Melting Pot Mind

Missing Links: The Global Food Fight

Nutshell:

“The poor are not only being hurt by the food crisis more than anyone else, but they are also being blamed for it. U.S. President George W. Bush, for example, noted that when poor countries like India prosper, people there “start demanding better nutrition and better food.” Therefore, he said, “demand is high, and that causes the price to go up.”

“But the most important catalysts of the current food crisis are government policies—especially in the United States—that encourage farmers to divert their production away from crops for human consumption and toward ethanol and other biofuels. Recent studies point out that these government decisions are responsible for more than 50 percent of the recent increase in food prices and will account for more than 33 percent of food inflation in the next decade.”

“In any case, at least we now know that the culprits of the higher food prices are not consumers in poor countries but farmers in rich ones—and the politicians they have in their pockets.”

Food Miles vs. Food Choices

Great article and data on how food’s method of production has a much more substantial environmental impact than the way in which it is finally transported to consumers. Although the author at Ethicurean ultimately concludes that there are other reasons, aside from environmental impact, to prefer local food, this info still proves very important in the debate over locavorism. It shows that the consolidation and economies of scale being realized in the organic food industry aren’t necessarily as opposed to sustainability as others have argued; neither is globalization. Great news for developing countries who can benefit highly from globalized agriculture. Another important note, which commenters have already pointed out, is that the data do not distinguish between pastured-raised beef, which has much smaller environmental impact, and the conventional grain-fed variety. Doing so would probably show grass-fed red meat to be much less polluting and closer to chicken & fish than is presently implied.

Academic Article: Food-Miles and the Relative Climate Impacts of Food Choices in the United States

The Doha Dilemma

Great article. Main take-home points:

The lavishness of farm subsidies means that the net effect of fully freeing trade would be to raise prices, by an average of 5.5% for primary farm products and 1.3% for processed goods, according to the World Bank. 

 In crude terms, food-exporting countries gain in the short term whereas net importers lose.

The authors point out that net food buyers tend to be richer than net sellers, so high food prices, on average, transfer income from richer to poorer households.

Higher farm income boosts demand for rural labour, increasing wages for landless peasants and others who buy rather than grow their food. Several studies show this income effect can outweigh the initial price effect. 

Fully free trade in farm goods would reduce poverty in 13 countries while raising it in two. 

Even if higher prices for staples exacerbate poverty in some countries, at least in the short term, the effect may be outweighed by increased demand for other farm exports, such as processed goods, as rich countries cut tariffs. 

Removing rich-country subsidies on staple goods, the focus of much debate in the Doha round, may be less useful in the fight against poverty than cutting tariffs would be.

Doctors Say ‘I’m Sorry’ Before ‘See You In Court’

This is an awesome read. Definitely something worth looking into while I’m in law school.

More Government Subsidies for Corporate Farmers

Fools.

I’m going to take a break from pretending that my opinions on health policy are of any significance, despite my complete lack of experience and formal training. Instead, lets talk about my paranoia regarding my housing search and move to Cambridge, and the ludicrous degree of planning that I find necessary to keep the insomnia fairies at bay. As time has progressed I’ve grown acutely aware of just how much of a risk-averse person I am. In fact, the other day some co-workers were asking each other what they would purchase for themselves if money were no obstacle, and my answer sparked a good deal of laughter; every kind of insurance known to mankind. No really, its true. Above buying cars, boats, and cool gadgets, the one thing that I’d buy would be insurance for any kind of unforeseen event that one could possibly insure against.

I really can’t completely account for my low risk tolerance other than the fact that my family’s financial (and, in some cases, emotional) stability has always been very shaky, and the health problems that my wife recently suffered from didn’t really foster much of a sense of security in life either. That still doesn’t account for everything though, because family members of mine who endured the same conditions don’t really seem to parallel my perspective. I’ve often referred to something that I call my ’spider sense’; a characteristic of my mind that makes me focus on something that I view as a threat, either in the present or in the future, and completely drown out everything else. Some might call this virtuous. Others might say I need to chill-out. I could rationalize it all by saying that I’m simply aware of the fact that, should a catastrophic event occur, nobody in my immediate family is in a stable enough position to help me out of it; parents and family can certainly ’subsidize’ risk tolerance. I’d say there is a line between being prudent and being paranoid, in the same way that there’s a difference between being adventurous and being stupidly reckless. I think that throughout my life I’ve operated on both sides of that line, depending on the situation, but overall my need for structure, predictability, and planning has served me well.

