Tocqueville and Ireland

When I first returned to my ancestral home in Ireland, Mohill, what struck me was that the Protestant Church was lavishly built and the graveyard was tine and aside the Church. The Catholic Church had been built atop a hill and looked like so many Catholic Romanesque Churches in the US after WW II, red brick, long, crowded, lots of kids. The graveyard was down the street a piece, massive in size, hundreds if not a thousand or more gravestones, not as ancient as the Protestant Church. Those facts told a great deal as to what had transpired under centuries of brutal English occupation.

Tocqueville visited Ireland in the summer of 1835, after his trip to the States, and he recorded the brief trip in some notes transcribed and translated into his Journey in Ireland, translated masterfully by Larkin. This is a wonderfully written book, with a sense of immediacy and presence. It is the contemporaneous reflections, not the deep thought of his American journey. He recorded what he saw when he saw it.

On p 11 he states:

The Protestant minister is in general a holy man, whom God has not overwhelmed with work; he has twenty or so thousand francs [£800] income, forty parishioners, and a small gothic church, which is built at the top of the park. The Catholic priest has a small house, a much smaller dinner, five or six thousand parishioners who are dying of hunger, and share their last penny with him; and he fancies that this state of things is not the best possible one. He thinks that if the Protestant minister had a little less and the poor Catholic population a little more, society would gain by it, and he is amazed that five thousand Catholics are obliged to pay twenty thousand francs in taxes to support the religion of forty Protestants.

Tocqueville reflects upon the reality of the situation. At that time the starving Irish were forced to support the English Church of some small but elite class.

On p 49 Tocqueville states:

I have not yet met a man in Ireland; to whatever party he belonged, who did not acknowledge, with more or less bitterness, that the aristocracy had governed the country very badly. The English say it openly, the Orangemen do not deny it, the Catholics shout it at the top of their voices.

I find that the language of the aristocracy proves it more than all the rest. All the rich Protestants that I saw in Dublin speak of the Catholic population only with an extraordinary hatred and contempt. They are, to all intents, savages incapable of recog­nizing a kindness, fanatics led into every disorder by their priests.

Now, these same people who hold such language are those who have held, and still hold in part, the whole government of the country. How to expect that people animated by such feelings and imbued with such opinions rightly or wrongly, 1 do not know, can treat with kindness, country's money.

Aristocracy, British Aristocracy, was the burden of those occupied, distant owners of land who oppressed the people who tried to scratch an existence from land which could never again be theirs. The lands were taken from them and distributed to those friends of the crown, deprived of any means of existence, the people for centuries managed a mere pittance of a life, lower than slaves in England, they were not even considered as property. Their overseers thought them less than human, livestock had more value.

On page 51 Tocqueville states:

Asked if there is a Catholic church. Answer yes, a mile away. The parish is very large. A parish priest and two curates. Asked how many Protestants in the parish. Answer three. Where is the Protestant minister? He lives in Waterford. Do they still pay the tithe? No, they stopped paying it three years ago. How much did the tithe amount to? 10 shillings per acre of wheat or potatoes. 8 shillings per acre of barley. Meadows were exempt.

Mr. Plunkett, a Dublin lawyer, told me today (22 July 1835) it is only since 1782 that the Catholics can own land. Before that time the law prevented it. One should not be surprised therefore that the Irish population is so completely excluded from the land and that it is so little divided up.

Tocqueville is often amazed of the brutality amongst the locals but he seems from time to time to understand it. As noted above the notes the prohibition on land ownership until 1782. The over-abundance of Catholic clergy, the absentee nature of the Protestant.

On p 59 he states:

We went to see today (14 July 1835) Msgr. Kinsely, bishop of Kilkenny. We found him very simply lodged. He told us: My revenue is not large and still less fixed. 1 have only what comes to me by the voluntary gifts of the faithful, but 1 can sometimes give a dinner. I have a gig and a horse. I find myself rich enough and 1 would despair if the state wished to pay me. Last spring I went to London for the sole purpose of preventing such a measure from being proposed. It would break the union that now exists between the clergy and the people. Now the people regard us as their own work and are attached to us because of what they give us. If we received money from the state they would regard us as public officials, and when we should advise them to respect law and order, they would say, they are paid for that.

Monsignor Kinsley added: In 1828 I was in France. On arriving Rouen I saw two sentries at the gate of the archbishop. What is that? I asked a French ecclesiastic who was accompanying me. It is a guard of honor for the archbishop. I do not want such guards of honor, I explained, they make [people] think your archbishop as a representative of the king.

