Monthly Archives: June 2009

Is Free Preventive Care The Answer?

In response to my earlier post of a couple of thoughts on healthcare, a reader called “bunkerbuster” throws a few interesting questions my way:

What’s your view on demand for health care?

The market model would have it increase to infinity if it becomes zero cost to the consumer.

Generally, that is the rule, but I think “bunkerbuster” is right to be skeptical for three reasons. First of all, the market model is a model, and nobody seriously expects models to work at the extremes. Having an infinity turn up in the middle of your model is usually a sign that you’ve gone too far.

Second, healthcare has non-financial costs—such as the time it takes from a busy day and the fact that it’s often very uncomfortable—that prevent the true cost to the consumer from ever dropping away to zero.

Third, like everything else, healthcare has diminishing returns. The most important bits of medical care are extremely important to your health, but additional care is less and less valuable. These returns likely diminish all the way to zero—or at least below the costs mentioned in the previous item. Once you’ve fixed everything that’s wrong with you, why would you buy more healthcare, even if it’s free?

(Of course, health problems can be defined down. Back when most children never made it to adulthood, nobody worried about allergies. Nowadays, people take pills to get rid of toenail fungus, and some plastic surgeons have lobbied to have small breasts classified as a disorder.)

But in reality, the non-union pipefitter who can now afford to have regular check ups may well have significantly lower long-term demand for medical services.

So here’s a point to ponder: If preventive care reduces long-term costs, shouldn’t we expect uninsured people to consume a lot of preventive care, since they are more directly exposed to the costs? That’s apparently not what happens, however, because our healthcare system already includes a distortion in healthcare pricing, as illustrated by the last part of the comment:

And there’s always the classic emergency room scenario in which demand for those ER resources balloons because the poor have nowhere else to go and because minor problems go untreated until they are emergencies…

This happens because hospital emergency rooms aren’t allowed to turn people away, even if they can’t pay. For poor people, this artificially lowers the price of emergency care with respect to non-emergency care, which distorts the healthcare decision-making process. From the indigent patient’s point of view, emergency care is cheaper than non-emergency care. And when something has a low price, people buy more of it.

Since non-emergency situations can progress into emergencies if untreated, this creates some perverse financial incentives for poor people to avoid preventive medical care. But what are the alternatives? Refusing emergency care to people who can’t pay? Paying for every doctor’s visit, no matter how unnecessary? There are no easy answers.

(And, just to mix things up a bit, some statistical evidence suggests that the benefits of preventive care aren’t as clear-cut as we might suppose.)

Scattershot 2009-06-29

Random shots around the web:

(Hat tip: Radley)

Eminently Ignorant

I’m probably being unfair, but it seems like Supreme Court Justice Clarence Thomas is a bit of a dumbass. (Or maybe, as fair Jennifer says, we should have listened to Anita Hill.) That’s really the only way to account for his explanation of why it was okay for a school principal to order a strip search of a 13-year-old girl to try to find some ibuprofen.

Thomas was the only Justice that thought this was okay. There are a number of ways he might have tried to justify his opinion—stare decisis, in loco parentis—and for all I know, he used them. But this is just plain stupid:

In this case, officials had searched the girl’s backpack and found nothing, Thomas said. “It was eminently reasonable to conclude the backpack was empty because Redding was secreting the pills in a place she thought no one would look,” he said.

I think that’s what mathematicians derisively call proof by ignorance: It must be true because I can’t think of any other possiblies.

In the unlikely even I ever meet Justice Thomas, I’m going to accuse him of smuggling crystal meth in his rectum. By his own logic, he ought to let me check, right?

(I know there’s more to it than that, but the stupidity here just pisses me off.)

Thomas adds this:

Thomas warned that the majority’s decision could backfire. “Redding would not have been the first person to conceal pills in her undergarments,” he said. “Nor will she be the last after today’s decision, which announces the safest place to secrete contraband in school.”

“Nor will she be the last”? What the fuck? They did search her underwear, and she didn’t have any drugs. I always assumed Thomas just looked like he was sleeping during oral arguments, or that he was bored because he’d already read it all in the briefs, but maybe he’s really just not paying attention.

It’s also a question of values. If the cost of keeping dickheaded school administrators from looking in little girls’ underwear is that a little more contraband gets into our schools, I, for one, am okay with that.

