One of the problems with a "free economy" is that it offers many opportunities for scammers. This was first brought home to me when in 1983, my Bulgarian roommate (not of Bulgarian descent, but literally from Bulgaria) in New York came back to our Columbia apartment with what he thought was a great deal on a camera lens. He was from a communist country, and naively believed he was getting a good deal, when in fact he had bought a damaged lens. He was understandably angry that such illegal (or at least immoral) activity could occur in a major city. For him, this was an indictment of the "free" market. I just thought it was the result of his naivete and greed (for a good deal, "too good to be true"), and unscrupulous merchants, but agreed that it should be illegal, though it turned out there was nothing my roommate could do.
It turns out that there a number of types of scams that occur when you buy a house. Your purchase of the house, and the mortgage you take out, are all public information, so people take that information and try to cheat new home buyers. We got the following letter in the mail:
The letter looks like it comes from our bank, the Busey Bank. The phrase "Notice: Financial Information Enclosed" is actually misleading. Inside, it has a return envelope, with the official "No Postage Necessary" seal. It looks important and official.
Then the card inside seems official because it has our name and address, the name of the bank, and even the exact figure of our mortgage amount (I've redacted the personal information, even though you can probably find it somewhere on the internet). It implies that I have to provide this information to comply with a mortgage protection plan that I already have.
What is astonishing, also, is that this arrived just about 10 days after we closed on our house, and just days after we moved in.
Only if you read the fine print do you realize it is not from the bank. The fine print says: "Information provided by Mortgage Protection Division. Not affiliated with any lending institution. All mortgage obtained only through public records. Benefits and carriers will vary coverage and are subject to underwriting approval." This "Division" is the name of a company, not a division of my bank. Sneaky.
This is really a sales pitch attempting to get me to buy mortgage insurance. They want me to give them more information, including our phone numbers, so they can try to sell insurance. Fortunately, at our closing, when I signed for the mortgage, our banker told us to ignore all these junk mail solicitations, but my wife and I still found ourselves looking at these twice to make sure they were not important (once my wife simply handed it to me to take care of, thinking it was important--and she's a lawyer!) It is well known that mortgage insurance is a bad deal for consumers; but it is very profitable, as much as 40 percent return to the insurance company, which leads company to try to drum up this business, hence the junk mail.
It is sometimes difficult to draw the line between deception and advertising. Plus, attempts to protect consumers can end up hurting them. Lisa Servon has studied payday loans and argues that they actually provide a service to poor people, and should therefore not be banned, though well-meaning liberals increasingly push for such legislation. There are certain emergency situations where paying a high interest rate on a loan makes rational economic sense. J.D. Vance in Hillbilly Elegy gives an example where he took out a payday loan to avoid his rent check bouncing, which would have cost more than the interest he paid on his payday loan, not to mention the cost to his credit score.
So maybe I'm being like the well-meaning liberals who want to ban payday loans because they don't understand the needs of the poor, but I find it astonishing that deceptive practices like the marketing for mortgage loans are allowed. I suppose they are a price we pay for having a free and dynamic economy. Still, I also wonder how people in that industry sleep at night, knowing they are getting business by misleading customers, both in their solicitation methods (with the misleading letters) and in the products they sell (which are not as good as simple term life insurance). One thing is sure; I'm being very American in expecting the market, and indeed the world, to be fair. Most peasants have long known the world is unfair and that the elites are out to exploit and take advantage of them. I think my friends in Taiwan believe scams and deception are inevitable (even though most people are very honest in Taiwan). It is a sign of the society and times I grew up in that I can believe deception should be banned. For most people, it is all too common, a given of market life. And perhaps it is.
Monday, June 19, 2017
June 12, 2017, was the 50th anniversary of the US Supreme Court decision Loving v Virginia, which overturned a Virginia state law making interracial marriage illegal. It finally eliminated all such racial bans across the US. There was considerable interest in the case in the US (see for example here and here).
|Mildred and Richard Loving|
One aspect of the story that few people realize, and that I was not aware of growing up in the US, is that these racial laws are not that old. The law used against the Lovings was the “Racial Integrity Act” of 1924. I understood that the laws were “an instrument of ‘White Supremacy’”, as Chief Justice Earl Warren had written in his unanimous opinion, but I did not understand, growing up, that these laws had to be strengthened and reinforced to continue to mark the lines between the races, and indeed to create the lines. Many earlier laws had been repealed from the 1860s to the 1880s (e.g. in Illinois, Michigan, and Washington). Similar laws were repealed in 15 states between 1948 and 1965, in many cases probably because they also discriminated against Asians (California in 1948, Indiana 1965; see full list here). The Loving v Virginia case overturned anti-miscegenation laws in the remaining 16 states, mostly in the Deep South.
