One For the Books

January 15, 2018
Posted by Jay Livingston

The ending of the Vikings-Saints game was one for the books.

By “ending” I don’t mean the fluke 60-yard catch-and-run touchdown as the clock ran out.  I mean the actual ending – the final play, the extra point, which didn’t come until eight minutes (it seemed like 20) after the touchdown.

And by “books” I don’t mean the record books. I mean the bookmakers. That point, or non-point, made a big difference only to them and their customers.

It was also one for this blog. In the early days of this blog, I had several posts that considered the idea of “the wisdom of crowds.” James Surowiecki’s book with that title was much on my mind, mostly because I thought that it was wrong, at least when the topic was football gambling. (See this post, for example.) The basic idea is that for guessing what is now unknown (a lost ship, the outcome of next week’s game, the weight of an ox), don’t ask an expert. Ask a crowd of ordinary but interested people and take the average. Gamblers call that choice the “chalk” – the team (or horse) that’s getting most of the action.

But gamblers also talk about the “smart money.” In sports betting, bookmakers don’t care so much about the crowd. But there are a few people whose action the books do pay special attention to, and not just because the bets are usually large. Last Monday, most books opened the Vikings-Saints game with the Vikings as 3½-point favorites. The public liked the Saints. Two out of every three bets took New Orleans plus the points.

Since bookmakers have a guaranteed profit when the amount bet on each side is the same, bookmakers should then have tried to discourage more Saints money by reducing the points – say from 3½ to 3. Instead, they raised the line to 4 and then 4½, The public may have been backing the Saints, but the smart money, the “sharps,” were taking the Vikings. By the weekend, the line had gone to 5 and then 5½.

With the Saints leading 24-23 with ten seconds left and the Vikings 60 yards from the goal line, it looked like the crowd was right. Then came the touchdown pass to Stefon Diggs. The score was now Vikings 29, Saints 24; the clock showed all zeros. The smart money, the bettors who had gone with the Vikings early in the week, looked very smart indeed. Among Saints backers, those who had bet late and gotten the 5½ came out ahead.

Bookmakers still lost money since a lot of the Saints action had come in on Sunday at 5½. But the touchdown saved them from paying off all those early bets on the Saints.

Then came the bizarre extra point. After the touchdown, with no time left on the clock, everyone thought the game was over. TV crews and others went out onto the field. Players strode gleefully or walked dejectedly to the locker room. The refs had to call them back out for the extra point. NFL rules require it. But there was no way the outcome would be changed, so who cared? Bettors and bookies, that’s who. The score was 29-24. For anyone who had bet the game at 5½, the extra point was the difference between winning and losing.

The Saints weren’t too enthusiastic about things and took their time coming out of the locker room and back onto the field.


When both teams had finally shown up, the Vikings, rather than trying to score, politely took a knee. Game over, finally.
 
It would have been even better for the books –  and worse for the crowd –  if the teams had taken the extra-point seriously. Normally, even with only a few seconds left on the clock, the teams would have lined up for the extra point, the kick would have been good, and the Vikings would have won by 6 points rather than 5. Bookies would have kept all the money that had been bet on the Saints. Instead, they had to pay off the late bets that came in on the Saints plus 5½.

In the end, the smart money – the sharps who bet the Vikings giving 3½ or 4 points – won. As for the crowd, some won, some lost, some got a push.


Punishing the Poor, Again

January 14, 2018
Posted by Jay Livingston

The Republican approach to Medicaid seems designed not to improve the health and lives of the poor but to bolster other people’s feelings of righteousness. That’s why these policies focus on punishment for the “undeserving poor.” (See the previous post.)

The same preference for punishing sinners rather than solving problems pervades the anti-abortion movement. If the goal is to reduce the number of abortions, it would seem logical to reduce unwanted pregnancies. But most anti-abortion groups and politicians also want to restrict birth control.

