Saturday, June 22, 2013

The faint imprint of European colonization in Africa

In much of Africa, therefore, the colonial imprint was barely noticeable.  Only a thin white line of control existed.  In northern Nigeria, Frederick Lugard set out to rule 10 million people with a staff of nine European administrators and a regiment of the West African Frontier Force consisting of 3,000 African troops under the command of European officers.  By the late 1930s, following the amalgamation of northern and southern Nigeria into one territory in 1914, the number of colonial administrators for a population of 20 million people was still less than 400.  The Sudan Political Service consisted of 140 officials ruling over 9 million people.  The whole of French Equatorial Africa in the mid-1930s was run by 206 administrative officers.  French West Africa, comprising eight territories with a population of 15 million, was served by only 385 colonial administrators. The whole of British tropical Africa, where 43 million people lived, was governed by 1,200 administrators.  
From Martin Meredith's The Fate of Africa.

Should we increase the supply of medical care?

Tyler Cowen recently endorsed some comments about the need to increase the supply of doctors in the U.S., an opinion which seems at odds with everything we know about supplier induced demand:
1. Ramp up drastically the training output of new doctors and nurses: More med schools, larger intakes per school, elimination of 4 years of pre-med university etc. More med school student scholarships and subsidies?  
2.Massively expand other lower tiers of the medical system: Physicians assistants, Nurse Practitioners etc. 
4. Fully recognize all medical degrees from similarly developed nations (e.g. Canada / UK / Japan / Australia etc.) to the point that doctors from these nations can register and practice almost instantly in the US. Provide an almost limitless immigration quota for doctors from western nations. Even better, aggressively recruit doctors from abroad. Mostly ignore APA’s opinions in this context.
As such, I was intrigued by seeing the DMCB's notes on a recent trip to Germany, where healthy system leaders  were conscious of the need to reduce the supply of medical care: 
In it's conversations with some of Germany's health system leaders, there appeared to be a consensus that there were "too many" hospitals and that some had to close.  This belief in supplier-induced demand, however, was tempered by the recognition that hospitals are not only important employers but have significant political power.  It remains to be seen if Berlin can pull that off.
The ACA is likely to increase the supply of medical care in the U.S., and this is one of the biggest reasons for pessimism on long-term health care spending.  And I'm pessimistic about the ability of government to reduce supply.  As long as prominent economists and policy wonks believe that greater supply will reduce prices, I will be skeptical that countries can pull off reductions in the supply of medical care.  

What is the role of government?

Some ideas:

  1. Government should represent its people’s preferences and interests via the democratic process. This seems nice, but it is the most clearly flawed.  First, nobody seems to really believe that politicians should blindly follow the desires of their citizens.  The populace is ill-informed, often wanting many incompatible things at the same time (lower taxes, but more government services).  It is often fickle, and can be easily swayed into extremes.  Elected officials are supposed to listen to their people, but also to lead them in the right directions when the situation demands it, and to play to their better angels. 
  2. Government should represent its people’s enlightened interests via the democratic process. This seems to be the sort of default position that many people hold now.  Elected officials are expected represent the interests and preferences of their constituents and also the national or state interest.  But they are expected to represent a sort of enlightened interest of their citizens, or what their citizens should want.  This is a nice concept, but the devil is in the details.  How should politicians decide what is in the best interests of their people?  This is just too subjective.  To believe that government should follow the interest of its citizens is to allow government an ethical role. You are allowing government to decide what issues should be prioritized over others. 
  3. Government should attempt to maximize the lives and health of its citizens. The appeal of this role for government (and the next) is that it is neat and objective.  Ethics can (mostly) be removed from the picture, and government can adopt a utilitarian attitude in policymaking, with maybe some tweaks around the edges.  I find this to be the most compelling role for government, but perhaps that is because I am most interested in health policy.  Or maybe vice versa.  In any case, this seems like the best way to find an objective role for government as well as a compassionate role for it. 
  4. Government should attempt to maximize the prosperity of its citizens.  I like this role for many of the same reasons as the previous role.  It is perhaps the most objective, and many would say that it is closest to what policymakers try to do.  A compelling argument could probably sway me to switch from #3 to #4.  I currently come down on the side of #3 because I think that health and life is a more worthy objective than prosperity.  Prosperity is good, and it leads to good outcomes such as better health, but I think it’s less valuable in itself.  An argument could be made though that many (say, professional football players) value prosperity over a few extra years of life (although I would argue that status plays a larger role than wealth in that decision). 
  5. Government should attempt to maximize the happiness of its citizens.  In a simpler world, this would be my favorite.  Happiness is a great ideal to strive for, and one can argue that there are objective metrics, but I’m skeptical.  I’ve never been convinced by any of the attempts to objectively measure happiness.  Some of the techniques are clever, and they are better than nothing, but none seem sound enough that I would feel comfortable building broader government policy around them.  

Friday, June 21, 2013

Knausgaard in Norway

More immediately striking, however, is another parallel concerning the ways in which fiction is born of fact, and the question whether this is fiction at all. As in Proust’s novel, the narrator of “My Struggle” has the same name as the author and seems to have lived much the same life, to have been preoccupied by much the same concerns and to be, as was Proust’s narrator, in search of a subject for his story, which subject turns out to be that very search. Proust changed a great deal — invented or amalgamated places (like the “Combray” of the book’s opening section), people (like the jealously held Albertine) and events (like the dipping of a madeleine in tea, presumably). Knausgaard, it appears, has not — and this has led to threats of legal action on the part of family members and a level of national and international attention such that a number of Norwegian companies have declared Knausgaard-free days during which debate is to be suspended in the name of some modicum of productivity. It is estimated that something approaching 1 in 10 Norwegians have read the book.
This is from the New York Times review of Book 2 of Karl Ove Knausgaard's six book series.

