Wednesday, February 28, 2007
The urgency of reforming medical insurance system in the US, why relative poverty matters and why the reform must help the poorest.
It's a sensationalistic story.
It's not a comprehensive study.
It's only the account of one boy.
It's certain there are other reasons why this happened.
But does any of that matter? The fact that it happened at all is bad enough.
Children should not be allowed to die of toothaches because they don't have insurance or money to cover simple dental care. This definitely should not be allowed to happen in the US of A. This is why relative poverty matters. This is why health care in this country needs urgent reform. And this is most definitely why healthcare reform in this country should account for the poorest in this country, even if they are fabulously wealthy by global and historical standards.
Monday, February 19, 2007
It turns out that African American living in the US have a lower life expectancy than the more "absolutely" poor lower class in India. (See Amartya Sen, Development as Freedom).
First of all, we're way too stretched out and too vulnerable in Iraq and Afghanistan to do anything. Rather than having them surrounded, we've entered their backyard and we have too many enemies there that we haven't defeated.
Second, if we were serious about nuclear non-proliferation we would've waved our big stick at North Korea, not at Iraq. We've lost all credibility in the world of weapons of mass destruction.
I agree with Hamilton's post below, this is a huge tragedy. More for the people of Iran than anything else. The people of Iran have been waging a slow cultural and democratic campaign to attempt to regain their freedom from the Ayatollahs without undoing their own identity. If the Ayatollahs get the bomb, it will most likely solidify that government's position.
Personally, I think a strike on Iran would be unjustified suicide. Iran is one of very few democracy like countries in that area. And they've got us with our pants down, vulnerable in both Iraq and Afghanistan.
But most importantly, we really need to rethink what war is. War is not a tool. It is not a means of diplomacy. It is not a means of meddling with other people's governments and decisions. War is a ghastly human tragedy that should only ever be the utmost last resort of a democratic people. War should never be voluntary. See The End of Iraq by Peter Galbraith.
Goes to show how good Krugman could be when he isn't ranting about things he knows very little about and instead sticking to economics.
We should expand the and reshape the two tier form of medical care, coverage and insurance that we currently have in this country into a three tier system that would look something like this:
First tier - strictly market based, completely deregulated tier, especially for the treatment of complex and difficult diseases such as cancer. Allow as much competition as possible by federalizing the regulatory system at this level.
Third tier - a universally covered medical system run by nurse practitioners who have been extensively trained in standard Western triage and diagnosis skills and pain management skills not unlike and perhaps even based in Chinese medicine. This tier should screen and manage all complaints before referral to the second tier. Practitioners at this level would devote substantial amounts of time to each patient and would not earn as much as practitioners at other tiers through the market mechanism, but through a substantial increase in government spending in programs similar to medicare and medicaid, they would still earn good money. In order to accomplish this military spending would have to be cut and lots of money would have to go into recruiting qualified nurses from abroad and subsidizing the training of individuals in the US.
Second tier - the usual medical industry composed of doctors who only see patients from the third tier who have clearly medical pathologies - i.e. bacterial infections, cancers etc but who cannot necessarily afford the more expensive market based systems.
All doctors would participate in all three tiers through some regulation (management of nurses in third tier) but how this would work I'm not entirely sure.
The purpose is to compromise between not impairing what works about the US system - obscure and complicated treatments are readily available for those who can afford them - but fixing what doesn't work - those who can't afford medical treatment tend to suffer disproportionately. The Canadian system errs on that side by allowing everyone the same access but thereby artificially restricts the access of those who can afford better treatment and consequently reduces incentives for improving and experimenting in medical techniques.
This is a very raw idea. This is my proposal, I'm curiously to hear constructive additions and modifications of this proposal. Help me flesh this out.
1) First he stated that the patent process is socially inefficient because it awards pharmaceutical companies monopoly power over their particular drugs, thus allowing them to reap large profits off of potentially small contributions but also giving them the incentive to maintain that monopoly power. To bolster this idea he put forth as a fact the idea that pharmaceutical companies spend more on marketing and advertisements than research. The implication being that pharmaceutical companies are using patents to solidify monopoly power rather than to do more research - which is the ostensible social purpose of patents - to give incentives for further research. But the question is, is it true that pharmaceutical companies spend more on marketing and advertising? And if so, where are these figures and what are these figures? Is it a 5 to 1 ratio and who is claiming this? Is this information being spun? And if it is not, shouldn't we be outraged?
2) Stiglitz made a second and similar proposition: he stated that pharmaceuticals spend more on lifestyle drugs - see viagra - then they do on lifesaving drugs. First, is this true? Second, what are the implications of this? I'm guessing my market oriented colleagues will suggest that the market wants what the market wants and that's ok. But as a matter of public policy, especially where lives are at stake, should we be willing to accept this? My answer to that question is an unequivocal no. But then this begs the question of what solution to the problem? Should some lines of research be sponsored wholly by government funding? And if so what implications for the patent process?
Saturday, February 17, 2007
Very possible the greatest failure or the biggest sign of the overall incompetance of this administration is its inability or create a new framework or regime for how the country and world is going to deal with proliferation issues.
There was a great appearance by Henry Kissinger on Charlie Rose not long ago in which he was discussing proliferation issues and he in an off-hand remark indicated his prediction that it will take a major nuclear attack on a world capital and then the world powers would really start to get serious about proliferation issues. One very strong advantage of a strike on Iran (although I see the disadvantages still outwieghing the advantages) would be sending a message to future countries looking to obtain nuclear capability.