The observation here tells mountains. On the one hand the clergy understands the need for separation of Church and State, in fact it would be the only way. On the other hand the Irish clergy immediately saw the problem in France by its proximity and possible collusion.

Of all of Tocqueville’s works this one is the freshest, most observant and worth a read at any time.

Medicare and Pundits

The NY Times opinion writer Brooks again repeats a distortion regarding Medicare. In my paper of 2 plus years ago on Medicare Myths I demolished this myth, as reported subsequently in the Washington Post.

Now Brooks states:

According to the Urban Institute, the average couple in 2010 had paid $109,000 in Medicare taxes during their working years but would be able to receive about $343,000 in benefits. A chunk of that $234,000 gap will be paid for by their grandkids. That should weigh on the conscience of every American over 55. You’re supposed to help your grandkids, not take from them. 

Let us not go through the details let us just do a simple reality check. Let us do the following:

1. Medicare collects 3% of our total compensation each year.

2. Assume that the Government never invests this, in reality it just spends it, so no interest.

3. Let us assume that at 65 the worker has worked 45 years. Not a bad assumption.

4. Let us assume that they were paid the same every year, so their total salary was 45 X. They contributed 3% of 45 X. Brooks quotes that as $109,000.

5. Now solve for X.

X=$109,000/(45*0.03)=$80,074 per year.

Thus anyone making less than this has paid in less and similarly any one more than this pays more.

Now for benefit:

1. At 65 your life expectancy is 16 years.

2. Your averegae Medicare take is $11,000 per year.

3. Your total take is $176,000.

4. You over benefitted by $67,000.

But the Urban Instituted inflated the payout but did not do so with the pay in! Rather unfair I believe. Also the problem is that poorer people are more unhealthy, obesity etc. The poorer get more and pay less. Can we correct that, perhaps.

But the assumptions and facts in the above are almost totally wrong, so let that be, after all it is just the Times and furthermore it is just some opinion writer as well, we could expect no more. In reality the analysis is a bit more complicated, as is most of reality and yes, many people get a deal, and well Mr. Brooks many people get to pay for the others. And for those of us fortunate to be health and to still work past 65 we collect zero and pay 3% till the day we die.

Is the system fair? I do not know but at least we should all deal with the facts. Brooks seems to continuously ignore them. The Urban Institute has an agenda as does Brookings. Why follow that agenda.

Patents and Their Value

I have a mixed view of patents. On the one hand it creates the patina of value for ideas. On the other hand it is an invitation for endless litigation. I have avoided patents my entire life, I publish and let the document suffice, or I have donated my patents to MIT if they see so inclined.

I feel this was due to my time on patent cases. In one I just happened to keep my lecture notes from the 1960s and in them I described a certain general implementation which some company thirty years after the lecture made a claim to have invented. It was common knowledge in the 60s but somehow the PTO never caught on.

But in the process it costs many entities millions each. To no avail in the end.

The NY Times has a telling piece on patents worth the read. As the Tomes aptly states:

One option is judicial activism. This year, Judge Posner, in an Illinois federal court, tossed out patent arguments made by both Apple and Motorola Mobility in a 38-page opinion that dismissed a lawsuit between the two companies. Cleaning up the patent mess, Judge Posner said in an interview, might also require reducing the duration of patents on digital technologies, which can be as long as 20 years. “That would make a big difference,” he said. “After five years, these patents are mainly traps for the unwary.” 

Ideas have also come from policy experts and Silicon Valley. The Federal Reserve Bank of St. Louis recently published a working paper calling for the abolition of patents, saying they do more harm than good. 

Another idea is to create different classes of patents, so that some kinds of inventions, like pharmaceuticals, would receive 20 years of ironclad protection, while others, like software, would receive shorter and more flexible terms.

In my view the patent is a double edged sword, on the one hand it conveys ownership and on the other it stifles creativity. What the best solution is one can but guess, however the problem is real. Anyone who develops technology recognizes the quick sands that are afoot, one cannot review all prior art, it is too massive, and ultimately one may accidentally cross a line set up by the PTO. On the other hand there are the patent collectors who set out to sue no matter what. Clearly the system is near being broken. How to fix it is the question.

Understanding Health Care Costs

In the current JAMA there is an article describing how medical students should have a better grasp of the costs of health care especially the complexities of many procedures.

