The International Society of Aesthetic Plastic Surgeons has released new data on the incidence of invasive and non-invasive cosmetic procedures. The U.S. leads in sheer numbers of procedures but, accounting for population, we fall into 4th place. South Korea leads for the number of procedures per person, followed by Greece and Italy.
By far the most common kinds of surgical cosmetic procedures are lipoplasty and breast augmentation. Along with fat, breasts seem to be a particular concern: breast lifts and breast reductions for both men and women are also in the top ten. Abdominoplasty, nose jobs, eyelid surgeries, and facelifts are as well.
Likewise, we’ve posted about surgeries that create an epithelial fold, a fold of skin in the eyelid more common in people with White than Asian ethnic backgrounds. This surgery is a trend among Asians and Asian-Americans, as colonization has left us with an association between Whiteness, attractiveness, and power.
Breast augmentation, the second biggest surgical procedure, is most commonly performed in America and Brazil. Buttock implants are also a Brazilian specialty, as is vaginal rejuvenation. Asia is keen on nose jobs: China, Japan and South Korea are among the top five nations for rhinoplasty.
More on where and how many procedures are being performed, but nothing on why, at the ISAPS report.
I want to make sure that we keep America a place of opportunity, where everyone… get[s] as much education as they can afford
After all, Mitt got as much education as he (his parents, really) could afford, so he thought it best if everyone had that same opportunity.
Opportunity – How much is that in American money?
Yesterday, Planet Money posted this graph showing the costs and benefits of a college education in several countries.
The title of the post summarizes the interpretation of the college-educated folks at Planet Money:
“College Costs More In America, But The Payoff Is Bigger”
But what if you look at the data from the other side? Here’s the half-empty-glass title:
“College in the US Costs a Lot, and If You Can’t Afford It, You’re Really Screwed”
…or words to that effect.
What the chart seems to show is inequality — specifically, the inequality between the college educated and everyone else. In advanced economies, like the those of the countries in the chart, education is important. But some of those countries, like the Scandinavian countries, have reduced the income sacrificed by non-college people relative to the college educated. Other countries favor a more unequal distribution of income.
To look a little closer, I looked at the relationship between the payoff of a BA degree for men and a country’s Gini coefficient, a measure of inequality. I used the ten countries in the Planet Money chart and added another ten OECD countries.
The correlation is 0.44. The US is the clear outlier. In the land of opportunity, if you’re a male, either you pay the considerable price of going to college, or you pay the price for not going to college.
With this inequality come the kinds of social consequences that Charles Murray elaborates in his latest book about non-educated Whites — disability, divorce, demoralization, death.
The poverty rate in the US in the mid-2000s was about 17%. In Sweden, the poverty rate was 5.3%; in Germany, 11%. That was the rate after adding in government transfers. In Germany, the poverty rate before those transfers was 33.6%, ten points higher than that in the US. Sweden’s pre-transfer poverty rate was about the same as ours.
Jared Bernstein has this chart showing pre-transfer and post-transfer rates for the OECD countries (click to enlarge):
1. Governments have the power to reduce poverty, and reduce it a lot. European governments do far more towards this goal than does the US government.
2. It’s unlikely that America’s poor people are twice as lazy or unskilled or dissolute as their European counterparts. Individual factors may explain differences between individuals, but these explanations have little relevance for the problem of overall poverty. The focus on individual qualities also has little use as a basis for policy. European countries have fewer people living in poverty, but not because those countries exhort the poor to lead more virtuous lives and punish them for their improvident ways. European countries have lower poverty rates because the governments provide money and services to those who need them.
3. The amount of welfare governments provide does not appear to have a dampening effect on the overall economy.
As I speculated years ago (here and here), it may be hard for Americans to imagine a world where the law guarantees them at least 20 paid vacation days per year. But such a world exists. It’s called Europe.*
Americans are the lucky ones. As Mitt Romney has warned us “European-style benefits” would “poison the very spirit of America.” Niall Ferguson, who weighs in frequently on history and economics, contrasts America’s “Protestant work ethic” with what you find in Europe – an “atheist sloth ethic.”
The graph is a bit misleading. It shows only what the law requires of employers. Americans do get vacations. But here in America, how much vacation you get, or whether you get any at all, and whether it’s paid – that all depends on what you can negotiate with your employer.
Since American vacations depend on what the boss will grant, some people get more paid vacation, some get less, and some get none. So it might be useful to ask which sectors of our economy are beehives of the work ethic and which are sloughs of sloth. (Ferguson’s employer, for example, Harvard University, probably gives him three months off in the summer, plus a week or two or more in the winter between semesters, plus spring break, and maybe a few other days. I wonder how he would react if Harvard did away with these sloth-inducing policies.)
