Tag Archives: organizations/institutions

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.

Saturday Stat: Salaries on University Campuses

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- PhD Comics.

Lisa Wade is a professor of sociology at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. You can follow her on Twitter and Facebook.

On the False Idea that Money is a Resource

I am so pleased to have stumbled across a short excerpt from a talk by Alan Watts, forwarded by a Twitter follower.  Watts makes a truly profound argument about what money really is.  I’ll summarize it here and you can watch the full three-and-a-half minute video below if you like.

Watts notes that we like to talk about “laws of nature,” or “observed regularities” in the world.  In order to observe these regularities, he points out, we have to invent something regular against which to compare nature. Clocks and rulers are these kinds of things.

All this is fine but, all too often, the clocks and the rulers come to seem more real than the nature that is being measured.  For example, he says, we might think that the sun is rising because it’s 6AM when, of course, the sun will rise independently of our measures.  It’s as if our clocks rule the universe instead of vice versa.

He uses these observations to make a comment about wealth and poverty. Money, he reminds us, isn’t real. It’s an invented measure.  A dollar is no different than a minute or an inch.  It is used to measure prosperity, but it doesn’t create prosperity any more than 6AM makes the sun rise or a ruler gives things inches.

When there is a crisis — an economic depression or a natural disaster, for example — we may want to fix it, but end up asking ourselves “Where’s the money going to come from?”  This is exactly the same mistake that we make, Watts argues, when we think that the sun rises because it’s 6AM.  He says:

They think money makes prosperity. It’s the other way around, it’s physical prosperity which has money as a way of measuring it.  But people think money has to come from somewhere… and it doesn’t. Money is something we have to invent, like inches.

So, you remember the Great Depression when there was a slump?  And what did we have a slump of?  Money.  There was no less wealth, no less energy, no less raw materials than there were before. But it’s like you came to work on building a house one day and they said, “Sorry, you can’t build this house today, no inches.”

“What do you mean no inches?”

“Just inches!  We don’t mean that… we’ve got inches of lumber, yes, we’ve got inches of metal, we’ve even got tape measures, but there’s a slump in inches as such.”

And people are that crazy!

This is backward thinking, he says.  It is allowing money to rule things when, in reality, it’s just a measure.

I encourage you to watch:

Lisa Wade is a professor of sociology at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. You can follow her on Twitter and Facebook.

Stay-at-Home Mothers on the Rise among Low-Income Families

“Stay-at-home mother” evokes black and white images of well-coiffed women in starched aprons. Rather than a vestige of a bygone era, stay-at-home moms are on the rise, according to the findings of a new Pew Research study. In 2012, 29% of women with children under the age of 18 stayed home, a number that has been on the rise since 1999 and is 3% higher than in 2008.

However, while more women are staying home with their children, the face of the stay-at-home mom has changed dramatically since the 1950s “Leave It to Beaver” days. Stay-at-home moms today are less educated and more likely to live in poverty than working moms. Younger mothers and immigrant mothers also make up a good portion of stay-at-home moms.

The story of why mothers are staying home is more complex than you may imagine and has more to do with the poor labor market, the exorbitant price of child care, and the contemporary structure of work. In a recent interview with Wisconsin Public RadioBarbara Risman, a sociologist at the University of Illinois at Chicago, spoke about how this report has been picked up by the mainstream media:

What’s surprising to me is the headlines and how it’s portrayed in the news. Although the numbers are going up, when you look at what mothers say, 6% of the mothers in this study say they are home because they can’t find a job. When you take those 6% of mothers out, the results are rather flat. Part of the real story here then is that it’s hard to find a job that allows you to work and covers your child care, particularly if you have less education and your earning potential isn’t very high.

These days stay-at-home moms, who are more likely to be less educated, are not able to make enough money for working to even be worthwhile. Many times, their pay wouldn’t actually cover the cost of child care. Beyond these important financial considerations, lower wage shift work makes it extremely difficult to coordinate child care in the midst of work schedules that change on a weekly basis.

Erin Hoekstra is pursuing a PhD in Sociology at the University of Minnesota. This post originally appeared on Citings and Sightings and you can read all of Erin’s contributions to The Society Pages here.  Cross-posted at Pacific Standard.

No Such Thing as a Free Lunch: Part I

On any given workday, over 31 million lunches are served to children in school cafeterias. Part of the U.S. Department of Agriculture’s (USDA) nutritional assistance efforts, the National School Lunch Program (NSLP) aims to deliver affordable and nutritious meals to the nation’s schoolchildren. After all, food plays a key part in helping them learn, grow, and thrive.

