Author Archives: jl2109

Insurance Companies and the Cost of Health Care

When my primary care physician, a wonderful doctor, told me he was retiring, he said, “I just can’t practice medicine anymore the way I want to.” It wasn’t the government or malpractice lawyers. It was the insurance companies.

This was long before Obamacare.  It was back when President W was telling us that “America has the best health care system in the world”; back when “the best” meant spending twice as much as other developed countries and getting health outcomes that were no better and by some measures worse. (That’s still true).

Many critics then blamed the insurance companies, whose administrative costs were so much higher than those of public health care, including our own Medicare. Some of that money went to employees whose job it was to increase insurers’ profits by not paying claims.  Back then we learned the word “rescission”  – finding a pretext for cancelling the coverage of people whose medical bills were too high.   Insurance company executives, summoned to Congressional hearings, stood their ground and offered some misleading statistics

None of the Congressional representatives on the committee asked the execs how much they were getting paid. Maybe they should have.

Health care in the U.S. is a $2.7 trillion dollar business, and the New York Times has an article about who’s getting the big bucks.  Not the doctors, it turns out.  And certainly not the people who have the most contact with sick people – nurses, EMTs, and those further down the chain.  Here’s the chart from the article, with an inset showing those administrative costs.

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As fine print at the top of the chart says, these are just salaries – walking-around money an exec gets for showing up.  The real money is in the options and incentives.

In a deal that is not unusual in the industry, Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised that year.

The anti-Obamacare rhetoric has railed against a “government takeover” of medicine. It is, of course, no such thing. Obama had to remove the “public option”; Republicans prevented the government from fielding a team and getting into the game. Instead, we have had an insurance company takeover of medicine. It’s not the government that’s coming between doctor and patient, it’s the insurance companies. Those dreaded “bureaucrats” aren’t working for the government of the people, by the people, and for the people. They’ve working for Aetna and Well-Point.

Even the doctors now sense that they too are merely working for The Man.

Doctors are beginning to push back: Last month, 75 doctors in northern Wisconsin [demanded] . . . health reforms . . . requiring that 95 percent of insurance premiums be used on medical care. The movement was ignited when a surgeon, Dr. Hans Rechsteiner, discovered that a brief outpatient appendectomy he had performed for a fee of $1,700 generated over $12,000 in hospital bills, including $6,500 for operating room and recovery room charges.

That $12,000 tab, for what it’s worth, is slightly under the U.S. average.

Cross-posted at Pacific Standard.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.

Louis C.K. on Assortative Mating

Usually, you want to match up with someone at about your level, or a little higher.  The trouble is that many people overestimate their own level.  Maybe that’s especially true of men.

One summer many years ago at the tennis courts, a guy I didn’t know  came over and asked me if I’d like to play. I hadn’t arranged a game with anyone, but I didn’t want to wind up playing some patzer.

“Are you any good?” I asked. He paused.

“Well, I’m not Jimmy Connors,” he said (I told this was many years ago), “but neither are you.”

In chess and other games, serious players have ratings. Give a roomful of possible partners, they can sort through the ratings and find a match with someone at roughly the same level.  It’s called assortative mating, though that term usually refers to the other kind of mating, not chess.  It’s the basis of the conflict in this poignant scene from “Louie.”

Vanessa is not a ten, neither is Louie.  According to principles of assortative mating, the tens will wind up with other tens, the nines with nines, and so on down the attractiveness scale. One problem in the “Louie” scene is that Louie seems to have an inflated view of his own attractiveness.  He’s aiming higher than Vanessa.  That’s typical.  So is the importance that Louie, the man, places on physical attractiveness. This excerpt begins with Louie telling Vanessa that she’s a really beautiful . . . . He can’t bring himself to say “girl”; he’s probably going to say “person.” But he’s obviously not saying what he thinks.

Or as Dan Ariely and colleagues concluded from their study of HotOrNot members:

[Men] were significantly more influenced by the consensus physical attractiveness of their potential dates than females were. [Men also] were less affected by how attractive they themselves were . . .  In making date choices, males are less influenced by their own rated attractiveness than females are.

Another dating site, OK Cupid, found a similar pattern when they looked at data about who gets messages.  They asked their customers to rate profile photos of the opposite sex on a scale of 0 to 5. They then tracked the number of messages for people at each level of attractiveness.  The graph below shows what women thought and what they did – that is, how attractive they found men, and who they sent messages to.

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Men who were rated 0 or 1 got fewer messages than their proportion in the population.  That figures. But even men who were only moderately attractive got more than their share. Generally, the fewer men at a level of attractiveness, the fewer total messages women sent. The 4s, for example, constituted only 2% of the population, and they got only 4% of all the messages.  The Vanessas on OK Cupid are not sending a lot of inquiries to guys who look like George Clooney.

