Peter Bregman in the Harvard Business Review suggests that to Get What You Want, Don’t Go With Your Gut.  Rather than let your emotions produce a reaction to an event that affects the outcome, you should pause and let your assessment of the preferred outcome guide the reaction.  Solid, Jedi Master stuff.  However, the more I read about moral psychology, the more I question this premise.  Joanthan Haidt at Virgina has done some interesting experiments asking students their moral evaluations of these scenarios in which no harm comes to subjects:

a son who promises his mother, while she was on her deathbed, that he would visit her grave every week, and then reneged on his commitment because he was busy.

a man buys a dead chicken at the supermarket and then has “relations” with it before cooking and eating it.

Most of the students responded with an strong “ewww” factor guiding their evaluations, but had difficulty coming up with rational explanations for why the behavior was morally wrong. The logic for its moral appropriateness, or inappropriateness, resided in “the gut” or the emotional brain. I wonder if better advice to those in the business world and, from my perspective, the political world would be to become skillful and knowing when to listen to your gut and when to listen to the rational brain that sets goals. It would seem that there are times when your gut is telling you that your outcomes need to change. Personally, I’d be ecstatic if more politicians listened to their gut when voting on legislation.

So people pick cockiness, or to use contemporary urban parlance, swagga’ over actual competence.  So says a researcher:

The research, by Don Moore of Carnegie Mellon University in Pittsburgh, Pennsylvania, shows that we prefer advice from a confident source, even to the point that we are willing to forgive a poor track record. Moore argues that in competitive situations, this can drive those offering advice to increasingly exaggerate how sure they are.

The piece goes on to describe other ways in which people are more drawn to those who present themselves as self-assured.  Isn’t this something Jay Z, or Erving Goffman, already knows.  What does this fact of human behavior say about our politics?  It sure explains the appeal of a Glen Beck or Rush Limbaugh.  Maybe that’s the problem with the progressive left, it lacks swagga’… I mean Amy Goodman?  Al Franken?  Lovely people, I’m sure, but c’mon.  Even Chuck D couldn’t make Air America cool!

An interesting thought experiment would consider how you could operationalize cockiness?

HT: orgtheory.net

Here’s a good ethical puzzle for a social problems or public policy class.  Is it morally acceptable for New York City to address their homeless problem by providing them a one-way airline ticket.  Apparently, the city has saved thousands of dollars by giving indigent residents the option of moving to another city or state.

On one hand, this seems to meet the conditions of market exchange — two parties engaged in a voluntary transaction.  And with the city’s unemployment over 10 percent, perhaps helping the homeless move addresses a jobs/labor spatial mismatch?  On the other hand, it seems as if the city is “giving up” on its residents.  It is presuming that providing social services is an economic drain rather than a human capital investment.  More importantly, it is signaling that some residents of the city are more valuables than others.

HT: Planetizen

I just learned about the brilliant site Kickstarter today. On Kickstarter, artists, musicians, inventors, journalists, or whoever can post a project they want to fund. The web site encourages generous people (with disposable income) to make small contributions to the projects. A few examples:
-Two brothers need $10,000 to finish their documentary about Fred Rogers (of “Mr. Rogers Neighborhood”)
-A singer-songwriter needs $3500 to record his debut album.
-A writer needs $5000 to fund a road trip to see various examples of folk architecture for a book.

In exchange donors get rewards from the project planners. If it’s a band, maybe you’ll get a sticker for a $5 donation, a digital copy of their album for $10, and a live performance at your house for $1000. The rewards depend on the project.

It occurs to me that this would be a fantastic way to fund research. It would mean that research was conducted for which there was genuinely popular demand. Maybe the public wants an ethnography of transgendered cowboys in the rodeo circuit, but has little interest in funding a survey on TV viewing habits. It would mean research went forward that matters to people.

Heck, I’d put one of my own future projects up there for funding, but I’m not sure what rewards I can offer. What’s the limit on how many people you can thank in a journal article’s acknowledgement?

