Friday, October 31, 2003
Volokh Conspirator Randy Barnett points to this NRO piece about how anti-Semitism is fashionable among educated people. A few nights ago, I was struck by the protesters with various anti-Israel posters as I was entering an Alan Dershowitz speech titled, "The Case for Israel" (the same title as his book). The protest surprised me because Professor Dershowitz advocates a two-state solution.
Home sweet home
Link above is to the venerable hometown paper and its reporting of a small bison stampede problem in town the whole day. As they say in the blogosphere, "read the whole thing."
Tuesday, October 28, 2003
Will Baude wants to know why test-prep teachers (Kaplan, Princeton Review, etc.) aren't paid based on improvement in score. This is an intriguing idea, that is, if I actually learned anything from that twerp who taught the MCAT class. People who take test-prep classes generally want to know what exactly is on the test so that, if the test is a knowledge based test like the MCAT, they can study all the relevant info, or if the test is akin to the LSAT, they can learn how to construct clever syllogisms in time to get that 180. We pay for the books that tell us how to do it and the schedule of study that is supposed to prepare us in three months and, if you're like me, ignore the talking head who guides you through the mysterious process. We also shell out the grand to take practice tests to establish pace and ease anxiety. The product you are buying isn't a service by a teacher but rather, the materials you have access to - all those books and practice tests. Kaplan values their materials so highly that I had to sign a contract stating that I would never sell my MCAT prep books. So why pay the talking heads based on improvement in test scores when their performance is irrelevant to success on the test (or at most a minor contributing factor)? As for paying the test-prep company based on performance, that's another post.
Monday, October 27, 2003
Hello to all. After months of being bothered, I join the ranks of my fellow alumni in the blogosphere. I am grateful to Beth for inviting me into the sacred domain of the reg rats.
It is with great disappointment that I must remain anonymous. The purpose of my anonymity is for one reason: to ensure some chance of becoming a clerk for a federal court in the near future. Just like ASCAP, which sends thousands of secret agents to report back copyright infringement of every beach party that plays a Gary Glitter tune, the federal government is always looking for ways to destroy the career of young lawyers who actually have an opinion on the law. I am no exception.
However, I do wish to give a few clues about myself. I attend law school in the mid-west. I have several degrees from the UofC but not a PhD. I speak several languages (Hebrew, German, and Japanese). I am a very bad law student. If any of these attributes are compelling to you, and you are the hiring partner of a law firm, please contact me!
In the future, I hope to dig up the nine years of experience I had at the UofC and apply it to the real world---you know, that place on 53rd and Blackstone.
As an opening shot, I would like to declare that I don't miss Hyde Park (another clue! I don't live in Hyde Park). It was just a few weeks ago that a fellow alumnus was pining for the UofC in my presence. We happened to turn on WGN--the lead story: dead baby found in trash can on 50th and Blackstone. Why that was just a scant three blocks from my former abode! But how could the police ever find the baby in the trash can: a beleaguered spokesperson for the CPD looks into the camera faintly smiling, "We would never have found the dead baby if it weren't for the trash workers' strike." Ah, Chicago, how could I have left thee (clue: I no longer live in Chicago)!
Friday, October 24, 2003
The New York times analyzed licensed dog data and reports that (surprise, surprise) Manhattan has a lot of shih-tzus and the bronx has a lot of rottweilers. More interesting to me, though, was that 80% of New York dogs aren't licensed. As an owner of a properly vaccinated and socialized schipperke, I'd like to know why I should buy a license. Obviously, it isn't possible for a city like New York to enforce licensure requirements. Are there benefits to having a license? New York makes you pay $8.50 or $11.50 for a dog license (depending on whether the dog is neutered). Presumably, the dog license is useful in case your pooch is lost, but so is a dog tag that you can buy at any pet store or a microchip that your vet can inject under your dog's skin. Maybe licensure helps cities gauge and pay for pet-related services? If anyone has any insight into this, I'd love to know.