Monday, February 12, 2007
Now that poverty means a risk of obesity, rather than starvation, it is harder to decide what constitutes the minimal decent standard of living a society should provide. On the one hand, there are those who feel that the minimum should basically be some fixed fraction of the top incomes—in essence, that it is indecent for anyone to be more than X times richer than the worst off. On the other hand, there are those who believe, as P.J. O'Rourke so pithily put it, that "the biblical injunction is to clothe the poor, not style them." For those people, once society has made sure you have three squares, a roof over your head (okay, with electricity and plumbing), and something to keep the wind and rain off your skin, then you've got all you're entitled too.
This seems to me much too narrow; after all, we could take care of that by putting everyone without a well-paying job in prison. Other things matter too, like the opportunity to fulfill ones potentials. But which things, exactly? I am still working that bit out.
With that in mind, I think it is important to note that the term poverty is unfortunately ambiguous. When I served in the Peace Corps poverty meant something far different from what it means in America. The best way to understand this is to separate from absolute poverty from relative poverty. Absolute poverty is lacking the means to meet basic human needs such as shelter and food. While around 1 billion people in the world still suffer in absolute poverty, almost no one in the United States does for an extended period of time. According to the USDA, less than .5% of Americans on any given day suffer hunger due to lack of funds for food. It would be wonderful to get that done to zero, but it is at a level now where community service groups, churches, non-profits, and food kitchens can generally provide for the small number of people who need food on any given day. Furthermore, Eighty-nine percent of the poor report their families have "enough" food to eat, while only 2 percent say they "often" do not have enough to eat.To get a better picture of Americans who live below the poverty line, here are some statistics from the Census Bureau:
Since America (and much of the developed world) does not really suffer from existential threats due to a lack of funds, our discussion on poverty is much different than an international focus on third world poverty. Americans worry about relative poverty. This is a much more difficult issue, because whereas everyone agrees that people living in conditions that are practically inhospitable is not to be tolerated, there is a healthy debate as to what an acceptable level of relative poverty a meritocratic society can or should have. I leave that discussion for later. Here I merely want to point out something I have found to be true talking to many people about poverty. Specifically, the American measurement of poverty includes many people who most Americans would not consider poor.
Forty-six percent of all poor households actually own their own homes. The average home owned by persons classified as poor by the Census Bureau is a three-bedroom house with one-and-a-half baths, a garage, and a porch or patio. Seventy-six percent of poor households have air conditioning. By contrast, 30 years ago, only 36 percent of the entire U.S. population enjoyed air conditioning. Only 6 percent of poor households are overcrowded. More than two-thirds have more than two rooms per person. Nearly three-quarters of poor households own a car; 30 percent own two or more cars. Ninety-seven percent of poor households have a color television; over half own two or more color televisions. Seventy-eight percent have a VCR or DVD player; 62 percent have cable or satellite TV reception. Seventy-three percent own microwave ovens, more than half have a stereo, and a third have an automatic dishwasher.
So the original discussion at lunch considered whether the income level that defines poverty in America should be raised in order for more Americans to be considered poor and collect more government services. I think an interesting argument could be made in the opposite direction that the current income level the defines poverty does not accord with what most Americans consider to be poverty. The issues of the working class are more important now that welfare reform has enabled many formerly poor to become contributing members of society. But those issues are distinct from hunger, homelessness, and underclass that have become less acute as the nation has grown richer. Perhaps it is time to redefine poor in a way that comports with common impressions and work on policies that address low-income workers who often do not consider themselves "in poverty."
What Is Poverty?
For most Americans, the word "poverty" suggests destitution: an inability to provide a family with nutritious food, clothing, and reasonable shelter. For example, the "Poverty Pulse" poll taken by the Catholic Campaign for Human Development in 2002 asked the general public the question: "How would you describe being poor in the U.S.?" The overwhelming majority of responses focused on homelessness, hunger or not being able to eat properly, and not being able to meet basic needs.
But if poverty means lacking nutritious food, adequate warm housing, and clothing for a family, relatively few of the 35 million people identified as being "in poverty" by the Census Bureau could be characterized as poor. While material hardship does exist in the United States, it is quite restricted in scope and severity. The average "poor" person, as defined by the government, has a living standard far higher than the public imagines.
Tuesday, February 6, 2007
CEO's who support higher minimum wages are not, as the media often casts them, renegade heros speaking truth to power because their inner moral voice bids them be silent no more. They are by and large, like Mr Sinegal, the heads of companies that pay well above the minimum wage. Forcing up the labour costs of their competitors, while simultaneously collecting good PR for "daring" to support a higher minimum, is a terrific business move. But it is not altruistic, nor does it make him a "maverick". Costco's biggest competitor, Wal-Mart, also supports a higher minimum wage, and for the same reason. Wal-Mart's average wage is already above the new minimum; it will cost the company little, while possibly forcing mom-and-pop stores that compete with Wal-Mart out of business. This seems blindingly obvious to me. Though I don't expect we'll see "the minimum wage—it's great for Wal-Mart!" in many Democratic campaign commercials.Just wanted to make sure that all those in favor of increasing the minimum wage know that a) They are taking Wal-Mart's side on the issue and b) They are pushing out mom-and-pop stores so they can feel better about themselves while making no sacrifices.