Canaries in the Coal Mine

Historically—or so we are told—miners tested the breathability of the air in mines by releasing a canary into the space. If the canary continued to fly and look healthy, the air was safe; if the bird died, it wasn’t.

Recently, Pew Research published findings about the millennials who are, for all intents and purposes, our American canaries. As we older citizens die out, the values, fears and ambitions of the millennial generation will determine the direction of the country.

Pew announced six “key takeaways” about this generation. Some were unsurprising: this is a financially burdened generation, largely as a result of student loan debt; as a result, fewer millennials are married than previous cohorts at the same age. They are also the most racially diverse generation thus far.

Two of the characteristics found by Pew deserve special “canary” status.

First,

Millennials have fewer attachments to traditional political and religious institutions, but they connect to personalized networks of friends, colleagues and affinity groups through social and digital media. Half of Millennials now describe themselves as political independents and 29% are not affiliated with any religion—numbers that are at or near the highest levels of political and religious disaffiliation recorded for any generation in the last quarter-century.

My discussions with students in this age cohort anecdotally support this conclusion—and suggest that the public behaviors and pronouncements of political and religious figures is one significant reason they reject those institutions. My students are repulsed by the use of religious or patriotic language in service of discrimination and generally hateful behaviors; rather than rejecting the specific individuals or organizations guilty of such behaviors, they tend to develop a “pox on all of you” attitude.

But a less obvious finding also casts considerable light on the institutionally detached status of this generation:

Millennials are less trusting of others than older Americans are. Asked a long-standing social science survey question, “Generally speaking, would you say that most people can be trusted or that you can’t be too careful in dealing with people,” just 19% of Millennials say most people can be trusted, compared with 31% of Gen Xers, 37% of Silents and 40% of Boomers.

This really troubling absence of trust manifests itself in a number of ways: millennials don’t expect Social Security to be there for them, for example (although, interestingly, they oppose proposals to cut benefits for current recipients). Their lack of trust in a wide variety of social institutions helps explain their rejection of political and religious identification, their pervasive skepticism about media information sources, and their increased reliance on friends and colleagues.

Assuming these findings continue to hold, what does this “canary” generation tell us about America’s future?

One the one hand, greater diversity and tolerance—together with rejection of dogma and partisanship—bodes well. This generation is likely to reject racism and address the glaring flaws in the criminal justice system, likely to welcome immigrants, likely to scorn anti-LGBT bias.

On the other hand, participation in a democratic polity requires at least a minimal level of trust—trust that the information one receives is credible, trust that the operations of government are mostly fair and ethical, trust that one’s fellow citizens are basically well-intentioned. Without that trust, without social capital, societies cannot function.

The canary isn’t dead. But it’s coughing a lot.

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Medicare for All

I’ve been interested to see how frequently the comments to this blog end up discussing (and debating) America’s health care system–even when the ostensible subject of that day’s post is something entirely different.

(As I was typing the phrase “healthcare system,” I was reminded of a graduate student—a hospital administrator—who corrected my use of that term. “America doesn’t have a healhcare system,” he said. “We have a healthcare industry” and it’s not the same thing.)

I often share insights from my cousin, a respected cardiologist who also spent many years teaching medicine. He recently sent me a thoughtful analysis of that healthcare industry, and the prospects for fixing what everyone realizes is unsustainable. I particularly like his introduction to the issue:

When considering the best way to solve our country’s medical care woes, I am reminded of Churchill’s famous statement about democracy as a form of government, in which he stated in effect: It’s a terrible system, but everything else is worse. This same statement might apply to a single payer system in medical care, for it probably beats everything else, as I explain below.

He noted that a truly effective system will require cost controls, including tort reform, the excessively high cost of drugs, inappropriate use of expensive tests and treatments, and several others. He is convinced that these issues can be resolved, and that a single-payer system (for example, “Medicare for All”) is both inevitable and the best solution:

In an article on why a single-payer system would be our best solution, Donald Berwick, MD, former administrator of the Centers for Medicare & Medicaid Services and an architect of the Affordable Care Act (ACA), contended that although the ACA has been “a step forward for the country,” it “does not deal with the problem of waste and complexity in the system,” as he feels a single-payer system would. I can personally attest to the complexity of the system with the many headaches provided by a dizzying array of differing insurance forms pertaining to treatments, hospital admissions and a multitude of other issues.

