A ‘cure’ for medical brain drain

Several months ago, I wrote a post suggesting that outsourcing (from developed countries to developing ones) should be viewed  as a potential cure for brain drain (which flows in the opposite direction).

One problem with that argument, which I acknowledged then, is that even if skilled workers stay in their home countries, they are still contributing their skills to the economies of developed countries.

But I now unveil to you, an idea which works around this problem, at least in medical outsourcing. When I say, “medical outsourcing” by the way, I’m excluding medical tourism (I don’t think that really qualifies as “outsourcing”). For a discussion of medical services that can be outsourced, see here.

The Idea

Let us establish a medical outsourcing facility in an African country that has a diaspora that includes many doctors practicing in other countries (Uganda, Ethiopia and Liberia, among many others). The doctors employed here will provide medical services outsourced by hospitals in rich countries.

BUT! We will restrict their hours to one of the following schedules:

Doctors may only work 20 hours per week -OR-

Doctors may work 40 hours per week, every other week

The agreement will be that those doctors who only work 20 hours per week will practice medicine in or around the city where the outsourcing facility is located.

Those who only work every other week, will practice medicine in rural (or otherwise more distant) areas during the alternating weeks.

This model overcomes two obstacles:

1. Doctors’ standard of living: Developed countries are sometimes accused of “looting” developing countries of their skilled professionals. In truth, it’s the individual workers who make the choice to use their skills in another country. Understandably, someone who has invested so heavily in their own education and skills wants to be compensated with a good salary and comfortable standard of living. Hospitals in the developing world are often unable to provide this, and consequently, doctors emigrate.

Although our facility would have to be able to provide a particular medical service at a lower cost to entice hospitals in the West to outsource that function, the difference in cost of living indices should allow our doctors to make a salary that is equal at purchasing power parity (but not at exchange rates) to what they would make if working in the US, Europe, Japan, etc.

2. Contribution to home country: A traditional outsourcing facility has obvious economic benefits for the workers employed there, but beyond that, it’s harder to gauge its benefit. In our setup, the doctors are practicing medicine in their home country, not just providing a second opinion on cases from somewhere else.

True, they would still only be seeing patients in their country half the time, but that is much better than practicing medicine there none of the time, which is the situation in the status quo, when a doctor chooses to practice medicine in a distant land.

Overall, this model has the potential to cure brain drain in a sector where it is particularly severe, and its consequences most harmful.

THOUGHTS???

Gardens in the Sky!

While January 13 may seem rather late for my first post of 2012, the subject of this post will seem rather early in the year for the majority of my readers who are in the northern hemisphere. I’m leaving plenty of time to plan and scheme to make this happen…

A few years ago, I saw a church in North Minneapolis that had expanded its community garden to cover part of its parking lot. No, they didn’t tear up the parking lot and replace it with the garden, they just created a garden on top of the asphalt.

I don’t know why this was so surprising to me at the time — if relatively tall and healthy plants can grow in pots which have less than a foot of dirt on top of plastic, why not on at least a foot of dirt mounded in rows on top of asphalt? In any case, the fact that people were growing food on top of a parking lot demonstrates the popularity of community gardens, but also the dwindling amount of space for such gardens in densely populated areas. Community gardening is more than just a fun weekend activity. As the world becomes more populated and more urbanised, urban agriculture is being recognised as a important component of food security.

So far, the amount of available land seems to be the main constraint on the growth of urban agriculture. But the garden-on-asphalt suggests there may be a way around that.

Green Roofs are already growing in popularity for new construction projects. Community gardens are already popular on the ground. But as far as I know, these two concepts have not been merged on the scale I now propose:

The Idea: Gardens in the Sky!

Rather than suggest that we start installing rooftop gardens on new buildings, I believe there are already plenty of existing garden-ready surfaces in places where people already live. I would suggest that there are three criteria a surface must meet to be viable for rooftop gardening:

1. It must be flat. Sorry, Al Johnson’s Swedish Restaurant in Door County is not a suitable model

2. It must have a large, continuous surface area. If it is to be viable as anything more than a hobby garden for a few individuals, the surface needs to be large, and if it is to be functional, the area needs to be mostly continuous

3. It must be in a densely populated area. This isn’t necessary for the rooftop garden per se, but if it’s not in such an area, then it wouldn’t have much advantage over the conventional ground-level garden.

