Wednesday, December 17, 2014

Why Price Competition Doesn't Work in Most Health Care Markets

The New York Times has published a good article on the wildly varying prices for diagnostic procedures and the apparent stickiness of those prices at the upper tail of the distribution.  The quickest possible look tells us that the prices are not set based on some kind of marginal cost thinking, as simple market models assume.  For example:

With pricing uncoupled from the actual cost of business, large disparities have evolved. The five hospitals within a 15-mile radius of Mr. Charlap’s home here charge an average of about $5,200 for an echocardiogram, according to an analysis of Medicare’s database. The seven teaching hospitals in Boston, affiliated with Harvard, Tufts and Boston University, charge an average of about $1,300 for the same test. There are even wide variations within cities: In Philadelphia, prices range from $700 to $12,000.
You don't need to know anything more than that to know that the markets are not truly competitive, that consumers are uninformed about the prices (except after the fact when it's too late to shop around) and that the supply side has price-setting power.

In other words, competition doesn't lower prices*.  Rather the reverse, in fact:


Tuesday, December 16, 2014

On Women in the US: Wikipedia, Montana Legislature And Skirt Lengths, And What Sony Pays to Its Female Stars.


Wikipedia, the wonderful experiment in anarchy, has a shadow side:

Wikipedia is a paradox and a miracle—a crowdsourced encyclopedia that has become the default destination for nonessential information. That it has survived almost 15 years and remained the top Google result for a vast number of searches is a testament to the impressive vision of founder Jimmy Wales and the devotion of its tens of thousands of volunteer editors. But beneath its reasonably serene surface, the website can be as ugly and bitter as 4chan and as mind-numbingly bureaucratic as a Kafka story. And it can be particularly unwelcoming to women.

Why unwelcoming to women?  Because of this:

Last week, Wikipedia’s highest court, the Arbitration Committee, composed of 12 elected volunteers who serve one- or two-year terms, handed down a decision in a controversial case having to do with the site’s self-formed Gender Gap Task Force, the goal of which is to increase female participation on Wikipedia from its current 10 percent to 25 percent by the end of next year. The dispute, which involved ongoing hostility from a handful of prickly longtime editors, had simmered for at least 18 months. In the end, the only woman in the argument, pro-GGTF libertarian feminist Carol Moore, was indefinitely banned from all of Wikipedia over her uncivil comments toward a group of male editors, whom she at one point dubbed “the Manchester Gangbangers and their cronies/minions.” Two of her chief antagonists in that group got comparative slaps on the wrist. One was the productive but notoriously hostile Eric “Fuck Wikipedia” Corbett, who has a milelong track record of incivility, had declared the task force a feminist “crusade ... to alienate every male editor,” and called Moore “nothing but a pain in the arse,” among less printable comments; he was handed a seemingly redundant “prohibition” on abusive language. The other editor was Sitush, who repeatedly criticized Moore for being “obsessed with an anti-male agenda” and then decided to research and write a Wikipedia biography of her; he walked away with a mere “warning.”

My guess is that a certain number of the volunteer editors (such as the man who called the founder of Wikipedia a "dishonest cunt")  don't exactly yearn for a larger input for women (aka cunt-carriers?).  The impression I get agrees with what the author of the article states:  The group with the greatest staying power wins, never mind the facts in the story.  Or in other words, if you offer anarchy it doesn't mean that power hierarchies are not created.  They just become impermeable to the influence of the rest of the group.

And if women face extra aggression in the editors' meeting places, it's unlikely that their numbers will rise very fast.  This extra aggression could be both because of misogyny of some milder type and because outsiders shouldn't break into the fortress.

In Montana, the members of the legislature are provided with a dress code.  The code differs for men and women.  It requires female legislators to be sensitive to "skirt lengths and necklines."  Male legislators are not asked to be sensitive to, say, the tightness of their pants in the groin area or how many buttons they have undone.  This is an unimportant matter, in the wider frame of things.  But as one Montana legislator states:

Ms. Eck said she was leaving a health care forum in Helena, the capital, on Monday when one of her Republican colleagues peered at her and told her that he was glad to see she was dressed appropriately.
“It just creates this ability to scrutinize women,” Ms. Eck said. “It makes it acceptable for someone who’s supposed to be my peer and my equal to look me up and down and comment on what I’m wearing. That doesn’t feel right.”
And there's a more traditional gender-political division here, too:

Eck said, "(The dress code) is signed by House leadership, but the Minority House leadership wasn't consulted and I do have an issue with that because the majority of our caucus is women and the majority of our leadership is women."
Speaker Knudsen said the matter's been blown out of proportion, and that no one is going to be measuring skirt lengths.

