet in pointing out the many pitfalls which have not been avoided and those which still can be, those critics would be wise to remember that the alternative road leads to the continued oppression of hundreds of millions of people and the continued festering of the pathologies that led to 9/11.

Now that President Bush is increasingly alone in pushing for freedom, I can only hope that his dissident spirit will continue to persevere.  For should that spirit break, evil will indeed triumph, and the consequences for our world would be disastrous.

 

For the full commentary, see:

Sharansky, Natan.  "Dissident President."  The Wall Street Journal  (Mon., April 24, 2006):  A15.

Charlie Munger Calls Ethanol “Stupid”

Charlie Munger.  Source of image:   http://daily.stanford.edu/tempo?page=content&id=16135&repository=0001_article#

 

Charlie Munger is the number two executive, next to Warren Buffett, at Berkshire Hathaway.  He is old enough, and successful enough, and gutsy enough, and curmudgeony enough, to call ethanol "stupid" while in the "cornhusker state" for the company’s annual meeting.  (Of course, he wasn’t running for public office, and knew he would soon be flying back to his home in California.)

 

Munger said using ethanol for fuel seems "stupid" to him because it takes more energy to create than it produces as a fuel.  Buffett said there are so many ethanol plants, existing or planned, that he doesn’t see how they can all continue operating profitably.

 

For the full article, see:

STEVE JORDON and JONATHAN WEGNER.  "Berkshire Notes: Clayton’s Excutives Double Up."  Omaha World-Herald  (Sunday, May 7, 2006):  1D.

(Note:  the annual meeting was held on Sat., May 6, 2006)  

Incentives and Constraints Matter, But Sometimes Values Do, Too


 Harvard sociology professor Orlando Patterson.  Source of image:
http://www.iadb.org/idbamerica/index.cfm?thisid=681

 

Cambridge, Mass. – Several recent studies have garnered wide attention for reconfirming the tragic disconnection of millions of black youths from the American mainstream. But they also highlighted another crisis: the failure of social scientists to adequately explain the problem, and their inability to come up with any effective strategy to deal with it.

The main cause for this shortcoming is a deep-seated dogma that has prevailed in social science and policy circles since the mid-1960’s: the rejection of any explanation that invokes a group’s cultural attributes — its distinctive attitudes, values and predispositions, and the resulting behavior of its members — and the relentless preference for relying on structural factors like low incomes, joblessness, poor schools and bad housing.

Harry Holzer, an economist at Georgetown University and a co-author of one of the recent studies, typifies this attitude. Joblessness, he feels, is due to largely weak schooling, a lack of reading and math skills at a time when such skills are increasingly required even for blue-collar jobs, and the poverty of black neighborhoods. Unable to find jobs, he claims, black males turn to illegal activities, especially the drug trade and chronic drug use, and often end up in prison. He also criticizes the practice of withholding child-support payments from the wages of absentee fathers who do find jobs, telling The Times that to these men, such levies ”amount to a tax on earnings.”

His conclusions are shared by scholars like Ronald B. Mincy of Columbia, the author of a study called ”Black Males Left Behind,” and Gary Orfield of Harvard, who asserts that America is ”pumping out boys with no honest alternative.”

This is all standard explanatory fare. And, as usual, it fails to answer the important questions. Why are young black men doing so poorly in school that they lack basic literacy and math skills? These scholars must know that countless studies by educational experts, going all the way back to the landmark report by James Coleman of Johns Hopkins University in 1966, have found that poor schools, per se, do not explain why after 10 years of education a young man remains illiterate.

Nor have studies explained why, if someone cannot get a job, he turns to crime and drug abuse. One does not imply the other. Joblessness is rampant in Latin America and India, but the mass of the populations does not turn to crime.

And why do so many young unemployed black men have children — several of them — which they have no resources or intention to support? And why, finally, do they murder each other at nine times the rate of white youths?

. . .  

So what are some of the cultural factors that explain the sorry state of young black men? They aren’t always obvious. Sociological investigation has found, in fact, that one popular explanation — that black children who do well are derided by fellow blacks for ”acting white” — turns out to be largely false, except for those attending a minority of mixed-race schools.

An anecdote helps explain why: Several years ago, one of my students went back to her high school to find out why it was that almost all the black girls graduated and went to college whereas nearly all the black boys either failed to graduate or did not go on to college. Distressingly, she found that all the black boys knew the consequences of not graduating and going on to college (”We’re not stupid!” they told her indignantly).