Michael Jackson, R.I.P.

Now that Michael Jackson is dead, I’m not going to miss him. I didn’t know him. I don’t think many people did. I do, however, miss the Michael Jackson I once thought I knew, back before it all got so weird. You see, there was a time…

I never really loved Michael Jackson’s music, but I loved his music videos. Back in the early 1980s, creating videos for songs was still a new and controversial idea. I liked the videos, but a lot of people, including a lot of artists, thought they were a distraction from the music. Record companies made videos, but they didn’t take them seriously.

Michael Jackson helped change all that. At a time when a music video might have a budget of $40,000, he spent about a half-million dollars on the Thriller video and got a major motion picture director to film it. Nowadays, many motion picture directors get started with music videos and think nothing of producing one for musicians they like, but back then nobody had heard of such a thing.

I admired Michael for taking this fledgling artform to heart and treating its fans with respect.

It may sound odd, but I also admired Michael Jackson for his willingness to let Weird Al Yankovic parody his songs. Musicians with considerably less fame and talent took themselves too seriously to let Al do his thing (I’m looking at you, Coolio!) but Michael Jackson was always willing.

That’s the Michael Jackson I miss. Something bad happened to him a long time ago.

in Music

Scattershot 2009-06-25

A few random shots around the web:

  • When I heard that bartender-beating Chicago cop Anthony Abbate got a light sentence, I wondered if someone who wasn’t a cop did the same thing, would he get off as easy? When Moser did some research, and the answers is probably yes. It was, after all, just a barfight.
  • Savana Redding wins her case against ibuprofen-seeking perverts.
  • I didn’t love the new Transformers movie, but I liked it more than Roger Ebert did.
  • Why? WHY? Why do they keep letting M. Night Shyamalan make movies! At least it’s an adaptation, so maybe it will have a point.


Not Much Punishment For Abbate, Even Less For Conspirators

Chicago police officer Anthony Abbate—caught on video beating up a young woman bartender—has been sentenced. He got probation.

Note that Abbate is still a police officer. The Independent Police Review Authority has recommended he be fired, and it sounds like he was convicted of a felony, which should disqualify him for the police force, but God only knows what the Police Board will do.

Chicago’s Police Board is often described as the “civilian review” component of the disciplinary system, which sounds good, but as I understand it, the only thing they can do in police disciplinary actions is to either approve, reduce, or eliminate the recommended punishment. In other words, it’s a way for the city political structure to protect officers who have connections.

My guess is that Abbate doesn’t have any connections good enough to survive so publicly disgracing the department, but…this is Chicago.

The thing is, Abbate’s not the real problem. He’s just a drunken fool. Notice, however, that there’s been no word in months about the allegations that other officers tried to cover this up and intimidate witnesses with threats of arrest. That would be a criminal conspiracy within the police department.

Nothing to see here. Move along.

Lawyer as Juror in a Murder Trial

Illinois’s own Jeremy Richey does some actual journalism and interviews California civil attorney Brian Pedigo about his experience as a juror for a murder trial. He talks about deliberations, and what he thinks each side did wrong or right.

By the way, he has one piece of advice for the prosecutor that I’d like to second if I’m ever on a jury again:

When handling a firearm, do not point it at the jury — have gun manners.  Point it always at the ground, even though it’s unloaded. 

Yeah. It may give us jurors a sense of what it was like to be the victim, but it’s also going to give me a sense that you’re an irresponsible jackass.

Mathematics In Gangland

Scott Greenfield, font of so much that I can riff off of, has a complaint about gang experts who try to paint every action by the defendant as related to his membership in a gang:

If a defendant has a tattoo, the expert will testify that tattoos are “brands” typically worn by gang members.  If the tattoo happens to say “Tiffany”, then the testimony is changed ever so slightly to accommodate, by the expert then saying that gang members typically brand themselves with the names of their girlfriends.  You get the message.  No matter what the evidence, the defendant can’t win.  It’s always connectible to being a gang member, according to the expert.