Many articles celebrating Loving Day, as it has become known, comment on the increase in frequency of interracial marriage. According to Pew, the rate has increased from 3 percent in 1967 to 17 percent today. Public opinion has changed too: according to a University of Chicago GeneralSocial Survey poll, only 14 percent of nonblack adults say they are “very or somewhat opposed” to a close relative marrying a black person, compared to 63 percent in 1990. (Of course, this is what they say to pollsters; the real number is likely to be higher, since there is strong social pressure to be non-racist--which is actually good.)
But it is worth looking more closely at these figures. First of all, it is striking that whites are the group with the lowest rate of intermarriage, just 11 percent, compared to 18 percent for blacks. For Asians, it is 29 percent, and for Hispanics it is 27 percent. Even more striking is that 39 percent of US-born Hispanics and almost half (46 percent) of US-born Asians marry outside their group.
As an aside, black men are twice as likely as black women to marry outside their group (24 vs 12 percent), while Asian women (36 percent) are much more likely that Asian men (21 percent) to marry out. (See details from Pew here).
Since whites are the larger group, it is perhaps not surprising that mixing is less common than in the minority groups. But I wonder if a good deal of the intermarriage is within “people of color” and thus not having as much effect on whites as might be assumed.
Furthermore, much of the supposed intermarriage may be between people who are already “mixed” themselves. A Eurasian man, born to an Asian mother and white father, will legally be considered Asian (the US government defines race matrilineally), but may not be treated as “Asian” in white American society. His marriage to a “white” woman will not raise as many eyebrows as his mother’s marriage may have.
Similarly, a white man married to a Cuban-American woman may be considered a “mixed marriage” because she checks the box as “Hispanic,” but in terms of phenotypic appearance, it is possible she could pass for white… or at least as Italian. It may not really be considered by their families as a "mixed marriage."
Gradually, American definitions of “race” have to change. Chief Justice Earl Warren had questioned the notion of a “pure race” in his questions to the lawyer for the state of Virginia, but the final decision did not address that issue, focusing just on the idea that anyone should be able to marry whoever they want. As one commentator points out, it is unfortunate that the Supreme Court did not challenge the very concept of race.
Dr. Seuss story of Sneetches with stars on their belly who discriminated against those who did not have a star. Technology to add and remove the star created confusion of categories, after which all lived happily together (see video of the story here). My father served in Puerto Rico during WWII, and he told me segregation in the military seemed ridiculous because brothers, with the same mother and father, would be assigned to “white” or “Negro” units, based on their physical appearance and the mood of the officer in charge on that particular day. Clearly “race” was a problematic category, and it undermined attempts to “keep them in their place.”
But ultimately, racism will be defeated through cultural change, not biological change. As in the story of the Sneetches, only when people agree to drop the categories will racism be overcome.
I heard a disturbing interview with Pat Buchanan on This American Life. Buchanan was asked how he felt that he had run for president three times in the 1990s and lost, but Trump took most of his ideas and won. (He said he was fine with it, happy the country is being saved.) In the interview, he defended his anti-immigrant position, a basically racist view, saying the country is already too divided, so the US should not let in non-white immigrants. He claims they do not assimilate. He thinks the US was better before 1960 when it was “majority European white” and when asked why he is against immigration, he says “I feel more comfortable with the folks [I] grew up with.” Until Trump’s election, these views were dying out with Buchanan’s generation. It remains to be seen whether the racism of the Alt Right is the last gasp of the reactionaries, or will be strengthened and emboldened by the Trump administration. In any case, I find it surprising and disappointing that intelligent people like Buchanan can say such racist things, fifty years after Loving v Virginia.
Friday, June 09, 2017
We are having some renovations done on our home, and the contractor’s site supervisor, who I’ll call John, had warned me well in advance that the drywall workers were very messy. He said he could not figure out why, but they were very dirty and did not bother to clean up the site. He warned me, and he was right.
There are two kinds of “drywall” workers: the ones that cut and screw/nail in the drywall onto the wooden frame, and the ones who use plaster to finish the wall. The second type of worker puts coats of plaster, which is called “mud,” to make the wall flat. They have to put on more than one coat, and then sand it to take out bubbles and make it smooth.
You can get a sense of what drywall workers do by looking at the pictures at this "how to" site here.
