Year: 2013

Quote For The Day

“It all goes back to (the Affordable Care Act) and how it changes so many components of the way we do business. The language I use now in the health care business is completely different than the language I used even five years ago …  Until now, the government has paid on volume. Now, it’s trying to pay more on quality,” – Peter Person, chief executive of Essentia Health, a 12,800-employee hospital system based in Duluth, Minn.

It’s from a USA Today piece that really does seem to show that Obamacare is helping to restrain healthcare costs which actually fell a teensy bit last year as a share of the  economy.

The Era Of Cheap Airfare

Flight Cost Per Mile

Derek Thompson notes that the cost of flying has plummeted:

Why don’t we appreciate this heyday in bargain flying? The first, and obvious, answer is that flying through the air in a big machine powered by a scarce resource will always cost a big number, and your average family expends very little energy adjusting big numbers for inflation. If you buy a round-trip ticket from New York to Columbus for $280 every year between 1986 and 2010, would you suddenly realize, after 24 years, that the real price of your ticket had dropped by exactly 50 percent? Probably not. You’d probably think, correctly, “I guess flying to Ohio costs $280.”

(Chart from Mark Perry)

A Degree In DIY

Lori Rotenberk reports growing interest in the folk school movement, which is “drawing young do-it-yourself homesteaders and restless baby boomers to the woods to learn about everything from organic farming to electric cars”:

People enrolling in folk schools range in age from 18 to 70. Enrollment is growing among high school graduates taking a gap year before starting college. College grads are opting to spend gap years at folk school, too, in some cases using the opportunity to rethink their careers. Some students in their late 20s and mid-30s come to learn a trade or craft for a second income. Add to the mix boomers who’ve been laid off, have difficulty finding work, and are hoping to start a small business, and others who have chosen to leave careers in pursuit of a long-ignored passion, and you have a recipe for dramatic growth.

Addicted To Arguing

Judith E. Glaser reveals the brain chemistry at work when you argue:

In situations of high stress, fear or distrust, the hormone and neurotransmitter cortisol floods the brain. Executive functions that help us with advanced thought processes like strategy, trust building, and compassion shut down. And the amygdala, our instinctive brain, takes over. The body makes a chemical choice about how best to protect itself — in this case from the shame and loss of power associated with being wrong — and as a result is unable to regulate its emotions or handle the gaps between expectations and reality.

This “chemical choice” can lead to problems:

When you argue and win, your brain floods with different hormones: adrenaline and dopamine, which makes you feel good, dominant, even invincible. It’s a the feeling any of us would want to replicate. So the next time we’re in a tense situation, we fight again. We get addicted to being right.

When Evangelicals Go Digging

Dylan Bergeson examines the “biblical archaeology” of the West Bank, funded by American churches and administered by Israel:

At first blush, [Texas Pastor Randall] Price seems like an unlikely candidate to head excavations amid one of the bitterest land disputes in the modern world. Though he never actually received a degree in archaeology, he built a global network around his brand of Near East biblical scholarship with an apocalyptic bent. He has written extensively for the website RaptureReady.com, given lectures suggesting that Iran is fulfilling the role of Antichrist, and has openly called for the United States to declare war on Islam.

They are getting lots of false positives:

[Prominent Israeli archaeologist Raphael] Greenberg estimates the majority of funding for excavations in Israel and Palestine comes from religious sources. As a result, he said, researchers are plagued by financial pressure to produce religiously significant discoveries. Recent years have seen multiple claims of finding Noah’s Ark, the secret location of the Ark of the Covenant, and most recently, a fraudulent ossuary that was claimed to contain the bones of Jesus’ family.

Are Doctors Overpaid? Ctd

More readers join the conversation:

I suppose I should be moved to pity by the reader whose physician husband works 55 hours a week and “cracks the six-figure mark”, but somehow the tears don’t flow. I’m a US-trained scientist, working at a leading UK university. My training wasn’t as expensive as a medical training, but it lasted longer. I feel privileged to be able to earn a good living doing the work I do, though I earn less than any physician I know. Sure, I could be earning many times my current salary on Wall Street. So what? People may choose their careers at the margins based on earnings, but it’s only one of many factors.

I’m certain that there are some brilliant potential surgeons who would rather work in a bank if we cut surgeons’ salaries, but there are surely plenty of others who now don’t go into medicine because they can’t afford the upfront costs of the education, or they are frightened of the debt burden.

That’s why the proposal to combine a cut in salaries with government subsidy of medical education is so important. (My doctoral studies, and those of a large number of scientists, were paid for by fellowships.) Another reader suggests that only stupid people would practice medicine if their salaries were moved closer to that of an average person. This is where the experience of other countries becomes relevant, though your reader chooses to ignore it, and retreat into American exceptionalism. Does he or she think that there are no jobs in IT or finance in Europe? (I’m a little mystified by this readers claim that the physicians elsewhere are earning $60k, when hardly any number on the chart – which is nearly 10 years old anyway – is that low.) The GPs I have seen in the UK have seemed every bit as intelligent and well trained as those I’ve seen in the US. And it’s much easier to get an appointment.

The real point is, no one gets paid what they “deserve”, but what those who employ them need or want to pay them for their services. So why is it that medical consumers in the US are so much worse than their counterparts in other advanced economies at negotiating a good price for competent medical service?

