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Thursday, January 21, 2010
Saturday, January 16, 2010
The price of being cheap
A few months back (although it feels like a few years ago), I posted a bit about what's going to happen to Medicaid under these health reform proposals. The gist of it was that Medicaid is going to be expanded to cover more people. At the time, the House bill called for expansions of Medicaid to include people whose incomes are up to just over 133% of the poverty line. That was later changed to 150% of the poverty line in the final bill that passed out of the House.
What's the virtue of doing this (from a politician's perspective)? It's cheap. Medicaid pays peanuts for the services that its recipients utilize. The downside of this, of course, is that many doctors don't bother to accept Medicaid clients because it's not particularly profitable (and Medicaid recipients as a group are generally difficult to deal with for a variety of reasons). But if we cover more people with Medicaid, that's a lot cheaper than helping to subsidize the purchase of private insurance. So instead of helping some uninsured person at 140% of the poverty line pay for private insurance, we'll be sticking him on cheap government insurance. This brings down the price tag of the bill.
But as that older post I referenced discussed, Medicaid is both cheap and very expensive. States never pay more than half of the costs of it and yet it still consumes an enormous chunk of state budgets. In fact, it's generally one of the two biggest items in state budgets (the other is education). And a great many states are in very serious financial trouble right now. As incomes drop during recessions and state tax revenues fall, more people tend to become eligible for Medicaid just as states begin having more and more trouble paying for things they could afford during the good times. In fact, since there are federal programs that give you a bit of a health care grace period when you lose your job--allowing you to keep getting the health insurance you got through your employer for a few extra months as long as you pay for it (or, thanks to the stimulus, 35% of it, with the feds temporarily picking up the rest of the tab)--the swelling of the Medicaid rolls tends to lag the worst of the recession a bit. So states might be taking an even bigger financial hit on Medicaid this year than they did last year. So what happens when Congress tells the states "oh, by the way, you're now required to cover more people and incur even more expenses than you did before"?
Bad things.
I got to listen in on a interview call the other day with the director of a certain national non-profit organization. This director mentioned that she had recently talked with representatives from a handful of states who indicated that unless they received more stimulus money to pay for certain programs, they were going to very seriously consider withdrawing from Medicaid funding. And this isn't an ideological threat; she indicated that 75% of the states who told her this were Democratic states.
States face certain requirements when they receive matching funds for their Medicaid program but they aren't required to actually have a Medicaid program. Indeed, the last holdout, Arizona, didn't institute a Medicaid program until 1982. But now certain states seem to be giving very serious thought to ending their programs because they're simply too expensive.
As you may remember, Senator Ben Nelson of Nebraska took a lot of heat recently for inserting a little sweetheart deal into the Senate bill for his home state: the costs of expanding Medicaid in Nebraska are to be borne by the federal government indefinitely. That is, they'll accept more people into their Medicaid program but it won't cost Cornhuskers any additional money because Uncle Sam is writing the check. Certain other states were understandably peeved that they're not getting the same perks as Nebraska. In his State of the State address recently, California's Governor Schwarzenegger was blunt:
(In case you're wondering about the state of that State: they're in deep shit.)
They want the deal, too. And maybe they'll get it. There were rumblings that the final, final, final bill (the all-important center box) that's being drawn up now (and should be out this week) might federalize the Medicaid expansion for every state indefinitely. I don't know how much that would cost the federal government or how it would bloat the price tag of the final bill. But it might keep some states from doing something nobody's ever done before: ending their state Medicaid programs as we know them.
What's the virtue of doing this (from a politician's perspective)? It's cheap. Medicaid pays peanuts for the services that its recipients utilize. The downside of this, of course, is that many doctors don't bother to accept Medicaid clients because it's not particularly profitable (and Medicaid recipients as a group are generally difficult to deal with for a variety of reasons). But if we cover more people with Medicaid, that's a lot cheaper than helping to subsidize the purchase of private insurance. So instead of helping some uninsured person at 140% of the poverty line pay for private insurance, we'll be sticking him on cheap government insurance. This brings down the price tag of the bill.