While I tend to agree with Paul Krugman that the Obama healthcare proposal is most akin to a Swiss-style healthcare programme {Hat Tip:: KM}, I think it’s useful to look at systems comparatively.  This clip is not from Sicko, but from CBS Sunday Morning::

While the French model is having its problems on the financing side and it is indeed embedded with French culture, I think it provides insights into thinking about healthcare as an institution.  I’m interested in how policy can shape innovation and if the federal government has monopsony power, it can create incentives for improvements in delivery.  The diagnostic approach and the housecalls are interesting approaches, but this would necessitate change.  Sociology predicts that there will be institutional resistance to change, but health care reform has the unique opportunity to shape new institutional logics.  I saw a presentation at ASA on compliance with a law limiting the hours of medical residents.  You would think it was a no-brainer.  It’s the law, hence there would be compliance.  Wrong.  The social construction of the medical establishment overrode this, shaping actual praxis.

Twitterversion:: Clip from #CBS Sunday Morn. on French healthcare. While not directly applicable, food 4 thought re: innov. & improvements.http://url.ie/28qf @Prof_K

Song:: La Mer

La Mer – Francoise Hardy

Anyone curious on how how pro-single payer physicians think about the issues, I encourage you to check out the Physicians for a National Healthcare Program {PNHP} FAQ.  Here’s a list of PNHP single-payer resources, as well.  As stated in an earlier post, I view health care as infrastructure that can spur innovation, creativity, and entrepreneurship and like many in the biotech. industry, I see a single-payer model {public finance of healthcare, as opposed to provision} as important for implementation of genomic medicine.

I won’t go into the healthcare debate and media circus, but will link to an article on a recent NBC poll.  Interestingly, 36% believe that Obama’s reform efforts are a good idea, but 53% support a paragraph describing his plans.  It’s a communication problem.  If you think all of the cacophony at the town halls is helping the GOP, you’re wrong.  The NBC poll reports 62% disapprove of their handling of health care.

The PNHP is highly critical of the administrative costs of healthcare and are no fans of the insurance industry.  Insurance also affects how healthcare providers do their jobs.  I have access to hospital data that’s used to “manage care” to maximize insurance reimbursement.  Moreover, there are powerful incentives in the insurance industry to maximize profits by denying claims.  The PNHP recognizes that a single-payer system will adversely affect insurance::

“The new system will still need some people to administer claims. Administration will shrink, however, eliminating the need for many insurance workers, as well as administrative staff in hospitals, clinics and nursing homes. More health care providers, especially in the fields of long-term care, home health care, and public health, will be needed, and many insurance clerks can be retrained to enter these fields. Many people now working in the insurance industry are, in fact, already health professionals (e.g. nurses) who will be able to find work in the health care field again. But many insurance and health administrative workers will need a job retraining and placement program. We anticipate that such a program would cost about $20 billion, a small fraction of the administrative savings from the transition to national health insurance.”

So, shouldn’t we be concerned about insurance ?  Are they getting a bad rap?  Are they really evil?  Isn’t it a part of financial intermediation, providing the critical function of polling resources and spreading risk?

Malcolm Gladwell in a 2005 New Yorker article did a good job of explaining two forms of insurance:: social and actuarial.  Social insurance pools money from many for a public good, regardless of usage, in order to sustain an infrastructure.  Actuarial insurance is quite different and has been the pathway that US healthcare has been going::

“How much you pay is in large part a function of your individual situation and history: someone who drives a sports car and has received twenty speeding tickets in the past two years pays a much higher annual premium than a soccer mom with a minivan.”

Think pre-existing conditions.  The actuarial model is why biotech. wants a single-payer system.  Genomics identify risks and will eventually match individuals, diseases, and therapies on the basis of genetic information.  Doctors see this on the horizon and Robin Cook, MD offered this NY Times op. ed. on how he had revised his views on universal health care.

But, if you were to craft a business model, which would you choose to invest in, if you wanted to make the most profit?::  {1} social insurance that pools equal premiums from all and allocates care to all or {2} actuarial insurance that charges more for people who have a higher likelihood of becoming ill and can deny care for pre-existing conditions or treatment deemed unwarranted.  The actuarial model can easily align with a set of values of individualism, as well as moral judgments about treating certain diseases {e.g., a smoker with lung cancer}.  I’ve seen people on discussion boards claim that “I can take care of my own” and perplexed why everyone else cannot.  How I see it, the current debates are really about using individualism to protect corporate interests.  I see plenty of incentives for the actuarial insurance industry and politicians to fan the argumentative flames about wild-eyed hypotheticals, as opposed to substantive debates about implementation. The devil is in the details.

