health/medicine

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.

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.

At Pew Social Trends, Gretchen Livingston has a new report on fathers staying at home with their kids. They define stay at home fathers as any father ages 18-69 living with his children who did not work for pay in the previous year (regardless of marital status or the employment status of others in the household). That produces this trend:

At least for the 1990s and early-2000s recessions, the figure very nicely shows spikes upward of stay-at-home dads during recessions, followed by declines that don’t wipe out the whole gain — we don’t know what will happen in the current decline as men’s employment rates rise.

In Pew’s numbers 21% of the stay at home fathers report their reason for being out of the labor force was caring for their home and family; 23% couldn’t find work, 35% couldn’t work because of health problems, and 22% were in school or retired.

It is reasonable to call a father staying at home with his kids a stay at home father, regardless of his reason. We never needed stay at home mothers to pass some motive-based criteria before we defined them as staying at home. And yet there is a tendency (not evidenced in this report) to read into this a bigger change in gender dynamics than there is. The Census Bureau has for years calculated a much more rigid definition that only applied to married parents of kids under 15: those out of the labor force all year, whose spouse was in the labor force all year, and who specified their reason as taking care of home and family. You can think of this as the hardcore stay at home parents, the ones who do it long term, and have a carework motivation for doing it. When you do it that way, stay at home mothers outnumber stay at home fathers 100-to-1.

I updated a figure from an earlier post for Bryce Covert at Think Progress, who wrote a nice piece with a lot of links on the gender division of labor. This shows the percentage of all married-couple families with kids under 15 who have one of the hardcore stay at home parents:

That is a real upward trend for stay at home fathers, but that pattern remains very rare.

See the Census spreadsheet for yourself here.  Cross-posted at Pacific Standard.

Philip N. Cohen is a professor of sociology at the University of Maryland, College Park, and writes the blog Family Inequality. You can follow him on Twitter or Facebook.

At the New York Times, Sabrina Tavernise and Robert Gebeloff discuss the tenaciousness of tobacco in low-income areas.  Smoking rates are declining, but much more slowly in some counties than others.  Local residents suggest that smoking is the least of their worries:

“Just sit and watch the parking lot for a day,” Mrs. Bowling said. “If smoking is the worst thing that’s happening, praise the Lord.”

Smoking rates, 1996:

Smoking rates, 2013:

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

A touching BBC story describes a new documentary, Menstrual Man, that chronicles the trials and tribulations of a humble man in India who sought to offer his wife a sanitary napkin.  After marrying, he discovered that his wife kept from him a secret: the rags she used and re-used to collect menstrual blood.

Only 12% of women in India used pads; they were simply too expensive for most to buy. Nearly three-quarters of all reproductive diseases were caused by poor menstrual hygiene.  A combination of high cost and embarrassment kept women from developing a safe method of managing menstruation.  Nearly a quarter of girls dropped out of school when they started their periods.

Arunachalam Muruganantham was driven to offer women a solution.  He was going to design a machine that would produce low cost menstrual pads.  He asked his wife to serve as an experimental subject, but one woman menstruating once a month wasn’t enough of a sample.  He asked medical students to participate, but the responses were slim.  He fashioned a fake uterus and collected goat blood, trying to experiment himself.

“Everyone thought he’d gone mad.”

His wife left, his mother left, his friends avoided him; it was suspected he was some kind of diseased or possessed sexual pervert, collecting menstrual blood to do god-knows-what.

Figuring out how to make highly absorptive cotton was a significant challenge.  He finally tricked a  multinational company into sending him samples of the raw material: cellulose from the bark of the tree.  Now he just had to design a cheap machine that would turn the raw material into pads.

Four-and-a-half years later, he was producing affordable menstrual pads for Indian women on a cheaply made machine.  He won an award.  His wife came back.

He built 250 machines, which he then took to the poorest areas of Northern India.  He gave them to women, at no profit, who could then produce the pads and sell them to local women.  Each woman now runs her own business.  “Over time the machines spread to 1,300 villages in 23 states.” He is now looking to expand to 106 more countries.

About his success, Muruganantham said:

Anyone with an MBA would immediately accumulate the maximum money. But I did not want to. Why? Because from childhood I know no human being died because of poverty — everything happens because of ignorance…. I have accumulated no money but I accumulate a lot of happiness.

Watch the trailer here.

Cross-posted at Pacific Standard.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

I’ve written extensively — not here, but professionally — on the ways in which Americans talk about the female genital cutting practices (FGCs) that are common in parts of Africa.  I’ve focused on the frames for the practice (common ones include women’s oppression, child abuse, a violation of bodily integrity, and cultural depravity), who has had the most power to shape American perceptions (e.g., journalists, activists, or scientists), and the implications of this discourse for thinking about and building gender egalitarian, multicultural democracies.

