Tag Archives: politics: the state

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.

$291,978 Spent in Philadelphia to Make Poverty Pretty

We have the money and the know how to tackle most of our social problems.  Certainly unemployment, houselessness, and poverty.  So, why don’t we?

In large part it is because our socially created wealth remains outside social control.  Critical economic decisions are driven by private interests not the public good.  One result is hipster economics.

If you are not familiar with the concept, I recommend Sarah Kendzior’s The Perils of Hipster Economics. Here is the first part:

On May 16, an artist, a railway service and a government agency spent $291,978 to block poverty from the public eye.

Called psychylustro, German artist Katharina Grosse’s project is a large-scale work designed to distract Amtrak train riders from the dilapidated buildings and fallen factories of north Philadelphia. The city has a 28 percent poverty rate – the highest of any major U.S. city – with much of it concentrated in the north. In some north Philadelphia elementary schools, nearly every child is living below the poverty line.

Grosse partnered with the National Endowment of the Arts and Amtrak to mask North Philadelphia’s hardship with a delightful view. The Wall Street Journal calls this “Fighting Urban Blight With Art.” Liz Thomas, the curator of the project, calls it “an experience that asks people to think about this space that they hurtle through every day.”

The project is not actually fighting blight, of course – only the ability of Amtrak customers to see it.

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“I need the brilliance of colour to get close to people, to stir up a sense of life experience and heighten their sense of presence,” Grosse proclaims.

“People,” in Grosse and Thomas’s formulation, are not those who actually live in north Philadelphia and bear the brunt of its burdens. “People” are those who can afford to view poverty through the lens of aesthetics as they pass it by.

Urban decay becomes a set piece to be remodeled or romanticised.

The rest of the article is here.

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

The U.S. is Replacing Good Jobs with Bad Ones

In a fancy bit of marketing, U.S. capitalists have been reborn as “job creators.”  As such, they were rewarded with lower taxes, weaker labor laws, and relaxed government regulation. However, despite record profits, their job creation performance leaves a lot to be desired.

According to the official data the last U.S. recession began in December 2007 and ended in June 2009. Thus, we have officially been in economic expansion for almost five years.  The gains from the expansion should be strong and broad-based enough to ensure real progress for the majority over the course of the business cycle.  If not, it’s a sign that we need a change in our basic economic structure.  In other words, it would be foolish to work to sustain an economic structure that was incapable of satisfying majority needs even when it was performing well according to its own logic.

A recent study by the National Employment Law Project titled The Low-Wage Recovery provides one indicator that it is time for us to pursue a change.  It shows that the current economic expansion is transitioning the U.S. into a low wage economy.

The figure below shows the net private sector job loss by industries classified according to their medium wage from January 2008 to February 2010 and the net private sector job gain using the same classification from March 2010 to March 2014. As we can see, the net job loss in the first period was greatest in high wage industries and the net job creation in the second period was greatest in low wage industries.

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As the study explains:

 The food services and drinking places, administrative and support services (includes temporary help), and retail trade industries are leading private sector job growth during the recent recovery phase. These industries, which pay relatively low wages, accounted for 39 percent of the private sector employment increase over the past four years.

If the hard times of recession disproportionately eliminate high wage jobs and the “so called” good times of recovery bring primarily low wage jobs, it is time to move beyond our current focus on the business cycle and initiate a critical assessment of the way our economy operates and in whose interest.

Cross-posted at Pacific Standard.

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

DEAD! Executions and the Power of Photography

In 1928 readers of the New York Daily News were shocked by this cover.  It was the first photograph ever taken of an electrocution.

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The executed is a woman named Ruth Snyder, convicted of murdering her husband.  The photographer was a journalist named Tom Howard.  Cameras were not allowed in the execution room, but Howard snuck a device in under his pant leg.  Prison officials weren’t  happy, but the paper was overjoyed.

The fact that the image was placed on the front page with the aggressive headline “DEAD!” suggests that editors expected the photograph to have an impact.  Summarizing at Time, Erica Fahr Campbell writes:

The black-and-white image was shocking to the U.S. and international public alike. There sat a 32-year-old wife and mother, killed for killing. Her blurred figured seemed to evoke her struggle, as one can imagine her last, strained breaths. Never before had the press been able to attain such a startling image—one not made in a faraway war, one not taken of the aftermath of a crime scene, but one capturing the very moment between life and death here at home.

It is one thing to know that executions are happening and another to see it, if mediated, with one’s own eyes.

Pictures can powerfully alter the dynamics of political debates.  Lennart Nilsson‘s famous series of photographs of fetuses, for example, humanized and romanticized the unborn.  They also erased pregnant women, making it easier to think of the fetus as an independent entity. A life, even.

Unfortunately, Campbell’s article doesn’t delve any further into the effect of this photograph on death penalty debates.  To this day, however, no prisons allow photography during executions.  What if things were different?  How might the careful documentation of this process — with all our technology for capturing and sharing images — change the debate today?  And whose interests are most protected by keeping executions invisible?

Cross-posted at Pacific Standard.

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.

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.

Saturday Stat: The U.S. is a “Low Tax Country”

This chart comes from Chuck Marr at the Center on Budget and Policy Priorities.  As Marr explains:

The United States is a relatively low-tax country, as the chart shows.  When measured as a share of the economy, total government receipts (a broad measure of revenue) are lower in the United States than in any other member of the Organization for Economic Co-operation and Development (OECD), even after accounting for the modest revenue increases in the 2012 “fiscal cliff” deal and the taxes that fund health reform.

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

Where Did Your 2013 Tax Dollars Go?

Each  year the National Priorities Project releases a visual illustrating how our tax dollars are spent.  This is the one for 2013, sans medicare and social security taxes.

1At the end of Sociology 101, I like to ask my students: “What is the state for?”  This often takes them aback, as most of them have never considered the question before.  Is it for defense?  It is to maximize happiness or reduce misery?  Is it for maximizing GDP?  Protecting private property?  Do we want to use it to influence other countries?  How?

There are many questions to ask and they are not purely theoretical.  I like how the spending of our tax dollars helps make the conversation more concrete.

Cross-posted at Business Insider.

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.

Diverse Countries Do Better with Female Heads of State

Countries with a lot of ethnic diversity generally show weaker economic growth than homogeneous countries.  A new study, however, discovered a variable that strongly reverses the trend: women leaders.

Management professor Susan Perkins and her colleagues compared the economic growth rate of 139 countries over 55 years.  They found that diverse countries did significantly better when a woman was at the helm.  The more diverse the country, the stronger the effect.

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Perkins and her co-authors cautiously attempt to explain their data (here), but think that it may have something to do with leadership style.  Female leaders have been shown to be more collaborative and non-authoritarian than men. Co-author Nicholas Pearce speculates:

In countries with a lot of internal conflict, oftentimes people are looking for signals that the person in charge is going to be collaborative and not dictatorial or self-interested. Women’s gender role is symbolic of collaboration, that they’re going to empower marginalized voices.

Because of gender stereotypes, then, women may seem more trustworthy. Meanwhile, real differences in leadership style may affirm those expectations and be more effective in practice.

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.