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Global Commentary
Monday, 25 October 2004
Health care and the market
Topic: Health
Recently, The New York Times carried an article by Donald L. Barlett and James B. Steele on health care in the United States. In the article, the authors assert that Americans do not have adequate health insurance coverage because of "the inability of market-based, for-profit medicine to deliver on the political promises".

We spend more per capita on health care than any other developed country. Yet on the important yardsticks, like life expectancy measured in healthy years, we don't even rank among the top 20 nations. In fact, according to the World Health Organisation, we come in an embarrassing 29th.
The authors claim that the market fails in the following:

  • The money in health care is in disease treatment whereas good health care requires disease prevention.


  • The market focuses on demand rather than on need, and carries out marketing to create that demand.


  • The United States government does not exert influence over prescription drug prices, so Americans pay more for these drugs.


  • The authors recommends the following:

    What's needed to control the costs and to provide basic health and hospitalisation coverage for all Americans is an independent agency that would set national health care policy, collect medical fees, pay claims, reimburse doctors fairly and restrain runaway drug prices -- a single-payer system that would eliminate the costly, inefficient bureaucracy generated by thousands of different plans.
    However, the authors' recommendation must be treated with a high degree of skepticism. In my opinion, the problem lies not in the fact that the market cannot deliver proper health care to Americans but that the United States has failed to provide an efficient, competitive market.

    The health care market is always likely to be controlled by health care professionals because of the concentration of knowledge in the latter. An efficient market requires a free flow of information. When information between service providers and consumers is as unbalanced as it usually is in health care, the resultant market is also unlikely to be very free.

    Therefore, health care regulation must focus on redressing this imbalance. Instead, health care regulation in the United States has often further distorted the free market.

    Many economists have already pointed out that onerous safety requirements in drug regulation raises the cost of bringing new drugs to the market, which are then passed on to consumers with the help of patent laws that restrict competition. Contrary to what the authors assert, the United States already influences drug prices through safety and patent regulation. But because the influence is by way of reducing effective competition, prices go up.

    Which makes it ironic that the authors want a single agency to control the entire health care system. The single agency will be devoid of competition and be one huge bureaucracy, with all its attendant inefficiency and disregard of market needs typical of such bureaucracies. It is hardly likely to result in an affordable and accessible health care system for the United States.


    Posted by lim_cs at 1:02 PM JST | post your comment (0) | link to this post
    Friday, 15 October 2004
    Cross-strait talks unlikely in the near future
    Topic: Politics
    Taiwan President Chen Shui-bian had, on 10 October, called for a resumption of cross-strait talks between China and Taiwan. However, because of his failure to accept the one-China principle, China has now rejected his proposal.

    On 13 October, Zhang Mingqing, spokesman for China's Taiwan Affairs Office, responded to President Chen: "Chen Shui-bian claims that he has intentions of easing tension and confrontation across the strait, but in his speech he obstinately sticks to his stand of one country on each side across the strait."

    Zhang called the remarks "an open and audacious expression of Taiwan independence", adding that it "constitutes another grave provocation to the peace and stability across the Taiwan Strait".

    China wants the one-China principle to be acknowledged by Taiwan before starting talks. Agreement on this principle, according to Beijing, was the basis on which the two sides met in Hong Kong in 1992, and is often called the 1992 consensus.

    Zhang reiterated China's stand on the 1992 consensus on 13 October: "It is our consistent stand and we have reiterated many times that if Taiwan authorities acknowledge the 1992 consensus, cross-strait dialogue and talks can be resumed immediately. This stand has never changed."

    And it is unlikely to change in the near future. China wants unification. Taiwan wants greater communication links for its businesses. Starting talks without agreement on the one-China principle confers relatively little benefit to the mainland, but suits the Taiwanese government just fine.

    For the latter reason, cross-strait talks is a bargaining chip which Beijing would want to withhold until Taiwan concedes on the one-China principle. And as long as President Chen panders to the pro-independence groups in Taiwan, that concession is unlikely to happen.


    Posted by lim_cs at 12:20 PM JST | post your comment (0) | link to this post
    Friday, 8 October 2004
    US lifestyle worsens children's health
    Topic: Health
    A recent New York Times report stated what many people already think: A US life-style is not healthy.