But as that older post I referenced discussed, Medicaid is both cheap and very expensive. States never pay more than half of the costs of it and yet it still consumes an enormous chunk of state budgets. In fact, it's generally one of the two biggest items in state budgets (the other is education). And a great many states are in very serious financial trouble right now. As incomes drop during recessions and state tax revenues fall, more people tend to become eligible for Medicaid just as states begin having more and more trouble paying for things they could afford during the good times. In fact, since there are federal programs that give you a bit of a health care grace period when you lose your job--allowing you to keep getting the health insurance you got through your employer for a few extra months as long as you pay for it (or, thanks to the stimulus, 35% of it, with the feds temporarily picking up the rest of the tab)--the swelling of the Medicaid rolls tends to lag the worst of the recession a bit. So states might be taking an even bigger financial hit on Medicaid this year than they did last year. So what happens when Congress tells the states "oh, by the way, you're now required to cover more people and incur even more expenses than you did before"?
Bad things.
I got to listen in on a interview call the other day with the director of a certain national non-profit organization. This director mentioned that she had recently talked with representatives from a handful of states who indicated that unless they received more stimulus money to pay for certain programs, they were going to very seriously consider withdrawing from Medicaid funding. And this isn't an ideological threat; she indicated that 75% of the states who told her this were Democratic states.
States face certain requirements when they receive matching funds for their Medicaid program but they aren't required to actually have a Medicaid program. Indeed, the last holdout, Arizona, didn't institute a Medicaid program until 1982. But now certain states seem to be giving very serious thought to ending their programs because they're simply too expensive.
As you may remember, Senator Ben Nelson of Nebraska took a lot of heat recently for inserting a little sweetheart deal into the Senate bill for his home state: the costs of expanding Medicaid in Nebraska are to be borne by the federal government indefinitely. That is, they'll accept more people into their Medicaid program but it won't cost Cornhuskers any additional money because Uncle Sam is writing the check. Certain other states were understandably peeved that they're not getting the same perks as Nebraska. In his State of the State address recently, California's Governor Schwarzenegger was blunt:
"California's congressional delegation should either vote against this bill that is a disaster for California or get in there and fight for the same sweetheart deal that Sen. Nelson of Nebraska got for the Cornhusker State," Schwarzenegger said in his state of the state address on Wednesday. Schwarzenegger said Nelson "got the corn and we got the husk."
(In case you're wondering about the state of that State: they're in deep shit.)
They want the deal, too. And maybe they'll get it. There were rumblings that the final, final, final bill (the all-important center box) that's being drawn up now (and should be out this week) might federalize the Medicaid expansion for every state indefinitely. I don't know how much that would cost the federal government or how it would bloat the price tag of the final bill. But it might keep some states from doing something nobody's ever done before: ending their state Medicaid programs as we know them.
Saturday, January 9, 2010
Speakeasy Book Club
I just started re-reading a classic: Policy Paradox by Deborah Stone. Policy Paradox is the single most influential book (to me) I read as an undergraduate. At the time I was asked to read it, I was restructuring my understanding of the political and policy spheres and struggling to grasp the nature of their intersection. Having stumbled over to policy from physics, I initially brought the eye of the scientist: a single problem will more likely than not have a single solution, a correct answer that can be devised by the clever policy scientist. This viewpoint isn't far from what I called the Utopian perspective in an old post.
At the time Policy Paradox came into the picture, I was beginning to move beyond that mode of thinking and to see more shades of gray. This book was immeasurably helpful in moving me along that path. To give you a feel for the way this book approaches public policy (and the impact it had on me), here's a sample from the introduction:
I also started re-reading my BA the other day (the paper they made me write to graduate); it's on the policy making process and the influence of Policy Paradox is clear. I'm kicking around the idea of putting up a post a week or so reacting to each of the chapters. But we'll see.
Meanwhile, if anyone else is interested in reading it, I highly recommend it: Policy Paradox.
You guys reading anything I should be reading?
At the time Policy Paradox came into the picture, I was beginning to move beyond that mode of thinking and to see more shades of gray. This book was immeasurably helpful in moving me along that path. To give you a feel for the way this book approaches public policy (and the impact it had on me), here's a sample from the introduction:
This book has two aims. First, I argue that the rationality project [a "mission of rescuing public policy from the irrationalities and indignities of politics, hoping to make policy instead with rational, analytical, and scientific methods"] misses the point of politics. Moreover, it is an impossible dream. From inside the rationality project, politics looks messy, foolish, erratic, and inexplicable. Events, actions, and ideas in the political world seem to leap outside the categories that logic and rationality offer. In the rationality project, the categories of analysis are somehow above politics or outside it. Rationality purports to offer a correct vantage point, from which we can judge the goodness of the real world.