Well, I'm back in the stacks but hopefully I've dragged a few Crescat readers with me. Thanks again to Will and everyone at Crescat Sententia for allowing me to guest-blog and for all the emails I received. Hopefully, email addresses and a blogroll will appear soon so that readers can contact us and see what we read.
Also, I'd like to take the opportunity of introducing a new reg rat, Toll Monkey. Tolls (not his real name) is an alumnus of Our Fair Institution and prefers to remain anonymus, at least for now, because of clerking aspirations.
I look forward to his contributions. Please email him and me (once our emails appear on the side) lots of comments.
Tuesday, October 21, 2003
As the consumate social scientist, let me give a cit. to back up my wild speculation below. On the question of the stabilizing effects of marriage, Laub and Sampson argue in their book Shared Beginnings, Divergent Lives that marriage as a life event and the investment that went along with it ended many a criminal career. Again as the consumate social scientist, let the caveats fly: their data is from the the first half of the last century, changing social meaning in marriage could change its conditioning impact, it could be that those who wanted to end criminal careers got married instead of those who got married ended criminal careers.
Back to studying up on logit and probit regressions.ck
Saturday, October 18, 2003
I feel so abandoned, so alone, its like the B-Level at 2 am (before the computers were added).
I've been half watching Crescat this week while being buried by my teaching load. As for the debate about marriage, I can offer very little as my Chicago magazine hasn't arrived yet. Generally speaking, though, its dangerous to judge someone's work based on Alumni Solicitation Monthly. Waite's finding was presented in her book The Case for Marriage. I haven't read the book but she pumped it repeatedly when I was in her methods class. Seeing as I went to a very small fraction of the class meetings I can't even say much based on that.
Generally, her findings sound right but I'd be surprised if she makes the strong causal argument the article suggests. Anyhow, assuming her findings, let me pull out my speculative sociology hat.
This is about as far away from what I study as you can get and still be in Sociology but I will suggest a few mechanisms that may explain the finding:
1) Nagging. Part of the health benefit is found in a mutual monitoring for health problems. Married couples have a higher transaction cost of leaving a relationship than cohabbers and thus invest more in prolonging it.
2) Kids. Beyond pure monitoring of syptoms, I suspect that a spouse is a stronger watchdog against medium to high risk health behaviors (injection drug use, alcohol abuse, smoking, fat, salt, carbs). I say this not because cohabbers don't care (we do!) bubut because married are more likely to have kids (depending on her coding) and kids are a strong deterrant to high risk behavior.
3) Insurance: Fewer employers each year are offering comprehensive health care benefits. By law in most places, though, if 1 spouse has coverage, the other can buy in cheaply (relative to buying privately). Being married, then, offers a substantial increase in the probability that 1 spouse has a job that provides employer paid health care. People with insurance use more preventative care, ounce of prevention,pound of cure...
Up next, I write about how health insurance is the root of all that is wrong with America. I'm on an insurance kick (why will be clear in a few weeks) and will use Beth's space to fill her Free-Market blog with Socialistic and Marxish ranting. That'll teach her to blog w/ undergrads.
Friday, October 17, 2003
Though midterms have had me maintaining radio silence, contact resumes today. I'll be guest-blogging for a little while over at Crescat Sententia. Please stop over and visit.
Thursday, October 16, 2003
UNC's e-mail servers were down for the past 36 hours returning most of the campus to the stone age (1992). People had to (GASP!) walk down the hall to ask a colleague a question.
The interesting part of this, for me, is that the reaction was evenly split between "E-mail is broken so I can't get work done" and "E-mail is broken so now I can get work done". I was a fence rider on this particular question. Got lots of work done but felt vaguely isolated from the outside world (unable to ignore the pressing messages in my inbox).
