A New Fad to Put People on a Diet (But Not a Fad Diet)

aka A New Partnership for Healthcare Cost Control . . .

I was delighted this morning to see this article in the NYTimes about a partnership between UnitedHealth and the YMCA to combat diabetes and heart conditions through a program focused on motivating life style changes. Not only is it a great collaboration; it also provides initial confirmation of a phenomenon I suspected would soon appear after the final passage of healthcare reform that includes a prohibition on denying coverage based on pre-existing conditions. Given that they can no longer avoid paying costly benefits to cover patients with obesity-linked conditions, like type II diabetes, large insurance plans have a new incentive to “exclude” the costs by helping their patients avoid developing these conditions in the first place.

The rapid growth of healthcare costs is a complex issue with a number of causes – a topic expertly explored by David Goldhill in this September 2009 Atlantic article . But in flying back and forth between North Carolina and various parts of Southeast Asia, I couldn’t help but wonder about the large role played by obesity, a condition that, in some people, can be alleviated with lifestyle changes. Why weren’t we seizing the low hanging fruit of obesity control to address rising healthcare costs?

Ok, so weight-loss isn’t exactly easy – as anyone who has tried it will tell you. But, as an economist, I believe strongly that incentives shape our behavior. As someone with a legendary sweet tooth, I also understand how tempting it can be to stray from the nutritional high road. This brings us to an incentive problem with how our current most popular obesity solution – the fad diet – is delivered. A common criticism of fad diets is that they often provide only temporary weight loss through unsustainable drastic changes in behavior. Who actually believed that they could stick to replacing two meals a day with Special K? Fad diets, most of which get their payment up front, don’t have the same long-term incentive to keep people slim that insurance companies do now that they can no longer ration coverage.

Given the high personal and societal costs of obesity, I am excited about what might come out of this new incentive structure for healthcare insurance companies. Hopefully this partnership between UnitedHealth and the YMCA is a sign of more initiatives to come.

Oh and one final YMCA inspired thought . . . Cardio Funk dance class, anyone!?!?

Malaysia’s New Economic Model – Much to Like

The world is changing. Giants are rising in the East and slow recoveries afflict the West. The flows of finance and trade move ever faster. In these changing times, old advantages in language and learning can be squandered within a generation. Competition rules the day. What’s a small, open economy to do?

On March 30th, Malaysia revealed its answer to that very question. Before an audience of international investors, Prime Minister Najib Tun Razak unveiled the initial outline of Malaysia’s much anticipated New Economic Model, the economic strategy behind the 10th Malaysia Plan. The NEM hopes to combat the tight squeeze facing Malaysia – caught competing with both low wage countries like China and Vietnam and high skills countries like Singapore and South Korea.

There’s a lot to get excited about in the NEM – especially the proposed shift to a market based affirmative action defined by need, not by race and the emphasis on simultaneously streamlining government regulations and decentralizing government decision making. If fully implemented, these two moves will spur innovation and increase societal cohesion in Malaysia. Of course, more details on how these reforms are to be implemented would cause even more excitement. But the renewal of Najib’s public commitment to reform is welcome news.

Since independence, and formally since the launch of the New Economic Policy in 1970, Malaysia has had a policy of promoting equality by reducing absolute poverty and transferring wealth from the wealthier Chinese community to the Malay community. Under former Prime Minister Mahathir’s more than two decade rule, redistribution morphed into an all out push to create an elite class of Malay businessmen heading internationally successful government linked corporations (GLCs) in government championed industries.

Unfortunately, while Malaysia’s past growth has done much to wipe out hardcore poverty; research by K.S. Jomo reveals that its affirmative action policies have done more to redistribute wealth at the top than to help Malaysia’s neediest – rural Malays. Targeting affirmative action policies directly at the impoverished, regardless of race, will benefit Malaysia’s neediest while diminishing the frustration felt by Malaysia’s minorities. That is, if these policies are implemented . . .

The hardest sell on implementation will be politicians who ostensibly represent those who would benefit the most i.e. the kampung Malays. Members of Perkasa, a right wing pro-Malay organization, cite the struggles of rural Malays as their raison d’etre . However, making the affirmative action system more direct will make it harder for politicians to dispense patronage. Some of Perkasa’s members could find themselves torn between supporting changes that will help rural Malays, and Malaysia as a whole, and defending a system that keeps its politicians in power.

That the goal is to incorporate the NEM into Malaysia’s 10th development plan should clue you in to the fact that Malaysia likes plans and reports – and that it has plenty of them. Indeed, the New Economic Model is just the latest transformation report following close on the heels of Najib’s 1Malaysia concept launched last April and the release of the Government Transformation Program report earlier this year.