The drywall workers were all Mexican, and they worked very fast. They work on stilts so that they don’t have to move ladders and go up and down. But when they were done, they left a mess in their wake. There were scraps of drywall, screws, tools all over the floor. Once the mud work started, the powdered plaster was everywhere and splots of plaster covered the floor all the way down the stairs and outside the door. These blobs landed on the floor when they took breaks and went outside. There was even white plaster on the walk outside our house. Fortunately the floors were covered with “ram board,” which protects them. This was amazing; the workers who had done demolition had not created the same kind of dust and mess.
Part of the reason for the mess is that the plaster powder is dusty and hard to keep under control. Plus, when the workers mix it, bits of it easily go spinning out of the bucket as they use the electric mixer to prepare the “mud” to a proper consistency. And then the sanding will inevitably cause a lot of dust. Still, that is only part of the reason. Tile workers also have to mix grout and cut tiles, and they don’t make that kind of mess. And they don’t leave a trail of plaster when they take breaks.
John had told me that he could not figure out why the drywall workers were so messy. He said they were the only trade that was so messy. Carpenters, plumbers, everyone else cleaned up after themselves.
It might be tempting to give a “cultural” explanation, and say it is because the workers are Mexican. This would be false, because the tile workers have been working recently and they are meticulous and very clean, and they are also Mexican. I also hasten to add that these kinds of “cultural” explanations are at best misleading, more likely totally wrong. When I was a kid, it was an ethnic slur but taken as common knowledge that Mexicans were “lazy.” Now, it is universally accepted that Mexicans are very hard workers. I don’t think Mexican culture has changed in one generation. Similar changes have occurred to Western perceptions of Chinese culture; Chinese have gone from working hard but not efficiently or intelligently in the 1950s, to being frighteningly efficient and intelligent workers today. If culture changes that quickly, what kind of explanatory power does it have? No, it is the American perception that has changed.
I was curious as to what could be the cause of drywall workers being so messy, so I asked John how the drywall workers are paid. Just as I suspected, they are paid by the square foot. Piece-rate! In fact, I found out from our contractor that drywall workers charge extra if you want them to clean up. Cleaning up is not part of their job. It ends up being cheaper for the contractor to use her own workers to clean up rather than pay the drywall workers to do it. So, they of course do not worry about cleaning up. Tile workers are paid by the job; there are tolerances for how even the tiles need to be, so they cannot rush a job. And they keep the job site clean.
Economists and economic anthropologists know the importance of incentives. We take it for granted that incentives strongly influence human behavior. Many people know that, but many also do not, or do not think of it. People are often tempted to make generalizations about the “culture” of an occupational group, or an ethnic group. In fact, in this case at least, the “messiness” of the workers is easily explained by the incentives they are working under.
There is also an additional layer, however, that does relate to “occupational culture.” Our contractor mentioned that until the recession of 2008, drywall workers only worked on new construction projects. Small renovation work was not of interest to them. Renovators used to have to do drywall “in-house” (with their own staff). John told me that because it is dusty, and it is easy to get cut while cutting the drywall, most carpenters do not like to do that work. And those who specialize in it are very fast and efficient at it. Because new construction decreased dramatically after 2008, the drywall workers were willing to take smaller renovation projects. And since there is a lot of renovation work available, and they’ve gotten used to working at small jobs, they continue to do renovation work even though the economy has picked up again.
But their way of working seems to still be that of work on new construction. As John put it, they seem to forget that there are people living in the house they are working on. In a new construction site, it does not matter if plaster gets on the floor, because the floor probably has not been finished, or even laid. It is different in a renovation, and it seems these workers have not modified their work practices. Maybe we could call this an occupational culture of "messiness" that carries over from working on new construction.
Many people are telling me that the labor market is getting tight. Indeed, my contractor told me that there is now a shortage of labor. She has trouble finding good carpenters. She said that the carpenters they get are often older; young people want a desk job, or something with computers. Yet, carpenters can make a good salary, easily $70,000 per year, she says. Her husband (who does office work for her renovation business) has pointed out that the tradesmen are in much better shape than he is, because they are always moving. Desk work is not very healthy, actually. But Americans tend to look down on physical labor, even on highly skilled work, much like Chinese do. Young people are less willing to go into the trades. There probably is some "cultural" bias at work, but I suspect that salary is still higher for most office work, and contributes to this bias.