While the servers were down, they backed up over 500,000 incoming e-mails waiting to be delivered. These are getting dropped into my in-box in a seemingly random order (not ordered by time, name, or source). It lends to e-mail checking that anticipation of unanticipated surprise found at easter egg hunts and when opening a Cracker Jack box.
I have some thoughts on markets but not on hospitals in Ohio. I plan to share when my to do list gets under the 25 item bar.
Friday, October 10, 2003
CAN THEY DO THIS??? MORE ON COLLUDING HOSPITAL LEGISLATION
According to the Ohio Chapter of the American College of Surgeons, which has so far not taken a position on HB 71,
"House Bill 71 was introduced largely at the request of central Ohio community hospitals that are opposed to the recent construction and development of 'boutique' orthopedic hospitals in Columbus suburbs. The community hospitals contend that boutique hospitals will 'cherry pick' the most profitable patients from the community hospitals' revenue base thus leaving the costlier low-pay and non-pay patients. It is argued that boutique hospitals will financially undermine the ability of community hospitals to continue to provide the same level of charitable care and less profitable services to the community."
Specialty or boutique hospitals are for-profit hospitals, usually physician owned, that provide a narrow range of health services, such as orthopedics, or psychiatry, or heart care. Think of them as an advanced group private practice - physicians get together, invest their own capital, and open a practice in their trained specialty. Only their practice offers services that a person only used to be able to get at a large hospital. For instance, when I injured my foot in gymnastics 15 years ago, I went to an orthopedic specialist who referred me to a surgeon based in a community hospital, where the surgery was performed. If I had the same injury now, I could make an appointment at a specialty hospital, where my injury would have been diagnosed, operated on, and followed-up. Specialty hospitals appeal to some physicians because they are smaller, more intimate environments that can provide continuity in care and physician control over their output and compensation. Specialty hospitals appeal to some patients because their existence enables more choice in service, they are efficient, intimate, and they can be more cost-effective. As one Columbus Dispatch letter to the editor put it, "There are no $5 aspirins in a boutique hospital." Boutique hospitals don't provide the entire spectrum of services in a specialty. Generally, the rarer, more complicated surgeries must be referred to the academic medical centers (community hospitals). Community hospitals get a lot of their revenue from surgical procedures that can be performed in specialty hospitals. Community hospitals also provide emergency services and medical care to the indigent.
If passed, HB 71 puts a two-year moratorium on construction and expansion of all for-profit specialty hospitals. If a for-profit hospital in existence meets certain criteria, such as operating a 24-hr emergency room, hiring physicians who don't have investment interests in the hospital, disclosing physician investment interests to patients, providing indigent care, and other criteria the hospital is exempt from the expansion moratorium. The bill also prohibits all hospitals from discriminating in hiring practices with relation to financial interests in the hospital, meaning that for-profit hospitals can't not hire someone only because he doesn't have an investment in the hospital and other hospitals can't not hire someone only because he has an investment in a for-profit hospital. The bill outlaws physician referrals for in-patient services to a hospital in which he or a family member has a financial interest and sets up a committee to study, among other things, the impact of specialty hosptials on the community.
