Patients, My Friend, Patients

A nurse at Inha University Hospital in Incheon on Thursday explains the physical check-up process to Americans visiting Korea on a medical tour. By Choi Min-gyu

Having devoted my past two posts to scolding the Joong-Ang Daily, I was pleasantly surprised this morning to come upon this piece, which reports on the experiences of 17 American tourists who came to Korea recently for various medical tests and treatments.

Medical tourism is, of course, nothing new: busloads of pensioners have been making regular trips to Mexico and Canada in search of low-cost prescription drugs; US citizens have been known to head for India or Thailand for LASIK surgery; and Korea, to judge by this and this, is quickly becoming a destination for medical tourists, particularly those in search of double eyelids or a double-D.¹

I'm no health care economist, but all of this makes me ponder the possibilities of an increasingly global health care industry. In the United States - where, as usual, health care is an issue in the presidential campaign - a great number of the competitive market forces have been removed from the health care industry, driving costs into the stratosphere and leaving many without insurance. At present, for example, health care in the United States is largely a state-by-state market due to government restrictions, meaning that a resident of Oregon cannot buy insurance approved in, say, Wyoming. This, as you might expect, limits competition and narrows the risk pool, both of which serve to push up the cost of a policy. And then there are the state mandates, requiring private insurance companies to cover such things as acupuncture and chiropractic services, further increasing costs across the board. None of this is to say anything about the byzantine tax structures that, some economists estimate, increase health care costs by 20-30%.²

Examining areas of health care not covered by insurance schemes can be enlightening, or at least thought-provoking. The cost of LASIK surgery, to take one example, has decreased dramatically over the past few years, even as the quality of the procedure has improved. It's fair to say that competition has a lot do with that, and not only competition within the United States. Any potential LASIK customer, facing a full out-of-pocket expenditure, can survey the options available around the world - in China, Korea, Canada, or the US, to name a few - and find a variety of prices and services available. Most Americans will elect to have the surgery in the United States, but the international competition almost certainly plays a role in the decreasing cost. Considered in this light, the possibilities for health care at large are intriguing.

Given the high degree of government involvement in health care around the world, achieving a level of unfettered competition akin to the LASIK industry is unlikely, but we shouldn't ingore the possibilities. Governments meddle in all kinds of industries - finance, media, technology, manufacturing - and yet each of these sectors has managed to evolve in spectacular ways over time. Might not the same prove true of health care?




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Notes

¹ Then again, the Joong-Ang ran this article last year, acknowledging that even its own writers might be overstating the medical tourism "boom" in Korea.

² For a bit more reading on the US health care system, and its attendant problems, see here and here.

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Law School Blues

It’s a fair question, actually: Why do I even bother to read the Joong-Ang Daily?

That’s what Na Young – in an “OK, OK, calm down” moment - wanted to know last night as I boiled over while reading this editorial by Young-Soo Jang, a constitutional law professor at Korea University.

In a prime example of the muddleheaded analysis¹ I’ve come to expect from this paper, Jang seems to argue against liberalizing the law school system in Korea. I say “seems” because, as usual, I can’t exactly tell what the writer means to say.

It is unfair to think that weeding out law departments at middle and low tier colleges is natural by emphasizing the theory of competition.

This is like saying it doesn’t matter if small and midsized companies are weeded out and only large companies survive. Just as large corporations and small businesses take different roles in the economy, different roles are expected from the major universities educating lawyers and smaller universities training those working in law-related professions.

What Jang doesn’t say is who or what, if not the market forces of competition, should determine these various “roles.” I feel safe in saying, however, that he envisions the government – aided by an intellectual elite that includes himself – continuing in its role as Grand Arbiter of Korean law schools, determining by fiat the “correct” number of lawyers who may matriculate each year.

There is in intellectual circles around the world a tendency to favor this and similar sorts of governmental meddling in such affairs - which is not terribly surprising, actually. After all, these same intellectuals stand to be in control of any such system. Jang’s article also exhibits a foible common especially in modern liberals: specifically, that if a system is imperfect, as defined by them, we must assume that there is a solution and allow lawmakers to intervene and impose that solution. Nevermind, of course, that not every problem has a political solution.

This further brings to mind Friedrich Hayek’s notion of spontaneous emergent orders, and his point that central planning breaks down because the planners always suffer from a dearth of information. There is no reason to expect, for instance, that the Korean government will be able to efficiently and properly define the appropriate role of each educational institution in the country and its corresponding role in producing a competent legal system. In fact, excessive governmental interference is a major reason for the current woes in the local legal market. Jang is right, actually, when he says, “if we neglect this issue, Korea’s legal education will be crippled, and the legal service industry is bound to have a big hole.” I wonder, though, if he recognizes that this problem already exists.

