The Controlled Economy of Dentistry

DentistryOver at Wonk Blog, Max Ehrenfreund wrote an article that is close to my heart, Why Dentists Are So Darn Rich. This is following from the lion hunting dentist. But I’ve long been aware of just how much money dentists make. I used to manage a dental office. And actually, I really liked it. I find dentistry fascinating — and it is really important. But it is also a scam.

A big reason that dentists make a lot of money is because they are small business owners. When I was working, a half hour cleaning cost $80, and the hygienists who did all the work got paid $45 per hour or $22.50 per patient — so that’s about one quarter of the cost. Let’s assume an overhead of 100%, which is high. The dentist/owner make $70 for each hour that the hygienist is working. Imagine if the dentist had three hygienists working — as some do.

But it is also true that dentists simply don’t compete with each other. Consider a crown. We charged $850 for a molar crown. The lab charged us $100 for it. The dentist normally had an assistant who made $25 per hour. The dentist needed to do about a half hour of work to prepare for the crown and take the impression. Putting it in could take as long as 15 minutes, but usually took less than five. But let’s make the math easy and say the whole thing took an hour. So the total cost was $125, which we will double with our 100% overhead. So the total cost was $250 for the crown, with a $600 profit. For one hour of work.

Ehrenfreund discussed the effect of insurance on dental costs. But I don’t think this actually has anything to do with it. Insurers pay as much as dentists charge. And dentists charge as much as they do because they are used to a certain standard of living. And that standard is very high. The truth of the matter is that I’ve known a lot of dentists. Some were really good at their jobs. Some I would never let work on me. But none of them was particularly brilliant. I think anyone could be taught to be a decent dentist.

The problem with dentistry is the problem with capitalism. I get so tired of hearing conservatives (libertarians especially) glibly talk about the efficiency of markets. There certainly are such things. I have little doubt that the corn futures market is as close to a Platonic ideal as we are ever going to get. But when we are talking about classes and the people who make them up, it is a very different matter. People often show surprise that billionaires continue to collect money. I’m surprised that they are surprised. Just like most poor people think they deserve to at least not starve to death, the billionaires believe they deserve ever greater wealth. It’s human nature.

So why do dentists make so much money? Because that’s how much money dentists make. The dentist I worked for had a brother who was a dentist. And they both had a father who was a dentist. The father built the practice, and the sons split it between them when he retired. You know: meritocracy! But the point is that no one goes off to dental school without knowing the kind of money that they are going to make. So sure: in an actual competitive market, cleanings could be $40 and crowns could be $300.[1] But they aren’t going to be because all the dentists — not the patients — have decided that they won’t work for that. And they have all kinds of laws and a great big lobbying group to make sure that they don’t have to.

[1] In fact, if you go to Mexico, where you will get US trained dentists, you will pay less than this. They have a far more free market in dental care than we have here in the US.

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Morning Music: Silly Elvis

My Way - ElvisIt’s a new week, and I thought I would do another series: cheesy Elvis songs. But I want to be clear: I love Elvis. He made a lot of great music. But I don’t want to focus on that. I want to focus on the silly side of The King. And that means I will probably focus on the movies. But not today.

In the 1970s, when Elvis was at the peak of his Vegas charm, he started to do the song “My Way.” I’m rather found of the song — most especially the Frank Sinatra version, which has a wonderful sadness to it. It is a great song to croon. But Elvis did it straight. There really is no pretense in his version — at least no pretense bearing in mind that it is Elvis. He shows a great deal of confidence in the strength of the song. He largely holds back. It really is a thing of beauty.

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Anniversary Post: Treblinka Revolt

Revolt in TreblinkaOn this day in 1943, after months of preparation, the Jewish prisoners of Treblinka revolted. They staged it for a hot day that many of the guards normally took off. They had made a duplicate key of the armory. So for about a half hour, they battled with the remaining guards. There were 700 men who took part in the uprising. But with the use of machine guns, the Nazis were able to kill the vast majority of them.

Still, roughly 200 of them escaped the camp. The Nazis pursued them in cars and on horses — killing most of them. But at least 70 made it to safety and lived at least until the end of the war. One of them was the 20 year old sculptor Samuel Willenberg — who is alive today.

