“Adopted,” A poem for a cold Saturday afternoon

My step-mother Arlene Pollack published her second poetry collection, Persons, Places, and Things. Here is the first poem in the collection.

 

Adoptedarlene_book

Knowing full well my search would lead nowhere,

With eyes veiled to conceal my interest,

I have looked for Mother in places known and rare.

 

At first I sought her in those places where

My heart felt most at home, yet, all the while,

Knowing full well my search would lead nowhere.

 

One summer in Rome, I thought I’d seen her there,

Retraced my steps to find her shop; could not.

I have looked for Mother in places known and rare.

 

I have looked for Mother deep within my heart,

Studying myself, the children I have borne,

Knowing full well my search would lead nowhere.

 

In my travels, making time to spare,

I have searched through records, for what I do not know.

I have looked for Mother in places known and rare.

 

I have not found my mother anywhere;

Yet she has never once been lost to me;

Knowing full well my search would lead nowhere,

I have looked for Mother in places known and rare.

If you like your reduced ER use, you can keep it

IMG_1553The latest results are in from the great Oregon Health Insurance Experiment (OHIE).

In a randomized experiment, individuals offered Medicaid coverage showed higher rates of emergency department (ED) use than did their otherwise comparable peers not given the same opportunity.

The effect size was pretty small—about one extra ED visit per recipient, every 3.5 years or so. In dollar terms, this amounts to an estimated annual expenditure increase of something like $120 per recipient. We can’t say from this paper whether the extra ED visits were valuable or cost-effective. We can say that these results will embarrass some liberal advocates who argued that expanded coverage would reduce overall rates of ED use.

They should. This talking point was never properly evidence-based or even particularly plausible given prior research. It’s not obvious that reducing the rate of ED use is even a sensible policy goal. Advocates across the political spectrum should stop using the ED for cheap talking points about the mythical savings associated with universal coverage or about the misbehavior of Medicaid recipients who supposedly waste huge amounts of money through overuse.

We might, instead, take some satisfaction that we have created a system, open 24 hours per day, 365 days per year, which people turn to when they need help. Our challenge is to make this system work.

More here.

“Targeted demobilization of minority voters”—the most disgraceful practice in American politics today

Perspectives on Politics is a leading journal published by the American Political Science Association. December’s issue includes a sobering article by Keith G. Bentele and Erin E. O’Brien titled, “Jim Crow 2.0? Why States Consider and Adopt Restrictive Voter Access Policies.” The abstract tells the basic story:

Recent years have seen a dramatic increase in state legislation likely to reduce access for some voters, including photo identification and proof of citizenship requirements, registration restrictions, absentee ballot voting restrictions, and reductions in early voting. Political operatives often ascribe malicious motives when their opponents either endorse or oppose such legislation. In an effort to bring empirical clarity and epistemological standards to what has been a deeply-charged, partisan, and frequently anecdotal debate, we use multiple specialized regression approaches to examine factors associated with both the proposal and adoption of restrictive voter access legislation from 2006–2011. Our results indicate that proposal and passage are highly partisan, strategic, and racialized affairs. These findings are consistent with a scenario in which the targeted demobilization of minority voters and African Americans is a central driver of recent legislative developments…. [emphasis added]

Bentele and O’Brien’s statistical analysis of 2006-2011 data makes plain what was already pretty obvious. Republican governors and legislatures have sought to hinder minority turnout for partisan purposes. States were especially likely to pass restrictive voting laws if Republicans were politically dominant, but where the state observed rising minority turnout or where the state was becoming more competitive in the national presidential race. Variables that capture the strategic value to Republicans of minority voter suppression are more powerful predictors of restrictive voting legislation than is actual incidence of voter fraud.

This is the most disgraceful and toxic practice in American political life. It’s out there. It’s blatant. I keep waiting for decent conservatives to speak out against this stuff. Now that would be a Sister Souldjah moment worth watching. So far, no takers.

Memories of these efforts will darken the Republican Party’s reputation for many years. It certainly should.