If we look at government wage statistics, we can see that while an experienced tradesman can make a good living, managers in office jobs can make more. Here are the annual mean wages for a few trades:
“Installation, Maintenance, and Repair Occupations:” $46,690
Cabinetmakers and Bench Carpenters: $34,800
This is higher than wages in Sales (average $40,560, but only $25,940 for Retail Sales Workers), and higher than wages in “Office and Administrative Support Occupations” (average $37,260, and $33,010 for “Office Clerks, General”). On the other hand, “First-Line Supervisors of Sales Workers” average $51,230, and “First-Line Supervisors of Office and Administrative Support Workers” make $57,890, so it may well be that young people are anticipating higher wages down the road when they can become supervisors, rather than focusing on the average wages of workers.
The case of messy drywall workers shows the importance of incentives (they are paid by piece-rate), but also the effect of occupational culture (they are used to work on new construction projects). Added to all this is the perception of work (of drywall work being dusty and “dirty,” and of construction and physical labor being less desirable than office work). “Culture” ends up being used in many different ways to summarize the current situation, and often does not really explain anything, but provides a hook for our description. As this example shows, there are many factors that influence "culture," so just calling it "culture" can be a circular explanation. We’re still struggling to describe all these factors clearly, especially how the different factors interact with each other.
Friday, May 12, 2017
A story about airline seats caught my eye, because it tells us something about markets. CNN Money reports:
American Airlines is planning to decrease the front-to-back space between some of its economy class seats by another two inches.
The airline says it plans to add more seats on its coming Boeing 737 Max jetliners. To do that, it will shrink the distance between seats, also known as pitch, from 31 inches to 29 inches on three rows of the airplane, and down to 30-inches in the rest of its main economy cabin.
With the change, American will become the first large U.S. carrier to offer legroom with a pitch that's nearly on par with ultra-low cost carriers Spirit Airlines and Frontier Airlines. Those seats are an industry minimum 28-inches apart.
By comparison, economy class pitch on Delta Air Lines and United ranges between 30 and 31 inches, while JetBlue Airways, Southwest Airlines and Alaska Airlines have between 31 and 33 inches.
As the big airlines match each other move for move, the risk is that 29 inches becomes the standard for flying economy in the United States. American has been a bellwether before for the airlines. For instance, it was the first big U.S. airline to introduce bag fees in 2008.
Airlines have enjoyed strong profits and low fuel fuel prices after a decade of consolidation. They're adding seats now to help offset rising employee wages.
"This is one of the best economic environments the U.S. airline industry has seen in decades," said Harteveldt. "There is no need to race to the bottom."
But a race to the bottom is indeed what we have. Interestingly, because humans are really just animals, one way you can see we are getting to "the bottom" is the increasing number of cases of violence that have been breaking out, in airplanes and at airports, as humans are increasingly stressed out by the travel conditions (see recent cases of Dr. Tao, a fight on a Southwest Airlines flight caught on video, fights due to frustration with Spirit Airlines' cancellations, and of course the infamous case of Dr. Dao, about which United Airlines has apologized (and paid compensation).
Airline violence has been a problem in China in recent years, too. According to the SCMP in 2013, Hong Kong Airlines reported that they had incidents of violence on flights between Hong Kong and China an average of three times per week, and so started teaching their flight crew martial arts.
In China, passenger violence is usually blamed on the "low quality" of Chinese tourists. Certainly, manners and "education" are important in preventing people from fighting all the time, but the stress of being in crowded spaces, of not having control, and being among strangers, all lower any person's trigger point for overreacting and even violence. (BTW, on the strong reaction to the Dr. Dao United incident in China, see this very insightful commentary).
In the US, there is a religious faith in the power of the market to solve everything. And indeed, market forces have reduced airfares and really created a much larger and more efficient industry. Where flights need to be negotiated by international agreements (e.g. between the US and China), prices are often inflated by the lack of competition. But what we see with airline seats is a market failure. American Airlines discovered many years ago that while consumers overwhelmingly say they want wider seats and more leg room, they are not willing to pay for it. They tried to meet customers' demand, but found that when they went to buy tickets, consumers preferred to save the money. This is especially true now with the internet, where it is very easy to compare prices. Expedia and Kayak and other travel sites all list fights by price; they do not list leg room (known as seat pitch).
So airlines start charging separately for baggage, and for choosing your seat, so the ticket can actually look cheaper when the customer goes to buy it. To some extent this is the way the market should work: people pay for what they want, and poor people (and students) take the middle seats.