The 1Malaysia concept, an attempt to emphasis unity and national identity over and beyond race in Malaysia, is desperately needed in this increasingly divided and contentious country. Similarly, the GTP, an attempt to reform Malaysia’s sclerotic bureaucracy to deliver on public services, also identifies much needed changes to enable the government to meet the needs of Malaysia’s citizens. But will these changes ever make it off the page and into action?

That’s the big concern swirling around Malaysia’s blogosphere. All signs point to strong headwinds. As the Malaysian Insider points out, Najib has already had to delay creating a goods and services tax and weaning Malaysia off petroleum subsidies. To get out in front of those winds and any efforts by rightwing groups like Perkasa to halt reform, Najib needs to stress that the old affirmative action system of privileges and quotas has stymied economic growth while failing to help Malaysia’s poorest.

The Thriller from Manila

So actually, the title of this post is one of the many official nicknames/tag lines for Manny Pacquiao, current world champion welterweight boxer and Manila’s favorite son. Given that Manny’s a little busy with a host of new endorsements and running for a congressional seat in the Philippines, I figure he won’t mind if I borrow his tag line for this post about the recent Fulbright Conference in Manila.

Southeast Asia, as a region, is so diverse that a single pre-departure orientation session in Washington for Fulbright Scholars headed to the region just doesn’t make sense. To compensate, starting last year, the regional Fulbright commissions have teamed up to host a mid-year research conference that both showcases the research being done and doubles as a meet and greet for all of the scholars.

Spending three full days with so many high achieving people, learning about an incredible array of different research projects, and hearing their stories about confronting everything from traffic snarls to culture shock was like jamming your finger into an electric socket in the middle of a wind tunnel (i.e. simultaneously charged up and blown away!). To give a mere sampling of the variety of the research projects, there were presentations on everything from mass starvation as a war crime in Cambodia to citizen journalism in Thailand to the linguistics of call centers to (and this was a personal favorite) the engineering behind the perpetually freezing indoor temperatures in Southeast Asia.

The conference’s setting, metro Manila, with its bustling sprawl of eleven million people, was also a thrill – in ways both good and bad. Manila makes KL look down right sleepy. The city was equally vibrant and bustling at noon as it was at midnight. Artistic expression forms the lifeblood of Philippine culture – dramatically displayed in the colorful frenetic paintings on the side of Jeepneys or smoothly rendered as a husky refrain of rhythm and blues sung inside a chill cafe. The night scene was equal parts raucous and cordial making it easy to meet and mingle.

Unfortunately, Manila’s hopping cultural scene and fantastic nightlife weren’t the only sources of excitement. Everywhere we went in metro Manila, the city seemed to take its own reputation for dangerousness seriously. I’ve never seen so many security guards, metal detectors, or bomb sniffing dogs. The 24-hour internet café next to our hotel in Malate (one of the seventeen cities that make up metro Manila) even felt it necessary to post a sign warning patrons check their firearms at the door. I suppose such a dangerous reputation isn’t surprising in the capital city of a country whose population has doubled since gaining independence in 1946.

The greatest challenge of visiting Manila, for me, was confronting the visible legacy of America’s brief stint as a traditional colonial power. Learning to live with America’s legacy, both the good and the bad, has been a big part of my education as an American learning to live abroad. Part of this education is accepting that many of the less wonderful parts of our legacy didn’t all start and end with Bush’s eight years in office. The obvious signs of America’s influence in the Philippines – tipping as an institution, driving on the right, the popularity of braces, and basketball being played on every available blacktop square – make our legacy there impossible to ignore. The challenge is discerning America’s impact on the Philippines’ dramatic arc from golden promise in the 1970s to relative stagnation today. Having at one time bought the Philippines from the Spanish, how much are we responsible for their subsequent development, especially considering how institutions created under a colonial power often morph into the institutions of the newly independent government? This is a question I do not have the expertise to answer, but it is still a question that begs contemplation from any American visiting the Philippines.

One of the local TV stations sent a news crew to film the opening ceremony of the conference. Check out the clip here, courtesy of YouTube!

Birthday at Bako

Pokok dan Pantai

February has been the month for birthdays among our KL crowd – first DX, then myself, and just yesterday, Robin. Coincidentally, Chinese New Year, Valentine’s Day, and the Prophet’s Birthday all fell in February this year. Let’s just say we’ve had a lot to celebrate!