Treblinka is an unimaginably horrible moment in human history. But it is hard not feel a certain thrill at the oppressed fighting back against their oppressors. Dying was certainly not the worst thing that could have happened to them. And the fact that a good 10% of them managed to escape and survive is a great thing. Not that the whole thing doesn’t make me both sad and angry.

We mark this day of the Treblinka revolt.

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Frankly Curious in Top Million Websites

Knight on Horseback - Don QuixoteI am three days of posts ahead as I write this. Normally, I would have moved this one to the Wednesday 5:05 pm post. But as you may have noticed, we’ve been having some server problems around here. Mostly they don’t stop pages from displaying. But they cause the categories to go away and, I assume, no one can post comments. At least I know that I can’t write anything online. The database can only be read — not written to. But nonetheless, today is a very big day: Frankly Curious dropped into the top one million most visited websites.

Now I know that this probably doesn’t sound like that big a deal. Top million?! But you have to look at this in context. There are roughly a billion websites on the internet. And yes, I would say that most of them are pretty boring and not active. But there are a lot of people toiling away out there. There are currently about 75 million WordPress installations up and running. And that’s just one content management system (CMS). So I don’t think it is unreasonable to assume that there are at least a hundred million notable websites in the world. So being in the top million is being in the top one percent. And I’ve never really hoped for more.

You may be wondering how I know that Frankly Curious in the top one million websites. Well, I don’t. I’m going on its Alexa rating, and it is certainly not perfect. It is basically a poll. And when a website isn’t that popular, the polling is noisy. Just the same, I’ve been watching it for years. It was parked out at about five million for a long time. And then it went through a period in the two million rang. But the main thing is that the Alexa rating has gone up along with my known Google Analytics numbers.

The current rank is: 914,051 (day); 932,292 (week); 1,158,662 (month); and 990,068 (three month). It’s this last number that I always look at. The daily number fluctuates wildly. The other day (because Bruce Bartlett was kind enough to link to me), the daily number was up at 200,000. But I’m not that interested in that kind of thing. Every website has good days now and then. As with most things, I’m interested in what Frankly Curious is as a kind of Platonic ideal — what would happen if I didn’t post anything.

There are other aspects of the traffic that aren’t as impressive. For one thing, Frankly Curious gets a lot of search engine traffic because of odd things I’ve written about. For example: Bugs: Rabbit or Hare? and College of Architecture and Planning Sign Is a Joke both get a tremendous amount of traffic. But people don’t hang around. They just want to know the truth (as I see it) about these very important topics. And then they move along.

On the other hand, the number of people who go straight to our home page without referral continues to go up. So that’s nice. And there are a half dozen regular commenters, which is even nicer. But the main thing is the idea of building something. I can’t say what it is. It’s great to have something tangible to represent what is, in fact, nothing but an addiction to writing.

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Political Empathy

Brian BeutlerThere’s a great dearth of empathy and moral imagination in politics. We see it when politicians with gay children come around belatedly to the view that gays and lesbians deserve equal treatment, or when they take pride in Confederate symbolism until a white supremacist massacres congregants in a black church. Progress might not be so halting if people had wider horizons, which is why encouraging them to see their priorities reflected in distant tragedies is a valuable thing.

—Brian Beutler
Cecil the Lion Has Nothing to Do With Your Politics

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The Fascism of National Review

William BuckleyThere was a really good Jeet Heer article over at New Republican, National Review’s Bad Conscience. It brings to mind my favorite William Buckley quote, “A Conservative is a fellow who is standing athwart history yelling ‘Stop!'” It’s so foreign to me. It would be one thing if history were making us worse, but it is actually making us better. We are, for example, far less violent than we used to be. What Buckley spent his whole like trying to stop was allowing the weak in society to get their fair share of the fruits of society. And that’s a pretty vile thing to stand athwart.

Heer’s article discusses the long history of Buckley’s magazine National Review and its’ love of fascism. We aren’t talking Nazism here. Even they understood that was a bridge too far. But when it came to Italian fascism, the magazine was fairly apologetic. And it was downright keen for Francisco Franco — publishing two laudatory articles about him when he died. This has long been an issue for me. In modern America, fascism is now seen bad exclusively because of the Nazi’s final solution. There is relatively little knowledge of how fascism was a rotten ideology. But that’s hardly surprising in a country that supports a lot of fascist ideals.