I argue, instead, that the very categories of thought underlying rational analysis are themselves a kind of paradox, defined in political struggle. They do not exist before or without politics, and because they are necessarily abstract (they are categories of thought, after all), they can have multiple meanings. Thus, analysis is itself a creature of politics; it is a strategically crafted argument, designed to create ambiguities and paradoxes and to resolve them in a particular direction. (This much is certainly awfully abstract for now, but each of the subsequent chapters is designed to show very concretely how one analytic category of politics and policy is a constantly evolving political creation).
Beyond demonstrating this central misconception of the rationality project, my second aim is to derive a kind of political analysis that makes sense of policy paradoxes such as the ones depicted above. I seek to create a framework in which such phenomena, the ordinary situations of politics, do not have to be explained away as extraordinary, written off as irrational, dismissed as folly, or disparaged as "pure politics." Unfortunately, much of the literature about public policy proceeds form the idea that policy making in practice deviates from such hypothetical standards of good policy making, and that there is thus something fundamentally wrong with politics. In creating an alternative mode of political analysis, I start from the belief that politics is a creative and valuable feature of social existence.
I also started re-reading my BA the other day (the paper they made me write to graduate); it's on the policy making process and the influence of Policy Paradox is clear. I'm kicking around the idea of putting up a post a week or so reacting to each of the chapters. But we'll see.
Meanwhile, if anyone else is interested in reading it, I highly recommend it: Policy Paradox.
You guys reading anything I should be reading?
Thursday, January 7, 2010
Battle of Shiloh: Throwing Stones at the 'Hornet's Nest'
In the field of history there is a fairly new and increasingly popular method of research called ethnohistory, where researchers go beyond traditional sources (books and manuscripts) and use other tools such as oral traditions and archaeology in order to fill in gaps and create a more complete picture of an event. This method is particularly useful in areas such as Native American history, where written documents from the individuals and tribes themselves are usually completely absent, forcing past historians to rely on biased (and occasionally flat-out false) accounts from outsiders. However, ethnohistory can also contribute important information to events that have been more than adequately documented. Military engagements are often among the most documented events in history, since officers are often required to write post-battle reports or testify at military tribunals; yet the confusing and complicated nature of war (as well as the urge to stress one's own achievements and gloss over the failures) creates gaps in the historical record, gaps that ethnohistory can and has helped fill.
The Battle of Shiloh took place in Tennessee on April 6th and 7th, 1862 during the American Civil War, and at that point represented the bloodiest military engagement in United States history: altogether slightly less than 24,000 casualties, a figure that would be outdone in later battles and even dwarfed at Gettysburg and Chickamauga. Arguably the most famous aspect of this battle was the Hornet's Nest, where scattered regiments from two Union divisions somehow organized a defense that held off waves of Confederate attacks for approximately seven hours until, after becoming completely surrounded, finally surrendered late in the day on the 6th. This delay bought the Union army enough time to regroup and counterattack the next day, turning a retreat into a vitally important victory for the North.
My first encounter with a very different version of this story came from catching an episode of 'Battlefield Detectives' which discussed this very event (see, we can learn something from tv), and others have additionally argued against this conception of the battle (for instance, this individual from HistoryNet.com) - offhand, I do not know any specific historians who have argued against the traditional account of the Hornets Nest, although some undoubtedly have. Using archaeology around both the Union and Confederate lines at the Hornet's Nest, researchers have found some startling evidence that contradicts descriptions from the soldiers.
For one, after methodically searching the Union line they found a lack of unfired ammunition, which is odd considering that in the heat of battle soldiers always dropped bullets when reloading. They did, however, find a decent number of fired ammunition along the Union line, indicating that the yanks were probably taking more fire from the rebs than they were dishing out.
Additionally, in the immediate aftermath of the battle gravediggers reported burying a comparatively small number of dead soldiers in the vicinity of the Hornet's Nest - strange, considering the custom was to use mass graves where the heaviest fighting had taken place in order to clean up the area as fast as possible. Even stranger is that years later when the government paid to have Union soldiers relocated to the national cemetery, they found that very few at all had been buried at the Hornet's Nest.