Another is even less sympathetic:

Your reader wrote:

I was in school (paying tuition) or in training (earning $20-$30K per year) for 12 years after college and collecting more than $150K in debt at a public medical school while others my age and background were moving up in their careers, earning increasingly higher wages (some made millions in the Internet bubble), increasing their retirement nest egg, buying houses, etc. I made my first paycheck from “overpaid” reimbursement at the ripe age of 33.

Cry me a frickin’ river. I’m a teacher. My training period (student teaching) was beyond full time hours and paid $0 a year. In fact, I had to pay tuition for the privilege of working 70 hours a week for no pay.  After completing my student teaching I found I was totally unemployable straight out of college – due to lack of experience – and had to embark on several years of substituting to burnish my resume.  Last year I was lucky to spend most of the year in long-term substituting (jobs lasting more than a month, which pays more than regular substituting).

I made $10,500 last year.  This year I am a first-year teacher with my own classroom, and I will make about $30k. If I max out my educational level, get rave performance reviews, and stay in the same school district for the next 20 years, I’ll max out at about $50k/year.  All the while I’m required to spend more money on education to keep my teaching certificate current.

My path through college was slower because I had to work while going to school. Even still I have about $80k in student loans.  I’m currently 35 and I will NEVER get the “overpaid” reimbursement paycheck this guy talks about.

I don’t particularly mind that my doctor’s overpaid, and I don’t expect sympathy for my low wages (I picked this career knowing what it entailed). But I’d rather my overpaid doctor not whine about the fact that he isn’t overpaid enough.

More perspective on the subject:

I’m a 30-year-old medical student and son of a highly-paid specialized physician. I am well aware of the opportunity costs involved in pursuing a career in medicine that your reader speaks of, and know well the debt burden faced by new physicians ($170,000 is the median indebtedness of medical school graduates). Assuming one has $25,000 in undergraduate debt (about the median), the monthly loan costs are about $2,250, or about $27,000 per year.

The median physician’s salary varies by specialty, but ranges from $350,000 (orthopedic surgery) to $150,000 (pediatrics) per year, after taxes, this is $250,000 to $115,000, respectively.  This leaves you with an after-tax, after-loan income of $223,000 to $88,000 assuming a one-income household.

I didn’t decide to enter this field to make money. It is a privilege to be studying medicine, and a privilege to be present in those intimate moments that are often the most critical moments in a human life. The fact that I can do all of this, and still be in the top 95%-75% of all disposable incomes in this country is nothing short of a blessing. Physician incomes aren’t the sole or primary cause of inflated health spending, but it certainly is part of the picture. I’m quite honestly disgusted at the self righteousness with which this particular reader writes, and hope that I never lose sight of the privilege that I have been granted.

A doctor gets the last word:

Medicine is a very rewarding career.  It pays fairly well.  For most doctors, not enough to make it into the 1%, but pretty close.  More importantly, it provides a lot of flexibility; you can get a job as a doctor nearly anywhere.  A friend of mine from residency went to work in Hawaii; how many auto plant workers can say that?  It has excellent job security.  Though I am sure there must be unemployed doctors, that number is quite small.  And it provides the opportunity to pursue a rewarding career.

On the other hand, it is a lot of work.  It is a lot of work, being paid fairly little, during a long training period.  It is a lot of nights away from family.  It is not a low stress occupation.  And although it pays comfortably, the upside financial reward is limited.  There aren’t multi-million dollar bonuses for doctors.  You aren’t going to take your company public and make a boatload from stock options.

Are doctors overpaid?  I don’t know.  I think we’re paid enough.  I didn’t go into medicine for the money, but it wasn’t a disincentive, either.  I’m happy with my choice, and I think most of your physician readers are too.  Which suggests that we aren’t underpaid.

A High Score In Appendectomies

Gaming is helping train the next generation of doctors:

Take Touch Surgery, an iPhone app. The Guardian described it as a training exercise that could help improve surgeons’ decision making and technical skills. The “mobile surgical simulator” allows users to learn the steps of 12 different operations with intense 3D animation, from cleft palate repair to emergency leg fasciotomies. Touch Surgery’s suite of games–if you’d like to call them that–is designed to compartamentalize each operation into a series of steps and check points, similar to a “level-save” feature in a standard video game, while tracking users’ progress and error-making through each decision point. Perhaps most critically, the simulations help users recognize risks–nerves and arteries to avoid, for example.

Should We Tax Bicycles?

Seattle is considering a $25 sales fee on bicycles that cost more than $500. Eric Jaffe weighs the pros and cons:

There are any number of reasons why a bike tax makes for poor public policy. For starters, the idea that bike riders don’t pay for the road is rather hollow. The vast majority of riders also own cars, after all, and riding creates negligible wear and tear on the road. Bike infrastructure costs public money, especially if it’s done right, but the bike tax wouldn’t even pay for much of it — with the state’s proposal expected to bring in only a reported $1 million over a decade.

But Jaffe notes that the bike community isn’t totally opposed. Rob Sadowsky, who heads the Bicycle Transportation Alliance, sees the fees as a potential political tool with the “chance to begin a dialogue with legislators about the best ways to achieve an equitable system of road funding.” Dominic Holden has been all over the story for The Stranger.