So I’ve been given Window #6 out of 11 in the Harvard Affiliated Housing lottery, which means that, while I’m not entirely out of luck, I’ll likely have slim pickings in terms of 1-bedroom apartments in the Cambridge area. One-bedroom apartments that cost around $1500 a month in rent I might add! Oh how Texas housing prices will be missed. I’ve done the following list of things in preparation for choosing our apartment and ensuring that our transition to Cambridge goes as smoothly as possible.

1. Using Google’s ‘My Maps’ feature, I’ve created a Google Map of Cambridge here and plotted all the places that to me are the most important in making a housing decision. Some plotted features include:

a. The Harvard Affiliated Housing apartments that I’ll have to choose from

b. Grocery stores, and I’ve made note of delivery options for those months when its just too cold to drag the stuff home: Whole Foods delivers and PeaPod, an online grocery store, serves the Cambridge area.

c. Pharmacies

d. Restaurants / Cafes

e. Lodging options in case we arrive prior to our lease date.

f. Zipcar locations - Zipcar is a car-sharing service that is quite popular in Cambridge. Its very important to me that there be some available cars nearby for those times when we need to get somewhere fast and don’t want to wait for public transportation.

g. Important public transport stops.

h. Banks and ATMs

i. Harvard Law - of course I had to plot the main point of reference. I don’t want an apartment that will require me to walk more than 15 minutes to get to campus.

2. Moving Truck Rental - I investigated various options for moving our furniture to Cambridge and, of course, self-moving is the only option for us poor folk. Having someone move all of our stuff for us would be at least ~$1700, not including the cost of actually transporting ourselves; simply not an option. Out of the main moving truck rental companies, Penske ultimately came out on top. $435 for a 16′ truck for 9 days, unlimited miles. It’s a steal even compared to the next best option, Budget, which was at least $100 more. It came out so low because of an additional discount that I got for being a AAA Member (remember the stuff about insuring against bad events?). It’s somewhat comical that gasoline is going to end up costing about 150% of the truck rental itself; around $600-700. The moving truck only gets between 8-10 MPG. Yes, I researched that too. I’ve already reserved it 3 months in advance to lock in the rate, but I can modify or cancel the reservation within 48 hours of its start date without penalty. I also plotted the Penske drop-off location on my Google Map.

3. Microsoft Streets and Trips with GPS Tracking - I purchased this software on ebay. It has a little USB GPS device that allows us to track our whereabouts on our laptop in real-time as we drive to Cambridge. Think of a Google Maps with GPS tracking. If we ever get lost along the trip, this is what will let us get back on course. I’m also going to use the software to map out grocery stores, restaurants, and lodging along the route.

4. Power Inverter for the Car - Cell phones and GPS tracking are a must, in my opinion, for a long-distance trip, but what happens if your devices run out of power? Here With this affordable device we’ll be able to run our laptops, charge our cell phones, and juice up whatever other electronic device we need through the cigarette lighter plug in the moving truck. Am I sure our moving truck has a cigarette lighter plug? I’ll have to investigate that one.

5. Change Banks - The bank that we presently use, while ubiquitous in Texas, doesn’t have branches in Massachusetts. So I contacted a national bank with locations in Cambridge and found out how to open an account online.

6. Movers in Cambridge - I researched companies that will help us move our furniture into our new apartment and a couple of highly reliable ones surfaced. I won’t be making any reservations until I’m positive of when we’ll be arriving, but the average rate is about $100-150 an hour for two movers, which is all we’ll need.

7. Permit Puller - So apparently to be able to park ANYWHERE on the streets in Cambridge you need a parking permit from the city, and that only gives you the ability to park if a spot is available. I imagine finding a spot to park a 16′ truck within a reasonable distance of our new apartment would be an absolute nightmare. In steps Permit Puller, which I stumbled upon when researching Cambridge moving companies. For a fee they will get you a parking permit and (here’s the awesome part) RESERVE you a large enough parking spot as close as possible to your place. They’ll even put up signs on your spot designating that it’s reserved for a moving truck. Sure, it ends up costing about $100 extra, but I find that a bargain for being able to pull into Cambridge and park right next to our apartment, instead of having to carry our furniture/boxes a long distance.

8. Address change inform list - This is standard for anyone moving. I’ve started compiling a list of all the companies/people we’ll have to inform of our new address, including what numbers we’ll have to call in order to do so.

