Asians again

This NYT article on interracial roommate relationships predictably focuses primarily on black-white tensions. It doesn't say anything especially interesting about interracial rooming until about halfway down the page:

Several studies have shown that living with a roommate of a different race changes students’ attitudes. One, from the University of California at Los Angeles, generally found decreased prejudice among students with different-race roommates — but those who roomed with Asian-Americans, the group that scored the highest on measures of prejudice, became more prejudiced themselves.

Um, lede buried! Asians are the most racially prejudiced ethnic group, and in turn make others more prejudiced? Such a statement demands at least a tiny bit more exposition, no?

I wonder if the UCLA study is skewed somehow by the fact that Asians are the biggest group on campus (we Bay Area snarks called it the University of Caucasians Lost among Asians). Under certain accounts, large concentrations of Asians tend to make educational environments extremely tense... and perhaps such concentration reinforces clubbiness within the group as well? Anecdotally, I've had Asian, white, Hispanic, black and Arab roommates, and I can safely say that everyone is pretty much the same when they're holding your hair back at 3 am. 

Health care and fundamental change

Any discussion of health care reform invites, as it should, comparison with foreign health care systems. These comparisons are obviously useful; for instance, I think the Dutch example offers some extremely important lessons for restructuring the US system. 

But it is of course just as important to point out very basic differences between those systems and ours in determining the applicability of foreign models. One of those differences is the role of doctors. As Atul Gawande points out in his seminal article on reigning in health care costs, "the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue." The culture of medical practice is extremely different in European welfare states, and one of the reasons is that doctors in this country are given every possible incentive to treat the practice of medicine as a business rather than as a profession.

Is that because American doctors are naturally rapacious capitalists? Of course not. The most obvious cause of these differing approaches is the enormous cost of medical education in the United States. In 2005, the average cost of a medical education in the US was estimated at $140,000 for public schools and $225,000 for private schools. That doesn't include the opportunity cost of being an intern, resident, fellow or specialist for several years at minimum wage. It is also on top of any loans taken out for the mandatory four years of undergraduate education. The cost of medical education in Europe, which in many cases begins right after high school, is far, far less. American doctors are thus under immediate and intense pressure to maximize revenue, either through entering high-pay specialties or by practicing medicine a la the doctors in McAllen, Texas. Relatively less-financially-burdened European doctors have a lot more professional flexibility as a result, allowing them to develop a more patient-centered culture. It seems to me that unless you can figure out a way of reducing the cost of medical education, driving down costs in either the public or private health care sector (which inevitably means lower payments to doctors) is a fool's errand. Why else would the American Medical Association be so consistently, implacably opposed to health care reform?