The Wall Street Journal recently (here) published a graph of BLS data on access to paid vacations; they break it up by industry near the bottom.
Those people who are cleaning your hotel room and serving your meals while you’re on vacation — only about one in four can get any paid vacation days. And at the other end, which economic sector is most indulgent of sloth among its workforce? Wall Street. Four out of five there get paid vacation.
How much paid vacation do we get? That depends on sector, but it also depends on length of service. As the Journal says,
Europeans also get more time off: usually a bare minimum of four weeks off a year. Most Americans have to stay in a job for 20 years to get that much, according to BLS data.
* The graph is from five years ago, but I doubt things have changed much. The US still has no federal or state laws requiring any paid vacation days.
The first suggests that the belief that hard work pays off remains strong in only a few countries: Pakistan (81%), the U.S. (77%), Tunisia (73%), Brazil (69%), India (67%) and Mexico (65%). The low scores in China, Germany, and Japan are worth noting. This is not to say that people everywhere are not working hard, just that many no longer believe there is a strong connection between their effort and outcome.
The second chart highlights the fact that growing numbers of people are losing faith in free market capitalism. Despite mainstream claims that “there is no alternative,” a high percentage of people in many countries do not believe that the free market system makes people better off.
GlobeScan polled more than 12,000 adults across 23 countries about their attitudes towards economic inequality and, as the chart below reveals, the results were remarkably similar to those highlighted above. In fact, as GlobeScan noted, “In 12 countries over 50% of people said they did not believe that the rich deserved their wealth.
It certainly seems that large numbers of people in many different countries are open to new ways of organizing economic activity.
The Supreme Court has ruled favorably on the legality of the Affordable Care Act. Actually, despite its name, the Act has more to do with extending and attempting to improve private health insurance coverage than it does with improving care or reducing its cost.
Unfortunately for us, the effort to improve our health care system has remained within bounds set by the needs of private health care providers and insurers. As President Obama made clear from the start of his push for health care reform, there would be no consideration of a universal system.
Critics of such a universal system are always quick to argue that only market forces driven by the private pursuit of profit can ensure an efficient health care system. Of course, in determining whether this is true, we need to recognize that efficiency is a complex term and that our health care system, like all systems, produces multiple outcomes. The most obvious ones are private profit as well as the quality and cost of the relevant health care.
In terms of private profit there can be no doubt that our health care system functions well. However, the story is quite different if we evaluate it in terms of quality and cost. The fact that we continue to embrace a private health care system makes clear which measures of efficiency are considered most important and by whom.
The following map shows the countries, colored green, that have adopted a universal health care system.
What’s astonishing is how cleanly the green and grey separate the developed nations from the developing, almost categorically. Nearly the entire developed world is colored, from Europe to the Asian powerhouses to South America’s southern cone to the Anglophone states of Australia, New Zealand, and Canada. The only developed outliers are a few still-troubled Balkan states, the Soviet-style autocracy of Belarus, and the U.S. of A., the richest nation in the world.
The handful of developing countries that provide universal access to health care include oil-rich Saudi Arabia and Oman, Latin success story Costa Rica, Kyrgyzstan, and, famously, Cuba, among a few others. A number of countries have attempted universal health care but failed, such as South Africa, which maintains a notoriously inefficient and troubled public plan to complement the private plans popular among middle- and upper-class citizens…
That brings us to another way that America is a big outlier on health care. The grey countries on this map tend to spend significantly less per capita on health care than do the green countries — except for the U.S., where the government spends way more on health care per person than do most countries with free, universal health care. This is also true of health care costs as a share of national GDP — in other words, how much of a country’s money goes into health care.
The OECD just published a major study on the health care systems of its 34 member nations. It found that:
Health spending accounted for 17.6% of GDP in the United States in 2010, down slightly from 2009 (17.7%) and by far the highest share in the OECD, and a full eight percentage points higher than the OECD average of 9.5%. Following the United States were the Netherlands (at 12.0% of GDP), and France and Germany (both at 11.6% of GDP).
The United States spent 8,233 USD on health per capita in 2010, two-and-a-half times more than the OECD average of 3,268 USD (adjusted for purchasing power parity). Following the United States were Norway and Switzerland which spent over 5,250 USD per capita. Americans spent more than twice as much as relatively rich European countries such as France, Sweden and the United Kingdom.