Ultimately, whatever opinion one wants to hold about the wide range of practices we typically refer to as “female genital mutilation,” it is very clear that the negative opinions of most Westerners are heavily based on misinformation and have been strongly shaped by racism, ethnocentrism, and a disgust or pity for an imagined Africa.  That doesn’t mean that Americans or Europeans aren’t allowed to oppose (some of) the practices (some of the time), but it does mean that we need to think carefully about how and why we do so.

One of the most powerful voices challenging Western thinking about FGCs is Fuambai Sia Ahmadu, a Sierra Leonan-American anthropologist who chose, at 21 years old, to undergo the genital cutting practice typical for girls in her ethnic group, Kono.

She has written about this experience and how it relates to the academic literature on genital cutting.  She has also joined other scholars — both African and Western — in arguing against the zero tolerance position on FGCs and in favor of a more fair and nuanced understanding of why people choose these procedures for themselves or their children and the positive and negative consequences of doing so.  To that end, she is the co-founder of African Women are Free to Choose and SiA Magazine, dedicated to “empowering circumcised women and girls in Africa and worldwide.”

You can hear Ahmadu discuss her perspective in this program:

[youtube]https://www.youtube.com/watch?v=mV6UfEaZHBE[/youtube]

Many people reading this may object to the idea of re-thinking zero tolerance approaches to FGCs.  I understand this reaction, but I urge such readers to do so anyway.  If we care enough about African women to be concerned about the state of their genitals, we must also be willing to pay attention to their hearts and their minds.  Even, or especially, if they say things we don’t like.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

In the wake of Philip Seymour Hoffman’s sad death, many are calling for various “harm reduction” approaches to substance use. Proponents of harm reduction have identified lots of ways to reduce the social and personal costs of drugs, but they often require us to shift our focus from the prevention of drug use itself to the prevention of harm. Resistance to such approaches often hinges on the notion that they somehow tolerate, facilitate, or even subsidize risky behavior.

This tension emerged clearly in my new article with Sarah Shannon in Social Problems. We re-analyzed an experimental jobs program that randomly assigned a basic low-wage work opportunity to long-term unemployed people as they left drug treatment. In some ways, the program worked beautifully. The job treatment group had significantly less crime and recidivism, especially for predatory economic crimes like robberies and burglaries. After 18 months, about 13 percent of the control group had been arrested for a new robbery or burglary, relative to only 7 percent of the treatment group. Put differently, 87 percent of those not offered the jobs survived a year and a half without such an arrest, relative to 93 percent of the treatment group who were offered jobs.

A randomized experiment that shows a 46 percent reduction in serious crime is a pretty big deal to criminologists, but the program has still been considered a failure. In part, this is because the “treatment” group who got the jobs relapsed to cocaine and heroin use at about the same rate as the control group. After 18 months, about 66 percent of the control group had not yet relapsed, relative to about 63 percent in the treatment group. So, there’s no evidence the program helped people avoid cocaine and heroin.

From an abstinence-only perspective, such programs look like failures. Nevertheless, even a crummy job and a few dollars clearly helped people avoid recidivism and improved the public safety of their communities. So, did the program work? From a harm reduction perspective, a jobs program for drug users surely “works” if it reduces crime and other harms, even if it doesn’t dent rates of cocaine or heroin use.

Chris Uggen is a professor of sociology at the University of Minnesota and the author of Locked Out: Felon Disenfranchisement and American Democracy, with Jeff Manza. You can follow him at his blog and on twitter. This post originally appeared at Public Criminology.

A popular quote urges us to shoot for the moon: even if we miss, it tells us, we’ll land among the stars. According to new research, there’s more to it than cheesy inspiration. Using data from two waves of the National Longitudinal Survey of Youth, sociologist John Reynolds and Chardie Baird test the common notion that failing to attain as much education as expected is associated with symptoms of depression in early/middle adulthood.

First, their results show that individuals with lower levels of education are more likely to exhibit signs of depression.

But, further statistical wrangling shows that their depression doesn’t come from the gap between plans and achievement. It comes from the low level of educational attainment in itself.

Reynolds and Baird conclude that there are no long-term emotional costs to aiming high and falling short when it comes to educational aspirations. This contradicts decades of research that holds that unmet educational expectations lead to psychological distress. In fact, not trying is the only way to ensure lower levels of education and increased chances of poor mental health. So, go ahead and shoot for that moon.

Thanks to advances in early diagnosis and treatment of breast cancer, white women’s survival rates have “sharply improved,” but black women’s have not.  As a result, white women are more likely to be diagnosed with breast cancer, but black women are more likely to die from it.  Researchers from the Sinai Institute found that Black women are 40% more likely to die from the disease than white women.

Experts trace the majority of the widening gap in survival rates to access, not biology.  Black women are more likely than white to be low income, uninsured, and suspicious of a historically discriminatory medical profession.

From Tara Parker-Pope for the New York Times.  Hat tip @ProfessorTD.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.