9. Zipcar membership - I can’t use the Harvard membership discount with Zipcar until I get my HUID, which should come in around June, but I’ve bookmarked the page that I’ll need to go to in order to have everything in line before we arrive in Cambridge. This way we can arrive, put up our stuff, drop off the moving truck, and then have zipcar available for any other errands we need to get done within the city.

10. Public Transportation - I’ve also bookmarked a few inexpensive books that I’m going to order about the different forms of public transportation in Boston. Since that will be our main form of transport, we’d better get to know the system at least somewhat before we arrive. Harvard also has a site, which I’ve bookmarked, to order a monthly MBTA pass at a discount.

11. Quicken - We’re going to have a lot of cash outflows this summer, with enrollment deposits, rent deposits, reservations, etc., which means that we have to ensure that we’ll have enough funds in our account at the appropriate times. Quicken, which I’ve used for some time now and recommend to everyone, has this great future that lets you input all of your deposits and withdrawals, and then it’ll make projections of what your account balance will be on each day of the year. This is extremely helpful, because the last thing you want is for your rent deposit check to bounce, resulting in a lost apartment and many nights of lost sleep; at least for me.

Well, that seems to sum up what preparations I’ve gotten done so far. The move is still 3 months way, so I’ll surely find several other things to add before then. Regardless of whether people find my preparation to be overkill, I think this list could serve as a good template for anyone planning a move across the country. It has definitely helped me feel a bit less stressed about handling such a big transition on our own.

Thanks to Marginal Revolution I was able to read this very interesting article, Organ Sales and Moral Travails, about how an organ vending system in Iran has, through financially compensating donors, virtually eliminated any shortage of kidneys in the country. I know I know, Iran isn’t exactly at the pinnacle of social policy, but we have to acknowledge that they are at least doing something right.

I’m sure there are a lot of people out there who are willing to acknowledge that attaching some form of financial compensation to organ donation would seriously improve the organ shortage in our country, which seems to only be getting worse. I actually donated my right kidney to an uncle of mine a couple of years ago, saving him from having to go on dialysis as he moved up a waiting list. It’s sad that thousands of people like him, who are perfectly willing and capable of paying for a vital organ, are prevented from doing so by paternalistic and extremely misguided legal regulations.

An organ vending system absolutely does not have to operate the way a normal commodity market would. That would indeed be horrific. It’s perfectly legitimate to argue that some form of regulation is necessary, including a means of subsidizing organ payments for those who cannot afford to pay on their own. However, making payments for organs completely illegal does nothing more than keep supply at a fraction of what it should and can be, which, in my opinion, is downright immoral. The present legal position on this matter is a perfect example of ‘good intentions’ gone completely wrong.

Can’t someone come up with an argument about the unconstitutionality of restricting organ vending? That may be stretching it a bit, but I have very little doubt that the tide is moving in favor of a policy that acknowledges that the only effective and sustainable way to meet the growing need for organs is to compensate donors.

Oh no, but we shouldn’t put a price on life! We do all the time, in the form of health insurance premiums, hospital bills, etc. etc. More socialized countries do it in the form of higher taxes. Health care isn’t free.

Oh no, but this would result in a system of disadvantaged individuals selling their organs to the more well-off! Well, not entirely, but that is kind of the idea. Want to pay off your college loans a little faster or earn some money to start a small business? Sell a kidney to someone who needs it. You’ve got two and, in most cases, only really need one. If you’re not doing anything to help people who are in need of funds, don’t keep them from meeting their needs in a safe manner that actually benefits society. There are a lot of ideas in health policy that are quite controversial, and for good reason, but I definitely see this one as a no-brainer.

Other good reads:

Rich, Not Poor, Are Crowding Emergency Rooms
Physicians press lawmakers to stop Medicare pay cuts
Panel’s Bipartisan View: F.D.A. is Underfinanced
Small company gets U.S. go-ahead on bird flu patch
‘A Race to the Starting Line’: Diagnosing What’s Holding Biotechnology Back

Daily caffeine ‘protects brain’

“After 12 weeks of a high-cholesterol diet, the blood brain barrier in those given caffeine was far more intact than in those given no caffeine.”

“Caffeine is a safe and readily available drug and its ability to stabilise the blood brain barrier means it could have an important part to play in therapies against neurological disorders.”

