Month: March 2014

Nathan McDermott debunks it:

In reality, gay Americans face disproportionately greater economic challenges than their straight counterparts. A new report released by UCLA’s Williams Institute [pdf] found that 29 percent of LGBT adults, approximately 2.4 million people, experienced food insecurity – a time when they did not have enough money to feed themselves or their family – in the past year. In contrast, 16 percent of Americans nationwide reported being food insecure in 2012. One in five gays and lesbians aged 18-44 received food stamps in the last year, compared with just over 1 in 4 same-sex couples raising children. The LGBT community has made huge political strides over the past decade, but in economic matters they still lag far behind the rest of the country.

Yes, that seems counter-intuitive to me. But that’s a function of my confirmation bias. And it’s one more reason why marriage matters. It consolidates wealth, and protects it. Interestingly, the data from UCLA show that bisexuals are worse off financially than gays and lesbians. Not sure what that means.

David Blumenthal argued that electronic medical records haven’t been widely adopted because they mostly benefit patients, not doctors. Fallows passes along some pointed criticism of that view. Here’s Creed Wait, “a family-practice doctor in Nebraska”:

The saying is, “Build a better mousetrap and the world will beat a path to your door.” The saying is not, “Build a different mousetrap, pay out nineteen billion dollars in incentives to use the mousetrap, mandate its use by law and punish those who fail to adopt it.  Then shove the world kicking and screaming against their will through your door.”

So far, doctors have been paid $19B in incentives to buy [Electronic Medical Record systems].  No one had to incentivize the cotton gin.  It was simply a better product. The current EMR system is a mess because the current EMR systems in use by the majority of physicians were written in the Rube Goldberg School of Software Design and work poorly.  There is no ‘asymmetry of benefits’ as proposed by Dr. Blumenthal.  Unless, of course, what he means by this is that only the software companies are benefitting from these federal mandates.

Wait offers a personal example:

One year ago in private practice I could see eighteen patients per day.  A transcriptionist typewrote my notes. These were typically three pages long, concise, complete and extremely useful.  Then our group bought an EMR.

After one year I was seeing fourteen patients a day, my notes were twelve pages long, the vital signs alone required a half page and the notes bordered on being useless.

My reimbursement per visit had increased, my face-to-face time with the patient was shorter, I was doing a poorer job, patients were less satisfied, and I was completely frustrated by trying to build each note out of dozens of pages of drop down menus.

Before implementing an EMR I had approached each patient encounter with an attitude of, “What can we do today to improve your health, happiness and overall satisfaction with life?”  The patient and I would have a meaningful conversation about the pertinent issues.  Once an EMR was implemented, a subtle change began.  It was so gradual that at first I did not even recognize the poison.  But after a few months I realized that the visit had slowly evolved into, “Just a minute, we need to be sure that we have checked off every box on every screen and we need to be sure that a narrative of some sort has been entered into every required field.”  Then there were realizations like, “Oh, look.  If we add one more point to the Review of Systems then we can raise the billing code one notch.  Hold that thought while I click, ‘wears glasses’ under the ROS field!”

Well, time’s up!  The fields are all now completed and all goals have been met!  Next!

The EMR had become the primary influence in the interview.  The dynamic had changed.  The patient and I were now both in the room to feed the hunger of the software.

Several readers are skeptical over the conclusions drawn here:

We know that by preschool differences in math and reading skills emerge between white and African-American students, so why shouldn’t we expect the same for behavioral issues? How does this research address the possibility that differences in home experience may create authentic differences in school behavior? Does this research tell us that two kids who commit the same offense will receive different punishments based on race? By immediately labeling this as “prejudice” we are imposing a set of assumptions. Don’t we owe these students a more rigorous approach to the problem?

Another is more direct:

I can’t be the only one who realizes that the widely-reported statistics from the DOE’s Civil Rights Data Collection are not, in fact, persuasive evidence of prejudice or discrimination. A glaringly obvious yet unexplored possibility is that the minority students in the data are simply engaging in more actions requiring punishment than their white counterparts. Full stop.

Why would this be so?