Abortion opponents should also, logically, promote policies that make motherhood easier, but they don’t. Instead, as Michelle Oberman in today’s New York Times (here) points out, abortion opponents typically focus on making abortion more and more difficult or even punishing abortion-seeking women. These policies fall hardest, of course, on women with little money.

The price of motherhood is set by our government’s policies. It will, at some level, always be cheaper for a woman to have an abortion than to have a baby. But if anti-abortion campaigners truly want to decrease the numbers of abortions, rather than passing laws designed to drive up the costs of abortion, they would do far better to invest in the kinds of economic supports that make becoming a parent a realistic possibility for struggling women.

Consider the medical needs of the women living at Rose Home: access to health care, substance-abuse and mental-health treatment, food and housing. Each has a price tag. Yet rather than offsetting the high price of motherhood, recent anti-abortion laws drive up the cost of abortion by closing clinics, forcing women to travel farther, and to wait longer before ending their pregnancies.

The abortion war, with its singular focus on law, distracts us from the economic factors entwined in a woman’s decision to terminate a pregnancy. In a world of true choice, whether a woman walked into a Planned Parenthood or a crisis pregnancy center, she would learn that society cared enough to provide her with the resources she needs, regardless of her decision.

Oberman refers to “focus on law” in that last paragraph, but the laws she’s talking about, much like the Medicaid work-requirement rules, are designed not to help pregnant women but to make life more difficult for the unrighteous. The message these laws send is not that we want you to become a mother but that we want to see you suffer for having an unwanted pregnancy. For abortion opponents, having their morality engraved into the law the allows for rejoicing in righteous victory, but as Oberman says, it doesn’t do much for poor women or for their babies.

Last week, a New York Times op-ed about Medicare had a title that characterized the Republican approach: “You’re Sick. Whose Fault Is That?” The same idea applied to abortion would give us “You’re Pregnant. Whose Fault Is That?” It’s a great question if you are interested in assessing blame. The payoff comes in the currency of feelings – guilt (for those with illness or unwanted pregnancy), pride or righteousness for the healthy and virtuous. But if you’re interested in effective policy to improve people’s health or reduce abortion, “whose fault?” is the wrong question.Why not ask, “How can we help?”

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* Policies like this play well in the US. Where other countries see problems and search for effective solutions, Americans tend to see moral wrongdoing that should be punished. This tendency is especially strong in the area of sexuality, especially female sexuality, and not just when the issue is abortion. 

Nine years ago I wrote (here) about a Pennsylvania district attorney who was threatening to prosecute 15-year old girls for “sexual abuse of a minor.” The minors? Themselves. Their crime? A year or two earlier, they had taken cell-phone photos of themselves that showed them from the waist-up wearing only a bra. If convicted, they could be sent to prison and forced to register as sex offenders.

GOP Medicaid – It’s About Righteousness, Not Health

January 11, 2018
Posted by Jay Livingston

In yesterday’s post, I concluded that the principle goal of the Republican approach to Medicaid was not to improve the health of poor people but to punish their unvirtuous behavior. Today, the Centers for Medicare & Medicaid Services pretty much confirmed that. They issued guidelines allowing states to force Medicaid recipients to get a job, or failing that, to volunteer or participate in job training.  Here is the tweet from Seema Verma, director of the Centers.


Verna assumes that forcing poor people to work or volunteer improves their health. It doesn’t. At the Upshot (the New York Times’s data-heavy sector, here) Margot Sanger-Katz reviews the evidence.

It is not at all clear how much work or income alone improve health. In fact, there’s quite a lot of evidence that causality can move in the opposite direction . . . .“Having the medical coverage helps people to get a job,” said LaDonna Pavetti, a vice president at the liberal Center on Budget and Policy Priorities, who has studied work requirements extensively. . . .

The earned-income tax credit, a program established specifically to raise the incomes of low-wage workers, wasn’t able to find any clear health benefit.