The Sony hack seems to reveal that the Hunger Games star Jennifer Lawrence was paid less than her male co-stars on American Hustle  and that 

The news is even more troubling when you take into consideration that the hack also revealed a staggering gender pay gap among Sony staffers. According to a spreadsheet listing the salaries of 6,000 employees, 17 of those employees were raking in $1 million or more, but only one of those $1 million-plus employees is a woman. Also, analyzing the pay of the two co-presidents of production at Columbia Pictures—who have the same job—pointed to another gender-pay disparity, with Michael De Luca ($2.4 million) making almost $1 million more than Hannah Minghella ($1.5 million).
These data are raw and unadjusted to anything that might be relevant in how someone is reimbursed.  Still, raw data like that suggests that more detailed study of the payment policies of Sony would be pretty interesting.

As I've written before, the secrecy about salaries and wages in the US serves only the employers who wish to pay people the smallest amount they can get away with.  And if the markets, overall, offer women lower alternative salaries, well, Sony can pay women less, too!  Save money, right?







 


Saturday, December 13, 2014

Going Home. Are US Women Leaving The Labor Market And If So, Why?


The New York Times is running a long series on the US employment situation.  Yesterday it ran a story of American men without jobs, today a similar type of story ran on American women.  It's the latter that requires some extra attention here.

It's not a bad story at all.  It looks well-researched and it points out the lack of government policies which would help women with children to stay in the labor force.  That lack is reinforced by the cultural norms which expect mothers to do all the hands-on child-care. 

But those problems have existed in the US for ever.  They are not new policies, and as such they cannot explain the crucial statistics the article quotes, these:

As recently as 1990, the United States had one of the top employment rates in the world for women, but it has now fallen behind many European countries. After climbing for six decades, the percentage of women in the American work force peaked in 1999, at 74 percent for women between 25 and 54. It has fallen since, to 69 percent today.
The article notes that countries such as Sweden, Norway, Switzerland, Canada, France, Britain, Denmark, Portugal and Japan all have higher labor market participation rates of women than the US, and the reasons for those differences are at least partly in the lack of paid parental leave and good subsidized daycare in the US.  Still, the drop in the US women's labor market participation rate from 1999 to 2013 has a better explanation than this:

But the failure of the United States to meet the needs of working parents doesn't respond to the headline of the piece, "why U.S. women are leaving jobs behind." The answer to this question is very clearly the state of the economy. After all, the employment to population ratio (EPOP) for prime age women peaked in 2000 at 74.2 percent, coincidentally the peak of the business cycle. After the stock bubble burst and threw the economy into recession in 2001 the EPOP for prime age women declined. It bottomed out at 71.8 percent in 2004 and then started to rise as the economy began to create jobs again. It peaked at 72.5 percent in 2006 and 2007 and then tumbled to a low of 69.0 percent in 2011. Since then it has inched up gradually as the labor market has begun to recover from the downturn.
I agree with that quote.  Note, especially, how the EPOP has varied within a short time period.  Those changes cannot be explained by the lack of support for working parents (read: mothers), because that lack of support has been fairly constant.

An interesting problem in stories like this one (or any stories which use interviews with individuals as anecdotes) is that the anecdotes appear to support the stories (women wishing to work but unable because of child-care obligations), simply because the interviewed people are telling the truth about their lives.  But the people picked for the interviews are selected to go with the plot the author(s) wish to follow.  Similar stories could have been told at the peak of the business cycle in 2000 or at any time, pretty much. 





Friday, December 12, 2014

When Religious Rights Clash With The Rights of Others


Religious rights often clash with human rights, because so many of them are demands to be allowed to decide how other people live or demands to be allowed to treat other people as lesser.   Ultimately, of course, they are all about organizing the whole world so that one's own religion trumps everything else, including other people's religions.  Just look at what the founding principles of the Islamic State are all about.  Granted, they tend to have the most severe form of demanding what they have decided to define as their religious rights, one which utterly shreds any human rights of women or gays and Lesbians or those whose religions (including their interpretations of the same religion) are different.