Ahh… just another reason to enjoy my daily 3-4 cups of black tea. I was an enormous coffee fan (not exactly a ‘unique’ quality in our society) up until a few months back, when I finally came to terms with the fact that coffee gave me really bad insomnia and that caffeine headaches really altered my mood. Since having switched to tea I’ve had probably 95% fewer cases of insomnia and rarely do I detect the afternoon ‘crash’ that I always experienced from coffee. I still try to treat myself to some quality decaf every now and then; I just love coffee’s taste. Some might even say that in switching to decaf you can learn to appreciate coffee even more, as you can savor all of its flavor without having to contend with the huge caffeine jolt that might have you lying in bed for hours unable to fall asleep. Cheers to moderate levels of caffeine and their presumed ability to save us from sleepiness and senility. Alliteration intended.

WSJ - Primary Care Needs Fixing Before Universal Care Can Work

In Massachusetts, Universal Coverage Strains Care

So the Primary Care shortage is another issue that has been getting a lot of attention lately. In a broad sense the problem is actually quite simple. Specialists earn more (possibly too much) and Primary care doctors are underpaid, so medical school students, burdened with even more debt than I’ll have after law school (possibly almost twice as much), vote with their feet and become specialists. The result is that the few who become GPs end up having to fit in way too many people into their practices in order to maintain their standard of living and cater to unmet demand. More work/stress + lower pay = choose a different field.

The big question that becomes obvious to me is… why the pay problem? Aren’t supply and demand supposed to meet at an optimal price which, presumably, should be satisfactory to both sides? If the shortage really is a big problem shouldn’t general practitioners be able to demand better compensation? Apparently, the source of the problem lies in the fact that physician compensation isn’t determined in the free market, but by Medicare and insurance companies who often times base their own pay schedules on Medicare. Artificial pricing = suboptimal supply.

The fact that Medicare (the government) is able to dictate compensation to general practitioners still doesn’t completely explain the whole situation though. Are general practitioners obligated to accept whatever the insurance companies and Medicare offer? Is there some law that I’m unaware of that forces them to accept Medicare patients? So far I’ve seen three main methods that general practitioners are using to deal with their inadequate pay.

1. Consolidate - Maybe part of the problem has been that GPs have generally operated as private practices; a fact which would give them very little bargaining power against the heavily consolidated insurance industry. Consolidation would also allow a group of GPs to share administrative costs, a big expense for all doctors (econ jargon = economies of scale). I don’t really have any data on it, but here in Austin I’ve seen that specialists tend to operate in very large practices, sometimes involving dozens of physicians in the same specialty. As far as gastroenterology (the field with which my wife has had the most encounters) goes, one specialist group covers almost the entire Austin market. A good portion of GPs seem to operate in large practices here as well though so I doubt that this issue really explains the disparity between primary care and specialist compensation.

2. Unplug - Part of the reason for why GPs are feeling squeezed is that administrative costs can be very high for keeping one’s practice plugged into the complex insurance system. The truth is though that primary care, something which is often routine or at least expected in some sense, shouldn’t really be covered by insurance in the first place. I’ve come across quite a few primary care practices that have successfully unplugged themselves and the trend is likely to continue as high deductible more realistic health insurance plans grow in popularity. It might even be possible that the administrative savings of unplugging can be so significant that doctors might end up earning more at the end of the day, while still offering competitive pricing to consumers. Still, it’s not difficult to see how the decision to unplug can be very difficult for a physician, as the vast majority of American consumers would still want that $10 office visit copay and would just switch to a GP covered by their insurance. That is, until their health insurance premiums become a problem… and they will. Physicians with strong patient loyalty (high quality) probably have an easier time deciding to unplug.

3. Concierge Care - Probably the most controversial of the three, concierge care involves ‘unplugging’ to an even greater level. Primary care becomes more of a pre-paid prescription service in which patients pay a certain fee per month or per year in exchange for much easier access to a much less busy primary care doctor. The controversy comes from the fact that concierge doctors generally care for a much smaller amount of patients than doctors in traditional practices do, which some say just exacerbates the GP shortage even further. I’m not sure I’m so judgmental about it. If concierge medicine turns out to be a financially sustainable model, it might end up raising the supply of physicians in the long run as medical students no longer view the field as inadequately compensated. At the moment concierge care definitely caters more towards the well-off, but if the model became more popular I imagine that some form of price competition would result in lower-cost, more efficient versions.

My overall under-qualified opinion is that the emergence of ‘unplugged’ primary care practices and even concierge medicine should be applauded, because, with all likelihood, it’s precisely this kind of market activity that will solve the primary care shortage. I’m sure a lot of people will view a concierge doctor as a sell-out, and its possible that some concierge doctors are money grubbers, but a lot of them just want to create a sustainable medical practice that provides its patients with more than 15-minute speed-talking sessions. It’s about time that primary care doctors begin to push back against a pricing structure that undervalues their work.

