Where Hospitals Charge Higher Prices for C-Sections, More C-Sections Are Performed

(p. B6) The more a hospital profits from a cesarean delivery, the more likely a woman is to get one, a new analysis suggests.

For the study, published in JAMA Network Open, researchers analyzed records of 13.2 million deliveries nationwide from 2010 to 2014, using a large database of generally healthy women.

. . .

During that period, profit from C-sections varied, from an average of $4,969 for the one-quarter of hospitals with the lowest charges to $26,129 for the quarter that charge the most.

The researchers found that compared with the one-quarter of hospitals that averaged the lowest profit per cesarean, those that made the most per formed 8 per cent more C-sections.

For the full story, see:

Nicholas Bakalar. “In Brief; Making Profits From C-Sections.” The New York Times (Tuesday, April 13, 2021): D6.

(Note: ellipsis added.)

(Note: after considerable search, I could not find this article in the online version of the NYT as of 4/24/21.)

The JAMA Network Open article discussed in the passages quoted above is:

Sakai-Bizmark, Rie, Michael G. Ross, Dennys Estevez, Lauren E. M. Bedel, Emily H. Marr, and Yusuke Tsugawa. “Evaluation of Hospital Cesarean Delivery–Related Profits and Rates in the United States.” JAMA Network Open 4, no. 3 (2021): e212235-e35.

Quiet, Modest Steinsberger Said Scientists Should “Be Interested in Learning About Nature,” Not in Seeking Prizes

(p. B12) Jack Steinberger, who shared the 1988 Nobel Prize in Physics for expanding understanding of the ghostly neutrino, a staggeringly ubiquitous subatomic particle, died on Saturday [Dec. 12, 2020] at his home in Geneva.

. . .

In 1988, The Economist said Dr. Steinberger “enjoys a reputation as one of the finest experimental physicists in the world.” The magazine continued, “In a field full of flamboyance and a fair bit of arrogance, he is a quiet, modest man; something of a physicist’s physicist.”

As if to prove the point, Dr. Steinberger told a meeting of Nobel laureates in 2008 that scientists should “be interested in learning about nature,” not prizes.

“The pretension that some of us are better than others,” he said, “I don’t think is a very good thing.”

For the full obituary, see:

Douglas Martin. “Jack Steinberger, Physicist Awarded a Joint Nobel Prize, Is Dead at 99.” The New York Times (Thursday, December 17, 2020): B12.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the obituary was updated Jan. 20, 2021, and has the title “Jack Steinberger, Nobel Winner in Physics, Dies at 99.”)

Tariffs Create Incentive to Drink Higher Alcohol Wine

(p. A1) Washington put 25% tariffs on wine from France, Spain, Germany and the U.K. in October 2019 in retaliation for subsidies they made to European aircraft man-(p. A9)ufacturer Airbus SE, arguing they hurt Boeing Co. But it applied only to wine with alcohol content of 14% or less.

What followed was a textbook lesson in tariff economics. Before, America imported about $150 million a year in European wine that exceeded 14% alcohol, Commerce Department data show. In the 12 months since the tariff took effect, that rose to $434 million.

For the full story, see:

Josh Zumbrun. “America Taxed Your Favorite Bordeaux? Try One With More Alcohol.” The Wall Street Journal (Friday, Nov 20, 2020): A1 & A9.

(Note: the online version of the story has the date November 19, 2020, and has the title “The Tale Behind StubHub’s Sale: How Eric Baker Bought Back the Ticket Seller.”)

Dictator Rawlings Transformed Ghana from Dictatorship to Democracy

I heard a plausible plenary lecture a few years ago at an APEE meeting where the African speaker argued that African autocrats would never voluntarily give up power, because doing so would mean they would trade personal riches for personal poverty. It was a sad but plausible argument, though one that makes Jerry Rawlings’s life especially intriguing.

(p. A22) Jerry Rawlings, a former Ghanaian Air Force officer who led two military coups before steering his country toward democracy with an authoritarian hand, died on Thursday in the nation’s capital, Accra.

. . .

By the time he left office voluntarily 22 years later, he had served two presidential terms brought about by free elections and had established Ghana as a rare democratic example on the continent. Today, peaceful handovers of power are routine in the country, hardly the case with the country’s neighbors.