Sanger-Katz links to an article by Robert Rector of the Heritage Foundation, a right-wing think tank. Even he doesn’t think that the new rules will improve the health of the poor. And because people without Medicaid will wind up going to the emergency room (far more expensive that regular treatment), work requirements won’t save the government any money. Heritage published the article last March with the headline, “Work Requirements in Medicaid Won’t Work . . .”

A work requirement would just make it less likely for able-bodied adults without dependent children, known as ABAWDs, to register for the program. The work requirement would reduce Medicaid enrollments, but Medicaid costs might well go up because the eligible ABAWDs would go to the emergency room rather than receive routine care elsewhere. . . .

Suppose a Medicaid eligible ABAWD enrolls in Medicaid and then fails to do his work assignment (a very likely outcome based on experience with other work requirements). This individual then shows up sick in the emergency room or clinic. Is the government going to deny him medical care because he did not do his workfare assignment? Of course not. [Well, maybe and maybe not. A lot of Tea Party types would gleefully deny him medical care. At a debate during the 2012 GOP primaries, they cheered at the idea of allowing someone without insurance to die. See this post.]

As Sanger-Katz says, Rector’s rationale for work requirements is not medical, it’s moral. The goal is not to make people healthy but to make them virtuous, to make them “personally responsible.”  And the way to do that is to punish them for their lack of virtue even though that may bring sickness and death. After all, since health is a matter of personal responsibility, it’s what they deserve. 

The new rules may not be very good at improving the health of poor people, but they will be effective at making the rest of us feel morally righteous. And isn’t that more important?

Virtue and Public Policy

January 10, 2018
Posted by Jay Livingston

In the conservative view, poverty and its associated ills happen not because poor people lack money and living-wage jobs but because poor people lack virtue. Since the 19th century, conservatives have struggled with the question of how to instill virtue in the lower classes. Their answer is usually some scheme for punishing bad behavior. Those policies are consistent with the idea that behavior arises from individual morality.

The trouble is that public policies derived from truths about individuals often have little general impact, especially when those policies emphasize punishment as the path to virtue. At The Upshot section of the New York Times website today (here), Dr.  Dhruv Khullar looks at how virtue and its lack affect health. The headline says,
“You’re Sick. Whose Fault Is That?”
Not mine. People like me, we go to the gym, we spin, we do yoga, we try not to gain weight, we don’t smoke, we wear FitBits and eat kale for godssake – all in the belief that this will keep us healthy and extend our years. There’s some evidence that we’re correct. But does our virtue point the way to effective policies? The sub-head in Dr. Khullar’s article has the answer.
It seems sensible to encourage “personal responsibility,” and yet policies that invoke the phrase can make health problems worse. 
Dr. Khullar offers the example of Indiana. When Indiana expanded Medicaid under the ACA, it added some provisions to punish unvirtuous health practices among the poor.*

To get full benefits in Indiana, patients must contribute monthly to a “personal wellness and responsibility account.” If they fail to pay, they may have benefits cut or lose coverage entirely for six months. They must also make co-payments for certain services, and pay a fee if they use the emergency department  unnecessarily.

Dr. Khullar says that the program has had “mixed results.” It is certainly not as effective as the state government claims. (Jake Harper at  NPR  goes deep into the weeds to fact-check those claims.)

At the same time the Indiana government rejected a more obvious way to reduce bad health practices, namely smoking. Some legislators thought that Hoosiers would cut down on their smoking if the tax on cigarettes was increased by $1 a pack. Less smoking and its attendant ills, more money for the state to use for healthcare or highways. Sounds like a good deal. But Gov. Pence and the Republicans in the state senate opposed the bill, and it never passed.

These legislative choices seem consistent with two principles cherished among conservatives: first, conservatives really hate restricting individual behavior even if those restrictions promote the general welfare (this same principle justifies their aversion to taxes, even “sin” taxes); and second conservatives really like punishing unvirtuous behavior among the poor

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* The woman who ran this program for Indiana when Mike Pence was governer is now the Trump administration’s head of Centers for Medicare and Medicaid Services.