But look at the men.

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Men are more generous in their estimates of beauty than are women. But they also ignore the Vanessas of the world (or at least the world of OK Cupid) and flock after the more attractive women.  Only 15% of the women were rated as a 4, but they received about 26% of the messages.  Women rated 5 received messages triple their proportion in the population.

What about those with so-so looks?  Women rated as 2s received only about 10% of the messages sent by men. But men at that same level received 25% of the messages women sent.  The women seem more realistic.

Vanessa too has no illusions about her own attractiveness. She refers to herself as “a fat girl,” and when Louie, trying to be kind, says, “You’re not fat,” she says: “You know what the meanest thing is you can say to a fat girl? [pause] ‘You’re not fat.’” But it’s only when she challenges Louie’s view of his own attractiveness that their relationship starts to change.

Y’know if you were standing over there looking at us, you know what you’d see?

What?

That we totally match. We’re actually a great couple together.

She doesn’t explain what she means by “totally match.” It could be their interests or ideas or personalities, but the imaginary stranger looking at them from over there couldn’t know about any of that. What that generalized other could see is that they are at roughly the same place on the assortative mating attractiveness scale.

Cross-posted at Pacific Standard.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.

Umpires and Expectation Bias

Here’s Matt Holliday. It’s strike three and it was three bad calls.

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Holliday’s body language speaks clearly, and his reaction is understandable. The pitch was wide, even wider than the first two pitches, both of which the umpire miscalled as strikes.   Here’s the data:

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The PITCHf/x technology that makes this graphic possible, whatever its value or threat to umpires, has been a boon for sabremetricians  and social scientists.  The big data provided can tell us not just the number of bad calls but the factors that make a bad call more or less likely.

In the New York Times, Brayden King and Jerry Kim report on their study of roughly 780,000 pitches in the 2008-09 season. Umpires erred on about 1 in every 7 pitches – 47,000 pitches over the plate that were called balls, and nearly 69,000 like those three to Matt Holliday.

Here are some of the other findings that King and Kim  report in today’s article.

  •  Umpires gave a slight edge to the home team pitchers, calling 13.3% of their pitches outside the zone as strikes.  Visitors got 12.6%.
  • The count mattered: At 0-0, the error rate was 14.7%, at 3-0, 18.6% of pitches outside the zone were called as strikes, and at 0-2, only 7.3% of pitches outside the zone were called as strikes.
  • All-star pitchers were more likely than others to get favorable calls…
  • …especially if the pitcher had a reputation as a location pitcher.
  • The importance of the situation (tie game, bottom of the ninth) made no difference in bad calls.

It seems that expectation accounts for a lot of these findings. It’s not that what you see is what you get. It’s that what you expect is what you see. We expect good All-star pitchers to throw more accurately.  We also expect that a pitcher who is way ahead in the count will throw a waste pitch and that on the 3-0, he’ll put it over the plate.  My guess is that umpires share these expectations. The difference is that the umps can turn their expectations into self-fulfilling prophecies.

Cross-posted at Business Insider.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.

An Optimistic Read of the Sexist Snickers Ad

Advertisements echo with many reverberations and overtones. Different people hear different things, and with all the multiple meanings, it’s not always clear which is most important.

This week Lisa Wade posted this Snickers ad from Australia. Its intended message of course is “Buy Snickers.” But its other message is more controversial, and Lisa and many of the commenters (more than 100 at last count) were understandably upset.

The construction workers (played by actors) shout at the women in the street (not actors). “Hey,” yells a builder, and the woman looks up defensively. But then instead of the usual sexist catcalls, the men shout things like,

I appreciate your appearance is just one aspect of who you are.

And

You know what I’d like to see? A society in which the objectification of women makes way for gender neutral interaction free from assumptions and expectations.

The women’s defensiveness softens.  They look back at the men. One woman, the surprise and delight evident in her smile, mouths, “Thank you.”

But, as the ad warned us at the very beginning, these men are “not themselves.”

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Hunger has transformed them. The ad repeats the same idea at the end.

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Here’s Lisa’s conclusion:

The twist ending is a genuine “fuck you” to the actual women who happened to walk by and become a part of the commercial… I bet seeing the commercial would feel like a betrayal. These women were (likely) given the impression that it was about respecting women, but instead it was about making fun of the idea that women deserve respect.

I suspect that Lisa too feels betrayed.  She has bought her last Snickers bar.

My take is more optimistic.

In an earlier generation, this ad would have been impossible. The catcalls of construction workers were something taken for granted and not questioned, almost as though they were an unchangeable part of nature.* They might be unpleasant, but so is what a bear does in the woods.