There are a few places that meet these criteria for sky gardens. The first that came to mind was the area in Loring Park near downtown Minneapolis where I lived several years ago. Here’s are screenshots from Google Street View and Bing’s Bird’s eye view of the street on which we used to live:  

As you can see, these apartment buildings are the same height, probably because they were built around the same era in the early 1900s. They are all relatively close together, making it possible to join them with walkways to make an even larger continuous area. There are plenty of areas with this same characteristic (concentrated apartment buildings of almost uniform height) in older neighbourhoods in most American cities. For example, these rowhouses in Washington, DC would make a good candidate:

Another category of rooftop suitable for sky gardens is the mass-produced concrete apartment blocks that sprung up in every country the Soviets touched. What these buildings lack in style or charm, they more than make up for in sky garden-suitability!  Once again, uniform height and close proximity would make it possible to link several buildings’ roofs together to make one continuously accesible surface.

One of these pictures is from Mongolia, and one from Latvia. Can you tell them apart?

Sky gardens in those parts of the former Soviet Union with heavy groundwater and soil contamination would have an extra advantage over ground-level agriculture.

So far I’ve been focusing on groups of buildings of uniform height that could be amalgamated into one large growing area. But, there’s one more category of building that rivals the Soviet apartment blocks in both architectural elegance and sky garden-readiness. These individual buildings are suitably massive by themselves, without any need to be  adjoined to adjacent buildings. I’m talking, of course, about the big box stores.

Here are a few stats to consider: the average Super Target covers 174,000 square feet or 4 acres. The largest Wal-Mart (in Albany, NY) covers 260,000 square feet, or almost 6 acres! That’s plenty of room to grow anything. Heck, even I might be convinced to darken the doors of a Wal-Mart if I could buy the most local produce possible — grown directly above the place where it’s sold.

There might be some other surfaces that meet the criteria for sky gardening: public housing projects in the US? Certain airport terminals? I don’t know, maybe you can help me think of more.

I’m also aware that there might be some technical challenges to sky gardening that wouldn’t bedevil conventional green roofs. Maybe you can help me identify those and find a way around.

THOUGHTS???

Luxury Bikes for the BRICS!

New format: Idea up front, explanation later.

Idea: Luxury bicycles marketed specifically to emerging economies

Explanation: Anyone who knows me, or who reads my other blog, knows that I will go to great lengths to ride my bike, even if only for short lengths. Because of my appreciation for these machines, I now posit the Maus Hypothesis of Bicycle Appreciation. 

My hypothesis is thus: that the appreciation for bicycles in a given country or society correlates to income along a U-curve. That is, in the poorest of countries, where bicycles are ubiquitous, they are appreciated for their many functions. Here in Uganda, bicycles serve as taxis, pushcarts, and even, as bicycles.

As incomes increase, appreciation of bicycles lowers. Because bicycles are associated with the days of poverty, they are shunned by the new rich who see cars as a status symbol.  But at the highest income levels, bicycle appreciation recovers. Here, people now have time for recreation, and thus view bicycles as fun. Also, in some places, cars have become so passe that they no longer carry value as a status symbol, and in densely populated urban areas, have diminished value as a mode of transport.

Here is how I would visually depict this hypothesis:


Obviously, there would be some outliers on this graph. The US has higher incomes, but lower appreciation for bicycles, due mostly to America’s deeply entrenched car culture, and low levels of physical fitness (although this is perhaps both cause and effect). Additionally, in some poor countries, say Mongolia, cycling has never gained widespread acceptance due to geography or culture. Also, keep in mind that the y-axis plots appreciation not usage of bikes.