Rick Altice on the challenges of correctional care (and related matters)

When I was a doctoral student, I wrote a desk-jockey dissertation. I analyzed a gigantic dataset to examine informal economic transfers within low-income families. Then I took a Yale postdoc. One of the first people I met there was Dr. Frederick Altice, who was a key investigator and clinician providing care to HIV-infected prisoners and drug users at the community health care van, a needle-exchange-based health services targeting street drug users. This was the mid-1990s and New Haven was an epicenter for HIV among drug users. It was a pretty awful time for the city. At least New Haven had intrepid people like Rick who worked to limit the public health harms and the human suffering.

One of my first times out, a woman stepped on the van to get some care. She was a sex worker and a person who injected drugs. Within the close quarters of that van, many of the other people waiting gave her a little extra room. She was very grimy, probably homeless.  Rick called her over. He pulled out an apple, and split it with his penknife. He handed her one piece, and said, “Why don’t you share this with me?”  As they ate together, he conducted a beautiful clinical interview that explored her incredible range of serious health problems.

I interviewed Rick today at Wonkblog. We talked about a range of pertinent issues in correctional care. If anything, Rick understates the challenge. Connecticut is quite unusual in providing generous Medicaid to many low-income adults who would be uninsured in other states. 

More here.

The late, not-so-great era of WASP ascendency

At the Wall Street Journal, Joseph Epstein has penned a paean to the era of WASP ascendency in American life, whose spirit is captured by quotes such as the following:

Much can be—and has been—written about the shortcomings of the WASPocracy. As a class, it was exclusionary and hence tolerant of social prejudice, if not often downright snobbish. Tradition-minded, it tended to be dead to innovation and social change. Imagination wasn’t high on its list of admired qualities. [....]

Under WASP hegemony, corruption, scandal and incompetence in high places weren’t, as now, regular features of public life. Under WASP rule, stability, solidity, gravity and a certain weight and aura of seriousness suffused public life. As a ruling class, today’s new meritocracy has failed to provide the positive qualities that older generations of WASPs provided. [....]

Trust, honor, character: The elements that have departed U.S. public life with the departure from prominence of WASP culture have not been taken up by the meritocrats. Many meritocrats who enter politics, when retired by the electorate from public life, proceed to careers in lobbying or other special-interest advocacy. University presidents no longer speak to the great issues in education but instead devote themselves to fundraising and public relations, and look to move on to the next, more prestigious university presidency.

The modern American meritocracy certainly has its serious hypocrisies and defects. One could write an entire book about the failures of the American elite in Iraq, the subprime crisis, and more. Perhaps someone named Christopher Hayes* might write such a book. He might call it Twilight of the Elites: America after Meritocracy.

Yet there is something crazy and a little sad about Epstein’s essay. Sure the old WASP elite was a tad snobbish and stodgy. These were hardly their worst problems. Under WASP hegemony, corruption and incompetence were actually quite common in high places, more common than today, in fact. Perhaps the misconduct and stupidity produced fewer scandals. if so, that was only because these behaviors were better-concealed from public view.Where is the honor or the character in maintaining a system of exclusion to protect one group’s social and economic privileges at the expense of others?

The unapologetic exclusion of Jews, African-Americans, Latinos, Asian-Americans, gays, Catholics. and women did not enhance the integrity or the technical competence of American government. Nor did it noticeably improve elite professions such as scientific research or clinical medicine to exclude these same groups. When I was a Princeton undergraduate, a disgruntled alumnus wrote into the student newspaper to lament the rising presence of “big-city, high-SAT intellectuals,” who were apparently ruining the once-gentlemanly environment. Thirty years before, people like this man successfully maintained quotas that cruelly excluded many among my parents’ generation from attending elite schools. Not coincidentally, the Princeton of (say) 1950 or 1960 was a decidedly mediocre place. We who came later owe a great debt to the pioneering generation who smashed down these barriers and opened the road for others, as well. Our current elites should do some serious housecleaning, but not out of any misguided nostalgia for the unfair and mediocre non-meritocratic era we’ve left behind.

