WSJ.com - How the Amish Drive Down Medical Costs

I don't normally go near the Wall Street Journal, but they do have some free articles and here is an excerpt from one--dealing with how the Anabaptists (Amish, Mennonites) deal with modern medicine.
How the Amish Drive Down Medical Costs:

"Heart of Lancaster is a small hospital, and its case load is fairly conventional. But the Anabaptists weren't looking for anything exotic. They wanted discounts on services such as orthopedic surgery, biopsies and childbirth. The hospital agreed to discounts of up to 40% off its top rates, resulting in prices that would still be slightly higher than Medicare reimbursements, the level most hospitals consider a minimum. Not satisfied, the Anabaptists pushed the executives to go lower. But the hospital said if it dropped prices to levels below Medicare reimbursements, it could be charged for fraud for charging Medicare patients more."

The Amish, and the other Anabaptists, fascinate me. They form a test case for many theories. Are they really American? How should one deal with other cultures (like those who discourage higher education)? etc. etc. In this connection, I strongly recommend the book "The Riddle of Amish Culture"by Donald Kraybill.

"Portgate" and Hutchison Whampoa

There's a fuss about the possibility of a company based in Dubai buying the company that runs a number of major U.S. ports. Critics on both sides of the aisle are yelling about the threat to security. It all reminds me of the 1990's controversy over Hutchison Whampoa and its taking over operation of the Panama Canal. In sum, an opportunity for some demagogery without substance.

Bigshottery, or You The Man

Christopher Lee has a good piece, albeit a bit lacking in cynicism, on backgrounders in the Post: Remember, You Didn't Hear This From Me . . .:

"Agencies cite any number of reasons for keeping names out of the press: allowing lower-level officials to be quoted might steal the spotlight from the Cabinet secretary or other high-ranking official; the briefers are policy wonks who are uncomfortable talking to reporters; the agency is involved in an issue, but in a supporting role; the officials are there to provide context or technical explanations as a courtesy, not to be the face of an agency."

My dyspeptic take: What much of this boils down to is that agency heads are ignorant bigshots. They don't know enough to be talking in detail to reporters and they want all the glory they can get. (It's a truism that the first thing any Beltway type does when picking up a book is to look in the index to find his or her name.) "Heads" want to be the "face" of the agency, not the brains, to be "the man".

But putting on my pseudo-economist glasses: any backgrounder involves a quid pro quo. The reporter likes it because they don't display their ignorance, as they might have to do in an open press conference. The official likes it because their hard-earned knowledge, won by years of toil in the trenches, can at least be flaunted. The agency head will tolerate the backgrounders as long as they don't take away any glory or raise questions about the head. There's also a question of balance--if there are more reporters with more time/space to fill with stories than there are agency heads with knowledge to impart, the reporter goes down the food chain.

Not Surprising, Republican Judges See White Collar Crime as Less Serious

The Post reports on a study of how judges from different parties analyze crimes and sentence criminals here-- NOTED WITH INTEREST:

"Federal judges appointed by Republicans give tougher sentences on street crime, whereas Democratic appointees take a stricter view of white-collar offenses."

The summary could be reversed, as I did in the title. It's the usual problem with many two-sided issues: do you say boys are doing worse in school or girls are doing better in school? It's a reminder of the importance of context and framing.

FEMA and DHS

George Buddy asked about FEMA's proper role, specifically its relation to DHS. I think a part of the problems we saw with Katrina were caused by the DHS reorganization. There's no doubt that reporting lines got confused--Brown felt loyalty to the people who bumped him up from FEMA deputy director to DHS undersecretary, not to Chertoff who arrived later. When Brown had a hot potato, he turned to his friends, not to his new boss. Chertoff, who was relying on Brown to alert him to problems, had his focus elsewhere. Just as we didn't realize before 9/11 that bin Laden could mount an attack much deadlier than any previous one, he (and we) didn't realize that Mother Nature could also mount an attack more devastating than prior hurricanes.