I am 20 pages from finishing Book 1 of the saga.  I've found it entertaining and interesting, but not gripping.  Four stars overall.  I suspect that I will enjoy the second book more than the first, based on what I've read about the themes covered -- childhood, adolescence and death in the first; marriage and adulthood in the second.

Chinese v. American perceptions about Africa

Perceiving opportunities like these and many others, however, will first require a revolution in American thinking about Africa. I have spent the last few years working on a book about China’s relationship with the continent, and could not have been more struck by the differences in attitude in the United States and China toward Africa. More than a million Chinese have moved to Africa in the last decade, largely because they see the continent as an arena of almost limitless opportunity. This holds true from big company executives to mom and pop entrepreneurs from China’s inland, second tier cities.            
Americans, meanwhile, despite their far deeper historical associations with the continent, including 13 percent of the population that traces its ancestry to Africa, cling to deeply engrained attitudes toward this part of the world, as a place of war, of misery, of strife, etc. For this reason, and because we cannot get over a long-running sense of Africa as a place to be aided, we are ill equipped to see or appreciate the opportunities that Africa offers.
That is from Howard French's post about China and the U.S. and their policies towards "Africa."

Thursday, June 20, 2013

On learning

From Snippets of Random:
“The best thing for being sad,” replied Merlin, beginning to puff and blow, “is to learn something. That’s the only thing that never fails. You may grow old and trembling in your anatomies, you may lie awake at night listening to the disorder of your veins, you may miss your only love, you may see the world about you devastated by evil lunatics, or know your honour trampled in the sewers of baser minds. There is only one thing for it then — to learn. Learn why the world wags and what wags it. That is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust, and never dream of regretting. Learning is the only thing for you. Look what a lot of things there are to learn.”

Wednesday, June 19, 2013

Gladwell on Albert Hirschman

There are some terrific lines in Malcolm Gladwell's latest article, a review of the new Albert Hirschman biography.

I loved this on having the courage to live with doubt, rather than being paralyzed by it.
The phrase that Hirschman and Colorni would repeat to each other was that they hoped to “prove Hamlet wrong.” Hamlet shouldn’t have been frozen by his doubts; he should have been freed by them. Hamlet took himself too seriously. He thought he needed to be perfect. Colorni and Hirschman didn’t. Courage, Colorni wrote, required the willingness “to always be on guard against oneself.”
In fact, I find that self-doubt is one of my bigger obstacles to blogging.  It is one thing to look like an idiot in an email discussion between friends; quite another to express ignorant opinion in a public forum.

And I really loved his wife's explanation for why their family moved to conflict-torn Colombia:
On a whim, he packed up the family and moved to Bogotá, Colombia, where he worked on a project for the World Bank. He crisscrossed the country with, Adelman writes, “pen in hand and paper handy, examining irrigation projects, talking to local bankers about their farm loans, and scribbling calculations about the costs of road building.”
Writing to her parents about the family’s decision to move to Colombia, which was then in the midst of a civil war, Sarah explained, “We both realize that you should think of the future—make plans for the children etc. But I think we both somehow feel that it is impossible to know what is best and that the present is so much more important—because if the present is solid and good it will be a surer basis for a good future than any plans that you can make.”

Changing social norms -- Facebook and organ donors

On May 1, 2012, Facebook added an option for users to share their organ-donor status on their timelines. Nearly 60,000 users did so on the first day, a number that gradually tailed off over the following few weeks. Cameron and several colleagues at Johns Hopkins and other public-health institutions followed up with a study in which they examined donor-registration rates in 44 states in the weeks before and after May 1.
They found that 616 people nationwide registered as organ donors online on a typical day before Facebook rolled out the new feature. On May 1, that number spiked to 13,012—21 times the baseline rate. And while registrations declined in the following two weeks, they stayed above the baseline for the duration of the study period, with a two-week total of 39,818 new registrations. In the scrappy, grassroots realm of organ-donation drives, this was a game-changer.

Monday, June 17, 2013

Getting security reform right in Mexico -- a public-private partnership

The private sector has helped the government, with both money and technical expertise, to recruit and run a new police force. The first task was to purge state and local police of infiltration by drug mafias. Rodrigo Medina, Nuevo León’s governor, says 4,200 police were fired or jailed after failing lie-detector and other tests. At first the armed forces (mainly marines) were drafted in to keep order. Then, with advice from the human-resources departments of Monterrey’s biggest firms, the government launched a national recruitment drive to build a new state police force, known as Fuerza Civil (civil force). 
This is made up of people who have never worked in law-enforcement before. Recruits were given business-style psychometric tests as well as military training. Their starting pay of more than 15,000 pesos ($1,175) a month is about double what a normal cop makes. The new policemen are housed in secure compounds that make it difficult for drug mafias to nobble them. The smartly dressed recruits patrol Monterrey in jeeps. Surveys suggest they enjoy the trust of citizens. 
A business group has set up a monitoring system, collecting data to compare security in Monterrey’s nine municipalities. Some firms have helped to finance a network, known as the Centre of Citizen Integration, to encourage people to report crimes—even those committed by the police or army. It has helped people overcome their huge mistrust of those who are supposed to protect them.
More from the Economist here.