But most of the article is dedicated to the way that National Review, while not pro-Nazi, was anti-anti-Nazi. It goes into some depth about how the magazine constantly criticized the “lurid extravaganza” of Adolf Eichmann’s trial. So the narrative was always: the Nazis were terrible, but these Jews are culpable because they can’t just forgive and forget. Really, Heer quotes one complaint about the Eichmann trial resulting in “bitterness, distrust, the refusal to forgive…”

What’s interesting is that this is the same way that National Review approached the civil rights struggle. But I think you can just use the “one generation” rule of thumb. Conservatives are always one generation behind history. It makes the whole “yelling ‘Stop!'” thing nonsense. What it looks more like is a petulant child who makes every possible excuse for not doing something. World War II ended in 1945, so it took National Review roughly until 1965 to get over its Nazi apologetics. Of course, it took Buckley two generations to apologize for all his racist publishing. And I’m not sure if National Review is even now over its fondness for non-Nazi fascism.

But the whole thing is fascinating in the sense that National Review’s past history of fascism apologetics and even love are behind it’s continued use of “fascism” to slander liberals. There is, for example, Kevin D Williamson’s recent claim in the magazine that Bernie Sander is a national socialist. And then, of course, “Jonah Goldberg authored a lengthy tome in 2008, Liberal Fascism.” But this isn’t a sign of conservatives trying to stop history. It is them being so devoid of any ideas — or intellectual integrity — that they just use their own sins and project them onto the other side. It used to be fine to call liberals socialists. But that word just doesn’t have the bite it once did. So we are fascists. Even though it was never liberals who claimed that Adolf Eichmann was being treated too harshly.

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What Respect Means to Police Officers

911 - Hang UpSteve M Over at No More Mister Nice Blog brought my attention to an interesting story, I Guess You Don’t Have to Be a Cop to Charge People With “Contempt of Cop.” Apparently, back in June, a woman whose friend had just been shot got into a little argument with a 911 dispatcher. The dispatcher asked, “Is he breathing?” The caller said, “He is barely breathing. How many times do I have to fucking tell you?!” At that point, the dispatcher said, “Okay, you know what ma’am? You can deal with it yourself. I’m not going to deal with this, okay.” And hung up. The friend died.

The point here is not that the dispatcher is a horrible person. For one thing, he didn’t completely abandon the caller. He had already called an ambulance, which arrived at the scene less than five minutes later. But clearly he was young and poorly trained. But his attitude speaks to a larger issue about public servants who demand to be treated with some conception of dignity that they think they deserve.

How the dispatcher acted on the phone was very much the sort of thing I would expect from customer service with AT&T. Well, worse than that. They put up with a whole lot worse than this. The caller said only a single even slightly offensive thing and the dispatcher decided that he had had enough. But in this case, the caller is watching her friend die. And the dispatcher thinks that his discomfort at being yelled at trumps that. It’s amazing.

But as Steve M noted, when the police go off in cases like this, they are always allowed to make the “threat” argument. Or as I put, “They were vewy vewy afwaid.” Clearly the dispatcher did not feel threatened in this case. And in most cases with police officers, this is all that is going on: they feel that they aren’t receiving the proper amount of respect. But whereas the dispatcher just abandoned the target of his anger, the police attack.

The best recent example of this is Sandra Bland. When Officer Brian Encinia pulls her over, he could just give her the ticket and move on. But he decided instead to make her bend to his will. It’s all about him getting the respect that he thinks he deserves. He most clearly never feels threatened. In fact, when Bland wouldn’t get out of the car, he went in after her. He didn’t call for backup. It’s all about some twisted notion of respect.

The question is why it is that people in these positions feel that others should be so deferential to them. After all, they generally interact with people under the worst of circumstances. Both the dispatcher and the Sandra Bland arresting officer got their start in fire departments. So I don’t think this is really about police in general. I think it is about the nature of their inbred — male dominated — cultures. It is a conservative culture: us against them; the good against the bad. So it is not at all surprising that this attitude sneaks in and they end up being far less professional than some minimum wage hack at AT&T.