So why were they flunking out? Their candid answer was that what sociologists call the ”cool-pose culture” of young black men was simply too gratifying to give up. For these young men, it was almost like a drug, hanging out on the street after school, shopping and dressing sharply, sexual conquests, party drugs, hip-hop music and culture, the fact that almost all the superstar athletes and a great many of the nation’s best entertainers were black.

Not only was living this subculture immensely fulfilling, the boys said, it also brought them a great deal of respect from white youths. This also explains the otherwise puzzling finding by social psychologists that young black men and women tend to have the highest levels of self-esteem of all ethnic groups, and that their self-image is independent of how badly they were doing in school.

I call this the Dionysian trap for young black men. The important thing to note about the subculture that ensnares them is that it is not disconnected from the mainstream culture. To the contrary, it has powerful support from some of America’s largest corporations. Hip-hop, professional basketball and homeboy fashions are as American as cherry pie. Young white Americans are very much into these things, but selectively; they know when it is time to turn off Fifty Cent and get out the SAT prep book.

For young black men, however, that culture is all there is — or so they think. Sadly, their complete engagement in this part of the American cultural mainstream, which they created and which feeds their pride and self-respect, is a major factor in their disconnection from the socioeconomic mainstream.

 

For the full commentary, see:

ORLANDO PATTERSON. "A Poverty of the Mind."  The New York Times, Section 4 (Sunday, March 26, 2006):  13.  



British Pull Own Teeth Under Public Dental Care

KellyWilliamToothless.jpg "William Kelly, 43, extracted part of his own tooth, leaving a black stump. He plans to pull one more."  Source of caption and image:  online version of NYT article cited below.

 

ROCHDALE, England, May 2 — "I snapped it out myself," said William Kelly, 43, describing his most recent dental procedure, the autoextraction of one of his upper teeth.

Now it is a jagged black stump, and the pain gnawing at Mr. Kelly’s mouth has transferred itself to a different tooth, mottled and rickety, on the other side of his mouth.  "I’m in the middle of pulling that one out, too," he said.

. . .

But the problem is serious.  Mr. Kelly’s predicament is not just a result of cigarettes and possibly indifferent oral hygiene; he is careful to brush once a day, he said.  Instead, it is due in large part to the deficiencies in Britain’s state-financed dental service, which, stretched beyond its limit, no longer serves everyone and no longer even pretends to try.

Every time he has tried to sign up, lining up with hundreds of others from the ranks of the desperate and the hurting — "I’ve seen people with bleeding gums where they’ve ripped their teeth out," he said grimly — he has arrived too late and missed the cutoff.

"You could argue that Britain has not seen lines like this since World War II," said Mark Pritchard, a member of Parliament who represents part of Shropshire, where the situation is just as grim.  "Churchill once said that the British are great queuers, but I don’t think he meant that in connection to dental care."

Britain has too few public dentists for too many people. At the beginning of the year, just 49 percent of the adults and 63 percent of the children in England and Wales were registered with public dentists.

And now, discouraged by what they say is the assembly-line nature of the job and by a new contract that pays them to perform a set number of "units of dental activity" per year, even more dentists are abandoning the health service and going into private practice — some 2,000 in April alone, the British Dental Association says.

. . .

The system, critics say, encourages state dentists to see too many patients in too short a time and to cut corners by, for instance, extracting teeth rather than performing root canals.

Claire Dacey, a nurse for a private dentist, said that when she worked in the National Health Service one dentist in the practice performed cleanings in five minutes flat.

Moreover, she said, by the time patients got in to see a dentist, many were in terrible shape.

"I had a lady who was in so much pain and had to wait so long that she got herself drunk and had her friend take out her tooth with a pair of pliers," Ms. Dacey said.

Some people simply seek treatment abroad.

 

For the full story, see:

SARAH LYALL.  "In a Dentist Shortage, British (Ouch) Do It Themselves."  The New York Times, Section 1  (Sun., May 7, 2006):  3. 

(Note: ellipsis added.)