The article states:

Teachers can demonstrate the consequences of seemingly simple decisions. For example, an order for an inpatient chest x-ray requires the following: someone schedules the test, someone informs the patient that the x-ray is being done and why, someone transfers the patient from the bed to a stretcher or wheelchair and transports him or her through hallways to the radiology department where the patient spends time alone in the holding area, and then someone leads the patient through maneuvers to obtain the radiograph. These steps are reversed to return the patient to his or her room. A radiologist interprets the image and creates a report. The clinician who ordered the test examines the report and then makes a decision based on that information. Then, the patient and often several family members need to be informed of the findings and how those findings will affect the next steps in care. This is not a simple process. Now multiply this by the number of patients under a team's care and the number of tests ordered for each patient. 

Consider the challenges of more complex diagnostic tests, such as colonoscopy. Then think about the influence of the patient's age and health status on that process. Having students observe each of these steps for tests they order on some of their patients would emphasize the effects of those decisions on patient comfort and resource utilization. This exercise would complement the strategy of showing trainees the prices of ordered health care services, an approach that has produced mixed results on cost reduction. It does so by translating prices in monetary units into real resource (primarily labor) requirements.

In 1991 I wrote a paper with Mike Sununu which examined the  number of steps in performing a nuclear scan (see the steps above). We examined ways to reduce the steps and in turn the costs. The article in JAMA raises a much larger set of issues. Health Care providers as a result of Government regulation as well as legal liabilities are often forced to go through steps so arcane and complex that they drive costs to extreme levels.

Health Care administrators all too often focus on collecting maximum benefits and fails grossly to address the issue of cost reductions, and they do not understand the work flow environment. The JAMA article establishes a paradigm for a set of simple procedures. However the overhead is exploding. As we have shown in a prior posting the only growing industry is health care, not because we provide more and better care but simply because it is so complex and arcane. No business person would tolerate such inefficiencies. However it is the Government which all too often makes this worse, just look at ACA.

With the EHR now coming to the fore, I observe several phenomenon, they drive costs up and care down. Namely the use is as follows:

1. The physician enters the data looking at the screen and not the patient. Osler would not at all be happy.

2. A second person follows the physician around typing into the system.

3. A physician takes notes and then has another person transcribe them after the fact into the EHR.

The variations go on. I have yet to see an EHR provide useful information for patient care. It is now just one more added burden. Using the work flow analysis as described above one could readily calculate costs, the benefit is de minimis but the cost is extraordinary.

Digging Into The Details

We have dug a bit deeper into the details of the employment report and show them here for a more detailed understanding. Above we show the breakout by sector as of September. Also just look at the total percents in Govt and Ed/Health.

A closer look at Government and Education/Healthcare shows continuing explosive growth in Health Care.

This I believe will be a serious problem going forward and will be uncontrollable unless major changes are made and that includes the removal of ACA and its demands.

The above shows the change from the beginning of the collapse until now. Remember that the population has increased so that growth which may appear may actually be just a population effect. We see Ed/Health and Government are the largest contributors.

Above is the employment by month by sector. We see some growth in a few sectors but great weakness across the board.

The above and following two depict percent changes by a few sectors. Note above we have dropped in Manufacturing and have negative growth.

And finally:

The details are not positive despite the spin machines.

Employment Update, Not Really Good

The latest report is in and despite the claim of a 7.8% rate when examined in minor detail it is still poor. Let us examine in a bit of detail:

First as above we see that the unemployment based upon the Jan 2008 percent of population employed is still just under 12%. In fact is has frozen there. Remember that more than 47% of the population was employed then and that the population increases at 250,000 or more a month so that we need about 120,000 plus new jobs a month just to stand still. That is the issue of having a moving denominator, one can come up with whatever number one wants.

What is critical in the above is that we are stalled at about 42% of the population employed whereas before the crash we had 45% of the population employed. Thus we have about 12 million lost from the employment pool, just written off, the "Forgotten Workers". The 7.8% is thus frankly an arithmetic fluke, an insult to those written out of the pages of the employable. I would never expect the Press to even understand this no less report on it, it is against their core and is not within their limited intellect.

The above shows the details of what I have said above especially the growing population but the lagging employment. In fact September was downward sloping. The Devil is always in the details.

The above gives further insight showing what we have discussed.

The red line shows whether we are gaining or losing. Here we show just about zero gain at best. Not what the DOL suggests.

Now my favorite. This is the Romer chart. She said we would be a booming economy by now. So much for left wing economists. Please don't have them build bridges.

The above is the error rate on Romer and below we show the percent error.