However distantly, the arguments the Islamic State uses are plants from the same root as the recent growth of the religious rights movement in the US,   This quote explains the similarity fairly well:

NM: Let's start with why these two things — religious belief and civil rights — have come to seem so at odds.
KF: Part of the problem is the way we're currently framing the issue. On the one hand, we have the free exercise of religion, which is largely based in an appeal to revelation, to the truths of religious texts and religious doctrine. And on the other hand we have rights of equality and liberty, which are based in rational arguments — what are people entitled to as a matter of their humanity because we should all be treated equally under law. It’s an incommensurable confrontation between revelation and rationality. What ends up happening is that religion ends up like a trump card — you throw it down, it’s a conversation stopper, and we don’t know how to get out of this impasse. Law is really ill equipped for adjudicating between the claims of revelation and the claims of rationality.
The more practical interpretation of that clash is that most large religions allow interpretations which take away equal rights from women, from gays and Lesbians and from those who possess different religions or none at all.  To be able to practice one's religion in peace, then, may well mean that other people's lives become harder, narrower, less free and more dangerous.  While this is very clear in the events happening in Iraq and Syria, the same basic conflict exists whenever one's religious rights are set above other people's human rights.


Thursday, December 11, 2014

Two Studies on Differences Between Men And Women At Work


These studies are, first,  on comparing men and women who acquired a Harvard MBA on various measures of success and satisfaction, and, second,  on the ratings online professors get, based on the gender the students think they belong to.

They both share a certain flavor of not being the last word on the topic, but they are also worth dipping into for what they can tell us.

Wednesday, December 10, 2014

Cromnibus. Or Making Sausage Out Of Pigs.


The name "cromnibus"* is a new silly word for both short-term and long-term government spending bills.  It's intended to keep the government funded until September 2015, while squeaking through all sorts of utterly unrelated riders.  The Republicans also want to use it to fight president Obama's immigration actions (that's the CR or continuing resolution part).  The measure must be voted on by midnight EST on Thursday.  Otherwise the government will shut down.

Since it's the time before Christmas and its traditional gifts, it's worth asking who might be treated as having been a good child this year.  The Department of Defense, for sure:

For the Defense Department, the legislation would provide $554.1 billion for fiscal 2015, just smaller than the $554.3 billion the Obama administration requested.
But the bill's $490.1 billion base 2015 Pentagon appropriations bill, if enacted this week, would be $3.3 billion larger than the amount allocated for fiscal 2014.
The measure would give the White House most of the funds it requested, including $3.4 billion of the $5.6 billion it recently asked for to fight the Islamic State in Iraq and Syria. It proposes $64 billion for the Pentagon's overseas contingency operations (OCO)account; with the war in Afghanistan winding down, that level would be about $21 billion less than the 2014 enacted level.
A summary of the cromnibus released by congressional leaders and top appropriators states it includes $93.8 billion for total Pentagon procurement, a $1 billion hike from the previous year. For R&D, DoD would get a total of $63.7 billion, up $700 million from 2014.
Amid worries about the military's readiness, appropriators are proposing $161.7 billion — $1.8 billion more than last year — for operation and maintenance accounts.
...
The measure also substantially ramps up funding for the Navy's E/A-18G electronic warfare jets to $1.4 billion, providing enough monies to buy 15 in fiscal 2015.
For the Navy, the legislation provides a $1 billion funding hike above the request for one San Antonio-class amphibious transport ship. It also would keep the American aircraft carrier fleet at 11, allocating $483.6 billion to refuel the USS George Washington.
The shutdown-skirting measure would increase funding for joint US-Israeli missile defense programs by $172 million. For the much-ballyhooed Iron Dome program, the appropriators doled out $175 million more than the $176 million the White House requested, for a program total of $351 million.
The National Guard and Reserve would get $1.2 billion more than requested to "enhance" their equipment, according to the summary.

Tuesday, December 09, 2014

Hoaxes? On The Rolling Stone Rape Article And Its Aftermath


This post covers sexual violence and rape

What is a hoax?  One online dictionary defines it as "a plan to deceive a large group of people; a trick," another one as "something intended to deceive or defraud."  Sounds pretty serious, right?  Note, in particular, the terms "a plan" and "intended."  We are not talking about a misunderstanding of events or of partial memory after, say, a traumatizing event.  No, a hoax is something planned on purpose, something intended to deceive.

This is how it all began.

First Round

The Rolling Stone magazine published an article about an alleged gang-rape, a shocking piece which hit many readers in the gut and made them doubt the wisdom of belonging to the human race, a piece which was about the inadequate response of the university where the event was said to have taken place, University of Virginia, a piece which was almost completely about "Jackie," the woman who stated that she was raped.

The article did not name those accused of the rape though it did name a fraternity building as the place for the rape and gave additional information which could be used to try to find the identity of one of the alleged rapists (called "Drew" in the story).  It also provided a date for the alleged gang-rape and some additional evidence of preceding events.