A final strike against the popular conception of the Hornet's Nest was that the canister fire (artillery shells that worked like a shotgun) that the Union supposedly rained down onto the Confederates to drive each wave back would have proven largely ineffective in reality - the Confederate line was apparently along the crest of a nearby hill, which would have absorbed most of the Union canister fire. In fact, archaeological evidence suggests that the Northern soldiers probably received more artillery fire than they shot out.
Ethnohistory (in this case, archaeology) thus helped historians create a more accurate depiction of the Battle of Shiloh. The episode of 'Battlefield Detectives' drew two conclusions from this evidence. First, that the popular conception of the Hornet's Nest probably arose from the anniversary celebrations held by Union veterans of the battle, where they would increasingly exaggerate their roles in the engagement. This seems a plausible explanation, considering others have pointed out that General Prentiss, one of the division commanders at the Hornet's Nest, initially gave a humble report of his unit's actions during the battle that he seemed to embellish slightly as time went on.
The second conclusion, however, struck me as a step in the wrong direction. The researchers seemed to feel that the Hornet's Nest simply was not really that important of an event during the battle. This argument is something of an overstatement. Regardless of whether or not the Union soldiers mowed down Confederate waves with musket volleys and canister fire, the approximately 3,000 men in the center of the Confederate attack remained an issue that the rebels had to deal with, slowing down their advance and buying Grant some time (some argue that the South should have simply bypassed the area, a strategy that tends to ignore the problem of now having a sizable force behind Confederate lines). And even if it was not the hurricane of a fight it has been made out to be, clashes and skirmishes still took place at the location; the Confederates were not able to simply skirt by the location to advance on the main body of Union infantry. Even the act of surrendering must have helped the North - the Confederates now had 2,200+ prisoners that had to be brought to the rear and put under at least minimal guard, costing time and manpower. In this case, casualties on the field do not necessarily correlate to strategic importance.
Ethnohistory can contribute greatly to our understanding of an event, as the work done recently on the Battle of Shiloh shows. However, I think it is important not to get too carried away and make radical conclusions simply because new evidence arises. Ethnohistory should fill in the gaps and help correct mistakes, but it should not be an all-important piece of the puzzle that alone can change history. That can be as problematic as those who ignore enthohistory altogether.
(Anyone else find it fitting that the history buff seems to write the more long-winded posts here? Trunkely, let's hear an in depth, step-by-step description of how one discovers, charts, and draws conclusions from stratification in rock layers.)
The Battle of Shiloh took place in Tennessee on April 6th and 7th, 1862 during the American Civil War, and at that point represented the bloodiest military engagement in United States history: altogether slightly less than 24,000 casualties, a figure that would be outdone in later battles and even dwarfed at Gettysburg and Chickamauga. Arguably the most famous aspect of this battle was the Hornet's Nest, where scattered regiments from two Union divisions somehow organized a defense that held off waves of Confederate attacks for approximately seven hours until, after becoming completely surrounded, finally surrendered late in the day on the 6th. This delay bought the Union army enough time to regroup and counterattack the next day, turning a retreat into a vitally important victory for the North.
My first encounter with a very different version of this story came from catching an episode of 'Battlefield Detectives' which discussed this very event (see, we can learn something from tv), and others have additionally argued against this conception of the battle (for instance, this individual from HistoryNet.com) - offhand, I do not know any specific historians who have argued against the traditional account of the Hornets Nest, although some undoubtedly have. Using archaeology around both the Union and Confederate lines at the Hornet's Nest, researchers have found some startling evidence that contradicts descriptions from the soldiers.
For one, after methodically searching the Union line they found a lack of unfired ammunition, which is odd considering that in the heat of battle soldiers always dropped bullets when reloading. They did, however, find a decent number of fired ammunition along the Union line, indicating that the yanks were probably taking more fire from the rebs than they were dishing out.
Additionally, in the immediate aftermath of the battle gravediggers reported burying a comparatively small number of dead soldiers in the vicinity of the Hornet's Nest - strange, considering the custom was to use mass graves where the heaviest fighting had taken place in order to clean up the area as fast as possible. Even stranger is that years later when the government paid to have Union soldiers relocated to the national cemetery, they found that very few at all had been buried at the Hornet's Nest.