I think the one very serious concern with all of this involves how it might impact low-income families who already have a difficult time paying for health care, even if the prices are below what is required for quality sustainable primary care. Some people view a doctor’s moving into concierge medicine as a decision to turn his/her back on the needy and just cater to those who can pay premium prices. I think its a good point, but I have a few short responses to this perspective:

1. If we expect primary care practitioners to not demand a quality of life which they feel is reasonable for their level of training and expertise, but instead we think that they should selflessly care for people at prices well below what an open market would provide them, then let’s not expect them to take on $200,000 in student debt in order to do so. We can’t expect doctors to fund their own educations and make huge time and financial sacrifices only to be given a quality of life at around the same level of say… your average engineer with a bachelor’s degree. It’s not fair and I’d say its downright unethical.

2. A doctor’s decision to establish an alternative payment structure for his/her primary care practice, whether it be unplugged fee-for-service or concierge care, by no means precludes the provision of charity or low-cost care to those who cannot pay full market prices. The discussion is not about raising the cost (or at least the compensation provided to GPs) for everyone regardless of their means, but that the average middle-class American family can afford to and should be willing to adequately compensate primary care doctors for their work. A number of methods for helping the poor pay for their care can be implemented without distorting the entire market. Trying to artificially keep compensation lower than it should be, or forcing doctors to stick with practice structures that they feel are not sustainable, ends up doing far more harm than good. Life isn’t as simple as just being a selfish money grubber or a selfless saint. I imagine lots of primary care doctors truly are motivated to do good by serving needy patients, but they, like many of us, are only willing to sacrifice so much in the process. I can’t blame them.

“the Medicare reimbursement for a half-hour primary care visit in Boston is $103.42; for a colonoscopy requiring roughly the same time, a gastroenterologist would receive $449.44.”

“I calculated that every time I have a Medicare patient it’s like handing them a $20 bill when they leave,” she said. “I never went into medicine to get rich, but I never expected to feel as disrespected as I feel. Where is the incentive for a practice like ours?”

Massachusetts hikes premiums for state-subsidized health plans by 10%

I’ve actually been quite curious about how the health insurance mandate has turned out in Massachusetts, or even just what exactly has been done to provide health care to the uninsured. One thing that I’ve become very aware of is that health insurance costs a pretty penny more in MA than in Texas. The student PPO policy that my wife and I have here in Austin has a very low deductible with great benefits, a very large network, and a price of around $4300 per year for the both of us; about $350 a month. If circumstances had been different I probably would’ve opted for a higher-deductible non-student plan that would’ve cost us more like $150 a month, but my wife’s pre-existing conditions make it impossible for us to sign up for a plan on the open market. The student policy allows us to enroll regardless of her medical history.

If I had arrived in Cambridge last year, Harvard’s plan would’ve set us back $6300, a good 45% more than our plan in Texas. Now the benefits in the Harvard plan are a tad bit better (honestly, they seem like overkill), but even a glance at market rates shows Massachusetts insurance costing a good amount more than plans with comparable benefits in Texas. What accounts for this higher price tag? The U.S. News Health Plan Rankings certainly indicate that the health care on the east cost is of much higher quality than what we get in the south. Hardly any Texas plans even made it onto whole list, while Massachusetts plans made up 4 of the top 10. So I guess its possible that the higher price tag just reflects the fact that in MA you’re getting the health care equivalent of a Lexus, whereas in Texas you get more of a Toyota.

It’s certainly no surprise to me that subsidizing health insurance is ending up a lot more expensive than people in MA had imagined. It’s incredible how cheap they are making (aka, how heavily they are subsidizing) health insurance for those who sign up for these ‘Commonwealth Care’ plans. $5 for a GP visit, $10 for a specialist, just $50 PER STAY in a hospital?!? Is that kind of price insulation really necessary? I’m downright amazed that a 10% premium hike is all that they are calling for. Without any plan for actually making health care more affordable, instead of just subsidizing health insurance, I wouldn’t be surprised if a 10% funding shortage ends up looking like petty cash in comparison to the funding problems that the Commonwealth Care program will eventually run into. Time will tell.

“Dr. Magee is not optimistic that providing health care to the uninsured is going to reduce overall health spending, as some have argued. “The truth is that health care costs money, and that more health care costs more money.”"