Gladwell concluded his article with the following::

“In the rest of the industrialized world, it is assumed that the more equally and widely the burdens of illness are shared, the better off the population as a whole is likely to be. The reason the United States has forty-five million people without coverage is that its health-care policy is in the hands of people who disagree, and who regard health insurance not as the solution but as the problem.”

Twitterversion:: Who will weep 4 actuarial US health insur. indstry? Are they/backers obfuscating real debates on implmntatn w/histrionics?http://url.ie/28qa @Prof_K

Song:: Pay For It – Lloyd Cole

Cool stuff for the day.

From the Good Magazine blog, Inhabit.com and Dwell have announced the finalists of a fantastic competition called Reburbia.  Participants were invited to consider how we could re-envision declining suburbs.  According to the contest description:

In a future where limited natural resources will force us to find better solutions for density and efficiency, what will become of the cul-de-sacs, cookie-cutter tract houses and generic strip malls that have long upheld the diffuse infrastructure of suburbia? How can we redirect these existing spaces to promote sustainability, walkability, and community? It’s a problem that demands a visionary design solution and we want you to create the vision!

Here are the  winners:

Turning McMansions into Biofilter Water Treatment Plants,

Rezoning suburban residential areas to include commercial ventures

and

Creating Big Box agriculture defined as: turning big box store parking lots into farms, the interior of the stores into greenhouses and restaurants, and many of the existing structural details into renewable energy generators.

Looks nice, but the big question is how you frame these changes so that local governments and NIMBY types are receptive. If anyone knows of any places where these types of ventures are happening, shoot me an e-mail.

Bee Lavender has a poignant piece in guardian.co.uk on why she prefers the British health care system (NHS) to the American version.  Here’s the key passage in her essay.

In the US, the greatest restriction on personal freedom that I have ever encountered in my own life, or witnessed in the lives of friends, all comes down to health insurance. Creative, innovative, talented people are unable to change jobs because they need the insurance. Small companies collapse because they cannot afford employee insurance. People die because they do not have insurance.

This to me seems the critical issue we need to work through as we move forward in the U.S. health care debate. Has the U.S. system reached a ceiling in its desire to create the underlying conditions for a free society? We’ve always had a struggle with spending on public goods in this country, but have lurched towards funding basic services to create a just society (education, Medicare, Social Security, etc.). There are lots of ways to cover everyone and the NHS has its critics, but I’m not sure if we as a nation think that access to health services is a precondition for living in a free society. I fear we become too fragmented or skeptical of government’s ability to provide public goods? I’m not sure if we in the social sciences can do more to help drive the debate since the question of universal coverage is about value orientations.

My Ph.D. alma mater, Boulder, Colorado, is home to the best performing housing market in America, which I why I had to live in a basement on Baseline and Dartmouth for four years 🙂  Check out how many of these markets are in college towns:

The Top 30 Housing Markets in America.

HT: Planetizen

HT: Planetizen

Civic engagement denizens, be careful what you wish for. A New York Times article elaborates on the Strange New World of Public Participation resulting from the traveling “town-hall-meeting-palooza” of the past two weeks:

The result was a series of made-for-YouTube moments, with video clips played endlessly on the Internet and cable television, the logical extreme, perhaps, of an era when Joe the Plumber is really named Sam. Along the way, another kind of Joe — Joe Six-Pack, the average Joe — seemed to disappear, pushed into the background by crowds bearing scripted talking points and signs.

“We’re living in the era of the viral town meeting,” said Ross Baker, a political scientist at Rutgers University who once worked as a Senate aide. “I remember back in the ’70s getting identically worded telegrams in the thousands. What’s happened now is the technology of protest has metastasized, and it threatens to overwhelm the relationship between members of Congress and their constituents.”

The advent of the Internet has created “hyper-public” spaces where the object of “discourse” (I’m being generous calling it that) is an audience of millions even if the pretext is a town hall meeting of dozens. Here’s Arlen Specter getting bum-rushed (I know, I’m 39, what do you want!) by his constituents.

The combination of a contentious issue, public forums, cell phone cameras and You Tube is a primeval soup for loud, outrageous rhetoric that can fill the 24 hour news hole. The question is whether members interpret this as the pulse of their constituents or an orchestrated set of activists using new technology effectively. I find all of this wanting…. If you’re going to make a scene at a town hall meeting, it should look like this:

Zuma Dogg Fights City Hall – Watch today’s top amazing videos here

I’d like my own Johnnie Cochrane team