But I would hope that cases like this would cause the society to stop apologizing for police brutality and murder with the facile claim, “Well, they have such dangerous jobs.” No they don’t! And even if they did, cases like Sandra Bland and Eric Garner and Walter Scott show that “danger” is not what these guys are on about. It is some notion of respect that they think they are owed. And if it comes down to it, they think it is all right to kill for it. But as a society, we need to stop thinking that this unconscionable violence is about public safety.


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Anniversary Post: Rex Noble

Talking Union BluesI guess we will end out this week of labor songs with “Talking Union Blues.” I love talking blues songs — they are one of the best forms for political songs. And this one is just perfect. It was written by Millard Lampell, Lee Hays, and Pete Seeger. I don’t have a lot to say about it. The great thing about talking blues songs is that they speak for themselves.

This performance is by a guy who calls himself Rex Noble — but his account actually indicates “Paul” as his first name. I have no idea who he is. He’s another example of these people with prodigious talent who somehow don’t have tens of thousands of screaming fans. At the same time, I can’t seem to go anywhere without seeing the tone deaf phenom Taylor Swift. Anyway, I like his version “Talking Union Blues.” He speeds it up and he gives it a bit more of that Bob Dylan sneer than Seeger did. Take a listen. It’s really great.


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Anniversary Post: Lynching of Frank Little

Frank LittleOn this day in 1917, Frank Little was lynched. He was a union leader with the Industrial Workers of the World, organizing workers in various industries throughout the United States. He had gone to Butte, Montana to help organize copper miners. And then, early in the morning of 1 August 1917, six masked men broke into his hotel room and dragged him away. They beat him and finally hanged him from the Milwaukee Railroad trestle. He was probably 38 at that time.

It is widely believed that the men were Pinkerton agents, but there might have also been local law enforcement in the group. This is what capitalism is. This is what the owners do. Quite literally, small changes in their profit margins are more important than human life. Of course, one might say that things are better now. The capitalists have learned how to get the workers to self-oppress. That’s true. But if the workers ever wake up, the capitalists will go back to killing. They aren’t hiring assassins the way they used to only because they don’t have to.

We mark the noble life and sad death of Frank Little.

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America’s Silly Acceptance of Propaganda

Martin LongmanOne of the things that I find most interesting about public life in America is the way that people just fall in line when it comes to who we love and who we hate. During the lead up to the Iraq War, the American people got a great big hate on about France because it wouldn’t allow us to use its airspace for a war that Americans now agree was at best really, really stupid. But that doesn’t stop Americans from widely disliking France to this day. In fact, there is the totally unreasonable belief that France is some kind of weak peacenik country. (I wish!)

It’s reminiscent of the Two Minute Hate in Nineteen Eighty-Four. The people hate and fear Emmanuel Goldstein because they are told to. As far as we can tell in the novel, if Goldstein is a real person, he’s a high ranking party official, glad to be used as a tool for oppressing the bourgeoisie. But the main thing about it is that for the vast majority of people, it is all so real. People don’t watch Fox News because they like being misinformed; they watch it because they know they are getting the truth. We can laugh at them, but a far more pernicious kind of propaganda is the way all of the mainstream media just treat some countries as bad and others as good.

Ordinary Life in IranIt’s not hard to see how this works. No country is all good or all bad. So for official government enemies, our media reports almost exclusively the bad things. For official government friends, our media reports almost exclusively the good things. I’ve discussed this before with respect to Venezuela and Saudi Arabia, American Double Standard Regarding Democracy. That’s a case where it isn’t even close. Venezuela has lots of problems, but it is a bastion of goodness and light compared to Saudi Arabia. But few Americans are aware of this. They just know that Saudi Arabia is “good” and Venezuela is “bad” — because they’ve been manipulated to believe that.

A better comparison is between Saudi Arabia and Iran. They are both Muslim theocracies. And yet we hate Iran and if we don’t love Saudi Arabia, we tend to apologize for it and say that it is moving in the right direction. What exactly that means for a country that officially kills its own citizens via beheading with sword and stoning, I can’t say. But Martin Longman brought up a very interesting fact the other day: Iran is a far better place to be Jewish than Saudi Arabia.