This ad recognizes that those attitudes and behaviors are a conscious choice and that all men, including builders, can choose a more evolved way of thinking and acting.  The ad further shows, that when they do make that choice, women are genuinely appreciative. “C’mon mates,” the ad is saying, “do you want a woman to turn away and quickly walk on, telling you in effect to fuck off? Or would you rather say something that makes her smile back at you?”  The choice is yours.

The surface meaning of the ad’s ending is , “April Fools. We’re just kidding about not being sexists.” But that’s a small matter. Not so far beneath that surface progressive ideas are having the last laugh, for more important than what the end of the ad says is what the rest of the ad shows – that ignorant and offensive sexism is a choice, and that real women respond positively to men who choose its opposite.

* Several of the comments at Sociological Images complained that the ad was “classist” for its reliance on this old working-class stereotype.

Cross-posted at Montclair SocioBlog.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.

The Rich to the Poor: Do What I Say, Not What I Do

Economic policies often rest on assumptions about human motivation.  Here’s Rep. Ryan (Republican of Wisconsin):

The left is making a big mistake here. What they’re offering people is a full stomach and an empty soul. People don’t just want a life of comfort. They want a life of dignity — of self-determination.

Fox News has been hitting the theme of “Entitlement Nation” lately. This Conservative case against things like Food Stamps, Medicare, welfare, unemployment benefits, etc rests on some easily understood principles of motivation and economics.

1.    Giving money or things to a person creates dependency and saps the desire to work. That’s bad for the person and bad for the country.
2.    A person working for money is good for the person and the country.
3.    We want to encourage work.
4.    We do not want to encourage dependency.
5.    Taxing something discourages it.

Now that you’ve mastered these, here’s the test question:

1. According to Conservatives, which should be taxed more heavily:

a.    money a person earns by working.
b.    money a person receives without working, for example because someone else died and left it in their will.

If you said “b,” you’d better go back to Conservative class. A good Conservative believes that the money a person gets without working for it should not be taxed at all.

Not all such money, of course.  Lottery tickets are bought disproportionately by lower-income people.  If a person gets income by winning the PowerBall or some other lottery, the Federal government taxes the money as income. Conservatives do not object.  But if a person gets income by winning the rich-parent lottery, Conservatives think he or she should not pay any taxes.

What Conservatives are saying to you is this: working for your money is not as good as instead of inheriting it. This message seems to contradict the principles listed above. But, as Jon Stewart recently pointed out, Conservatives apply those principles of economics and motivational psychology only to the poor, not to wealthy individuals or corporations.

Cross-posted at Montclair SocioBlog and the Huffington Post.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.

To Whom is George Zimmerman a Hero? And Why?

16George Zimmerman was signing autographs at a gun show in Orlando this week. Only 200 showed up for the meet-and-greet, but Zimmerman has many supporters around the country, and, as Jonathan Capeheart says:

This leads to what should bean inevitable question: Who are these people glorifying the killer of an unarmed teenager in one of the most racially polarized incidents in recent history?

I keep wondering how Jonathan Haidt – with his theory of the differing values of liberals and conservatives — would explain this embrace of Zimmerman. The liberal reaction presents no problems. Haidt says that liberal morality rests on two principles:

  • Care/Harm
  • Fairness/Cheating

Killing someone certainly qualifies as Harm, and, almost literally, getting away with murder is not Fair.

The Zimmerman side is that he shot in self-defense. That argument persuaded the jury, or at least created sufficient reasonable doubt. But it doesn’t explain why some people on the right see him as a hero. What moral principle does he represent?

In Haidt’s schema, conservatives take Harm and Fairness into account but balance them with three others:

  • Loyalty/Betrayal
  • Authority/Subversion
  • Sanctity/Degradation

(A sixth foundation – Liberty/oppression – underlies both the liberal and conservative side.)

It’s hard to see how any of these describe the autograph-seekers.  What else might explain that reaction?

The obvious candidate is racism. If the races had been reversed — if a Black man had confronted a White teenager, killed him, and then been acquitted on self-defense grounds — would the left have hailed him as a hero? I doubt it. Would those same autograph hounds in Orlando have sought him out? I doubt it.  And if Black people had then turned out to get his autograph, can you imagine what the reaction on the right would have been?

But it’s not just racism. It’s a more general willingness to do harm, great harm, to those who “deserve” it.  The liberal view (Harm/Care) is that while in some circumstances killing may be necessary or inevitable, it is still unfortunate.  But over on the right, killing, torture, and perhaps other forms of harm are cause for celebration, so long as these can be justified. In 2008, Republicans cheered Sarah Palin when she stood up for torture. In 2011, they cheered Rick Perry for signing death warrants for record numbers of executions. When Wolf Blitzer hypothsized a young man who had decided not to buy medical insurance but now lay in the ICU, and Blitzer asked “Should we let him die?” several people in the Republican audience enthusiastically shouted out, “Yes.”