It’s mostly in the emerging markets that bicycles face the biggest challenge. I’m thinking specifically of the BRICS – Brazil, Russia, India, China and South Africa, and even more specifically of India and China. The BRICS account for over 40% of the world’s population, a quarter of its landmass and most of its current economic growth. Thus, the transport and lifestyle habits of people in these countries will have a massive impact on the future of the planet.

As I’ve suggested, bicycles are by no means scarce in these countries. But as soon as people have enough money, they usually trade them in for automobiles. There might be any number of reasons someone decides to purchase a car, but I would guess that the main one is status. After all, if you live in China or India, and you’ve ridden a bike your whole life, it’s probably because that was all you could afford. If you continue to ride a bike, people will assume your situation hasn’t changed. But driving a car will make it clear that you’ve done well for yourself.

If 1.4 billion Chinese people and 1.2 billion Indians start driving cars at the same rate as Americans, it’s curtains for those countries’ infrastructure and air quality. As in the US, the individual desire for status will probably trump any feeling of societal obligation.

If I’m correct that people buy cars to display their wealth and status (it’s hard to explain any functional benefit to having a car instead of a bike in Beijing or Delhi), the disadvantage of bikes is that they are associated with poverty, rather than wealth.

But not so for the luxury bike!

How is a luxury bike different from any other bike? In the same way that an Acura is different from a Honda: different branding and nicer accessories. A solid bike with a plush leather saddle, brake and shift levers made of chrome or some other unnecessary metal, and the right brand name on the frame could quite effectively convey one’s status.

Coming soon to a bike near you?

The production and manufacture of these bicycles would be the easy part. The branding and marketing would be more difficult. We could either try to develop a brand from scratch, equating our bikes with power and sophistication and recruiting a celebrity or two to endorse the brand. Or we could licence the name of an existing luxury brand, e.g. build our bikes and then paint the name ‘Gucci’ on then (and then perhaps encrust the name with diamonds).

These bicycles would be marketed to the fast-growing middle classes in emerging economies. This segment has shown a high degree of brand consciousness and is at highest risk of buying a car.

Who wants to go in on this venture???

My thoughts on a few things

I would never suggest that my friends back in the US are predictable, but oftentimes, if there is a particular development in the news, I know someone is going to ask me about it at a party. Since I have yet to establish myself as a repository of opinions on the same topics here, I find it necessary to answer the questions you would’ve asked me if you’d seen me the last few weekends.  Here are my thoughts on…

Protests in Russia

I’m quite frankly just as shocked (if not more so) as anyone else. Protesting is a very un-Russian thing to do, which suggests that either there is some outside influence (possible, but not in the way you might think), or the Russian body politic has reached a hitherto unreached breaking point (in my view, only slightly more likely).

The idea that the US or any other Western power is behind the protests is absurd. Western governments have an interest in the political stability in Russia, and would probably rather take their chances with a rearranged Putin-Medvedev duumvirate than gamble by supporting a popular uprising that might bring to the fore a more ardently nationalist leader.

But I think there is some external influence emanating from the Arab Spring and the various other protest movements that have gained traction around the world this year. Once again, it would be absurd to suggest that the same sequence of events that played out in North Africa could be repeated in Russia. There are plenty of reasons why this is the case, but the most significant is rather practical: It’s not SPRING. The revolution in Egypt gained steam as the protestors camped out in Tahrir Square and became an immovable presence. I’ve been in Russia in December and I can assure you that no one will be camping outside. It will be very hard for infrequent demonstrations that disperse at night to gain much momentum.

I’ve heard several Western news outlets suggest that the reason Russians are disgruntled is the announcement by Putin and Medvedev that they would once again trade places (currently they are Prime Minister and President, respectively). This view holds that Russian people were upset by their leaders so brazenly announcing the future of Russian politics without first consulting the people. This is pure bollocks. Russian politics has been carefully orchestrated for some time, and in fact, these two announced an identical switch-a-roo in 2007 (except with the roles reversed) and executed it in 2008 with little backlash. Clearly this is about more than just the two men at the top…

NHL Realignment

I am unequivocally in favour of it. I give the NHL kudos for deciding on a complete overhaul rather than just a minor adjustment to the current division format.