My two cents:
This legislation is bad all-around. Boutique hospitals are profitable because they meet a market need. Patients demand community hospital alternatives for any number of reasons: they are smaller, scheduling is faster, they are more cost-effective, they are closer to home, and they give patients more time/continuity with their physicians. Physicians are ready to meet this need because they are tired of not having control over their output. The previously referred-to letter to the editor (available online only to Columbus Dispatch subscribers) mentions that at community hosptials, physicians are not paid for treatment of the non-paying patients (hospitals are subsidized by the federal government for non-payers but not physicians). It also mentions that in community hospitals, physicians don't always have control over staff and supplies. The physician writing the letter stated that he sometimes worked with assistants who didn't know what surgery he was performing or even which organ he was operating on. Specialty hospitals give physicians the opportunity to control their environment, who they work with, how they're paid, and how they interact with their patients. Being financially invested in a hospital seems to me an excellent quality assurance mechanism. If a for-profit hospital provides sub-standard service, consumers won't choose it and it loses money. The physician's profit actually correlates with the quality of service he provides. If hospitals are required to hire people without financial interests in their organizations, they are undermining their quality assurance mechanism. Also, a community hospital can decide to charge $5 for an aspirin, and we have to pay it if that hospital is the only game in town. Now that other hospitals want to compete, the community hospitals have decided to collude and that's not right. Community hospitals argue that care for the indigent burdens them and other services pay for it. If someone else can offer other services better than they can, people won't come to them for those services and they can't pay for the indigent. The answer is not preventing others from offering better services. Even if indigent care suffers, why should it subordinate basic freedom? Also, if a competitive market is allowed to operate in health care, eventually, health care costs will go down, benefitting the indigent.
Wednesday, October 08, 2003
NAKED DOCS AND COLLUDING HOSPITALS
The rising cost of medical liability insurance is causing some doctors to forego coverage altogether. Linear algebra demands my time right now but I will blog more about this issue in the coming days and weeks. Overlawyered.com links to blog-posts discussing docs "going bare."
Also, legislation putting a two-year moratorium on new and expanding for-profit hospitals passed the Ohio House and was introduced to the Senate a couple of weeks ago. I'm no lawyer so HB 71 will take me a while to sift through. This bill summary is excerpted from the Legislative Service Commission bill analysis:
- Establishes a two-year moratorium on establishment, development, expansion, or construction of a new for-profit special hospital unless the project meets certain requirements that except it from the moratorium.
- Creates the Special Hospitals Study Committee.
- Requires a physician who has a financial interest in a hospital to disclose the interest to patients in writing when the physician refers to the hospital.
- During the moratorium, prohibits a physician who has a financial interest in a for-profit hospital from referring patients to the hospital for inpatient services.
- For a two-year period, prohibits a hospital governing body from discriminating against a physician for hospital staff membership or professional privileges on the basis of whether the physician has an ownership or investment interest in a special hospital.
Thoughts to come after I take a closer look at the bill. An initial scan gives me the shivers. As far as I can tell, the "certain requirements that exempt it from the moratorium" depend on whether the Department of Health think that the hospital serves the public need.
I knew there was a good reason (other than an insufficiently stocked sociology gravy train) that I didn't subscribe to The Atlantic Monthly. According to this NYT article, they've tossed their hat into the college ranking ring. They offer America's HS students (parents) another, much less sophisticated*, measure of where to spend four years drinking. They base their ranking on "rejection rate, median SAT scores, and class rank of its applicants" The commonality amongst these metrics is that each of them has only the loosest connection to any college experience. They measure essentially the competition in the admissions process (assuming a quantatively based admissions criteria).
Ordinarily, I would let this slide, I'm in grad school, the students I teach at UNC won't change composition in the coming years based on this**. The great sin of The Atlantic that provokes this is their method drops my beloved (sometimes hated) alma mater from 13th (USNWR) to 39th. UofC drops because it is a great school whose admissions standards are, with regard to numbers, quite low. Last week I shilled at a local college fair and went through the "uncommon app" with high school students pointing out that 'Chicago' wanted to get to know them as people and to make sure that their fit with the place went beyond mere cognitive ability.
Still you ask, why does this bother you?. Pride is my first answer. My second is more noble. I'd hate to have a good kid who would fit in at UofC miss out because he/she/his/her parent applies an entirely irrational selection criteria to the question (ie I'm only applying top 25). Also, I'm generally annoyed when claims don't match metrics. In this case, they should rename their list "America's toughest colleges to get into based on quantitative factors". Probably wouldn't sell well from the newstands.
*basing this on the NYT article, I have yet to see this on a newstand
**Because the outstate/instate composition is set in the legislature and out-of-state admission is so insanely competitive anyway, externalities like a ranking seem to me unlikely to sway anything very much around here.
