Bureaucrats and Health Care

April 26, 2009
Posted by Jay Livingston

My health care plan will make it easier for more Americans to find and keep good health care insurance. His plan will . . . force families into a government-run health care system where a bureaucrat...(AUDIENCE BOOS)... where a bureaucrat stands between you and your doctor.(AUDIENCE BOOS)

That was John McCain addressing the Republican convention last September. It’s the official party line on health care. Bobby Jindal said the same thing in the Republican response to the State of the Union speech.

Health care decisions should be made by doctors and patients, not by government bureaucrats.

Maybe these guys never have to deal with insurance companies – like George Bush Sr. not knowing about checkout-line scanners – or maybe their non-Weberian definition of bureaucrat includes only those who work for the government.

I’ve got news for them. Insurance companies are bureaucracies. And unlike the government, they are in business to make a profit. They make a profit by taking in as much as possible in premiums and paying out as little as possible in claims.

Does this goal affect the decisions of their employees (i.e., bureaucrats)? Here’s a chart from a NPR/Kaiser Family Foundation/Harvard School of Public Health survey.*

(Click on the chart for a larger view.)

One-fourth of the people had, within the last year, experienced exactly what the Republicans are talking about: a doctor’s decision was overridden by a bureaucrat. (The 46 million Americans who have no health insurance don’t have to worry about this.)

The survey also found that the cost of medical treatment mattered.


Even among those with high incomes ($80,000 a year or more), one in eight had postponed needed care or gone without a prescribed medication.

*A copy of the report is here.

Good Cheer

April 25, 2009 Posted by Jay Livingston< On Thursday, lisa posted this ad at Sociological Images, and I’ve watched it at least a dozen times since then.

Despite Lisa’s perfectly valid critique about men and family-work, I still love this ad, and I’m not sure why. Probably because the guy’s performance has absolutely no trace of irony or role-distance. Norms of age and gender be damned, he’s just into it, whole-heartedly and unself-consciously.
We’re a bit late on this one, we sociologists. If we watched The View, we’d have picked up on it when Whoopi aired it last September. (HT Megan, who was also touched by it, probably more deeply than I was).

Have You Stopped Killing Your Spouse?

April 24, 2009
Posted by Jay Livingston

Something I read in another blog sent me digging into the statistics on homicide between husbands and wives or other “intimates.” I remembered from my days in the crim biz that the US was unique in that wives here killed their husbands almost as frequently as husbands killed wives. This statistic, the “spousal rate of killing” (SROK), was introduced in a now-classic1992 article by Margo Wilson and Martin Daly. In most countries, that rate is 25-30%. In the US, Wilson and Daly pointed out, it was about 75%.

But something has happened, over the last thirty years or so (data here). And as far as I can tell from a quick search on the Internet, nobody seems to have noticed.

(Click on the graph for a larger view.)

Between 1976 and 2005, the number of women killed by their male partners decreased by about 25%, less than the decrease in all homicides nationwide. But the number of men killed by women dropped dramatically, from 1300 to 330, a 75% decrease (since the population increased in those three decades, the change in rates is probably even greater. The SROK fell from 82% to 28%.

My Internet search for explanations was cursory at best, but it turned up nothing. I have only two ideas:

1. Men Behaving Better. Men have stopped doing those things that made women want to kill them.

I offered this explanation to two women in the Justice Studies department here. They rejected it out of hand and without comment. (Maybe they didn’t like the blaming-the-victim assumption: if women kill men, it’s because of what men do. Or maybe they were using a convenience sample of anecdotal data on men’s behavior.) One of these women, Lisa Anne Zilney, offered a counter-explanation . . .

2. Women Having Options. Women’s shelters and other facilities have given women an alternative. Without these, the only way to escape an intolerable situation at home was to get rid of the cause. Providing abused and desperate women a safe place to go saves lives – and apparently not just the lives of women.

I’m not wild about either of these explanations for the steep decline in the SROK (and as I recall, Wilson and Daly weren’t wild about any of their explanations of why it was so high).

Any ideas?

Neutralization and Torture

April 22, 2009
Posted by Jay Livingston

“Techniques of Neutralization” (Sykes and Matza, 1957) is a classic article in the sociology of deviance. Neutralizations, according to Sykes and Matza, are ideas that delinquents use to neutralize the rules against some deviant act. Sykes and Matza argue that neutralizations enable the delinquency and come prior to the delinquent act.

I’m not so sure – a kid might well commit crimes even without these rationalizations – but these neutralizations certainly work as after-the-fact justifications. At the very least, the list of neutralizations gives students something to think about and memorize (and it gives teachers something to use in multiple-choice exam questions). In case you’ve forgotten them (or never heard of them), here they are:

• denial of responsibility (I didn’t mean it; it wasn’t my fault)
• denial of injury (no harm, no foul)
• denial of victim (they deserved it; who cares about them)
• condemnation of the condemners (cops are corrupt)
• appeal to higher loyalties (I had to help my buddies)

I hadn’t thought about this article in a long time, but torture is in the news, and the rationales put forward by highly educated and sophisticated people defending the torture sound exactly like the ideas Sykes and Matza heard from criminal kids over 50 years ago. Today’s editorial in today’s Wall Street Journal hit four out of five.

Denial of Injury

Contrary to the claim that the memos detail “brutal” techniques . . .what they mainly show is the lengths to which the Justice Department went not to cross the line into torture. . . .

Denial of Victim

“Zubaydeh has become accustomed to a certain level of treatment and displays no signs of willingness to disclose further information” (quoting a memo from legal counsel Bybee).

Condemnation of the Condemners

the ICRC [Red Cross] has become as much a political, as humanitarian, operation. . .
the liberal mob . . .Mr. Obama . . . may try to sate the mob by going after Bush officials who wrote the memos. . . . Mr. Obama seems more than willing to indulge the revenge fantasies of the left, as long as its potential victims served a different President.

Appeal to Higher Loyalties

to break a terrorist they believed had information that could potentially save American lives.

The fifth neutralization comes from former CIA director Michael Hayden, quoted in today’s New York Times)

Denial of Responsibility

I have said to all who will listen that the agency did none of this out of enthusiasm. It did it out of duty.

That’s just from two major newspapers in one day. I’m sure that if I’d reviewed O’Reilly, Hannity, Coulter, et al., I would have found many other examples that seem to come straight out of the delinquents’ script. However, delinquents seem reluctant to use the one justification for crime most favored by the supporters of torture: It works; it’s a great way to get what you want.*

As I said, I’m somewhat skeptical that these neutralizations always precede the juvenile delinquency and make it possible. The torture gang, however, provides a much better illustration of Sykes and Matza’s theory. For the most part, those involved in any way made sure that the neutralizations were in place (and in writing) before they started the “enhanced interrogations” (they also made sure the euphemisms were in place). That’s the difference between criminal gangs on the street and those in government and other formal organizations.

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*The justification that torture works is, like the denial of injury, simply not factual. (See here, for example.) But as with all these neutralizations, what is important is not accuracy but rather plausibility, however slim. A plausible justification allows the neutralizers to fool themselves, at least partially, and perhaps to fool others, so that they can repeat their act again. And again. And again. (One victim was warterboarded 183 times. That's takes a lot of neutralizing, though presumably these neutralizing ideas become part of a taken-for-granted background reality.)