For my actual birthday weekend, Brian, who had not yet been to Malaysian Borneo, and I took a quick trip to explore Kuching, Sarawak – proud home of headhunters, cat statues, and Bako National Forest. Kuching is one of the many wonderful port cities in Malaysia that have made the most of both their historic heritage and their proximity to cooling breezes blowing in off the river. Walking through Kuching’s historic district and breathing in the sweet air was an absolute delight after the stultifying heat we’ve had for the past few weeks in Kuala Lumpur.

Kuching’s historic district runs right along the riverfront. This predominantly Chinese area is home to one of my favorite Malaysian architectural institutions – the rows of narrow, two-story shophouses. My fascination with Malaysia’s antique shophouses may have as much to do with the classic elegance of their proportions as it does with my own workaholic nature. Shophouses earned their name because the ground floor usually houses a business while the top story is reserved for the private life of the family living above their work. Passing by the shophouses in the historic district we could see all manner of trades and professions being carried out – everything from two old women carefully folding ornate gilt red paper for firework casings to buslting noodle shops serving local specialties to men carving swirling decorations onto custom-made coffins. It was fascinating to see so many different business types operating in such close proximity to each other.

Green Light of the Forest

As fabulous as it was to meander around Kuching’s historic riverfront, the real treat was our two day excursion to Bako National Forest, a mere 45-minute ride on a ramshackle 1950s era public bus outside of Kuching. Bako is special not only because it is one of the oldest national parks in Malaysia, but also because its unique island topography is home to a wide range of forest types. My conception of a tropical rainforest had been shaped by the towering dipterocarps and muddy jungle floors of Danum Valley in Sabah. Walking the Lintang Trail in Bako, which gradually ascends from a mangrove forest on the island’s edge through a scrappy marshland forest to what I think of as a traditional rainforest covering the island’s peak, was a little like undergoing a pilgrimage in which all of my previous assumptions about rainforests were gradually destroyed.

We were fortunate to have two full days to explore the island, but we could definitely have spent more time. On our second day, hiking to a remote waterfall, we met an older Canadian man who returns every year to Bako for a month long vacation. We found him lying down, eyes closed, submerged in an amazingly cool jungle pool at the foot of the waterfall. To have that type of time, to spend a whole day soaking in a jungle pool, must be amazing.

Monkeys and Mangroves

While we envied the Canadian his time, we did manage to see a number of cool animals and plants including lots of pitcher plants and the ugliest Borneo Bearded Pig imaginable (picture below). On our nightwalk, we came perilously close to a jewel green Bishop’s Pit-Viper crouched at ankle level on a limb overhanging the footbridge. Let’s just say we were close enough to this deadly beauty to learn that a flickering viper’s tongue is a sure sign that he is getting ready to strike. The most beautiful sight, however, were the thousands of tiny fireflies dancing among the dark mangrove trees twinkling out into the distance as far as the eye could see.

Leaf Stained Water Flowing Among Rocks

It was hard to say goodbye to Bako when we finally had to leave, but we found a little bit of the forest waiting for us upon our return to Kuching. Barney Chan, a recently retired forester and former head of the Malaysian Timber Council, is a one man unofficial welcoming crew for Kuching. He seems to spend a good deal of his new retirement time showing visiting friends around his home town. Under his energetic tutelage (if you’ve met Barney, you know what I mean by energetic), we explored the many culinary wonders of Kuching including three layer tea (the secret bottom layer being pure cane sugar) and tomato fried kway teow.

In between hopping from coffeeshop to restaurant and back to coffeeshop, we met up with one of Barney’s retired forestry friends who at one time had been responsible for running Bako. Both Barney and his friend were trained as economists, and both hold very different economic views. When he introduced us to his friend, Barney jokingly said “now don’t listen to this old socialist.” His friend replied with a mock offended huff “I’m no longer socialist, I’m communist!” I swear I learned more debating the 1997 Crisis with those two retired foresters than I did from several months of research!

Home for the Holidays

My Brothers, the Dog, and I

Or “How I Went Home and Came Back Again”

There is nothing like going away and coming back to make things both wondrous and strange. Going home for the Christmas and then returning to KL again, I was able to experience that strange familiarity of homecoming from two directions.

Christmas in North Carolina was not part of the original plan. Before I left in August, the plan was for my parents to come visit KL sometime in May. As I began my adjustment to the heat, spice, and humor of life in Malaysia some of my stories made more of an impact on my mom than others. “It’s really hot in Malaysia isn’t it?” and “How long is the flight to KL, again?” slowly led to the conclusion that my parents would rather meet half way, in a place, say, like Hawaii, than take the marathon flight out to KL. One bout of homesickness and several Kayak.com searches later, when I realized that it was cheaper for me to fly home than fly to Hawaii that settled it. I was coming home for Christmas!

