On the economic geography of health care

"Health care in America is in crisis" is a serious understatement. It will only get worse!

Consider, for instance, employment.  We tend to assume that health care is a growing industry and, therefore, that is where the income stream is, right?  Yes, jobs are there, but ...

Yet for every higher-paying job held by workers like nurses and doctors, more than six workers such as orderlies, phlebotomists and cooks make less than $15 an hour. Nationwide, 70 percent of hospital service workers make less than $15 an hour, NELP found. In the Midwest, it's 71 percent.

Now, the $15/hr might sound like quite a compensation to a person in Bihar.  But, ahem, a cup of coffee is not 15 rupees either; there is the cost of living:

Most counties in the U.S. have a cost of living across industries that isn't covered by minimum wage incomes, according to a recent blog post from Amy Glasmeier, a professor and co-chair at the Massachusetts Institute of Technology's economic geography and regional planning Ph. D program.
For instance, in Chicago, a single parent of one child needs to earn $24.67 an hour to meet a definition of living wage, while a person living alone there needs at least $12.33, based on a living-wage calculator  developed by Glasmeier in conjunction with MIT.

At least the cities are better, when one looks at health care in rural America; "half of the country's rural counties now don't have hospitals with obstetric services":

Maternity care is disappearing from America's rural counties, and for the 28 million women of reproductive age living in those areas, pregnancy and childbirth are becoming more complicated—and more dangerous.

One important factor is nothing but dollars and cents:

If hospitals want to offer obstetric services, they need to be ready for a baby to be born at any time—they need to have a bed available, the equipment available for mom and for baby, clinicians and staff available that have the necessary skills. That's a substantial expense. If a hospital's revenues are limited because it has a low volume of births—as many rural hospitals do—or if revenues are unpredictable, that creates a really difficult administrative problem.

It is exactly in such situations that we expect the government to step in where the market fails, right?  Especially when you consider this: "Medicaid funds about half of all births in the United States, and an even greater percentage of births in rural hospitals."  So, if these health care services for pregnant women are gone ...?

State and federal programs to support the rural maternity workforce are crucial. There ought to be programs to support training in emergency births in rural communities that lose obstetric care, and to support the costs of providing maternity care in communities where there are willing providers.

trump and his 63 million voters can fix this all with a complete repeal of Obamacare, right?

On life and death in India. Now "Congo Fever" :(

The Economist has one of the best opening lines ever in some of the recent journalism stories I have read recently:

YOU can be killed by an exotic variety of diseases in India.

Isn't that the case!

About four or five years ago, I was shocked when I first read about a Dengue Fever epidemic in India, and then even more shocked when I met one who was down with that fever.  And then the last time when I was there, I find out that an aunt had Chikungunya and took months to recover.  A couple of days before I left the country I called my friend's parents to say hi to them, and his mother said that she still has pain--months after a Chikungunya infection.  The good thing is that these women (all women? really?) recovered well enough.

Up until all these, I thought Dengue and Chikungunya were infections that we had to watch out for while in Africa.  I suppose there is phenomenal globalization in infectious diseases too. 

Anyway, what is the latest exotic killer in India, you ask? "Congo Fever:"

A tick-borne virus, endemic to parts of Africa, the Middle East and elsewhere, it passes easily from livestock to man, and then between humans. Horrible symptoms include fever, internal bleeding and liver failure. Some 30% of infected humans die, usually within a couple of weeks.
The authorities in Gujarat, western India, were therefore alarmed when in January a medical intern died of the disease, formally known as Crimean-Congo haemorrhagic fever. Earlier in the month it killed three others: a patient, plus a doctor and nurse who had cared for her. These appear to be the first recorded deaths in India from the illness. On February 5th doctors reported two more cases in Gujarat. The fever’s arrival is a mystery.

It is crazy!

It is unfortunate that rural development and health do not attract enough attention in India.  Politicians and governments are far more interested in urban-oriented investments with whatever money is left after they have swindled. 

Indian officials acknowledge that the country needs to increase investment in irrigation, encourage competition in wholesale and retail markets, and provide targeted food subsidies to the poor. And they also have to provide more education and jobs to villagers, so fewer people are forced to live off the land.
Experts say India needs to make changes like some of the ones China made, beginning in the late 1970s, when it started investing heavily in agriculture and eased regulations on farming.
As recently as 1977, Chinese and Indian farmers harvested roughly the same amount of wheat for each acre that they planted. But by 2009, United Nations data shows that wheat yields were 1.7 times higher in China than in India.
Kaushik Basu, a Cornell University professor who is also the chief economic adviser to India’s finance minister, says he now sees more willingness by Indian officials to reform agriculture policies.
But outside experts like Mr. Gulati are skeptical that real change will come from the government. The ruling coalition has been hobbled by corruption scandals, and an energized opposition last year effectively blocked proceedings in Parliament.

The country is rapidly devolving into a bizarre version of "democratic oligarchy" ... the phenomenal amounts being spent on cricket is evidence enough.

I hope a few more people will follow the example that Wipro's Azim Premji is setting with his philanthropy:

In India, man has yet to make peace with nature

I visited Mumbai to spend a couple of days with my great-aunt, who lives with her daughter’s family in a suburb. Suburbs, according to a typical joke in urban planning, are places where street names bear the names of trees that were cut down en masse to make way for the development.