Aside from the implication by Scott that police gang experts are pulling answers out of their ass don’t really know much about gangs, I can also see something of a logical problem with the so-called expert’s theory. The cop’s statement that gang members have specific types of tattoos is a logical statement: If he’s a gang member, then he’ll have a specific tattoo, say of a snarling dog. If we try to get all mathematical, the statement it would look like this:

gang member ==> dog tattoo

But that’s not what the prosecutor wants the jury to believe. The prosecutor doesn’t care about the tattoo. He’s trying to prove that the defendant is a gang member. He’s trying to prove the converse:

dog tattoo ==> gang member

The problem is, as a matter of math, the truth of a statement does not imply the truth of its converse. Even if it’s true that all gang members have dog tattoos, it doesn’t mean all people with dog tattoos are gang members. It’s easier to see with a more obvious example: All gang members have noses:

gang member ==> nose

but that doesn’t in any way prove

nose ==> gang member

That is, not all people with noses are gang members.

So why is it that “all people with noses are gang members” is obviously wrong, but “all people with dog tattoos are gang members” seems plausible? The answer is a little more complicated because it involves the real world, the statistics of experimental design for testing hypotheses, and the availability heuristic.

Suppose you wanted to test the hypothesis “all people with X are gang members,” where X is either “noses” or “dog tattoos.” You’d do it by setting up an experiment—in this case a survey of the population—to look for counterexamples to the hypothesis. That is, you’d try to find people who have X but are not gang members. Finding even one proves it’s not absolute truth.

The real world is a little fuzzy—especially in the social sciences—and our methods of testing are less than perfect, so real-world hypothesis testing usually involves testing a statistical relationship. In this case, we’d be testing “people with X have a high probability of being gang members” and we’d still be looking for people who have X but are not gang members. The more such counterexamples we find, the lower the probability of a relationship.

A scientific test of this kind of hypothesis would involve conducting random surveys and gathering enough data to reach statistically reliable conclusions. But when it’s not a scientific investigation, when it’s just us trying to figure something out, we don’t do a scientific study. We just try to think of counterexamples.

When X is “noses” it’s easy. We all know lots of people with noses, and nearly all of them are not gang members. Such a large number of counterexamples makes it easy to destroy the hypothesis that all people with noses are gang members.

When the hypothesis is “all people with dog tattoos are gang members,” it’s a little harder to think of counterexamples, simply because dog tattoos are so rare that we may not know of anybody who has one. Our inability to find counterexamples makes the hypothesis seem plausible.

This way of thinking is called the availability heuristic. We assume something is likely because we can easily bring to mind examples. The more examples we can think of, the more likely we believe it to be.

Although the availability heuristic is not as rigorous and generalized as conducting a scientific investigation, in essence it’s a similar process. A scientific investigation gathers data using randomized trials, controlled studies, and careful surveys and then analyzes the data to arrive at results. The availability heuristic does the same kind of analysis, but it works only on the data we have in our heads at that moment. There is no data gathering process.

The availability heuristic is a perfectly valid way of thinking about our day-to-day world, about which we have lots of data but don’t have time to gather more. It tends to fail us, however, when thinking about parts of the world with which we are unfamiliar. That’s why we have science.

What are the practical implications of all this philosophy when it comes to thinking about gang experts? Probably not much. But if I ever find myself on a jury listening to this kind of testimony, I hope I’ll keep a few points in mind.

Basically, any assertion of a general rule—all fish have fins, all cats have fur, all people with dog tattoos are gang members—is equivalent to an assertion that counterexamples do not exist: There are no fish that don’t have fins, there are no cats that don’t have fur, there are no people who have dog tattoos who are not in gangs.

(Actually, the gang expert will likely invoke several indicators of gang membership in combination—gang tattoos, gang hats, gang shoe laces, gang jewelry—and the standard in the courtroom is not that there are absolutely no counterexamples, but rather that counterexamples are rare enough that they do not constitute a cause for reasonable doubt. Nevertheless, an assertion of a general rule is still an assertion about the rarity of counterexamples.)

So if you hear someone say that dog tattoos are sign of gang membership, you should be wondering why that person believes there are no (or few) counterexamples. Remember, it’s not just about gangs. It’s also about tattoos. If he’s really an expert on gangs, he may very well have observed that gang members have dog tattoos, but how does he know that non-gang-members don’t have dog tattoos as well? He’d have to know a lot about tattoo prevalence in society at large. In addition to being a gang expert, he’d also have to be a tattoo expert.

Or at least he’d have to have received reliable information from a tattoo expert or be aware of a scientific study of some kind that addressed the issue. If I were on the jury, I’d want to hear about that.