For starters, the new format is a lot greener, as it will require fewer cross-continent trips. This has the added advantage of decreasing players’ fatigue from factors other than actually playing hockey!

There have been some legitimate criticisms of the new four-conference format, but most can be easily dealt with.

One argument is that, by giving playoff spots to the top 4 teams in each conference, weak teams in weak conferences will unfairly get in while good teams in stronger conferences will unfairly be left out of the playoffs. This is inevitable in any system, though, and is already present in the current one anyway.

If last year’s teams had been divided up into the four new conferences, and playoff spots had been allocated using the new model, 15 of the same 16 teams would have made the playoffs. And the one team that would have been cheated out of a spot last year (the LA Kings) would actually be unfairly awarded a playoff spot this year if the season ended today. So the new model giveth and it taketh, but it doesn’t seem that it creates any inherently weak conference that would perpetually benefit from the imbalance.

Another objection to the new format is that it, by having a schedule so heavily tilted toward intra-conference match-ups, it will kill off other rivalries.  It must be said, however, that the best and most enduring rivalries are regional rivalries, which this new format enhances.

For example, during the late 90s and early 2000s, one of the best rivalries was Colorado-Detroit, a hate-filled rivalry fueled by several hard-fought playoff series in consecutive years. Now, that rivalry has faded as the players from those years have moved on. In the last few years, Chicago-Vancouver has been a great and bloody rivalry, spurred by the exact same causes. But it too, will soon disappear and is indeed already fading.

The truly enduring rivalries are those that are built by teams playing each other multiple games every regular season, sometimes evenly-matched, sometimes with the possibility for a legitimately surprising upset, but always with animosity borne out of the two teams being so close that the teams and their fans can really rub each other the wrong way. The best rivalries in the NHL are Montreal-Toronto, Boston-Montreal, Philadelphia-Pittsburgh, and some would add the “Battle of Alberta” between Calgary and Edmonton.  These are all regional rivalries and all will be preserved in the new format.

New, enterprising, innovative ideas

I have some! Even though this blog has been entirely inactive for several months, my mind hasn’t. Soon, I’ll be sharing more of my crazy schemes with you…

One simple way YOU can save the NHL

Just because I’ve moved to Africa doesn’t mean I’ve forgotten the plight of North America’s (currently) second least popular major sports league.

Shortly after the end of the last NHL season, which was a few weeks ago, at least, I wrote that, in order to save itself, the NHL needs to have shorter seasons.  Surprisingly, Commissioner Gary Bettman did not call me (or anyone else, I imagine) to discuss the idea.

So now it’s time for grassroots action by all of us.

Just to remind you, a shorter NHL season benefits everyone:

  • For players, a shorter season means less fatigue and chance of injury
  • For owners, fewer games (i.e. less supply) can mean potentially higher ticket prices (see NFL)
  • For fans, a shorter season would be less taxing on attention spans, and would mean we don’t have to wait as long for something interesting or consequential to happen
  • For the sport as a whole, a shorter season would be easier for casual fans to follow and would mean the NHL regular season would no longer have to compete with the playoffs of EVERY OTHER SPORT for viewership
But as with so many other noble causes, it appears change may only come if there’s pressure from the masses.   So now that the pre-season has already begun (nothing says September like pre-season hockey!) and the regular season is only two weeks away, I think it’s time for all fans who care about the sport to organize ourselves and take the following action:

Boycott the NHL until November

And when I say boycott, I mean boycott.  Don’t go to any games, don’t watch any games on TV, don’t even watch highlights online until November.  If you are a diehard fan, this might be very hard.  If you are a casual fan, you might have accidentally done this anyway.

If tonnes of people join in, it could make the first month of the season so unprofitable that the powers that be in the NHL might start wondering if they should just chop a month or two off the schedule.

Normally at the end of my posts, I ask for your thoughts.  As always, I welcome them.  But this time, I would also suggest that you share this post with anyone you know who cares about the future of the NHL.

DO IT FOR THE CHILDREN!!!