Tuesday, October 07, 2003
Nobel Prize Rumor U of C lets someone else win one? If this is true the reaction will be far more entertaining than the awarding as such. Nowhere near as amusing as "soccer"'s nomination (and rumored consideration) a few years back.
Announcement rumoured at 4pm tomorrow (swedish time) I guess but don't know for sure that's 10am est.
UPDATE: announcement now set for 11am (Swedish) on Friday. 5am here?
Stole the link to DeLong from Calpundit
ANOTHER ONE FOR THE T-SHIRT
Alexei A. Abrikosov of the University of Chicago's Argonne National Laboratory wins this year's Nobel Prize in Physics.
MORE ON BIAS IN ACADEMIA
Professor Jacob Levy of The Volokh Conspiracy comments on my experience with classroom bias.
Professor Levy makes a point that I wasn't able to articulate very well:
"It's the little jokes, one-liners, casual asides, and obviously-everybody-knows comments that you've got to watch out for. This is a familiar point with regard to hostile environments against, e.g., women. But it's also true as regards whether the classroom is experienced as a place open to political disagreements. The more a prof's lecture is peppered with these little asides and dicta, the more the impression is created that views other than the prof's own won't be given a respectful hearing."
Public health study is perhaps different from a lot of academia because the end-goal of academic programs in public health is the improvement of public health, not necessarily understanding it or questioning its value. In history or poli-sci classes, policies and events are scrutinized from all perspectives and no ends or methods are accepted without question. The goal is better understanding, not promotion. In many of my public health classes, it's taken for granted that public health is the ultimate end, and as students of public health, we're just trying to find ways to reach that end. To me, personal freedom is of the highest value and I don't believe that it should be subordinate to even the loftiest of public health goals. I'm all for improving public health, but not at the expense of liberty and I'm in school to study public health to draw my own conclusions about what should be changed, why, and how-- not to be taught that public health is the supreme goal and that x,y, and z policies are the ways to improve public health.
The "little jokes, one-liners, casual asides, and obviously-everyone-knows comments" I've experienced in my program aren't just left-leaning comments promoting regulation. They are evidence of the unquestioned attitude that public health is the supreme goal and that our job as public health practitioners is to change public policy to promote this goal. I don't accept those premises and therefore am uneasy with a lot of my coursework.
Well, I'm here and the technology seems to be working so I may as well poke my head above ground and say hello. I suspect that at least most of you (its only now occured to me to ask Beth who's reading this) know about who I am. For those of you who don't, the blurb below gives the key historical points.
To give everyone a sense of where my source material comes from, my bedside table reading stack (aside from what I'm supposed to be reading for classes I take/teach) includes Carl Ernst's Following Muhammad, Thucydides' History of the Pelopennesian War (bedtime reading) and the current editions of The New Yorker, Harpers, The New Republic, Bitch, AJS, and Daedalus.
Blog/online wise I read Talking Points Memo, Crooked Timber, Calpundit, The Volokh Conspiracy, Dan Drezner, Political Aims, Atrios, Slate, The New York Times, and last but not least, the good old hometown paper.
Its a long shopping list and explains, most likely, why my MA progress has been slow since the start of school a few months ago.
Substance will follow eventually.
Monday, October 06, 2003
PLURAL TITLE NOW MAKES SENSE
Welcome to the newest Reg Rat, Clint Key. Clint, a Montanan, ex-ranch hand, University of Chicago alumnus, sociology graduate student at the University of North Carolina, inveterate reader, and self-described huge dork will be joining the blog. When the spirit moves him, I look forward to his posts.
Friday, October 03, 2003
YET ANOTHER LAUREATE
Congrats to JM Coetzee (pronounced kut-ZEE-uh), this year's Nobel Laureate in Literature and visiting professor at the University of Chicago. I guess the t-shirt needs updating.
