Dialing, Dollars, and Doctors

June 10, 2009
Posted by Jay Livingston

The only health care costs I was thinking about when I started calling orthopedists today were my own. That’s why my first question was to make sure that the doctor participated in my insurance plan. I was calling only orthopedists listed listed on my plan’s website. But the woman who finally answered the phone of my first choice told me No.

The personal is the political, and I started thinking of all those warnings from conservatives that if the government gets into health care, we won’t be able to choose our own doctors, and we’ll be subject to incompetent government bureaucracy. It took only one phone call to discover that under what I have now, I can’t choose my own doctor, and that, at least when it comes to keeping their website information current, the insurance company bureaucracy isn’t exactly a paragon of competence.

A public option might be just as good. And who knows – with Obama in office, maybe the music you have to listen to while you’re waiting will be better.

I expected to be put on hold, and I expected the music. But I wasn’t prepared for the ads over the music – a woman’s reassuring voice telling me about all the wonderful kinds of surgery now available. It wasn’t as blatant as those ads on the subway decades ago for Dr. Tush* and his hemorrhoid surgery. The on-hold message didn’t exactly say, “What would it take for me to put you today into this quick and sporty little arthroscopic hand surgery?” There was also the difference that while the straphanger-friendly proctologist was going for volume, the orthopedists were aiming at a smaller customer base but pushing their more expensive products. Still, it was clear that all these practitioners were paying close attention to the bottom line.

Then I remembered that just this morning, Ezra Klein blogging at WaPo had said something along similar lines – less personal, more political and economic.
Reforms to . . . the way doctors are paid would actually do much to change the drivers of health-care spending. . . . Most doctors are paid on a fee-for-service model. Every time they do something to you, they get money for it. That's a subtle incentive toward expensive overtreatment. Conversely, if we paid doctors exactly the same amount overall, but made that money a yearly salary rather than a reward for volume of treatment, doctors would lose an important incentive to provide more health-care services than we actually need.
Ezra also recommends Atul Gawande’s recent New Yorker article, which ought to be required reading for anybody who has anything to do with healthcare.

* Amazingly, I could not find anything about Dr. Tush on the Internet. I’m pretty sure he wound up in prison, but I don’t know whether for medical or financial malfeasance

Well You Needn't

June 7, 2009
Posted by Jay Livingston

The primary school my son went to is moving, and there was a farewell tour of the old building. The walls were covered with the kids’ art and their class projects. I was looking at the classroom doors – guides to trends in names. Gone were Emily and Alexandra and of course Jason.
But this one stopped me in my tracks.


“There’s Only One Aretha,” I remembered. It was the title of a chapter in Beyond Jennifer and Jason: An Enlightened Guide to Naming Your Baby, by far the best of the books my wife and I consulted back in the late 80s. (The title has since been updated: Beyond Jennifer & Jason, Madison & Montana: What to Name Your Baby Now.)

Don’t name your kid Aretha – that was the gist of the chapter – unless you want to doom her to a lifetime of predictable comments. There are some names that are unique. There’s only one of them, and it’s been taken.

Surely Thelonius must be such a name – even his son goes by T.S. Monk, Jr. But at least on the West Side, maybe it has broken out.

The Dog Corrupted My Homework

June 5, 2009
Posted by Jay Livingston

Inside Higher Ed today reports on a company that sells corrupted files for students to submit in lieu of the paper they haven’t finished. “It will take your professor several hours if not days to notice your file is 'unfortunately' corrupted. Use the time this website just bought you wisely and finish that paper!!!”

A few readers at Ed (Inside Higher Ed and I are on a last name basis) offered ways to defeat such tactics.

I have several reactions..
  • Formal rationality and substantive rationality: If you set up a bureaucratized, McDonaldized version of “education,” where forms are more important than substance, you should expect this cat-and-mouse game of students trying not to learn, and teachers trying to catch them.

  • A day in the life. Corrupted-files.com promises students “several hours.” Maybe even a day or two. Will that time really make a difference in quality? Probably not. But students may have complicated lives, and my course is only one of its elements. And suppose that the extra day or two would make a difference in quality . . . .

  • Do you want it Wednesday or do you want it good? It’s a standard line among sitcom writers. TV has to run on schedule, so the answer is usually Wednesday. Which is why TV is so often not good. But my course is not a sitcom (or is it?), and I would much rather have the work be good.

  • WTF? RTF. I ask students to submit papers as Rich Text Format (.rtf) documents. I don’t know if this reduces the possibility for corruption. It does make the paper readable in other formats (like my beloved WordPerfect). And I once heard that a virus can be embedded in a Word document but not in a .rtf document.*

*And please no PowerPoint. As Lord Acton said of the effect of presentation software on thinking, “PowerPoint tends to corrupt. Absolute PowerPoint corrupts absolutely.”

Which Side (of the Newsstand) Are You On?

June 2, 2009
Posted by Jay Livingston

Inflation or deflation – which is the greater cause for concern? Maybe your answer depends on your relation to the means of producing the New York Times – are you a writer or a reader?

On Friday, Paul Krugman wrote:
Suddenly it seems as if everyone is talking about inflation. . . .But does the big inflation scare make any sense? Basically, no . . .. Deflation, not inflation, is the clear and present danger.
When I went to buy the paper Monday to see Krugman’s next column, the newsstand price had risen by 33% – from $1.50 to $2.00. (The increase, equal to the price of New York’s other two dailies, means that the Times price is 300% that of the Daily News or Post.)