Mr. Rawlings’ contradictory legacy — brutal beginnings, uncompromising military rule, then free elections — underscores the difficult path to democratic governance still faced by many African nations. But in Ghana at least, where Mr. Rawlings is regarded as something of a founding father after the country’s difficult first steps, democracy is an assumption.

Given Ghana’s first experiences of him, that outcome would not have been predicted. He appeared at first to have all the makings of one of the continent’s classic military autocrats.

For the full obituary, see:

Adam Nossiter. “Jerry Rawlings, Strongman Turned Statesman Who Steered Ghana to Democracy, Dies at 73.” The New York Times (Friday, November 13, 2020): A22.

(Note: ellipsis added.)

(Note: the online version of the obituary has the date Nov. 12, 2020, and has the title “Jerry Rawlings, From Coup-Plotter to Ghanaian Statesman, Dies at 73.”)

Federal Sugar Quotas Increase Demand for Corn Syrup, Increasing Suffering from Gout

Corn syrup is a substitute for sugar. Federal sugar import quotas increase the price of sugar. As a result, the demand for corn syrup increases. The result, as affirmed in the article quoted below, is an increase in Americans suffering from gout.

(p. 32) As the British and American historians Roy Porter and George Sebastian Rousseau write in “Gout: The Patrician Malady” (1998), the disease, cast by some as “a quasi-deity born of the union of Bacchus and Venus,” appeared to reach epidemic proportions in 18th-century England as more people attained affluence.

. . .

The disease has not been banished to the past, nor is it any longer the exclusive insignia of rich white men (if it ever really was). From the 1960s to the 1990s, the number of sufferers more than doubled in the United States, and that’s continued to rise.

. . .

According to data collected by the National Health and Nutrition Examination Survey (NHANES), as of 2016, around 9.2 million American adults, 5.9 million men and 3.3 million women, were living with the disease, making up 3.9 percent of the adult population, and another 32.5 million (14.6 percent) exhibited hyperuricemia, elevated levels of uric acid, putting them at risk.

. . .

Some scientists point (p. 34) to the dramatic rise in rates of obesity — from 13.4 percent of adults in 1980 to 42.4 percent in 2017-18, again per the NHANES — since excess weight depresses kidney efficiency, and to the likely not unrelated introduction, in 1967, of high-fructose corn syrup, which can cause the body to produce higher levels of uric acid, and its wholesale embrace in the early 1980s by the American food industry and then the world.

. . .

(p. 35) The disease remains mysterious in its onset. Beyond genetic factors, high-fructose corn syrup poses a greater danger than a lobe of foie gras, cutting across class lines.

For the full story, see:

Ligaya Mishan. “The Disease of Kings.” The New York Times Style Magazine (Sunday, November 15, 2020): 32 & 34-35.

(Note: ellipses added.)

(Note: the online version of the story was updated Nov. 14, 2020, and has the title “Once the Disease of Gluttonous Aristocrats, Gout Is Now Tormenting the Masses.”)

“A Safe Space for Entrepreneurs to Share Their Stories of Ascent”

(p. 1) Guy Raz is wrapping up an episode of How I Built This, his podcast about the origin stories of late capitalism, when his guest, the Israeli investor Haim Saban, gets to the good part. The throw-your-arms-aloft, finish-line moment of his personal business journey. In the story Mr. Saban is telling, he is about to make a lot of money, and then quadruple it into even more money.

Mr. Raz cuts in, astonished. “But half a billion dollars — that’s a lot of money,” he says. “I mean, wow.”

“Two billion is more,” Mr. Saban says.

“Was money — becoming really rich — did that motivate you?” Mr. Raz asks a moment later.

“You know, it wasn’t only money, but it was also money,” Mr. Saban says. “Money is a marker to success.”

There’s a moment like this in every episode of How I Built This. The guest has let his or her guard down and revealed something intimate, or financial, or financially intimate, and Mr. Raz keeps the disclosures rolling by reacting with total marvelment.

. . .

By creating a safe space for entrepreneurs to share their stories of ascent, Mr. Raz has become one of the most popular podcasters in history.

For the full story, see:

Nellie Bowles. “How Guy Raz Built ‘How I Built This’.” The New York Times, SundayBusiness Section (Sunday, November 25, 2018): 1 & 7.

(Note: ellipsis added. In the original, the word “more” is italicized.)