A final strike against the popular conception of the Hornet's Nest was that the canister fire (artillery shells that worked like a shotgun) that the Union supposedly rained down onto the Confederates to drive each wave back would have proven largely ineffective in reality - the Confederate line was apparently along the crest of a nearby hill, which would have absorbed most of the Union canister fire. In fact, archaeological evidence suggests that the Northern soldiers probably received more artillery fire than they shot out.
Ethnohistory (in this case, archaeology) thus helped historians create a more accurate depiction of the Battle of Shiloh. The episode of 'Battlefield Detectives' drew two conclusions from this evidence. First, that the popular conception of the Hornet's Nest probably arose from the anniversary celebrations held by Union veterans of the battle, where they would increasingly exaggerate their roles in the engagement. This seems a plausible explanation, considering others have pointed out that General Prentiss, one of the division commanders at the Hornet's Nest, initially gave a humble report of his unit's actions during the battle that he seemed to embellish slightly as time went on.
The second conclusion, however, struck me as a step in the wrong direction. The researchers seemed to feel that the Hornet's Nest simply was not really that important of an event during the battle. This argument is something of an overstatement. Regardless of whether or not the Union soldiers mowed down Confederate waves with musket volleys and canister fire, the approximately 3,000 men in the center of the Confederate attack remained an issue that the rebels had to deal with, slowing down their advance and buying Grant some time (some argue that the South should have simply bypassed the area, a strategy that tends to ignore the problem of now having a sizable force behind Confederate lines). And even if it was not the hurricane of a fight it has been made out to be, clashes and skirmishes still took place at the location; the Confederates were not able to simply skirt by the location to advance on the main body of Union infantry. Even the act of surrendering must have helped the North - the Confederates now had 2,200+ prisoners that had to be brought to the rear and put under at least minimal guard, costing time and manpower. In this case, casualties on the field do not necessarily correlate to strategic importance.
Ethnohistory can contribute greatly to our understanding of an event, as the work done recently on the Battle of Shiloh shows. However, I think it is important not to get too carried away and make radical conclusions simply because new evidence arises. Ethnohistory should fill in the gaps and help correct mistakes, but it should not be an all-important piece of the puzzle that alone can change history. That can be as problematic as those who ignore enthohistory altogether.
(Anyone else find it fitting that the history buff seems to write the more long-winded posts here? Trunkely, let's hear an in depth, step-by-step description of how one discovers, charts, and draws conclusions from stratification in rock layers.)
Sunday, January 3, 2010
invention of radio
The invention of the radio is somewhat hard to pinpoint to one single inventor or even one single year. From what Wikipedia tells us, the most important aspects of the history of the radio happened between ca. 1860 and 1910. This link gives an interesting table of the men involved and what they did.
The first transatlantic (and thus very useful) transmission occurred on 12 December, 1901 so let's use that year for all intents and purposes.
Modern man is thought to have appeared around 100,000 years ago (give or take 50,000 years) according to the "out of africa" theory. This essentially means that in a geological blink of an eye (100k years) we went from apes to apes with long distance communication. Within 100 years of the invention of the radio SETI started searching the skies and broadcasting into space. However, few know about what happened in 1924. On August 22, Mars was in closest opposition since 1804. The Army and the Navy were ordered to scan the skies and report any findings. Even though only static was found, it signals a pretty amazing feat of mankind and our grasp of science seeing that this was only about 25 years since we had invented functional radios.
The Drake equation has factors for the fraction of planets that can support life, develop intelligent life, develop civilizations with technology to broadcast into space, and the durations of those signals. What I want to know is this: did we develop outrageously quickly? Or are we slower than normal? Should these questions be factored into the Drake equation? It looks like Wikipedia beat me to it:
...this model has a large anthropic bias and there are still zero degrees of freedom. Note that the capacity and willingness to participate in extraterrestrial communication has come relatively "quickly", with the Earth having only an estimated 100,000 year history of intelligent human life, and less than a century of technological ability.Be that as it may, I still find it amazing how quick it all happened and hope that for all the other planets with life out there, that it happens even quicker.
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