The most irksome sentence in Jang’s piece, however, is this: “All members of society need to faithfully play their roles and complement one another.” I wasn’t aware that I had such a societal role to “faithfully play.” Sure, in a totalitarian or socialist society, people may be assigned a particular place according to the whims of some central planner, but South Korea is no such a place. Perhaps this slipped Mr. Jang’s mind.

Regular readers of idiots' collective will recall that the debate over liberalizing Korea's law schools is one that has stuck in my craw for some time (e.g. here). The truth is, though, even though I've tried to follow the issue, I’m still having a bear of a time understanding what Mr. Jang means to say. So please, read his piece and help me out.


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Notes
¹ ...or shaky translations.

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Joong-Ang Daily: Defender of the Middle Class

Tucked into my daily copy of the International Herald Tribune is a copy of the Joong-Ang Daily, which affects to provide a regular dose of Korean news but which usually succeeds only in riling me up with its pisspoor reportage and disingenuous social commentary. I'm not sure how much it costs to fold the Joong-Ang into my IHT, but I can assure you that its inclusion, on most days, devalues the package as a whole and I like to think I'm doing the publisher a favor by taking a copy off their hands everyday - a guaranteed point in my karma column, six days a week.

I write as much after reading this feature in yesterday's edition of the Joong-Ang, in which the paper profiles Kim Byeong-Cheol, a former branch manager for Dongwha Bank who, at 50 years old, lost his 80 million won per year job when Shinhan Bank acquired Dongwha in the wake of the 1997-98 Asian Financial Crisis. Since that time, he's sputtered and lurched from one failed business venture to the next and now relies on the income from his wife's noodle shop to pay the bills each month.

In the last decade, Kim has also gone to the mat with alcoholism and cancer - a hard-knock life, to be sure. The writer of this piece, Choi Joon-ho, however, chalks up Kim's adversity to every factor - inflation, energy prices, corporate consolidation, decline of the middle class - except Kim's life choices. No one will argue that Kim asked to be laid off from his job, but neither did anyone ask him to become an alcoholic and check out for six months. As a result, the reader is left scratching his head, wondering what men like Kim would have us do for him. Would he prefer that the government insulate everyone from the swings of the economy, or that it limit his chances strive for improvement, even at the risk of failure? A government can certainly do this, but I don't think Kim would be too happy with the resulting standard of living.

Just when I was ready to pitch the paper into the shredder in frustration, the article went me one further and quoted Kim Mun-jo, a sociologist at Korea University. Full disclosure: I don't have much time for the field of sociology, a discipline filled largely with doctoral grumblers who either failed or never attended their economics courses in university. I was little surprised, then, when I read the following:

Kim Mun-jo, a sociologist at Korea University, said the Korean middle class used to make up close to 70 percent of the country. That figure has shrunk to 40 percent.

Kim says many Koreans have given up hope of climbing the social ladder. “Before the financial crisis, people hoped they could enter the upper classes by studying hard. There was a positive attitude prevailing in society,” said the professor.

“But people have given up the belief that if they work hard, they can buy an apartment in Gangnam [southern Seoul] by the time they are in their 40s,” he says. He estimates that only about 20 percent of people in Korea these days are future-oriented and have a positive attitude.

The questions begged in this excerpt are numerous, so let's hit them one at a time. First, how is Kim measuring his income for his definitions of the middle class? Is he using household income? Per capita income? There are, as Mark Twain noted, lies, damned lies, and statistics, but no one at the Joong-Ang felt compelled to explain these numbers.

As for consumption, it's human nature to want more than we have, but this doesn't mean that anyone should be guaranteed an apartment in Gangnam. Hell, I'd like to think that if I work hard, live a virtuous life, and floss regularly, that I'll be able to afford an apartment on Central Park West, but I choose to be realistic and know that it will likely never happen. Am I bitter that someone else can afford that apartment? Not especially. One cultural factor exacerbating the financial woes in Korea is that every Lee, Park and Kim wants the same apartment, the same job and the same goddamned car, thus putting a premium on these items. There are, however - and contrary to popular Korean belief - livable areas of Seoul other than Gangnam. The Korean obsession with living in Gangnam, then, is not an economic problem for the government, but rather a trace of that nasty human tendency toward envying what others have.

And finally, how exactly does one define, much less quantify, the percentage of "future-oriented" people with positive attitudes? Sounds like a job for a sociologist to me.

I'm not, in all of this, ignoring the fact that much of society is being squeezed by the current rise in energy and commodity prices. They pinch - believe me, I know. I'm not rich and I have to pay them, too. Still, by virtually any measure, the middle class - and, I would argue, the lower class - of Korea is better off today than it was ten, and certainly twenty, years ago. I defy anyone to walk into an "average" Korean house in 1988 or 1998 and honestly tell me, after evaluating the standard of living, that you'd rather live in those bygone times.