But the pressure to reduce costs also gradually makes the airlines stuff as many passengers as they can in an airplane. Customers gradually get used to the newly crowded conditions--except those that lash out. Only some sort of industry standard will prevent airlines from continuing to reduce seat space. (I can foresee extra charges if you are fat, wide, or "excessively" tall; that is the natural next step). Congress told the airlines that either they come up with rules or congress will do it for them.
The problem is that since so many people "believe" in the free market and do not understand that in some cases markets can fail, I don't see this being solved any time soon. A Red State columnist even criticized congress holding hearings on the United incident, predictably claiming any government interference would just raise prices for consumers and not improve service. Congress did hold hearings, and both Republicans and Democrats criticized the airlines, but it seems even this issue will be political, with Democrats calling for regulations and Republicans against regulations. The possibility of a free market with some regulations to set minimum standards is impossible to achieve. American Airlines reducing their seat size right after the hearings in Congress seems to prove that this market failure will not be solved or even addressed any time soon.
Friday, May 05, 2017
I heard a very interesting NPR Fresh Air interview withRichard Rothstein yesterday on the podcast while doing errands (transcript here). He has just published a book that shows how US federal government policies during the New Deal (1933-1941) had systematically discriminated against Blacks. He noted, for example, that the term “redlining” referred to government maps that had neighborhoods marked with a red line where government loans were not allowed because residents of those neighborhoods were Black. I thought I had heard him on Fresh Air before, so I googled his name. Sure enough, I found that he was a guest on Fresh Air almost two years ago.
In my google search, I stumbled across a right wing blog by Jack Coleman of the Media Research Center’s “News Busters” (which claims to expose "liberal bias") that has a severely distorted take on Rothstein’s argument, and it—and especially the comments section—show serious lack of understanding of social forces.
First the distortions. Coleman begins by implying that though FDR is an iconic leader for liberals, his record with the New Deal is problematic. He then includes a transcript of sections of the Fresh Air interview, with key parts in bold, to highlight the facts raised by Rothstein. These facts (accurately reported) include:
- The Public Works Administration of the New Deal had explicit segregation policy, “So public housing policy created racial segregation where none existed before.”
- The Federal Housing Administration would not give loans to Blacks, so the suburbs that sprang up after WWII were all white.
- “Public housing became all-black in the inner city. And these two policies -- of public housing and Federal Housing Administration subsidization of suburbs -- are the two major factors that have created the segregation that we know today.”
Coleman also highlights a part of the interview where Rothstein mentions that George Romney (Mitt’s father and former governor of Michigan) had tried, as Nixon’s Secretary of Housing and Urban Development, to only offer federal funds to communities that desegregated, but was blocked by the Nixon administration. He somehow thinks this exonerates Republicans from being charged with racism; seems to me it only exonerates Romney the Elder. Coleman also notes that unions prevented Blacks from joining, and that this discrimination was endorsed by the National Labor Relations Board, so was not merely a local action. Only after 1964 was this reversed. Again, this is supposed to indict all labor unions (American conservatives hate unions), but my take is that racism was deep-seated and made worse by state action, not that racism was somehow inherent in labor unions.
Rothstein’s point is made clear when he notes that for most Americans, homeownership is the main way that wealth was created and accumulated, and since subsidized home ownership was not possible for Blacks, it resulted in much lower levels of wealth for Blacks. While Blacks earn 60% as much as whites, they own only 5% as much wealth as whites. This provides Blacks with less of a buffer, which is why Blacks suffered more than whites from the Great Recession of 2008.
(As an aside, Rothstein repeats many of these points in his 2017 interview, including these 60% and 5% numbers. I checked the transcripts to see if the 2017 interview was not a repeat of the 2015 interview, but it is a new interview, albeit with some repetition. A good interviewee knows how to tell a story and focus on the core message, even if he/she is repeating himself. If I had been interviewed, I might have assumed listeners had heard me the first time, or would be annoyed by my repetition. As it happens, I only vaguely remembered the first interview, so he was right to repeat himself.)
Coleman’s take on all this is to imply that liberals have suppressed this information because it conveniently “perpetuates the myth that the Republicans are solely responsible for racism in this country.” This “myth” is, in fact, a surprise to me. A myth of a myth. While the Republicans are indeed the party of racism today, they were clearly the opposite from Lincoln through to Eisenhower. Coleman displays fake surprise that a Berkeley professor would do such research, and that such a story would end up on “liberal media.” This is rather disingenuous, since it is liberals in general who are concerned with questions of inequality (conservatives assume a free market would reduce inequality; they do not believe Picketty). Coleman likes the story only because he thinks it undermines the ideals and practices of the New Deal, which conservatives love to hate.