It also seems clear that the Bush administration after Sept. 11 said that the "war" on terrorism was more important than disaster preparations. Congress agreed and pushed the DHS reorg. There was a smokescreen of rhetoric whereby the policymakers tried to convince themselves that DHS would be a more efficient use of resources. There's some logic to this--the response to a natural disaster and an attack will often be similar and the coordination with state and local first responders must use the same infrastructure. But the reality, as any experienced bureaucrat knew, was that creating DHS would cause us to be less prepared over the next few years, both for disaster and terror, than the alternative. The truth is any reorganization uses so much bureaucratic energy that the sum is significantly less than the whole for several years. So we won't know for another 10 or 20 years whether there's a net improvement or not.

Suppose Mr. Negroponte came to the President and said: "Sir, our enemy has dispatched a team that has the capability of killing a thousand people and destroying 50 billion dollars worth of property. Current intelligence shows that the team is likely headed for New Orleans and has a 50 percent chance of carrying out their mission." What would Bush do? He certainly wouldn't do what he did the end of August. (Or maybe I should say--he would do something, not nothing.)

The First Amendment Doesn't Apply Everywhere

This was an amazing story in this morning's Post--read the whole thing.

Policing Porn Is Not Part of Job Description:

"Two uniformed men strolled into the main room of the Little Falls library in Bethesda one day last week and demanded the attention of all patrons using the computers. Then they made their announcement: The viewing of Internet pornography was forbidden.

The men looked stern and wore baseball caps emblazoned with the words 'Homeland Security.' "

...[further on] The sexual harassment policy forbids the "display of offensive or obscene printed or visual material." But in a library, which is both a public arena and a county workplace, the U.S. Constitution trumps Montgomery's rules.

I was struck by the implication in the last sentence that the Constitution doesn't always and everywhere trump Montgomery County's rules. But I guess it's true--any employer can impose some restrictions not applicable in a public area.

[The men were employees of the Montgomery county Homeland Security Department trying to enforce a ban on accessing porn through government owned equipment.]

Participation in Organizations--Hirschman

I've previously blogged on Albert Hirschman's "Exit, Voice, and Loyalty : Responses to Decline in Firms, Organizations, and States". I just got through commenting on Caleb McDaniel's blog
using Hirschman's schema in connection with the abolitionists.

There's another aspect, particularly with voluntary organizations, like alumni associations/college trustee elections and homeowner's associations: how many people have to participate to make the election/vote binding on the whole? I just got a package from the Reston Association (the closest thing Reston has to a government) changing the quorum requirement to 30 percent. My cluster association has been unable to get 10 percent participation in the annual meeting. I think Dartmouth is trying to reduce its quorum percentage. Hirschman would interpret all of these as saying "voice" is silent because the members are satisfied.

The Boomers Want Immortality

At least, that's how this web site strikes me, although one could say the same thing of this blog.
FAQ - MemoryWiki:

"Think of the Future

Your experiences are the stuff of history, literally. You may think 'Who would be interested in my experiences of this or that? Lots of people were there, and everyone knows about what happened.' Well, that's true, for now. But all the people, like you, who are alive today and who bore witness to the significant events of our age, will pass on. Our collective memory -- yours, mine, all of ours -- will go into the great beyond with us, vanishing forever. Over the coming decade, century, and millenium, your experiences will slowly dissappear. The past, they say, is a foreign country -- distant, strange, often unknowable. Unless you have a map. Your memoirs, recorded and shared at MemoryWiki, are that map for future generations. Go ahead. Tell the future how it was to be alive now. Your children, childrens' children and all who follow will want to know. You've got a story. Make it history."

Ah, the Romance of the Past is Fading

From a comment to a Joel Achenbach posts--Achenblog: Daily Humor and Observations from Joel Achenbach: "The biggest cross-generational shock when my son became a Boy Scout was the ubiquity of propane camp stoves. It seems so few places allow open fires for cooking, that it has become a necessity."

I remember from childhood the romantic pictures of people around campfires, faces highlighted with the light from the fire. Not that I ever experienced that, although we did cook marshmallows once on sticks over a small fire in the yard. And it was standard practice to burn our paper trash (we lived in the country).

What's the romance in a propane stove?

The Collapsing Bubble

There seems to be agreement that the real estate bubble is collapsing. Here's an interesting site:
How Much Real Estate Can a Salary Buy? - New York Times

Factoids--in the DC area the percentage of income went from 17 to 24 from the late 90's to now. In upstate New York cities the percentage is still around 10 percent.