The week before I went home I could barely focus on anything else. My big “try to finish this stage of research before you leave” push was met by an all time productivity low as I intermitently checked the weather in Charlotte and added things like “see uncensored movies” and “cook Malay for parents” to my ever growing list of things to do in North Carolina.

Even the Mulu caves with their gargantuan caverns and rugged legacy of titanic forces could barely keep me from chattering on about North Carolina when I went to visit Munirah in Miri. Somehow, in the midst of tropical jungle with hand eating catepillars and gigantic walking stick bugs everywhere, I managed to say something like “oh, this limestone reminds me of home . . .” I think Munirah wanted to hit me!

All of the anticipation and the buildup still couldn’t compare to what it felt like to finally be home. I nearly knocked my dad over when he walked into the airport. For a few days, the sheer familiarity of life at home made life in Malaysia fade into those recesses of the mind reserved for dreams. My littlest brother Jake had grown another foot or so since the summer. Clay, my little brother, had survived his first semester at college, in engineering school no less! And my dog, Cassidy, looked something like a petite polar bear in her winter coat of fur.

I spent the next two weeks soaking up all the aspects of American life, both the small and the cosmically important, that I had missed in KL. Catching up with friends and hanging around with family were the best. But little things like small talk with strangers and sugar free flavor shots also added to the holiday cheer. There was a friend filled visit to Chapel Hill and Greensboro followed by Christmas with the family and then a dash up to Duplin County to see my dad’s side before it was finally time to say goodbye, again, and fly across the sea.

Three things struck me during my reunions with friends from college and high school. First, everyone looked a tad more serious and professional than they had before I left. Winter styles will do this, but I could tell there was something more. And, my friends in law school will kill me for this, but they especially seemed to have acquired this serious glamour and were far more analytical than they were before.

Second, everyone, except those still in college and those in TFA, mentioned how hard it was to find friends and a network half as interesting as the ones they had known in college. It seemed everyone was struggling with how to fill their time. While sad, this made me feel a little better about my own struggle to connect with people in KL.

Finally, I realized that for the next several years at least or until we all either move to DC or found a retirement home for Chapel Hill graduates, the holidays are going to be one of the few times when I will be able to catch up with my closest friends in person. The holidays are more exciting than they were in college, but also bittersweet.

The flight(s) back to KL was mostly uneventful. On the runway in Newark, the pilot did make a rather peculiar announcement that we would be delayed a bit ” so they can saw a piece back onto the plane,” but missing parts or not we still made it into Hong Kong just fine, if three hours late.

New Year’s Eve in the Hong Kong transfer terminal was probably the cutest thing I’ve ever seen. A few seconds before the stroke of midnight, one of the pink-scarfed airline attendants manning the transfer desks counted down the time on her phone and then shouted across the hall to the attendants manning the desks on the other side. “Happy New Year!” trilled back and forth from either side. One attendant almost fell out of her chair trying to call friends to wish them a happy new year as her friend jumped up and down beside her. The airline attendents kindly included the only two occupants of the transfer hall, a matronly Fillipino woman and me, in their cheer. As the sounds of New Year’s wishes filled the hall, the Fillipino woman sat up from her berth on the airport benches and said to me “Happy New Year – next year will be better!” with an ironic twist of her head to encompass the gleeful airline attendants, the empty airport, and our spot in the transfer hall.

A good thirteen hours later when I finally arrived at my apartment, KL seemed so familiar but yet unreal. The doormen raised their eyebrows as I walked in – perhaps in reference to my two week absence or the heavy winter coat thrown over my bag. After winter in North Carolina, KL resembled a pungent sauna smelling of spice and fermentation. Brighter, hotter, louder than I remembered, it was still, in an almost inverted way, my home.

More Pictures from Sabah!!

Ok, here are the rest of the pictures from Jess and my most excellent Borneo rainforest adventure! I hope you enjoy.

Danum Valley River Shot

Danum Valley is one of the most special reserves in Sabah. The amount of wildlife there was incredible. Just sitting on the porch of the canteen we could see all sorts of species from hornbills to gibbons!

Forest Canopy Shot

My one regret from the trip is that I didn’t look up at the canopy enough. You can see how beautiful the greenscape over our heads could be. I spent too much time checking my socks for leeches!

Enter the Jungle

This was a rather sturdy suspension bridge leading into the main trail area at Danum. It was always a sight to behold before enter the jungle itself.

Artistic Bug Photo

Traveling with an ecologist was hilarious at times, especially during her frequent stops to pick up, look at, or photograph bugs. This shot turned out to be pretty artistic. Maybe a second career for Jess? Once she’s done working at DeLong Labs in Cambridge, of course!