    Foreign-born children are healthier when they arrive in the United States than those of the same age who were born in the country, a study shows. But the longer immigrant children stay in the US, adopting the diet and lifestyle of their peers, the unhealthier they are likely to become, according to the report released this week.
    The study is a synthesis of several national studies by the David and Lucile Packard Foundation, a California philanthropy that studies the well-being of children.

    The report suggests that a language barrier may ironically help immigrants.

    "It's a bit of a twist," said Ms Kathleen Harris, director of the National Longitudinal Study of Adolescent Health...cited in the report. "Linguistic isolation is a protective thing because it slows assimilation, and most people think assimilation is good." But, she added, "in this case, assimilation means adopting unhealthy behaviour and risk factors from which they are protected in their own culture".
    The report stated that among first generation of immigrant adolescents, there was less asthma, less obesity and fewer school days missed than was the case among the second generation, that is, those born in the US to immigrant parents. The foreign-born children were also less involved in substance use, sex, delinquency and violence.

    Apparently, an American life-style is not what it's cracked up to be. Then again, I am sure there are many who never thought it was.


    Posted by lim_cs at 4:30 PM JST | post your comment (0) | link to this post
    Monday, 4 October 2004
    China tightening media reporting on Japan
    Topic: Politics
    A recent Asia News Network despatch reported that China is tightening controls on its domestic media reporting on Japan to rein in anti-Japanese views. This is supposed to be an attempt to prevent bilateral relations with Japan from deteriorating.

    I can understand the reason for the measure. Nationalist sentiment in China is very strong. So strong that it is often irrational, with individuals hitting out in emotional outbursts whenever perceptions of slight against the Chinese people are evoked.

    And Chinese sentiment against Japan has always been strong as a result of the latter's wartime atrocities. During the Asian Cup football championship held in China in July and August, the crowd regularly jeered the Japanese team, and supported any other team that played against Japan.

    Singapore also became the target of mainland Chinese ire when then-Deputy Prime Minister Lee Hsien Loong visited Taiwan (see my earlier post, "Lee Hsien Loong's Taiwan visit unleashes storm from China").

    Such expressions of negative sentiment are obviously unproductive. China may be an emerging giant, but it still cannot afford to alienate its neighbours and friends.

    Clamping down on the media, however, may not be the most constructive way of handling the situation. At a time when China is supposed to be opening up to the world, what the Chinese people need is more information, not less. And controlling the official media does not prevent negative sentiments from being disseminated through the Internet.

    Perhaps a more constructive way of handling the situation is by combating negative public views with positive ones. Government officials could point out the many benefits that China derives from its relations with Japan, such as investment and technology transfer, while downplaying past grievances.

    The only problem with this, of course, is that such a course of action requires more effort on the part of the Chinese government and takes longer for the results to become obvious.

    So it looks like we are stuck with China continuing to use the old technique of media control to achieve its official aims.


    Posted by lim_cs at 11:46 AM JST | post your comment (0) | link to this post
    Sunday, 26 September 2004
    Kidnapping rages on in Iraq
    Topic: Politics
    In the wake of the American occupation of Iraq, kidnappings have been occurring on a regular basis. More than 100 foreigners have been kidnapped in Iraq since Saddam Hussein was toppled about one and a half years ago, and about 30 have been killed. Many more Iraqis have also been kidnapped.

    Last week, two American civil engineers were beheaded, while another Briton is threatened with the same fate. In the same week, six Egyptians and four Iraqis working for the country's cell-phone company Iraqna were also kidnapped.

    Some experts think that these kidnappers are essentially interested in the publicity. Others think that common criminals have joined the fray, working with insurgents to profit from what has been called a "hostage economy" where political groups "outsource" the seizures to criminal gangs for money.

    Steve Casteel, the United States' senior adviser to Iraq's Interior Ministry, says that the terrorists use kidnapping to intimidate and enforce their will as well as impose a sense of insecurity on Iraqis.

    The media's role in promoting the kidnappings have also come under scrutiny. Most media companies outside the Arab world are now refraining from showing the most graphic and horrific scenes -- that is, the beheading -- but the mere reporting of these events give the terrorists the publicity they seek.

    As Lord Tebbit, the former Tory Cabinet minister who was himself a victim of terrorism in the Brighton bombing 20 years ago, said: "We let this dominate the news agenda. It's meat and drink to the hostage takers."