And James Burdick, MD, a transplant surgeon at Johns Hopkins University School of Medicine and author of the forthcoming book Talking About SINGLE PAYER!, argued that a single-payer system is “a more economical way to use healthcare resources. You could reduce expenses and still improve quality. That’s a tremendous opportunity that you don’t have in many other fields.” Of course, as he pointed out, this would virtually eliminate the entire commercial insurance industry—with $730 billion in revenues and a workforce of 470,000. (Maybe these same workers could be involved in more productive work such as restoring our nation’s wobbly infrastructure!) But Dr Burdick also maintains that a single payer system would likely restore doctors’ authority. And those who favor this system say that for all practices, administrative costs would plummet because there would be only one set of payment rules and forms, with the result that prior authorizations, narrow networks, and out-of-pocket payments would be eliminated.

He also reports that there is growing physician support for a single-payer system. For example, a 2014 survey of Maine physicians conducted found that nearly 65% of respondents preferred the single-payer option over trying to fix the current system—up from 52% in a 2008 survey.

Interestingly, a majority of the population (51%) now supports Medicare for all, according to a national poll released this past year.

In reality, a government-run single-payer system is the only way to provide effective basic medical health therapy and management, but for those who desire a higher level of care—and can afford it—there should be a private-pay system, contrast with the Canadian system. This would, de facto, constitute a two-tiered system. This might be objectionable to egalitarians that wish to have a “one size fits all” system, but would be the most pragmatic approach.

Usually those against single payer system trot out the usual vague objections that we are becoming “socialistic.” But what about our current Medicare system, is that not socialistic? I might add further that I personally have worked at a VA hospital, and, despite all the current noise, found that once patients were able to access the system, the care is quite good. Its main problem seems to be gaining initial entry into an overburdened system in a timely manner. By contrast, it is highly unlikely that a random assortment of for-profit HMOs would do a better job serving the high-utilization health needs of our veterans.

His conclusion–with which I concur:

Whether we like it or not, basic healthcare is like a utility—something everyone needs, and, in the best interest of our society, everyone should receive. Although there are many variations of the general theme as I have enumerated above, we are moving inevitably toward a single payer system. When it finally arrives, I believe everyone will be relieved, if not pleased, even including the Republicans!

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What is with the Fixation on Potties?

Oh, Indiana! You have so many virtues….and so many legislators with questionable reasoning abilities. The legislative session that just began promises to be a bonanza for those who enjoy black comedy and unintentional irony.

For those of us who want adult government, not so much.

A major focus of the upcoming session will be the effort to add four words and a comma to Indiana’s existing civil rights law.  In the aftermath of last year’s RFRA debacle, business and civic organizations have partnered with LGBT organizations and faith communities to lobby for the addition of “sexual orientation” and “gender identity” to the existing list of things (race, religion, gender, etc.)that Hoosiers can’t use as reasons to discriminate against other people.

All of these characteristics should be totally irrelevant to an individual’s right to rent an apartment, enroll in an educational institution or buy goods and services in the marketplace.

Four words and a comma. It’s not rocket science.

Lawmakers who really do want to discriminate but want to pretend otherwise have come up with all manner of convoluted bills to allow disparate treatment to continue. Others have simply abandoned the pretense, offering proposals that, if passed, would tell the world that Hoosier Hospitality is a highly selective concept.

And the world has noticed. This is from Talking Points Memo:

An Indiana rep recently proposed a bill that would hit transgender individuals with a Class A misdemeanor if they used a public restroom that doesn’t conform to their gender at birth.

I can see the signs now: Before using this potty, please deposit your DNA sample with the attendant…..

The whole potty fixation is a mystery to me. I was just in New York—I know, a den of iniquity—and most of the public restrooms I used were “one at a time” facilities available to either gender. (If you’re really worried about who uses which toilet, I have a suggestion: Get a life!)

This bill should die a quick death. Last year, similar bills failed to pass in Kentucky, Florida, Nevada and Texas (hardly liberal bastions), and the Department of Justice has declared that restricting transgender students’ access to public restrooms amounts to sex discrimination under Title IX, but hey–this is Indiana.