The writer of the Joong-Ang piece also fails to note that one of Kim Byeong-Cheol's chief obstacles in the past ten years has not been economic hurdles, but rather cultural ones. With its obsessive, Confucian focus on age and hierarchy, Korea is a terrible place to make a fresh start when you're in your fifties. My mother, to fight anecdote with anecdote, returned to university, earned a graduate degree and completely changed her career while in her forties, a feat which would be almost impossible in Korea. Most companies are reluctant to hire a person who would have to work under a younger boss, which, in addition to stalling the lives of folks like Kim, deprives the Korean economy of workers with valuable experience and knowledge.

...and, as we know, depriving Korea of knowledge is the Joong-Ang's job.

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Grocery Bombs Away

South Korean protesters hurl eggs and tomatoes at the Japanese Embassy during a rally against Japan's announcement of its decision to include in school textbooks its claims to islands controlled by South Korea in Seoul, South Korea, Wednesday, July 16, 2008. Japan's government Tuesday defended its decision, a move that prompted Seoul to lodge a protest and recall its ambassador. (Photo by Lee Jin-Man)

Notes to Protesters:

1. One of your own South Korean citizens was shot to death last week, not by Japan but by North Korea. I hope you'll make some time for that protest when you're finished chucking your groceries at the Japanese embassy.

2. Speaking of groceries, you guys must be doing quite well financially if, despite the rising cost of food, you can nonetheless afford to throw eggs and tomatoes at embassies. I trust, then, that you're not among those complaining about these skyrocketing prices.

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It's All About Me

A few weeks after getting married I was looking through our wedding pictures in search of photographs worth preserving in the wedding album and, as I flipped through the images on my computer, I did a double-take and went back to one that caught my eye. In it, an unidentified woman is helping a young boy, his pants around his ankles, urinate into a bottle held by a man in a dark suit. At least, I assume the boy is pissing into a bottle. The boy has his back turned to the camera, so I suppose it's equally possible that the man in the suit is catching the urine - as much of it as possible - in his hand. This man, however, is my father-in-law and this child - this...this little urinator - is a distant cousin of my wife, so I prefer to think that they were at least using a bottle. I mean, come on, I have to shake this man's hand every time we meet.

As you might imagine, the fact that someone was helping a child urinate in the midmost midst of our wedding reception did not sit well with me, and the fact that one of these someones is my father-in-law made it all the worse. This young child isn't innocent either, and I fully intend to be at his wedding - when I'll be in my fifties or sixties - if only to fill a few bottles of my own. We'll see how he likes it when people show up and start urinating in the middle of his wedding banquet.

Pictures like this one beg any number of questions - who the fuck does that little twerp think he is? - not the least of which are those of etiquette and consideration for others. I, for one, am not keen on eating next to someone who is emptying his bladder, however small and young that bladder may be. And I'd like to think that most Koreans share my sentiments, that urinating in the middle of a dining space bespeaks, universally, a disregard for others that would get you ostracized in any human society.

If only.

Every country and culture bears its own peculiar norms and mores, and while I hate to superimpose upon Korea my own notions of decorum, that's precisely what I'm going to do. I hesitate to say that Koreans, as a people, are any more or less rude than, say, your average Dane or Angolan, but I will say that rudeness is exceptionally prevalent on this peninsula. Or perhaps "rude" is the wrong word, as this behavior never seems to be intentionally offensive. The most offensive actions - the pushing, the spitting, the urine-bottling - smack more of oblivion, a complete lack of awareness of how one's actions will affect others, than they do of any intended offense.

Take, for instance, the two young women, probably in their early 20s, on the subway last night. Both girls were wearing sleeveless shirts, Girl A's being a plain baby blue number while Girl B's shirt read, appropriately, "It's All About Me." They stood chatting for a few minutes until Girl A pulled a small spray bottle out of her purse. Girl B then held up each arm in turn while Girl A sprayed something into her armpits. The smell of deodorant quickly filled the subway car, which was not entirely unpleasant given that the train was busy and that the hot, humid weather doesn't make for pleasant-smelling crowds. But still, who sprays deodorant on their friend's armpits, much less in a crowded subway? Roll-on maybe, but spray? What's next, trimming their toenails on the train? Oh wait, I've seen that, too.

I doubt that any of these people intended to offend those around them; they simply never considered that perhaps their actions might be just a tad uncouth. Maybe no one ever told them that urination, toenail clipping and the application of deodorant can all be done quite conveniently and privately in one place - the goddamn restroom.

You know, in writing this, I've gotten myself so worked up that I nearly wet my pants. Now, who's going to hold this bottle for me?

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