To reach those who need it most, the federal and local governments work together to offer free lunch to children whose parents cannot afford to pay for it. But money is just one way a meal can be compensated for: the ‘free’ school lunch comes at other costs.

First, there are the health costs. At its inception, the NSLP was not designed as a social program. Instead, it was a response to agricultural overproduction and a surplus of farm produce, writes historian Susan Levine. The policymakers’ goal was to get rid of excess foods while supporting domestic production.

As a result, nutrition was of secondary concern to them: one year, eggs would be on the menu daily; another, they would hardly make an appearance. It wasn’t until the war, when politicians grew concerned about the ability of the nation’s men to fight, and until it became apparent hungry children don’t do well in classrooms they were newly required to sit in, that anyone took a serious look at what kids at school were actually eating.

1 (2)Photo: Gary Tramontina (New York Times)

By that time, it was too late. The program was already run like a business, and not even the introduction of nutritional standards helped. Today, these normatives are outdated – children snack rather than eat three square meals, and are less physically active, requiring fewer calories – and almost impossible to follow with the budget restrictions school lunch planners face.

The private industry was quick to offer solutions, but is more interested in profits than schoolchildren’s waistlines. Enriched and fortified chips and candies of otherwise dubious nutritional value appear in school cafeterias and vending machines, often a more popular choice with kids than apples. Frozen and convenience foods are replacing fresh meals cooked on premises. And the labyrinthine regulations of meal calorie contents coupled with cafeteria financial realities often mean adding more sugar to students’ plates is the only thing that can bring down its fat content, for example.

The food itself is not the only factor contributing to children’s undesirable health outcomes. Economist Rachana Bhatt finds the amount of time students have to enjoy lunch also matters. Students tight on time – they must squeeze all getting to the cafeteria, standing in line, eating their food, and cleaning up into their lunch break – might choose to skip the meal, leading them to overeat later, or eat quicker, leading them to consume more due to the delay in feeling full. Even if all school lunches offered healthy options, time would complicate their relationship with health outcomes: Bhatt found students who had less time for lunch were more likely to be overweight.

The lunch may be free when children choose their meal and sit down to eat it, then. But it may come at a substantial cost several years down the line, when a young adult is paying for diabetes medication and visits to the doctor to monitor their blood pressure.

Read Part II of “No Such Thing as a Free School Lunch.”

Teja Pristavec is a graduate student in the sociology department, and an IHHCPAR Excellence Fellow,  at Rutgers University. She blogs at A Serving of Sociology, where this post originally appeared. Cross-posted at Pacific Standard.

Money as a Social Construction

We all know that, on some basic level, money is purely symbolic.  It only works because everyone collectively agrees to participate in the fantasy that a dollar bill is worth a dollar, whatever that is.  Moreover, most of our money these days is purely electronic, represented by ones and zeros and real only in the most abstract sense possible.

Christopher Ingraham at the Washington Post offered another way of thinking about money as a social construction: how much it costs to make it.  None of our coins are actually worth what they cost, and pennies and nickels are worth quite a bit less.

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The excess cost of producing pennies and nickels means a budget deficit for the Treasury. In 2013, producing the coins cost the government $105 million dollars above and beyond the coins’ value.

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Interestingly, moves to eliminate pennies have been successfully opposed by the zinc industry for years, illustrating another sociological phenomenon: the power of corporations to shape government decisions.

Lisa Wade is a professor of sociology at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. You can follow her on Twitter and Facebook.

Security Guards Now Outnumber High School Teachers

There are now more people working as private security guards than high school teachers.

Samuel Bowles and Arjun Jayadev offer the following graph, highlighting the number of “protective service workers”* employed per 10,000 workers and the degree of income inequality in the year 2000 for 16 countries.  The United States is tops on both counts.

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Two things stand out from this graph beyond U.S. “leadership.”  The first is the relationship between the share of protective service workers  – or “guard labor” – and inequality.  As Bowles and Jayadev comment:

In America, growing inequality has been accompanied by a boom in gated communities and armies of doormen controlling access to upscale apartment buildings. We did not count the doormen, or those producing the gates, locks and security equipment. One could quibble about the numbers; we have elsewhere adopted a broader definition, including prisoners, work supervisors with disciplinary functions, and others.

But however one totes up guard labor in the United States, there is a lot of it, and it seems to go along with economic inequality. States with high levels of income inequality — New York and Louisiana — employ twice as many security workers (as a fraction of their labor force) as less unequal states like Idaho and New Hampshire.