(Note: the online version of the story has the date Nov. 23, 2018, and has the same title as the print version.)

Ranchers Will Protect and Invest in Brazilian Forest Land That They Own

(p. A1) POMBAL, Brazil—For the past 15 years, Carlos Pacheco has raised cattle in what was once virgin forest. When pastures went bad, he would simply cut deeper into the Amazon, one of millions of farmers who have helped strip away about a fifth of the world’s greatest rainforest.

Because he expanded into land he doesn’t own, he can’t use it as collateral for a loan to buy equipment and fertilizer, nor can he tap the expertise of a government agronomist. The upshot is that he uses more land to raise each cow than do legal farmers in the breadbasket of southern Brazil.

It may sound counterintuitive, but Brazilian authorities think giving Mr. Pacheco a deed to the land he farms might curtail deforestation. The idea is it could help him become a more efficient farmer, able to produce more on less land, and also make him hesitate to just walk away from depleted pastures and carve new ones. In short, it might discourage him and squatters like him from cutting ever deeper into the jungle.

“If this doesn’t happen, we will continue to deforest,” said the 49-year-old rancher, the leader of a tightknit group of several hundred settlers on the forest frontier.

The administration of Brazilian President Jair Bolsonaro wants to see if he is right. In February [2020], it plans to start handing out deeds to some 300,000 Amazon squatters, with a plan that might help but has raised a howl of disapproval for re-(p. A12)warding bad behavior.

. . .

Over the decades, 73-year-old cattleman João Bueno cut into the forest in Pará state to build a network of ranches totaling 45,000 acres, with 28,000 head of cattle.

He has a special document that allows him to produce and sell cattle to a slaughterhouse, but it isn’t a title, so it doesn’t allow him to use the land as loan collateral. Mr. Bueno said tapping credit would permit him to modernize his operation with fertilizer and techniques common elsewhere, raising three times as many head of cattle on the same acreage.

“Land without documentation is nobody’s land, so people take advantage of it to clear forest for pastures,” Mr. Bueno said.

For the full story, see:

Paulo Trevisani and Juan Forero. “Brazil’s Unusual Bid to Curb Deforestation.” The Wall Street Journal (Saturday, February 1, 2020): A1 & A12.

(Note: ellipsis, and bracketed year, added.)

(Note: the online version of the story has the date January 31, 2020, and has the title “Squatters Cut Down the Rainforest. Brazil Wants to Give Them the Land.”)

Wasteful Administrative Health Care Costs

The study quoted from below suggests that the main cure for wasteful administrative costs is a “single payer” system, which is a politically correct euphemism for socialized medicine. I suggest that a better cure would be to eliminate the government middle-man, and make the patient be the payer. The patient as payer would seek and buy low-cost cures or therapies, which would shift efforts at healthcare innovation toward lower cost innovations. As has been suggested for education, vouchers could provide poor patients with the means to pay for basic care.

(p. B4) Even a divided America can agree on this goal: a health system that is cheaper but doesn’t sacrifice quality. In other words, just get rid of the waste.
A new study, published Monday [October 7, 2020] in JAMA, finds that roughly 20 percent to 25 percent of American health care spending is wasteful. It’s a startling number but not a new finding. What is surprising is how little we know about how to prevent it.

. . .

Teresa Rogstad of Humana and Natasha Parekh, a physician with the University of Pittsburgh, were co-authors of the study, which combed through 54 studies and reports published since 2012 that estimated the waste or savings from changes in practice and policy.

. . .

The estimated waste is at least $760 billion per year. That’s comparable to government spending on Medicare and exceeds national military spending, as well as total primary and secondary education spending.

. . .

The largest source of waste, according to the study, is administrative costs, totaling $266 billion a year. This includes time and resources devoted to billing and reporting to insurers and public programs. Despite this high cost, the authors found no studies that evaluate approaches to reducing it.

For the full commentary, see:

Austin Frakt. “THE NEW HEALTH CARE; Up to 25% of Health Costs Called Wasteful.” The New York Times (Tuesday, October 8, 2019): B4.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the commentary has the date Oct. 7, 2019, and has the title “THE NEW HEALTH CARE; The Huge Waste in the U.S. Health System.”)

The print version of the academic article in JAMA mentioned above is:

Shrank, William H., Teresa L. Rogstad, and Natasha Parekh. “Waste in the Us Health Care System: Estimated Costs and Potential for Savings.” JAMA 322, no. 15 (Oct. 15, 2019): 1501-09.