Perhaps I betray my own biases, but I think there is something undignified to celebrate an era and to celebrate the people who so mistreated our own parents, and many others besides. I do have one consolation. Epstein’s misguided essay beats this somewhat similar Walter Lippmann gem, which defines the genre.

*Yeah, I initially misspelled Chris Hayes’ name, which is ironic, given this clip from the University of Chicago’s 67th annual Latke-Hamantasch comic debate.

One homeless girl

My latest wonkblog column explores homelessness issues:

My first foray into social services was as a night volunteer in a homeless shelter. I particularly remember one bright and vivacious 12-year-old girl. The two of us sometimes talked during dinner. As we talked, her little brother would buzz around us, using language and gestures more suited to the Navy than to his preschool. Her parents were puzzlingly limited. I would sometimes help them with simple tasks such as assembling their children’s Christmas toys. They angered easily, with predictable results. In the middle of all this family chaos was this calm and resilient young girl. She made me a fantastic playful picture depicting a punked-out teenager with multiple piercings. I had no idea how to help her.

I thought about her as I read the initial installments of Andrea Elliott’s amazing, heartbreaking New York Times profile of another middle-schooler named Dasani, who lives in a homeless shelter called Auburn Family Residence, in Brooklyn’s Fort Greene section. Dasani shares a 520-square-foot room with her parents and her seven siblings. She’s one of 280 children in this huge and forbidding structure. I don’t know that we’re sure how to help her, either… (more here).

Space prevented me from exploring one other issue: the simple role of bad luck. Dasani’s story includes savage turns of fate that so easily might have turned out differently. I’m tempted to dismiss the importance of bad luck. Families living near the water line have a way of conspiring in their own misfortune. If Chanel wasn’t arrested on one day, she might easily have been arrested on another occasion—for example the day she shoplifted Dasani’s birthday cake.

But bad luck does actually matter. The worst twist of fate concerned Chanel’s mother, Dasani’s grandmother, Joanie. Stably employed as a municipal worker after her own struggles with addiction. Joanie provided one of the very few sources of personal and financial stability in Dasani’s life. When this indispensable woman died of leukemia at age 55, her family never really recovered. “Why did she have to go away so quickly?” Dasani asked. I found myself asking the same question.

If you happen to be around Stanford tomorrow….

Please join me at their health policy forum to talk serious mental illness and crime. I’ll be on a panel with the LA County Sheriff Lee Baca and the chair of psychiatry at Stanford, Dr. Laura Roberts. The policy forum is open to the public and will be held this Thursday from 11:30 A.M. to 1:00 P.M, at the Li Ka Shing Center.

Below is Keith’s blurb for the event.

The horrifying mass murders at the Washington Navy Yard and Sandy Hook Elementary School were both committed by individuals with long-standing mental-health problems. The events galvanized a national discussion about how to improve the accessibility and quality of our mental-health system.

At the same time, these tragedies can paint in the mind of the public a false image of the mentally ill as universally violent and dangerous rather than human beings in need of assistance and compassionate care. That may account for why a shamefully large number of mentally ill people are behind bars. L.A. County Sheriff Lee Baca has found himself heading what he calls “the nation’s largest mental hospital:” The L.A. County Jail.

While protecting public safety is a critical concern, it’s important to maintain perspective when analyzing the role of mental illness in violent crime. Harold Pollack, PhD, of the University of Chicago puts it this way:

Millions of Americans suffer from some form of severe mental illness, or SMI. It’s important to remember that the vast majority of these men and women have never committed a violent crime and never will commit one. Indeed, the mentally ill are often victims of violent crime, a social problem that has not received sufficient attention.

To dig into these important issues in a productive way, the medical school’s next Health Policy Forum will be devoted to the topic “Serious Mental Illness: How can we balance public health and public safety?” Harold Pollack and Lee Baca will come to Stanford for the forum and will be joined by Laura Roberts, MD, chair of the Department of Psychiatry and Behavioral Sciences. The policy forum is open to the public and will be held this Thursday from 11:30 A.M. to 1:00 P.M, at the Li Ka Shing Center. If you’re a local reader, we hope you can attend and join in the conversation.