More Tigers Leeches - Oh My!

Oh leeches! These are Tiger Leeches, one of the two dominant leech species in Borneo. They are incredibly colorful with streaks of orange, blue, green, and sometimes red. They’re also faster and more persistent than their boring brown Borneo Leech cousins.

Forest Butterfly

One of hundreds of beautiful butterflies we saw in and around Danum. There were so many different species we lost count!

Tiger Leech!!

We also lost count of the number of leeches we saw. Yuck!

Super Neat Bug

Ok, I wish we’d been able to get a less blurry picture of this bug, but this was the best we could do. I think the humidity was a little too high. Check out the nose and beautiful colors on this one. Jess says that she saw several different varieties of this bug up in Perak, each one a different combination of fantastic colors.

Rolly Polly Bug

Yep, there goes Jess, picking up a bug! She had a special thing for rolly pollies and hermit crabs. To be fair, I had a thing for cowry shells.

Can You See the Crocodile?

I’m glad we saw this guy (over three meters long!) towards the end of our boat tour. Crocodiles were definitely on my species wish list before the trip so I’m glad we got to see one. After seeing so many alligators in the US, I was itching to see their more dangerous cousins!

Sleeping Trogon

The best time to look at birds was actually at night when they came low in the canopy to roost. Because they can’t see in the dark, the birds wouldn’t twitch so much as a muscle no matter how close you came to them. We were probably two or three feet away from this couple when this shot was taken.

Lots of Elephants!

Our guides estimated that all in all, between the ones on the river shore and the ones back hidden in the bamboo, the herd of pygmy elephants we saw had over 70 individuals! We were incredibly lucky to see them. Because they had two baby elephants under a month old with them, they didn’t retreat into the forest as fast as they would normally have. It gave us a great chance to watch the elephants play and to be watched in return!

Elephants with Month Old Baby

You can see one of the tiny elephant calves right here. They were adorable!

That’s all the photos! I’m still working on getting a camera before my trip to Penang and my trip to Sarawak. Hopefully, I’ll have more photos to post in the future!

Sabah!!

A couple of weeks ago, my friend Jess, a forestry researcher from the States, and I embarked on a mad dash adventure to Sabah in Malaysian Borneo in hopes of visiting the legendary Danum Valley rainforest preserve. Here are some photographic highlights (courtesy of Jess’ photography skills, my camera has been busted for the last month or so – apologies to those of you who have been wanting more pictures):

Jess Playing in the Street Market

Kota Kinabulu has a wonderful Sunday night market full of fruit, food, and neat handicraft vendors. As we were walking through the market, two older men motioned us over to try our hands at the gamelon. Jess was a natural – perhaps a new musical star in the making!

Roadside Fruit Vendor

The fruit in Sabah was amazing. Here you can see my favorite type of fruit, salak fruit, which is incredibly hard to find in Kuala Lumpur. No good explanation yet for why it is so hard to find. The best one I have heard so far is that it is considered more of a “kampung fruit” (i.e. village fruit). I guess I’ll just have to start making trips to villages then!

Yep . . . scorpion . . . that's what we found in our hotel room

This was an interesting interlude. We were getting ready to turn in the night, lazily chatting about our plans for the next day, when Jess sat bolt upright and gasped “what’s that by your shoe?!” Sure enough, we had a huge night visitor. Not deadly, but it would have hurt a lot if we met his stinger.

Green Pit Viper

Sometimes traveling in the jungle brought back memories of a book I had when I was little called “Prickly and Poisonous.” It was full of the most colorful illustrations of all the world’s deadliest species. This one, the green pit viper, was everywhere on our first night walk outside Sandakan. We saw four that night alone. They are disarmingly delicate sitting like tiny green gems among the night foilage. But if they bite you, it’s pretty much over. The crazy thing is that the pit vipers were not the most poisonous snake I saw while in Sabah. While looking for cowry shells on Sapi island, I glanced down to find a beautiful blue and black sea snake with the merest hint of gold on its nose floating in the tidal pool at my feet. It was absolutely the most beautiful and most deadly creature I saw on the entire trip. I just wish I’d had a camera with me!

The Lizard Who Thought He Was A Leaf

We felt some serious “be the leaf” vibe from this little lizard zen master. There was a lot of leaf imitation going on in the forest – from a bird that flew like a falling leaf to a giant horned frog who looked just like a leaf except for the fact that he was massive! (picture of the frog coming soon)

Beautiful water view off of Sapi Island

Ok, so this image was supposed to rotate a bit. Sorry – it’s still a beautiful view if you turn your head!

Many more photos coming soon (or at least, as soon as I find a better internet connection!)