    Andrew Neil, the broadcaster and former editor of the Sunday Times, agreed, although he rejected calls for censorship. "We are playing into the hands of the terrorists... It seems to me they're rather sophisticated: they can see our TV on the web and our tabloids, and they know how it's playing. Having said all that, I see no alternative. In a free country with a free press we have to cover the news."

    Ultimately, stemming the kidnapping has to come from improved law and order in Iraq itself. How that is to be done is the key question.

    Christopher Beese, chief operating officer of ArmorGroup, a security company operating in Iraq, is not very confident that the question can be easily answered. "The Iraq situation is new. They are not looking for money," he said. "We have a new dimension facing us. It may well be that we do not find an answer to it."

    Casteel, however, believes the police will prevail if they "stay the course". But he cautioned that that could take a long time.


    Posted by lim_cs at 1:57 PM JST | post your comment (0) | link to this post
    Monday, 20 September 2004
    Eating habits and age
    Topic: Health
    A study by nutritionists at the University of Newcastle has found that adults eat twice as much fruits and vegetables as they did when they were children and take in less fat and sugar.

    The study, which is published in the academic journal Appetite, looked at the eating habits of 200 children aged 11 and 12 and then revisited the same people in their early 30s.

    The finding should not come as too much of a surprise. For one thing, adults are more aware of the health consequences of a poor diet. And the fact that the consequences are more imminent for them should provide them with greater motivation to improve their eating habits.

    Of course, knowing that adults eat more fruits and vegetables and less fat and sugar than children is one thing. The other question is whether they should actually start younger.

    Animal studies have shown that extremely low-calorie diets produce considerably extended life spans. Significantly greater life-span extensions are achieved when the low-calorie diets are started young than when started in adulthood.

    It is likely that a similar difference should apply to the high fruit/vegetable and low fat/sugar diet.

    However, animal studies also show that undernutrition in young animals also cause stunted growth. That is obviously not ideal for our children.

    It is not necessarily true that what is healthy for adults is also healthy for children.


    Posted by lim_cs at 9:59 PM JST | post your comment (0) | link to this post
    Saturday, 11 September 2004
    Religion retains strong hold on societies
    Topic: Society
    Religion continues to play an important role in modern societies. And I am not just talking about Islamic fundamentalism.

    True, the latter continues to be a source of religious militancy, not just in the Middle East but in South-east Asia as well -- witness the recent bombing near the Australian embassy in Jakarta, Indonesia that has so far left nine dead and well over a hundred injured.

    However, religion remains important even in Christian Europe.

    Recently, Serbia's education minister, Ljiljana Colic, ordered schools to stop teaching the theory of evolution, saying that in future Charles Darwin's theory would only be taught alongside creationism, the Bible's account of God's creation of the world. Ms Colic said the two theories were equally dogmatic.

    The newspaper Glas Javnosti quoted biologist Nikola Tucic as describing the ruling as "outrageous", and showing that Serbia's Orthodox Church was interfering in politics.

    "We are slowly turning into a theocratic state and in the 21st Century we are going back to the Book of Revelations," he told the newspaper. "There were attempts like this in several US states, but they were rejected. It turns out that our fundamentalists are much more successful."

    However, after protests from scientists, teachers and opposition parties, the Serbian government has decided to drop the move.

    The secular tradition remains strong in Europe, but at the same time, religious fundamentalism also retains a strong presence in most societies.


    Posted by lim_cs at 11:44 AM JST | post your comment (0) | link to this post
    Tuesday, 7 September 2004
    Tragedy in Beslan
    Topic: Politics
    Over 300 people were killed -- about half of them children -- by terrorists when they attacked a school in Beslan in southern Russia last week. The tragedy has brought condemnations from all over the world. It has also reminded everyone that the Russian occupation of Chechnya, for whom the terrorists are believed to have struck, remains a problem.

    The Chechens have been fighting against Russian rule for a long time, often through terrorist activities. In August alone, three incidents have been linked to them: two involving the explosion of passenger planes, one involving a car bomb.

    The Russian government's response has tended to be -- in the words of Jonathan Eyal, Director of Studies at the Royal United Services Institute in London -- "ham-fisted", using "brute force against the Chechens without offering a political process".