Implicit in Coleman’s critique is also the idea that if it had not been for “government interference,” there would not have been any discrimination. That is not how most liberals will take this story. They will see it as a case of how despite the liberal intentions of the FDR administration, Black interests were sacrificed because of racist notions at the time. Liberals will not see this story as undermining the New Deal. But conservatives are right that “good intentions” and government programs have the potential to cause great harm. Of course, not acting can also cause or perpetuate great harm.
The most up-voted comments to Coleman’s blog shows that right wing Americans are intensely individualistic. One comment is a resentful attack against “victimhood”, particularly of “blaming conservatives and Republicans, and whites in general.” Addressing Blacks, he/she says:
Stop blaming whites, stop blaming slavery, stop blaming Jim Crow and segragation [sic] and start taking an independent initiative to make a better life for yourself and your family. Continue to blame whites and don't be surprised to find your children and grandchildren still living in ghettos for generations to come.
A comment to this comment says:
Until a spotlight is turned on black inner city culture...nothing will change. It's not about race...but it's always been about culture. Getting an education, being married, and bringing up your children to do the same is a large part of the answer. Why can't anyone say that in public today?
Because it is simplistic and wrong?
That writer falls back on the common “blame the victim” argument: Blacks are poor because of their individual behavior, because of their (implicitly) dysfunctional culture. Americans are intensely individualist and ahistorical. These commentators are not interested in how the past affects the present. Interestingly, they are not even following the logic of the blog (and the book), which is that federal government intervention made poverty worse for Blacks. These readers assume that by getting an education, being married, etc., one can single-handedly pull oneself up by the bootstraps, as the expression goes. The institutional factors like redlining that disadvantaged Blacks are completely ignored. While Rothstein is making institutional racism even more dramatically clear with his research, these commentators insist on individuals being Horatio Alger. They are saying, OK, racism happened, but get over it! Move on! If only it were so easy.
There are important individual choices that each person makes that affect their lifecourse. But any basic social science course (by which I mean sociology, anthropology, political science; not economics) will also teach us that we do not make these choices entirely freely. Interestingly, conservatives in Europe are more aware of the importance of institutions and historical forces in shaping our individual choices. American conservatives have perhaps studied too much economics, and reduce everything to the individual. We need better ways of integrating the structural forces of society with individual choices. This has, in fact, been one of the main issues in anthropology over the past 40 years. But there is little hope for the US politically if many people cannot see structural forces, and even misread research like Rothstein’s and think it only means individuals need to make better choices.
Wednesday, April 26, 2017
I went to see a dentist, since it has been over six months since I saw my dentist in Hong Kong. The experience with the dentist has left me mulling over the differences in medical systems.
We had a great dentist in Hong Kong. My wife’s insurance paid for dental care, and it was not that expensive; the cost was about US$120 per visit. I never understood how Dr. Leung stayed in business (and sent his sons to private international school, and to private universities in the US), since he had an office in Central, and a receptionist plus two assistants, yet he did all the dental cleaning and consultations himself.
About 10 years ago, he got headphones so you could listen to music while he cleaned your teeth. Then about 5 years ago he got video goggles, and then a video screen, so you could watch videos. I think young people got more hip music, but I got the likes of Yanni. I loved that Dr. Leung explained everything thoroughly, and that he was very conservative. He did not do anything unless it was really necessary, and did not suggest additional treatments or cosmetic upgrades.
In Saint Louis, I had to pick a doctor from a list of doctors provided by our insurer. It took over two hours to find an appropriate dentist, because the list had minimal information and I had to google each one. I eliminated all those that said they had over 35 years of experience—yes, I admit to being ageist, but I recently read an article that recommended doctors with some experience but not too much time away from their training. I also wanted a dentist reasonably nearby. One practice I called only served children—that was not clear on my list or on their website. Finally I found a doctor I will call Dr. Smith. She had about 10 years of experience, and I was able to make an appointment for the following week.
First thing I noticed was that even to make the appointment, I had to give them all my insurance information. Then, when I arrived and spoke to the receptionist, I was asked to sign an electronic reader three times, even though I was not shown the text to which I was agreeing. I thought this was a bit odd. I always grumbled at the Hang Seng Bank that they made me sign a blank form before they entered my information, and I did not expect to have to sign with no statement in the US. Ironically, one of my signatures was supposed to indicate that I accepted HIPAA, the national privacy rule. I commented to the receptionist on how weird it was that I was signing a privacy release form without seeing the text, and she said they would print a form out for me later. They did. Of course it is four pages long, in small type, so I guess they don’t want people like me to actually stand there and read it.
