Sunday, September 15, 2013

The lessons of North Korea

Juche Monument, Pyongyang, North Korea (aka DPRK) with a human standing in front, for scale. There should be an index that measures the size of national monuments. I can't help but speculate that the larger a nation's monuments, the more authoritarian is the state. I think of the pyramids, and the monument to Vittorio Emanuele II in Rome. Perhaps there are other, stronger, correlations. Maybe the larger monuments indicate a stronger state elite (elites who build things to impress the masses with their power, and to get the masses to be "proud" of the state--i.e., the elite). And maybe this is all too crude. After all, the US seems to have had its peak of monument building well before its recent peak of centralized power. The biggest monuments in DC arethe Washington Monument (built between 1848-1885) and the Lincoln Memorial (1914-1922).

The DPRK is sociologically fascinating. Social scientists spend much of their time showing that people's choices are shaped by the culture and society (well, except for economists, who still believe in the autonomous individual). When we face a society where choices are really constrained, like the DPRK, then we are forced to recognize that choice is, in fact, important in most modern societies. Yes, all societies limit our choices and mold us in certain ways. But the DPRK is at an extreme. The task of combining structure and agency is never easy, and new terms such as "structuration" don't help much, except to highlight the challenge. Every society is weird in some way. The DPRK's weirdness forces anyone who dismisses choice and markets as not important to recognize that freedom to choose actually does matter. It is an exotic culture of our time that shows the limits of what humans can bear and do, a fascinating example, and one in the end that highlights why some level of individual freedom is in fact necessary and desirable.

Thursday, September 05, 2013

Hong Kong Has "The Most Efficient Health Care System In The World"

The Huffington Post has an interesting article that shows that according to a recent Bloomberg ranking, Hong Kong has the most efficient health care system in the world. The real point of the story is to show that the US is 46th of 48 countries: 
"In other words, the world's richest country spends more of its money on health care while getting less than almost every other nation in return."
Of course, all such rankings depend on how variables are measured. In this case, though I'm happy to have Hong Kong's success recognized, I think the measure is a bit too primitive.
Each country was ranked on three criteria: life expectancy (weighted 60%), relative per capita cost of health care (30%); and absolute per capita cost of health care (10%). Countries were scored on each criterion and the scores were weighted and summed to obtain their efficiency scores.
So life expectancy is the only measure of health outcome.  A bit primitive, but not invalid.

The main message from the story is that all the top (most efficient) systems are heavily state controlled, and are universal.
Despite being considered by some as having the freest economy in the world, Hong Kong's universal health care system involves heavy government participation; its own health secretary calls public medicine the "cornerstone" of the system. Public hospitals account for 90 percent of in-patient procedures, while the numerous private options are mostly used by the wealthy.
Many Americans will just dismiss this. Nothing will shake their faith in the "free" market.