Even Georgia doesn’t want to be “the next Indiana.” 

For a legislature dominated by self-described proponents of “limited government,” the bills submitted thus far certainly are a mixed bag. On the one hand, our “small government” Christian conservatives are proposing a bill that would effectively  outlaw abortions (no terminations after a heartbeat is detectable–about the same time most women find out they’re pregnant). On the other hand, it’s hard to square that “pro life” position with the bill allowing habitual drunks to buy guns, the bill removing the need to license guns, the bill to allow guns on college campuses…

Maybe they want to be able to shoot people they think are using the wrong potty?

In any case, if the “wrong toilet” and gun bills pass, I’m moving to a saner state….Evidently, there are a lot of them.

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Yeats Was So Right….

One of my favorite quotes is from a poem by William Butler Yeats, who wrote that “The best lack all conviction, while the worst are full of passionate intensity.”

Science has confirmed the observation, at least with respect to the “worst,” and to the extent that “best” and “worst” refer to intellectual acuity.

In 1999, David Dunning and Justin Kruger of the department of psychology at Cornell University conducted a fascinating study after reading about a man named McArthur Wheeler. Wheeler  robbed two banks after covering his face with lemon juice in the mistaken belief that, because lemon juice is usable as invisible ink, it would prevent his face from being recorded on surveillance cameras.

Earlier studies had suggested that what might delicately be termed “ignorance of performance standards” accounts for a substantial amount of incorrect self-assessment of competence. In other words–as the Facebook meme has it–stupid people are too stupid to recognize their stupidity.

Dunning and Kruger found that, for a given skill, incompetent people will:

  • fail to recognize their own lack of skill
  • fail to recognize the extent of their inadequacy
  • fail to recognize genuine skill in others
  • will only recognize and acknowledge their own lack of skill after they are exposed to training for that skill

According to Dunning, “If you’re incompetent, you can’t know you’re incompetent.… [T]he skills you need to produce a right answer are exactly the skills you need to recognize what a right answer is.”

According to Wikipedia (yes, I know–I don’t let my students cite to Wikipedia, but it’s convenient and generally, albeit not always, accurate):

Dunning and Kruger set out to test these hypotheses on Cornell undergraduates in psychology courses. In a series of studies, they examined subject self-assessment of logical reasoning skills, grammatical skills, and humor. After being shown their test scores, the subjects were asked to estimate their own rank. The competent group estimated their rank accurately, while the incompetent group overestimated theirs.

Across four studies, the authors found that participants scoring in the bottom quartile on tests of humor, grammar, and logic grossly overestimated their test performance and ability. Although test scores put them in the 12th percentile, they estimated themselves to be in the 62nd.

(This definitely explains most of  the students who come in to complain about their grades….but I digress.)

How did Yeats put it? Those who know the least are those with the most “passionate intensity.”

The evidence is everywhere. Just look at Congress, or the Indiana General Assembly.

Or the “Y’all Qaeda” standoff in Oregon…

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Speaking of Infectious Diseases…

It would do us well to remember that chosen ignorance isn’t confined to the uneducated, Fox-“news”-watching, fearful folks who tend to be the butt of liberal disdain.

 A new study confirms its presence in tonier liberal precincts as well.

When it comes to science illiteracy in the form of Creationism, we know what kind of people are more likely to believe it: Those who attend church frequently, the elderly, and people without much formal education.

But when it comes to parents who refuse to vaccinate their children, the demographics are very different, according to a new study in the American Journal of Public Health.

The people most likely to refuse to have their children vaccinated tend to be white, well-educated and affluent.

Although this particular data point was not in the study, I’d be very surprised if the same people who are rejecting the overwhelming scientific consensus about the value of vaccination aren’t also sneering at the “anti-science” folks denying the reality of climate change.

At both ends of the political spectrum, we have people picking and choosing the scientists and scientific conclusions they are prepared to accept. I’m neither a sociologist nor a political psychologist, so I’m unprepared to offer a theory about why liberals choose to reject one set of conclusions and conservatives another, although I have a sneaking suspicion that in each case, tribal identity plays a large part.

And independent–let alone critical– thinking plays very little…..

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