Expense of Clinical Trials Reduce the Incentive to Re-Purpose Old, Cheap, Off-Patent Vaccines

(p. A5) “Retrospective studies are great and they provide some hints, but there are caveats,” said Dr. Shyam Kottilil, a professor of medicine with the Institute of Human Virology at the University of Maryland School of Medicine. “It’s very difficult to establish causality.”

Interest in the cross-protective effects of vaccines has led to efforts to repurpose old vaccines that may have potential to provide at least transient protection against the coronavirus until a specific vaccine against SARS-CoV-2 is developed and proven safe and effective, he said.

“But nobody knows whether this approach will work unless we test them,” Dr. Kottilil said. “To endorse this, you need to do really good randomized clinical trials.” There is little incentive for private companies to invest in expensive trials because the old vaccines are cheap and off-patent, he added.

For the full story, see:

Roni Caryn Rabin. “Are Past Vaccinations a Shield? It’s Doubtful.” The New York Times (Thursday, July 30, 2020): A5.

(Note: the online version of the story has the date July 29, 2020, and has the title “Old Vaccines May Stop the Coronavirus, Study Hints. Scientists Are Skeptical.”)

The Son of Jonas Salk Calls Operation Warp Speed “Absolutely Extraordinary”

A screen capture from the Replica Edition of the NYT, p. A4 for Thurs., Nov. 18, 2020.

(p. A4) A 76-year-old man in La Jolla, Calif., says he will get a coronavirus but not the way he got a polio vaccine when he was 9 — lined up in the kitchen next to his two siblings. Their father had sterilized the needles and syringes by boiling them on the stove.

The father was Dr. Jonas Salk, who had developed the vaccine.

. . .

At the time, the vaccine had gone through trials with small numbers of children. A trial with 1.8 million children did not begin until the next year, and the vaccine did not receive approval as safe and effective until a year after that — a timetable that he said made the development of coronavirus vaccine candidates in just months “absolutely extraordinary.” He said he had been concerned about pressure from the Trump administration to have a vaccine ready by Election Day. But he also said the decision to back the development of vaccines through Operation Warp Speed, the federal effort to accelerate vaccine development, “was quite positive.”

For the full story, see:

Barron, James. “Coronavirus Update; ‘l Just Didn’t Feel the Shot’.” The New York Times (Wednesday, November 18, 2020): A4.

(Note: ellipsis added.)

(Note: after considerable time spent searching, I was unable to find this article on the nytimes.com web site. I searched on 11/21/20 for the article that had appeared in-print on 11/18/20. In my experience, it is extremely rare for so recent a print article to be missing from the online web site. So, for documentary purposes, I have reproduced a screen capture of the article from the Replica Edition. (For subscribers to the NYT, The Replica Edition provides an online replica of the print edition for the previous 30 days of issues of the NYT.)

California Government Allowed “Buildup” of “Fuel for Future Blazes”

(p. A1) California is one of America’s marvels. By moving vast quantities of water and suppressing wildfires for decades, the state has transformed its arid and mountainous landscape into the richest, most populous and bounteous place in the nation.

. . .

(p. A16) The intensity of the fires . . . reflects decades of policy decisions that altered those forests, according to Robert Bonnie, who oversaw the United States Forest Service under President Barack Obama. And the cost of those decisions is now coming due.

In an effort to protect homes and encourage new building, governments for decades focused on suppressing fires that occurred naturally, allowing the buildup of vegetation that would provide fuel for future blazes. Even after the drawbacks of that approach became clear, officials remained reluctant to reduce that vegetation through prescribed burns, wary of upsetting residents with smoke or starting a fire that might burn out of control.

That approach made California’s forests more comfortable for the estimated 11 million people who now live in and around them. But it has also made them more susceptible to catastrophic fires. “We’ve sort of built up this fire debt,” Mr. Bonnie said. “People are going to have to tolerate smoke and risk.”

For the full story, see:

Christopher Flavelle. “Mankind’s Feats Place California At Climate Risk.” The New York Times (Monday, September 21, 2020): A1 & A15.

(Note: ellipses added.)

(Note: the online version of the story has the date September 20, 2020, and has the title “How California Became Ground Zero for Climate Disasters.”)