    After the tragedy in Beslan, Israel offered its help with counter-terrorism expertise. However, Israel itself is mired in clashes with the Palestinians, where reprisals follow reprisals in an unending cycle of violence. For a more comprehensive solution to the Chechen problem, the Russians must look elsewhere.

    As Eyal wrote in The Straits Times on 3 September, the fight against terrorism "must involve a judicious mix of force and politics". This is one lesson that the world already knows and should not need to have to re-learn.

    The cost of the lesson, as in Beslan, is often too painful to bear.


    Posted by lim_cs at 4:30 PM JST | post your comment (0) | link to this post
    Tuesday, 31 August 2004
    President Bush struggles to maintain trust
    Topic: Politics
    The US Republican Party began its national convention in New York yesterday to officially nominate Mr George W. Bush as their candidate for the presidential election in November.

    However, even before the convention began, protestors took to the streets of New York on Sunday in the thousands -- organisers claimed the number to be over 500,000. Some protestors carried signs saying "Support our troops -- send them home".

    Disenchantment over the handling of the war in Iraq was obviously a major reason for the protest. Other protestors were angry over the lack of jobs.

    James O'Toole, research professor at the University of Southern California's Center for Effective Organizations and former assistant to the secretary of health, education and welfare in the Nixon administration, has suggested perhaps a more fundamental problem that Americans have with the Bush administration.

    In an article for Fast Company, O'Toole wrote:

    President Bush has vacillated between contradictory approaches to leadership: realism and idealism... Realists and idealists can both be effective leaders. But one cannot be both at once. And that cuts to the heart of President Bush's problem. In the international arena, he first offered realist arguments for invading Iraq (the threat posed by weapons of mass destruction), then switched to idealist motivations (bringing democracy to the Middle East). Domestically, he pushed the idealist notion that taxes should be reduced to shrink government -- but later suggested, realistically, that a tax cut would act as an anti-recession stimulus.

    Such waffling has undercut the level of trust in President Bush's administration, even within his own party... The leadership lesson for President Bush -- and for any leader -- is simple: Followers don't much care if leaders are realists or idealists, but they distrust inconstancy.
    Inconsistent behaviour is a problem faced by many ambitious leaders. Intelligent, charismatic leaders usually know what their followers want them to say and do.

    However, in doing what their followers want, inevitably, all leaders will make mistakes at some point in time or other. Ambitious leaders feel especially threatened by such mistakes and, in their desperation to salvage their reputations, are likely to try to justify their actions even in the face of the mistakes.

    This is when they are most likely to "waffle" and shift positions, which in turn makes them appear inconsistent. And ironically, damage their reputations even more by appearing hypocritical and untrustworthy.


    Posted by lim_cs at 7:28 PM JST | post your comment (0) | link to this post
    Thursday, 26 August 2004
    Gene helps to burn fat
    Topic: Health
    Researchers have discovered how to alter a gene in mice that increased their stamina and enabled them to eat huge amounts of food without getting fat.

    Howard Hughes Medical Institute investigator Ronald Evans, leader of the study, said that it could lead to a pill that gives many of the benefits of exercise without the need to exercise.

    "It is a pill that, in part, mimics exercise. It mimics the metabolic activity associated with exercise," he told Reuters recently.

    The gene involved is called PPAR-delta, a master regulator of different genes. Activating this gene had been shown to help raise metabolism and fat-burning.

    Dr Evans and his colleagues wrote in the journal Public Library of Science Biology that they altered the PPAR-delta gene to stay in a permanently "on" position and then genetically engineered mice with it.

    The genetically engineered mice were able to run an hour longer than normal mice were, and when fed a high-fat diet, the normal mice became fat, while the genetically altered mice gained no weight.

    The mice grew more slow-twitch muscle fibres, which are used for endurance activity, as opposed to the fast-twitch muscles used for sprinting.

    Dr Evans said he is still studying the mice to determine the impact on longevity. With obesity linked to several age-related diseases like heart disease, diabetes and cancer, there is potential beneficial impact.

    The researchers used genetic manipulation in the study, but they also gave an experimental drug called GW501516 that also activates PPAR-delta. Normal mice given the drug could also eat a high-fat diet without gaining weight.

    In the fight against obesity and its associated diseases, these findings should be welcome indeed.


    Posted by lim_cs at 7:27 PM JST | post your comment (0) | link to this post

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