Richard Gunderman argues in favor of concierge medicine, a system in which patients pay hefty fees to spend more time with their doctors:

The concierge model of practice is growing, and it is estimated that more than 4,000 U.S. physicians have adopted some variation of it. Most are general internists, with family practitioners second. It is attractive to physicians because they are relieved of much of the pressure to move patients through quickly, and they can devote more time to prevention and wellness….

Of course, there are drawbacks to concierge practice. For one thing, some patients cannot afford it, and others will choose not to pay the fee. Critics also see such models as promoting a two-tiered system of healthcare, in which those with more money get better care.

“But we have always had a two-tiered system,” [internist Frederic] Becker counters, “and it is better to care for 600 patients well than just adequately for three or four times that number. Someday patients, physicians, and healthcare payers will recognize that slower-paced but truly high-quality medical care is a better value than the fast medicine many physicians feel pressured to practice today.”

Meanwhile, Christopher Flavelle fears the rise of specialists who demand cash payments:

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poverty world

Pointing to a new study showing that income inequality is rapidly declining at the global level, Tyler Cowen argues that the redistribution favored by egalitarian movements in the US would end up hurting international prosperity:

Although significant economic problems remain, we have been living in equalizing times for the world — a change that has been largely for the good. That may not make for convincing sloganeering, but it’s the truth. … Many egalitarians push for policies to redistribute some income within nations, including the United States. That’s worth considering, but with a cautionary note. Such initiatives will prove more beneficial on the global level if there is more wealth to redistribute. In the United States, greater wealth would maintain the nation’s ability to invest abroad, buy foreign products, absorb immigrants and generate innovation, with significant benefit for global income and equality.

Mark Perry backs up Cowen’s thesis with the above chart. But Daniel Little criticizes Cowen’s “Panglossian” picture of global inequality:

Cowen bases his case on what seems on its face paradoxical but is in fact correct: it is possible for a set of 100 countries to each experience increasing income inequality and yet the aggregate of those populations to experience falling inequality. And this is precisely what he thinks is happening.

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EL SALVADOR-GANGS-TRUCE

Alec MacGillis shines a light on US gun trafficking to Central America, making the argument that our loose gun regulations are contributing to these countries’ gang violence problem:

According to data collected by the ATF, nearly half of the guns seized from criminals in El Salvador and submitted for tracing in the ATF’s online system last year originated in the U.S., versus 38 and 24 percent in Honduras and Guatemala, respectively. Many of those guns were imported through legal channels, either to government or law enforcement agencies in the three countries or to firearms dealers there.

But a not-insignificant number of the U.S.-sourced gunsmore than 20 percent in both Guatemala and Honduraswere traced to retail sales in the U.S. That is, they were sold by U.S. gun dealers and then transported south, typically hidden in vehicles headed across Mexico, though sometimes also stowed in checked airline luggage, air cargo, or even boat shipments. (Similar ratios were found in traces the ATF conducted in 2009 of 6,000 seized guns stored in a Guatemalan military bunker40 percent of the guns came from the United States, and slightly less than half of those were found to have been legally imported, leaving hundreds that were apparently trafficked.)

“It is a problem,” says Jose Miguel Cruz, an expert in Central American gang violence at Florida International University. “The problem is we don’t have any idea how many [of the trafficked guns] there are. It’s a big, dark area.”

Cynthia Arnson, director of the Latin American Program at the Woodrow Wilson International Center for Scholars, tells Dylan Matthews that an effective American response to the crisis must address its root causes:

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The Final Frontier: Population 6

Jul 22 2014 @ 9:05am

To mark the 45th anniversary of the Apollo moon landing, Nefarious Plots charted the total number of humans in space over time:

Space Population

Interactive version of the chart here. Susannah Locke captions:

Check out the big, red USSR/Russian blocks versus those skinny American lines in blue. That’s because the American presence in space has often consisted of shorter missions. A lot of this discrepancy has to do with access to space stations, where people can hang out for long periods, sometimes even longer than a year at a time.

All-You-Can-Read

Jul 22 2014 @ 8:31am

Hayley Tsukayama urges consumers to be honest with themselves about their reading habits before signing up for Amazon’s new literary service:

Kindle Unlimited is $9.99 per month. So you’ll be paying Amazon, whose chief executive Jeffrey Bezos owns The Washington Post, around $120 per year for the unfettered e-book access. If you’re habitually spending money on more than one book per month, then it’s a service to think about. It has its perks for big book buyers – namely that don’t have to worry about spending money on a book you end up hating.

But, chances are, you aren’t reading more than one book per month. In January, the Pew Internet and American Life Project asked how many books the typical American had read in the past year.

The answer? Five.

Maria Bustillos contends that “it shouldn’t cost a thing to borrow a book”:

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Not Single-Issue Voters

Jul 22 2014 @ 8:00am

Reacting to the “Beyoncé voters” meme spawned by that awful Fox segment, Tanya Basu warns against seeing single women as a monolithic voting bloc:

The only thing that unites all single women is their marital status. That’s it.

Simply looking at their marital status doesn’t begin to speak to the complexity of their lives. Some have been married before. Some are in relationships. Some are engaged. Some have children. But at this moment, just about the only thing linking the struggling single mother working a minimum-wage job and the middle-aged businesswoman with a swanky Upper East Side apartment is the lack of jewelry on their left ring finger.