Outsourcing: the cure for Brain Drain?

Addressing a highly sensitive issue in a casual blog post is risky.  So let’s tackle two highly sensitive issues this week!!!

I want to preface my proposal(s) with an argument that I am surprised is not made more often by proponents of outsourcing:

Outsourcing is increasingly a countervailing force to brain drain.

I say ‘increasingly’ because, in its early days, outsourcing was just replacing a national brain drain (educated workers in poorer countries leaving for richer countries where they could make more money) with a sectoral brain drain (trained professionals in poor countries, such as doctors, leaving for call centres where they could make more money).

But now that higher value processes in healthcare, IT, finance, etc. are being outsourced, it’s possible for an educated, trained professional to stay in her home country AND stay in her field of expertise AND make a good salary.

True, even though that worker is staying in her home country and using her skills and education, most of it is going to benefit a company somewhere else.  But there are still several net benefits to this situation:

  1. An educated middle class is being created in that country, with all the advantages to democracy that follow.
  2. Those workers will be paying taxes in their home countries rather than to Western governments.  This should improve public services, infrastructure, etc. especially since #1 will create a check on corruption and mismanagement of public funds.
Of course, outsourcing is not just one big bed of roses.  Most of the benefits of outsourcing have, so far, accrued to a tiny handful of Asian and Central European countries (India accounts for anywhere between 80-90% of global outsourcing).  And of course there are the workers in the US and Western Europe who lose their jobs because of outsourcing (although many big Indian firms are now outsourcing jobs BACK to the US).
What to do, what to do?

Let’s focus on tax incentives for US companies that send jobs offshore.  These are not as straightforward as some politicians make them sound, so they’re an unwieldy tool, but for now, they’ll have to do. There is no specific “Outsourcing Deduction” but because companies are allowed to deduct business expenses, they can write off the cost of closing a facility in the US and opening one somewhere else.  Moreover, some companies successfully game the US tax system by claiming a deduction for taxes paid to foreign governments without paying taxes to the US. Democratic efforts to tighten these loopholes have been filibustered.

In my opinion, there’s nothing inherently sinister about the current incentives.  I don’t think they’re evil, just unnecessary; usually a company decides to outsource a particular function because it makes economic sense, not because of the tax incentives.  So why subsidise something that was going to happen anyway?

But simply preventing companies from writing off expenses related to outsourcing or claiming deductions on foreign taxes is too heavy-handed, not to mention politically impossible.  Here’s my proposal:

1. Limit the amount companies can deduct for outsourcing expenses.  As this will result in a net gain for the Treasury, the savings could be invested in programmes that help workers who’ve lost their jobs directly because of outsourcing (and not merely because of foreign competition) gain new skills.*

2. Adjust the amount of foreign taxes paid that a company can deduct based on how prosperous that foreign country is.  The percentage could be indexed to GNI, GDP per capita, or some other measure.  As an example, a company could claim a bigger deduction for taxes paid in Uganda than in India, and a much bigger deduction for taxes paid in the DRC than in the PRC.

Available for offshore facilities!

Why would this help?

Well, let’s make the rather straightforward assumption that outsourcing is inevitable. So as a company is deciding where to locate a new facility, it now has several more factors to consider.  A poorer country that might otherwise not have been considered, perhaps because the cost of relocating there or of  giving sufficient training to local workers was too high, is now in the running because the company could deduct a higher percentage of its foreign taxes.

The first proposal is sort of a throwaway, but taken together, these two changes could help spread the benefits of outsourcing more widely across the globe while mitigating the harm done to workers in industrialised countries.

THOUGHTS???

*My more politically astute readers will note that even this proposal fails the current House Republicans’ ideological test of “cut-go.” No matter, this idea will probably still be good in 2013.

The other blog

This blog is already targeting a dangerously narrow and specific audience.  But now I’m setting out to capture a new demographic: people who are not interested in my ideas, but are interested in my (and my wife’s) experiences.

So please, visit Faith and David…THE BLOG!

PS, a new post will be coming soon on this site as well, hopefully.