As an aside, the form says in 13 languages that you can call for assistance in other languages. The line in Chinese is in traditional characters, and seems to be written by some non-thinking bureaucrat. It literally says, “Note: If you use traditional Chinese characters, you can receive language assistance service. Please dial 1-800-XXX-XXXX.” (注意: 如果您使用繁體中文,您可以獲得語言援助服務. 請致電 1-800-XXX-XXXX.) What does "traditional characters" have to do with it?! Why did it not just say “If you speak Chinese…”?! Plus, all mainland immigrants must feel left out, since it is in traditional and not simplified characters! And it does not specify whether the service is in Mandarin, Cantonese, or any other "dialect."
I was then brought into a room for X-rays. They took a panorama of my mouth, and then an image of each pair of teeth, so lots of X-rays. The assistant assured me because the machine is digital and does not use film like they did in the old days, the amount of radiation is less than what I would get from a sunny day. It was a more elaborate process than at Dr. Leung’s.
Then I was moved to a consultation room. When I sat down, someone else’s records were on the computer screen in front of me. Ha! I wonder if that is allowed under HIPAA. The assistant quickly changed the records to mine, and I waited a few minutes until Dr. Smith came in. She told me that my teeth were fine, and that one sensitive tooth is actually fine. Then she said the manager would come to see me. I wondered, why?
The manager came, and then I understood. She used the computer screen to show me what each of my cleaning processes would cost, and was covered and not covered by my insurance. Most bizarrely, the first column was the “list price” and the next column showed the discounted price negotiated by my insurance company. The third column showed what the insurance company would pay, and the fourth and last column showed the portion I would have to pay. She said there were three levels of cleaning, including a top level “laser cleaning” which is not required but highly recommended. The screen showed that for the top level, I would have to pay for it entirely—the insurance did not cover it. Bizarrely, the prices are for one quarter of your mouth, so each procedure is listed four times. Turns out, my insurance only pays for the basic cleaning. How am I supposed to decide whether I really need the laser cleaning? I decided to try it once. But I had to schedule a separate appointment for the cleaning. It had taken an hour for the initial consultation, and it would be another hour for the cleaning. Dr. Leung does the cleaning in 30 minutes. He works and moves very fast. The technician is more deliberate. Not sure which is better. I’m happy with a technician doing the routine cleaning, but I know some people prefer to have the “real” dentist work on their teeth.
Another interesting difference is that both my dentist here and the technician wore a special kind of magnifying glasses with an LED light in the middle of the forehead. They are called dental loops and my technician told me they cost over US$2000. At the same time, and probably because of the LED light, they had me wear yellow safety goggles while they worked on me.
One advantage of being in the US is that it is much easier for me to chat with service personnel, and I enjoy that very much. Hierarchy and language differences made chit chatting more difficult for me in Hong Kong. On the other hand, some of the conversations here are kind of strange. My dental hygienist was shocked that I had lived in Hong Kong, and that I could survive 15 hours in an airplane. She admitted that did not like leaving home, and said that when she goes to Florida for a vacation, she worries something might happen and so as soon as she arrives she begins planning how she would escape. This is not Hong Kong, where people dream of vacations in Thailand. (In fairness, people in Missouri also dream of tropical vacations, but in the Caribbean).
I realized once I had the cleaning done that Dr. Leung charged about $130 for the same process, but just my portion of the bill here was almost $400! The insurance paid another $600. It is not like Hong Kong is a poor country with a lower cost of living. It is hard to understand why the cost in the US is so much higher for medical care.
Elisabeth Rosenthal, who was the NY Times Beijing correspondent for 6 years in the 1990s, has written a book on the medical system. I heard her speak on NPR’s Fresh Air where she talked about the problems of the US’s medical system. She was a physician before becoming a reporter, initially as a medical reporter before becoming an international correspondent. She is very clear about the ways that medicine is not a market like automobiles. She notes that a for-profit health care industry will seek to treat a medical condition, not to cure it. A cure for diabetes would wipe out a billion dollar industry. She also explains how prices will rise to whatever the market will bear, and they never go down (“sticky prices”). The Republican faith that market competition will solve all of the US’s health care problems is simplistic at best. I found the process of finding a dentist and choosing service to be quite time consuming—and I can’t really say I chose intelligently.