Basu also reminds us that female voters’ concerns do not always center on gender-related issues:

While many women do care a great deal about contraception and equal pay, the biggest concern most women have right now is how the leaders we elect will create a job-friendly environment. Since single women earn less than single men and married women, their jobs are extremely important, especially if they’re trying to get health insurance for themselves and/or their children. They were hit especially hard by unemployment during the Great Recession. And job security isn’t just on the minds of 20-somethings: Senior single women are facing increasing economic insecurity too. In other words, birth control isn’t what will get single women (or for that matter, anyone) to the polls come November. It’s jobs and economic stability.

Shifty Work Conditions

Jul 22 2014 @ 7:29am

McArdle contemplates the current state of part-time labor:

Unfortunately, the weakness in the labor market has coincided with yet another market development: scheduling software and technology that allows retailers to manage their workforce as another just-in-time input.

Workers are asked to input blocks of hours when they will be available; the software then crunches through everyone’s availability and spits out a schedule that takes account of everything from weather forecasts to the danger that a worker will go over the maximum number of hours to still be considered part time. Obviously, you can’t string together multiple jobs this way, because each job requires that you block out many more available hours than you will actually work. Meanwhile, Steve Greenhouse reports on even worse practices that I hadn’t heard of: requiring workers to be “on call” at short notice or scheduling them for shifts and then sending them home if business looks light.

In this situation, no matter how hard you are willing to work, stringing together anything approaching a minimum income becomes impossible. That makes it much more deeply troubling than low pay.

The Best Of The Dish Today

Jul 21 2014 @ 9:15pm

Tensions Remain High At Israeli Gaza Border

If you believe, as most Republicans still seem to do, that the most important boon for the economy and the deficit would be further tax cuts, then surely Kansas’ recent, radical experiment in slashing tax rates should merit a view. The result, it now appears, is that tax revenues in Kansas have collapsed:

From June, 2013 to June, 2014, all Kansas tax revenue plunged by 11 percent. Individual income taxes fell from $2.9 billion to $2.2 billion and all income tax collections plummeted from $3.3 billion to $2.6 billion, a drop of more than 20 percent.

Did growth rebound? Nah: “Since the first round of tax cuts, job growth in Kansas has lagged the U.S. economy. So have personal incomes.” Now take a look at California, that big tax-and-spend liberal state. In 2013, they went in the opposite direction and raised taxes considerably on sales and high incomes. Many predicted disaster. The result?

Last year California added 410,418 jobs, an increase of 2.8 percent over 2012, significantly better than the 1.8 percent national increase in jobs. California is home to 12 percent of Americans, but last year it accounted for 17.5 percent of new jobs, Bureau of Labor Statistics data shows.

Obviously, there are other factors involved in both cases, and you should read the links to see the qualifications. But they are qualifications. We’ve know for a long time that cutting taxes does not help the government’s bottom line and has very limited potential for job growth given the historically low rates of tax in the US right now. But we didn’t know that tax increases could coexist with quite robust job growth and fiscal health. Count this as one more piece of evidence that re-thinking Republican economics on reformocon lines is a necessary but not sufficient initiative to alter GOP dogma.

Today, we covered the ever-more-sobering news out of Ukraine and Gaza – in particular Putin’s dead end and Netanyahu’s Gaza strategy (if you can call it that). And if you weren’t depressed enough, here’s a look at the fate of Iraq’s beleaguered Christians. To balance this a bit, check out pheromone dating rituals and an ode to the pit-bull as the archetypal American dog.

The most popular post of the day was “The Oldest Depiction Of Sex On Record” on the Ron Jeremys of ancient Egypt, followed by Holding Corpses Hostage. Many of today’s posts were updated with your emails, including this back and forth sparked by a reader upset with his situation under Obamacare.

39 more readers became subscribers today (a much bigger Monday total than usual, probably due to our Gaza coverage and Ukraine coverage). You can join those new subscribers here - and get access to all the readons and Deep Dish - for a little as $1.99 month. Gift subscriptions are available here.

See you in the morning.

(Photo: Family members of Major Tsafrir Bar-Or mourn and cry during his funeral on July 21, 2014 in Holon, Israel. By Ilia Yefimovich/Getty Images)

The View From Your Window

Jul 21 2014 @ 8:34pm

OLYMPUS DIGITAL CAMERA

Rockport, Massachusetts, 7 pm

Last week, Maggie Koerth-Baker warned that chikungunya, a mosquito-borne disease that’s not typically fatal but currently has no cure, is inevitably making its way to the US:

The virus has been known since the 1950s, but because it was largely non-lethal and largely confined to developing countries in Africa and Asia, the Western medical establishment didn’t much care about it until 10 years ago. That’s when chikungunya showed up on the French-controlled island of La Réunion, in the Indian Ocean, where it infected 40 percent of the population. Since then, it’s exploded in parts of Asia where it hadn’t been seen in decades (and other parts where it hadn’t been seen at all), reached Australia and Taiwan, and made landfall in Italy and France. And all of that was before the outbreak in the Caribbean.

So what changed? The sudden spread of chikungunya seems to be related to two things. First, the virus itself mutated. The strain that’s spreading around the world is different from the one that hung around sub-Saharan Africa. Specifically, it’s much more efficient at replicating itself in the guts of mosquitoes. That seems to have increased both its ability to move into new places and its ability to be carried by different species of mosquito.

That same day, the CDC announced the first locally acquired case of the virus in Florida. Vanessa Vitiello Urquhart explains why medical entomologists (like her wife Cassandra) are freaking out:

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