What does all of this mean in terms of health outcomes? According to the OECD report:
Most OECD countries have enjoyed large gains in life expectancy over the past decades. In the United States, life expectancy at birth increased by almost 9 years between 1960 and 2010, but this is less than the increase of over 15 years in Japan and over 11 years on average in OECD countries. As a result, while life expectancy in the United States used to be 1½ year above the OECD average in 1960, it is now, at 78.7 years in 2010, more than one year below the average of 79.8 years. Japan, Switzerland, Italy and Spain are the OECD countries with the highest life expectancy, exceeding 82 years.
One possible explanation for this lagging performance, highlighted in an earlier OECD report, is that the U.S. ranked 26th in terms of the number of practicing physicians relative to its population, 29th in terms of the number of doctor consultations per capita, 29th in terms of the number of hospital beds per capita, and 29th in terms of the average length of hospital stay. At the same time, the “U.S. health system does do a lot of interventions… it has a lot of expensive diagnostic equipment, which it uses a lot. And it does a lot of elective surgery — the sort of activities where it is not always clear cut about whether a particular intervention is necessary or not.”
Private health care providers and insurers are clear about how they measure health care efficiency. And as long as we rely on them to set the terms of the debate we will continue to suffer the consequences.
In a previous post I discussed how the U.S. became more religious in the 1950s, in part in response to its the Cold War enemies (atheist communists). In fact, the U.S. is among the most religious countries in the world. Using data from the International Social Survey Programme, Sociologist Tom Smith paints wildly different religious portraits of 28 nations (full text).
When asked whether they “know that God really exists and… have no doubt about it,” 61% of Americans say “yes.” Of the 28 nations studied, only four were more likely to say “yes” to this question: Poland, Israel, Chile, and the Philippines. Here’s how we look compared to similar countries:
Here’s all 28 in rank order (borrowed from LiveScience). Notice how wide the divergence is. In Japan, the least religious country according to this measure, only 4% say they have no doubt God exists. In The Philippines, 84% have no doubt.
% Have No Doubt God Exists:
Japan: 4.3 percent
East Germany: 7.8 percent
Czech Republic: 11.1
Great Britain: 16.8
The Netherlands: 21.2
New Zealand: 26.4
West Germany: 26.7
Northern Ireland: 45.6
United States: 60.6
The Philippines: 83.6
Americans are also particularly likely to believe in a “personal God,” one who is closely attentive to the lives of each and every person.
Quite interestingly, the U.S. is in the minority in that Americans tend to become increasingly religious as they age. In most countries, people become less religious over time. This graph (confusingly labeled), shows changes in DISbelief over the life course. The U.S. is the only country among these in which disbelief declines:
Lifetime Change in Religiosity (from increase in disbelief to increase in belief):
The Netherlands: -14.0
Great Britain: -10.1
Germany (East): -6.9
Czech Republic: -5.5
Germany (West): -5.4
New Zealand: -4.0
The Philippines: +0.8
Northern Ireland: +1.0
United States: +1.4
Rates of atheism — a strong disbelief in God — also vary tremendously. East Germany is the most atheist, with more than half of citizens claiming disbelief. The country is a stark contrast to the atheist among them, Poland and the U.S. (only 3% atheist), Chile and Cyprus (2%), and The Phillipines (1%).
East Germany: 52.1
Czech Republic: 39.9
The Netherlands: 19.7
Great Britain: 18.0
New Zealand: 12.6
West Germany: 10.3
Northern Ireland: 6.6
United States: 3.0
The Philippines: 0.7
As a post-9/11 American watching another election cycle, I can’t help but notice how so much of our rhetoric revolves — sometimes overtly and sometimes not — around people who are the wrong religion. Notably, Muslims. And yet, the U.S. and many Muslim countries are alike in being strongly religious, at least in comparison to the many strongly secular countries.
This is odd because stands in contrast to recent data on American attitudes. Within the U.S., people express much less tolerance for atheists than they do Muslims (homosexuals, African Americans, and immigrants). Weirdly, we think we have more in common with more secular nations like Great Britain than we do with countries like Pakistan or Saudi Arabia. In certain ways, the opposite might be true.
UPDATE: Since posting this, I’ve discovered that the numbers do not accurately reflect the ratio of CEO vs. worker pay. Writes PolitiFact:
We don’t doubt the chart’s underlying point that the ratio of CEO pay to worker pay is high in the United States, and is likely higher in our free-wheeling economy than it is in the historically more egalitarian nations of Europe.
But in its claim that the U.S. ratio is 475 to 1, the chart conveys a sense of certitude and statistical precision that simply isn’t warranted — and which is contradicted by the facts. The latest number for the U.S. is 185 to 1 in one study and 325 to 1 in another [though in previous years, those ratios have reached as high as 525 to 1] — and those numbers were not generated by groups that might have an ideological interest in downplaying the gaps between rich and poor. We rate the claim on the U.S. ratio False.