Now my dentist has recommended I see a surgeon about a cyst above a tooth. Dr. Leung knew about that tooth and said we’d just watch it. I suspect the surgeon will want to operate. My cousin, who is a surgeon, has told me that surgeons believe they can solve any problem with their scalpel. That’s why they’re surgeons. So if the oral surgeon recommends an operation, is it just a way for him to drum up business? Do I really need this surgery? I may have to ask Dr. Leung.
Thursday, February 23, 2017
Yesterday, I joined several hundred volunteers at a Jewish cemetery, the Chesed Shel Emeth Cemetery, in University City, for a clean-up. Over the previous weekend, 154 tombstones were knocked over in an act of vandalism that may have been anti-Semitic (see video of the damage here).
I now live in University City, and with all the hate going around, I decided to go to help and to make a political statement against prejudice and hate. Police do not know who did the vandalism. While usually anti-Semitic violence is accompanied by painted swastikas and other obvious messages, there was no such symbolic message other than the overturned tombstones. It could be just the work of mischievous youths, but the large number of vandalized tombstones suggests it might be a hate crime. Police are still investigating.
The cleanup was organized for Wednesday afternoon, and the new state governor, Eric Greitens, was scheduled to speak at 3:00 pm. Greitens himself is Jewish, and it is important for leaders to speak out against such vandalism and hatred.
Anticipating a crowd, I arrived early, at 2:30, and was surprised by the heavy police presence. Then I was surprised that we had to go through security screening. While in line, some started to speculate that Vice-President Mike Pence might be attending, since he was already in St Louis for another event. When I saw that we were being screened by a Secret Service agent, I suspected that might be correct. And when we saw over a dozen police cars arriving, we knew that was likely the case. The Secret Service agent made us remove all our metal from our pockets, and then checked us with a metal detector. Once passed security, we were given a colored sticker: I was in the yellow group, assigned to clean up a drive and clip a hedge at the south end of the cemetery.
Pence and Greitens came from a side entrance; they came to the center of the cemetery and stood on the back of a pickup truck and made some brief comments. (See local newspaper story here) Greitens said that the vandals do not represent Missouri, but that we, the volunteers, did. He also said that he had spoken to President Trump that morning and that he had been told by Trump to thank us for fighting anti-Semitism. Pence also said that the volunteers represent what is good about America. Both were brief and made appropriate and good comments.
The NPR radio report said that Greitens and Pence joined the cleanup and the interfaith ceremony afterwards, but they did not (the longer online article was accurate, so this was no doubt an editing error)[Correction: they did use a rake for a few minutes for a photo op]. They left after about 15 minutes. But I do not begrudge them that; they have more important things to do, and it was already good that they came to emphasize opposition to anti-Semitism and hate.
But I can’t help but feel like Pence was largely whitewashing the Trump administration’s responsibility for the rise in hate. Just last Thursday, Trump refused to answer a question about anti-Semitism from a Jewish reporter, telling him rudely to sit down (see NY Times story here). Two days ago, an article in Slate.com referred to Trump's "disturbing dalliance with anti-Semitic rhetoric". Trump is largely responsible for the rising climate of intolerance and bigotry that is returning to the country.
The St Louis Post Dispatch article said Pence and Greitens received “resounding applause” at many points, but that was not my impression. I thought it was clear the response was muted, and only a few people were very loud in cheering when Pence introduced himself saying, “I’m Mike Pence, and I’m the Vice President of the United States.” Of course, we were in a cemetery, and it was a somber occasion, so it was not the kind of place where you would cheer loudly. Still, I don’t think most in the crowd were strong Trump fans. And while most people were no doubt happy that leaders were taking this attack seriously, many must have also thought, as I did, that it was a bit late to condemn such violence. After all, Trump stoked white resentment and never spoke up against the KKK and other hate groups. So it is a bit disingenuous now to be surprised and saddened by what he has sown.
As he left, Pence shook hands with many in attendance. He walked right by me, and shook the hand of one of the friends I was with. But I stepped back, as did another friend. I could not bring myself to try to shake his hand. Power attracts, but I felt I would be a hypocrite if I shook hands with this politician who was responsible for anti-LGBTQ laws in Indiana, as well as reactionary economic policies. I’m told Pence is a good person, but I profoundly disagree with him on many issues. While I was glad he finally spoke out against hate, and relieved that this was finally something all could agree on, I still found his administration partly responsible for the environment that makes such hate and vandalism more likely. Maybe I’m just adding to the polarization of the country. But just maybe, sometimes, we have to make moral statements.