Radiologist Outsourcing Is Mainly a Myth

LeonhardtDavid.jpg David Leonhardt.  Source of image:  http://www.nytimes.com/2006/04/19/business/19leonhardt.html?_r=1&oref=slogin

 

A few years ago, stories about a scary new kind of outsourcing began making the rounds.  Apparently, hospitals were starting to send their radiology work to India, where doctors who make far less than American radiologists do were reading X-rays, M.R.I.’s and CT scans.

It quickly became a signature example of how globalization was moving up the food chain, threatening not just factory and call center workers but the so-called knowledge workers who were supposed to be immune.  If radiologists and their $350,000 average salaries weren’t safe from the jobs exodus, who was?

On ABC, George Will said the outsourcing of radiology could make health care affordable again, to which Senator Charles E. Schumer of New York retorted that thousands of American radiologists would lose their jobs.  On NPR, an economist said the pay of radiologists was already suffering. At the White House, an adviser to President Bush suggested that fewer medical students would enter the field in the future.

"We’re losing radiologists," Representative Sherrod Brown, an Ohio Democrat, said on CNN while Lou Dobbs listened approvingly.  "We’re losing all kinds of white-collar jobs, all kinds of jobs in addition to manufacturing jobs, which we’re losing by the droves in my state."

But up in Boston, Frank Levy, an economist at the Massachusetts Institute of Technology, realized that he still had not heard or read much about actual Indian radiologists.  Like the once elusive Snuffleupagus of Sesame Street, they were much discussed but rarely seen.  So Mr. Levy began looking.  He teamed up with two other M.I.T. researchers, Ari Goelman and Kyoung-Hee Yu, and they dug into the global radiology business.

In the end, they were able to find exactly one company in India that was reading images from American patients.  It employs three radiologists.  There may be other such radiologists scattered around India, but Mr. Levy says, "I think 20 is an overestimate."

Some exodus.

 

For the full story, see:

Leonhardt, David.  "Political Clout in the Age of Outsourcing."  The New York Times (Weds., April 19, 2006):  C1 & C4.

Taxpayer Pays $120 to Displace a Barrel of Oil With Ethanol

 

John Deutch served as Undersecretary of Energy under President Jimmy Carter.  He also served in the Clinton administration, and is now an MIT chemistry professor.  In the selection below, he explains why corn-based ethanol in the United States, is not an efficient way to produce energy.  In a later section of his commentary, he is more positive about the economics of producing ethanol from switch grass.  (The main difference, he says, is that switch grass can be cultivated using much less petroleum than is used for corn.) 

 

Today, we use corn to produce ethanol in an automobile fuel known as "gasohol" — 10% ethanol and 90% gasoline.  Generous federal and state subsidies, largely in the form of exemption from gasoline taxes for gasohol, explain the growth of its use; in 2005, over four billion gallons of ethanol were used in gasohol out of a total gasoline pool of 120 billion gallons.  Politicians from corn-states and other proponents of renewable energy support this federal subsidy, but most energy experts believe using corn to make ethanol is not effective in the long run because the net amount of oil saved by gasohol use is minimal.

In the U.S., cultivation of corn is highly energy-intensive and a significant amount of oil and natural gas is used in growing, fertilizing and harvesting it.  Moreover, there is a substantial energy requirement — much of it supplied by diesel or natural gas — for the fermentation and distillation process that converts corn to ethanol.  These petroleum inputs must be subtracted when calculating the net amount of oil that is displaced by the use of ethanol in gasohol. While there is some quarreling among experts, it is clear that it takes two-thirds of a gallon of oil to make a gallon equivalent of ethanol from corn.  Thus one gallon of ethanol used in gasohol displaces perhaps one-third of a gallon of oil or less.

A federal tax credit of 10 cents per gallon on gasohol, therefore, costs the taxpayer a hefty $120 per barrel of oil displaced cost.  Surely it is worthwhile to look for cheaper ways to eliminate oil.

The economics are not the same in other countries.  Brazil is a well-known example, where sugarcane grows in the tropical climate and conventional fermentation and distillation readily yields ethanol.  Ethanol is said to provide 40% of automobile fuel in Brazil and compete with gasoline without government subsidy.  Depending on the future world price of sugar and the lessening of trade restrictions on both sugar and sugar-derived ethanol, Brazil could become a net exporter of this biofuel.

 

For the full commentary, see:

JOHN DEUTCH.  "Biomass Movement."  The Wall Street Journal  (Weds., May 10, 2006):  A18.