Thursday, October 02, 2003
My milk expertise is quoted on the venerable Crescat Sententia.
The New York Times reports on required hospital services to the indigent. Hospitals are required by law to provide emergency room care regardless of ability to pay. Is this right? I venture to say that even if hospitals are not required to provide such care, doctors and nurses aren't going to allow someone right in front of them to die. In a true emergency, ability to pay is not the first thing considered. People rushed into an emergency room on the brink of death are treated as fast as medically possible and the bill is sorted out later. When you dial 911, the operator doesn't ask, "And how might you be paying for the ambulance today?" However, true emergencies don't comprise the majority of visits to the ER by those who can't pay. Because the ER is required to treat without compensation, it is often used as a primary care physician's office for those with limited resources, reducing the quality of care to those with real emergencies and burdening hospital resources. Why should a private hospital subsidize these activities? The usual reply is "because health care is a necessity or universal right." Well, isn't eating also a necessity? Are grocers required to give away food just because someone says he can't afford it? If the person takes it without paying, isn't that considered stealing to even the most soft-hearted among us? The article mentions that the State of New York puts a tax on all hospital bills which goes into a state-controlled fund, distributed to hospitals to compensate for care of the poor. However, also according to the article, $847 million is the fund's total payout and actual unpaid hospital bills amount to $2.5 billion a year. Hospitals have to shoulder 2/3 of the burden of caring for the poor. Might I also add that the other third is shouldered by the paying hospital patients whose care is compromised by abuse of the system. My public policy suggestion is to scrap the legislation and levy altogether. I contend that in true emergencies, hospitals will provide care first and worry about bills later. People who use emergency rooms for purposes other than emergent medical problems will be dissuaded to because of the prohibitive cost and hospitals will be able to improve the quality of care they provide by freeing resources. It's in a hospital's best interest if it works out an installment payment plan for those with limited resources, and for the true charity cases, a hospital can decide its own way to fund care. Even if the hospital charges other patients a fee for it's charity as part of providing service, this has to be more efficient than the government mandating a state-controlled kitty.
GIANT APES AND LIZARDS DESTROYING CITIES
The old arcade game Rampage is available to play for free here. A highly recommended distraction from tiresome required reading.
ALWAYS TAKE THE WEATHER WITH YOU
Ohio State University's School of Atmospheric Sciences has a great weather server. Not only can you get up to date weather info for anywhere in the U.S., you can also learn about such weather topics as convective inhibition, storm relative helicity, and radar.
Wednesday, October 01, 2003
The Washington Post reports that women with breast implants have higher rates of suicide than other women. The study includes data from Swedish, Finnish, and American women and the data indicate a threefold increase in suicide rate compared to non-augmented women. This should not be surprising, as most women who elect for an expensive and invasive surgery to improve sexual appeal can't possibly have very good self-esteem to begin with. Supporting this is the finding that women who have undergone breast augmentation after mastectomy don't have the elevated suicide rate. As a group, people who want to change their normal, albeit humanly varying breasts can't be expected to be as mentally sound as people who would like to change disfigured body parts that remind them of a horrible disease. Also, suicide rates in general are higher for western women, i.e., those who can afford the surgery and are thus more likely to think about and undergo the operation. (most recent death by suicide stats per 100,000 women: US-4.1, UK-3.3, Finland-10.9, Sweden-8, Peru 0.4, Thailand-2.4, Brazil-1.8 to list just a few). Why do rich women kill themselves? Lack of better things to do? Do they have nothing else serious to worry about so they obsess over themselves? Short answer: probably. Long answer: there's also a lot more to it. However, it's ridiculous to claim any causation between breast implants and suicide. Take a close look at the sample population before claiming that silicone makes you crazy.
NB: The previous link is to World Health Organization data. The WHO site is an excellent database for all kinds of health statistics, especially mortality and birth data.
Thanks to OxBlog for the pointer.