Ordinary Life in Saudi ArabiaActually, that kind of under-states it. The truth is that in Saudi Arabia, “Jewish (as well as Christian and other non-Muslim) religious services are prohibited from being held on Saudi Arabian soil.” What’s more, “Persons with an Israeli government stamp in their passport or who are openly Jewish are generally not permitted into the Kingdom.”

Meanwhile, in Iran, things are not so bad for Jews. “Iran’s Jewish community is officially recognized as a religious minority group by the government, and, like the Zoroastrians and Christians, they are allocated one seat in the Iranian Parliament.” There appear to be about 25,000 Jews in Iran. I’m sure that doesn’t make Iran a great place to be Jewish — or anything else, for that matter. But why is it that a government like Iran’s that has at least a modicum of respect for Judaism is the one that we assume can’t possibly get along with Israel. But the government that won’t allow Jews (Or Israelis!) into its country is a great ally of Israel?

What’s really going on is that it is all about power politics. The US, Israel, and Saudi Arabia are all bound together by similar strategic interests. Yet right now, our supposed greatest threat in the region is the Islamic State. And it is Sunni — like Saudi Arabia. In fact, wealthy donors in Saudi Arabia (Of course!) were funding the Islamic State for years. Meanwhile, Iran has at war with the Islamic State for years.

None of this is to say that Iran is some great country. But it is just to highlight that our attitudes toward Iran and Saudi Arabia have nothing whatsoever to do with the common American propaganda about freedom and democracy. Saudi Arabia is a terrible country, but if we just made a nuclear deal with it, there would be no complaining.

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An Excellent Question for Donald Trump

David Cay JohnstonYour first major deal was converting the decrepit Commodore Hotel next to Grand Central Station into a Grand Hyatt. Mayor Abe Beame, a close ally of your father Fred, gave you the first-ever property tax abatement on a New York City hotel, worth at least $400 million over 40 years.

Since you boast that you are a self-made billionaire, how do you rationalize soliciting and accepting $400 million of welfare from the taxpayers?

—David Cay Johnston
21 Questions For Donald Trump

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Helping Business and Workers That We Won’t Do

Dean BakerOver the weekend, Dean Baker wrote, Will Hillary Clinton Have a Serious Plan to Persuade Companies to Invest in Workers? It seems that Clinton is calling for companies to invest in their workers, and Baker would like to know if she has any plans to cause that to happen, or whether she is just expecting that her pretty words will convince them. It isn’t surprising that the mainstream media is not interested in the question. After all, they too are in the pretty but anemic words business.

Baker noted, “It actually is not hard to give companies more incentive to invest in their workers, we can just make it harder for them to fire them.” This is something that is very big in Europe. But in America, we have done nothing over the past 60 years but move away from this. The argument is that businesses must have total flexibility or we won’t have acceptable growth. What workers might need doesn’t matter. But it is interesting that allowing businesses to lay off workers at the first sign of an economic downturn just plays into the paradox of thrift.

If a business sees a recession is coming on and lays off half its employees, there will be a all those employees who are not buying things. This will cause the recession to get even worse — even faster. Now, this is a fine strategy for any specific business. But in the aggregate, it is bad for all businesses — because there will be fewer people around to buy their products. So legislation that stopped businesses from doing something that will ultimately be bad for them is a good idea. Or at least it is if the concern really is economic growth.

Of course, I don’t think that is why conservatives want to give businesses the most flexibility and workers the least flexibility. More and more, I look back to Edmund Burke when thinking about conservatism. The great concern is that if you allow the workers to get comfortable, they will revolt. And by “revolt,” they mean “ask for anything at all.” So I think the whole idea here is to make workers as insecure as possible. But all that ultimately does is put off the day when workers demand some kind of equal share of the resources of this country. But I guess the conservatives figure that they’ve been able to finesse it this long, and now with Fox News, it is a good bet that they can continue on indefinitely.

I like Hillary Clinton. But I have no illusions that she isn’t part of the power elite. She will not do anything that taxes her class. But even if she did do something, it would be changed over time to help the business community. Dean Baker discussed how a Carter administration program to allow workers to become part owners has been instead little more than a “tax break for creative owners.” To me, it is all about this: it isn’t enough to elect a president. Unless we can keep a liberal government in power for a decade, we are going to get relatively little reform. And given that a large section of the liberal coalition has something better to do during off-year elections, we have a problem.

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