The Mumbai suburb that I went to, Mulund, has names of trees that are not even native to the local geography. The name of a multi-storied housing complex is “Silver Birch” and, oddly enough, there are quite a few other complexes in the same neighborhood with names such as “Pinewood” and “Silver Oaks.”

Of considerably more importance than names of alien tree species is how these residential complexes reflect a critical tension between urbanization and green space.

The geographic expansion into the suburbs has meant a slow encroachment on forest areas and the hills that surround Mumbai. Mulund is a poster-child for this encroachment. Loss of trees and green space has become a heated public policy issue here, and elsewhere. Finally!

As viewers of the Oscar-winning “Slumdog Millionaire” might recall, Mumbai is a huge metropolis with a population of more than 13 million — though it feels as if there are a hundred times more. The housing needs, as one might imagine, are immense, as was evident in the same movie, which is also why middle- and upper-middle classes commute for hours from distant suburbs.

Suburbanization has resulted in significant loss of green space. It is not that the government or the people were unconcerned; when a government is resource-starved, and with hundreds of thousands clamoring to find a place of their own, it was easier for everyone to be in denial. Or, a policy of benign neglect, as we sometimes refer to such practices in the profession.

But when urban forests have been replaced by concrete buildings that seem to be taller and wider than the redwood trees after which at least one building is named, benign neglect cannot continue forever.

Thanks to the work of environmentalists and the government, too, it appears that large-scale destruction of forests has been slowed down, if not completely halted. These efforts are also reflected in the manner in which metropolitan areas now review land development proposals. To such an extent that it was feared that the government would swing a wrecking ball to demolish all structures that compromised urban green spaces. Such a retroactive decision would, obviously, add to the chaos that characterizes life in India.

The courts have taken a rational view in their recent decision to regularize all developments constructed before 2005. The status of more recent constructions is not quite clear, however.

This competition between nature and humans is not merely in the metropolitan area of Mumbai. It is a story that is repeated in many ways all over the country. According to India’s Ministry of Environment and Forests, “Due to the impact of biotic pressure on our forests, many forest areas spread across the country have been depleted and degraded, which is a serious concern.”

Recent incidents are telling: A couple of hundred miles away from Mumbai, in the forest areas, villagers stoned a leopard to death, even while forest officials stood by. And the story gets even worse — it was the third such leopard-stoning in the country within a matter of days. The villagers pelted the big cat because it had strayed into the village searching for food and water and, in the process, attacked a couple of youngsters.

Also in the news a few days ago was a story about the absence of tigers in one of India’s tiger parks — Panna National Park — which is in the central Indian state of Madhya Pradesh. Apparently it was not the first occurrence in India — tigers have yet to be spotted in another reserve in the same state, and in a third protected area in the state of Rajasthan, which is in northwestern India.

It is clear that the flora and fauna will continue to face intense competition from humans in villages and cities alike. I hope that Mumbaikars and other Indians, too, will soon figure out how to peacefully coexist with nature, as much as we in Oregon — with “real” birches and oaks — have, by and large, worked out. We ought to thank pioneering visionaries like Gov. Tom McCall for that.

For The Register-Guard
Appeared in print: Saturday, Aug 1, 2009

Are New Yorkers simply detestable?

Steven Chapman on Why it's time to bury the myth of rural virtue:

In 2007, a survey of 8th graders by the Monitoring the Future project at the University of Michigan found that country kids were 26 percent more likely to experiment with drugs than middle-schoolers elsewhere. Overall methamphetamine consumption among adults and teens is more than 50 percent higher in the country.The story with alcohol is worse still. ... Nor is the countryside exempt from social problems often associated with the inner city—such as, if you'll forgive me, out-of-wedlock births. ...The highest rates of births to unwed mothers are in Mississippi and New Mexico, both of which have high rural populations. The most urban states, New Jersey and California, do better than the average in out-of-wedlock births.

Jon Stewart got ticked off for the same big-town-bashing that certain politicians engage in, implying that big towns are nothing but immoral in every possible way. Watch him here:

$200 oil and $7 gas ... oh my!

So, this WSJ blog, refers to "the latest gloomy forecast from Jeff Rubin at Canadian brokerage CIBC World Markets .... $200 oil in 2010, with gasoline at $7 a gallon. And that is going to turn Americans into car-shunning Europeans once and for all—poor Americans, at least"
The poor will be screwed, once again!
A comment, by a Joe Ballard, is pretty interesting, and ariculates a hypothesis that I too have been postulating for a while:
So let’s play it all out according to these assumptions. $7 a barrel translates to 10 million fewer cars on the road which leads to more people taking mass transit and moving to urban areas, where transit makes sense. I see the affect of this migration being extremely contractionary for consumer spending and therefore the overall US economy.
Today it’s easy to fill your car up with unneeded consumer products when out running errands. What will happen when people start taking the bus and train? I would think pure logistics of carrying your typical Costco load onto a bus will limit daily spending to pure necessities. Even the smaller urban space you would now be forced to live in will constrict what you fill it with, right? What about diminished tourism as a result of high oil? Won’t that decrease overall consumption?
My point is that higher oil can only shrink our consumption and therefore our GDP…at least for the near term. This contraction WILL have a ripple affect on the rest of the world. Unlike Europe (which he tries to draw parallels with) we are the world’s consumers.