When we look across advanced industrialized countries, we see the same pattern: the more inequality, the more guard labor. As the graph shows, the United States leads in both.

The second is the rapid rise in the U.S. share of guard labor and inequality from 1979 to 2000.

One can only wonder in what ways and for whom this large and growing dependence on guard labor represents a rational use of social resources.

* For those who like definitions: The category protective service workers includes those employed as Private Security Guards, Supervisors of Correctional Officers, Supervisors of Police and Detectives, Supervisors of all other Protective Service Workers, Bailiffs, Correctional Officers and Jailers, Detectives and Criminal Investigators, Fish and Game Wardens, Parking Enforcement Workers, Police and Patrol Officers, Transit and Railroad Police, Private Detectives and Investigators, Gaming Surveillance Officers, and Transportation Security Screeners.  A broader measure of guard labor might include members of the armed forces, civilian employees of the military, and those that produce weapons to those employed as protective service workers.  That total was 5.2 million workers in 2011.

Cross-posted at Reports from the Economic Front.

Martin Hart-Landsberg is a professor of economics at Lewis and Clark College. You can follow him at Reports from the Economic Front.

Should There be Trigger Warnings on Syllabi?

Apparently universities are issuing guidelines to help professors consider adding “trigger warnings” to syllabi for “racism, classism, sexism, heterosexism, cissexism, ableism, and other issues of privilege and oppression,” and to remove triggering material when it doesn’t “directly contribute to learning goals.” One example given is Chinua Achebe’s “Things Fall Apart” for its colonialism trigger. This from New Republic this week.

I have no desire to enter the fray of online discussions on trigger warnings and sensitivity. I have used trigger warnings. Most recently, I made a personal decision to not retweet Dylan Farrow’s piece in the New York Times detailing Woody Allen’s sexual abuse. I was uncomfortable shoving a very powerful description at people without some kind of warning. I couldn’t read past the first three sentences. I couldn’t imagine how it read for others. So, I referenced the article with a trigger warning and kept it moving.

But, I’m not sure that’s at all the kind of deliberation universities are doing with their trigger warning policies. Call me cynical, but the “student-customer” movement is the soft power arm of the neo-liberal corporatization of higher education. The message is that no one should ever be uncomfortable because students do not pay to feel things like confusion or anger. That sounds very rational until we consider how the student-customer model doesn’t silence power so much as it stifles any discourse about how power acts on people.

I’ve talked before about how the student-customer model becomes a tool to rationalize away the critical canon of race, sex, gender, sexuality, colonialism, and capitalism.

The trigger warned syllabus feels like it is in this tradition. And I will tell you why.

In the last three weeks alone: a college student has had structural violence of normative harassment foisted on her for daring to have sex (for money), black college students at Harvard have taken to social media to catalog the casual racism of their colleagues, and black male students at UCLA made a video documenting their erasure.

It would seem that the most significant “issue” for a trigger warning is actual racism, sexism, ableism, and systems of oppression. Cause I’ve got to tell you, I’ve had my crystal stair dead end at the floor of racism and sexism and I’ve read “Things Fall Apart.” The trigger warning scale of each in no way compares.

Yet, no one is arguing for trigger warnings in the routine spaces where symbolic and structural violence are acted on students at the margins. No one, to my knowledge, is affixing trigger warnings to department meetings that WASP-y normative expectations may require you to code switch yourself into oblivion to participate as a full member of the group. Instead, trigger warnings are being encouraged for sites of resistance, not mechanisms of oppression.

At for-profit colleges, strict curriculum control and enrollment contracts effectively restrict all critical literature and pedagogy. We elites balk at such barbarism. What’s a trigger warning but the prestige university version? A normative exclusion as opposed to a regulatory one?

Trigger warnings make sense on platforms where troubling information can be foisted upon you without prior knowledge, as in the case of retweets. Those platforms are in the business of messaging and amplification.

That is an odd business for higher education to be in… unless the business of higher education is now officially business.

In which case, we may as well give up on the tenuous appeal we have to public good and citizenry-building because we don’t have a kickstand to lean on.

If universities are not in the business of being uncomfortable places for silent acts of power and privilege then the trigger warning we need is: higher education is dead but credential production lives on; enter at your own risk.

Tressie McMillan Cottom is a PhD candidate in the Sociology Department at Emory University in Atlanta, GA.  Her doctoral research is a comparative study of the expansion of for-profit colleges.  You can follow her on twitter and at her blog, where this post originally appeared.