My guess as to the common thread here is a dimension Haidt doesn’t include as a foundation of morality: boundary rigidity. In those earlier posts, I referred to this, or something similar, as “tribalism.”

Morality is not some abstract universal that applies to all people.  Tribal morality divides the world into Us and Them.  What’s moral is what’s good for Us.  This morality does not extend to Them.

Could it be that as you get farther out on the right, you find more people whose boundaries are more rigid?  They are the hard liners who draw hard lines. Once those lines are drawn, it’s impossible to have sympathy — to extend Care — to someone on the other side. If you imagine that you live in a world where an attack by Them is always imminent, defending those boundaries becomes very important.

That seems to be the world of gun-rights crowd lionizing Zimmerman.  Their cherished scenario is the defense of boundaries against those who are clearly Not Us.  They stand their ground and defend themselves, their families, their houses and property, even their towns and communities.  It is a story they never tire of, repeated time after time in NRA publications.  Zimmerman is a hero because his story, in their view, embodies the narrative of righteous slaughter.

Cross-posted at Montclair SocioBlog.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.

Why Survey Questions Matter: Blasphemy Edition

“How could we get evidence for this?” I often ask students. And the answer, almost always is, “Do a survey.” The word survey has magical power; anything designated by that name wears a cloak of infallibility.

“Survey just means asking a bunch of people a bunch of questions,” I’ll say. “Whether it has any value depends on how good the bunch of people is and how good the questions are.”  My hope is that a few examples of bad sampling and bad questions will demystify.

For example, Variety:

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Here’s the lede:

Despite its Biblical inspiration, Paramount’s upcoming “Noah” may face some rough seas with religious audiences, according to a new survey by Faith Driven Consumers.

The data to confirm that idea:

The religious organization found in a survey that 98% of its supporters were not “satisfied” with Hollywood’s take on religious stories such as “Noah,” which focuses on Biblical figure Noah.

The sample:

Faith Driven Consumers surveyed its supporters over several days and based the results on a collected 5,000+ responses.

And (I’m saving the best till last) here’s the crucial survey question:

As a Faith Driven Consumer, are you satisfied with a Biblically themed movie — designed to appeal to you — which replaces the Bible’s core message with one created by Hollywood?

As if the part about “replacing the Bible’s core message” weren’t enough, the item reminds the respondent of her or his identity as a Faith Driven Consumer. It does make you wonder about that 2% who either were fine with the Hollywood* message or didn’t know.

You can’t really fault Faith Driven Consumer too much for this shoddy “research.” They’re not in business to find the sociological facts. What’s appalling is that Variety accepts it at face value and without comment.

Cross-posted at Montclair SocioBlog.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.

Republicans, Democrats, and Trust in the Government

A survey question is only as good as its choices. Sometimes an important choice has been left off the menu.  I was Gallup polled once, long ago. I’ve always felt that they didn’t get my real opinion.

“What’d they ask?” said my brother when I mentioned it to him.

“You know, they asked whether I approved of the way the President was doing his job.”  Nixon – this was in 1969.
“What’d you say?”

“I said I disapproved of his entire existential being.”

I was exaggerating my opinion, and I didn’t actually say that to the pollster.  But even if I had, my opinion would have been coded as “disapprove.”

For many years the American National Election Study has asked:

How much of the time do you think you can trust the government in Washington to do what is right – just about always, most of the time or only some of the time?

The trouble with these choices at that they exclude the truly disaffected. The worst you can say about the federal government is that it can be trusted “only some of the time.”  A few ornery souls say they don’t trust the federal at all. But because that view is a write-in candidate, it usually gets only one or two percent of the vote.

This year the study included “never” in the options read to respondents.  Putting “no-way, no-how” right there on the ballot makes a big difference. And as you’d expect, there were party differences:

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Over half of Republicans say that the federal government can NEVER be trusted.

The graph appears in this Monkey Cage post by Marc Hetherington and Thomas Rudolph. Of course, some of those “never” Republicans don’t really mean “never ever.”  If a Republican becomes president, they’ll become more trusting, and the “never-trust” Democrat tide will rise.  Here’s the Hetherington-Rudolph graph tracking changes in the percent of people who do trust Washington during different administrations.

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This one seems to show three things:

  1. Trust took a dive in the 1960s and 70s and never really recovered.
  2. Republican trust is much more volatile, with greater fluctuations depending on which party is in the White House.
  3. Republicans really, really hate President Obama.

Cross-posted at Montclair SocioBlog.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.