The possibilities are numerous, but I suspect socio-economic status and family environment are the main culprits. The federal studies in question don’t adjust for those factors.

Just to be clear: I’m well aware of white privilege and the many economic, social, and legal barriers that prevent full equality in modern society, but simply saying “unequal outcome = racism” is bogus. And I think in this context it is particularly absurd coming from the Department of Education. There are plenty of areas where statistics have uncovered racially biased enforcement of rules. I’m thinking particularly about marijuana arrests, where it’s clear that rates of use are pretty much the same everywhere but minorities – and black people in particular – are being singled out for punishment. Those are the kinds of statistics that would, for me, evidence racially-motivated punishment in the school context.

So we need to compare apples to apples. How often are the different ethnic groups engaging in behavior for which suspension is a possible punishment? If white students were getting into on-campus fights at the same rate as minority students but being suspended only one-third as often, that would be clear evidence of discrimination. Perhaps an enterprising Dish reader can find a study showing disparate punishment outcomes despite identical behavior. Until then, your readers need to recognize the crummy and possibly misleading nature of these statistics.

Another gets very anecdotal, with a second-hand source:

When my daughter was in a small suburban elementary school, every black male in her grade of 120 students was in trouble to one extent or another. Her principal told me, and I’m paraphrasing, “Every black male student in this school is under some form of corrective counseling. Every student currently under escalated counseling in this school is a black male.”

One called his teacher a bitch. Expelled. Another refused to take his seat and stop talking, ever. Removed from regular schooling. All of them, every single one – so I was told, anyway – used foul language openly. Most were removed to remedial facilities on the second or third foul language offense. There were only one or two black male students left in regular classes and they were on thin ice, I was told.

The school principal told me that the fathers – and here we’re talking degreed professionals, for the most part, including executives and at least one lawyer as recall – were responsible for the behavior. During counseling sessions, some of the mothers expressed outrage, one screaming at the father “I hope you’re satisfied; you’re ruining his life and he’s only in first grade!” One of the mothers told her, “It’s not the school. It’s a black-male thing nowadays, with black fathers encouraging sons to be black and aggressively stand their ground in school.”

I found it interesting that the principal told me that “this is all new, in recent years”. And that there was little or no pushback or denial from the parents about the behavior. No lawsuits or protests. Also no similar behavior at all from black female students, who seemed as normal and well-adjusted as their white and Hispanic counterparts.

In an interview with Prospero, Olga Sobolev explains how global military conflicts shaped the literature of the US and the Soviet Union:

The response to the first world war was great literature like T.S. Eliot and Ezra Pound, but after the second world war the response was mostly pulp fiction, thrillers and spy novels. The novel is very much based on an individual view of the world, but, because there was such strong propaganda against Communism, there was a group-consciousness response based on stereotypes that fitted into this genre of formula fiction of spy novels and thrillers.

She goes on to provide context for the birth of James Bond:

So readers on both sides of the Iron Curtain were consuming these ideological patterns and stereotypes?

Yes, but in slightly different ways.

In the Soviet Union it came from the top down, but in the West the propaganda was regulated by economic means. Left-wing writers were removed from the shelves (Howard Fast, Dalton Trumbo and even Frank Baum, author of “The Wizard of Oz”) though never actually censored. They were not in demand because of media propaganda, so what was in demand was the thrillers and spy fiction. Interestingly, apart from Richard Condon’s “The Manchurian Candidate” (1953), which was American, the novels were mostly British. There was Ian Fleming’s Bond, of course, and then, later, John Le Carré, a more literary writer than Fleming. [Le Carré’s character George] Smiley is human where Bond is not. “The Spy Who Came in From the Cold” (1963) was a huge success because Kim Philby defected in 1963, and 1961 had seen the Maclean and Burgess defections, so Le Carré was on the wave of these huge political incidents. Then there was “Tinker, Tailor, Soldier, Spy” (1974), and “Smiley’s People” (1979) when the Anthony Blunt affair was in the headlines.

Casey Cep shares a story about her father, who, having a heart attack early one morning, requested the ambulance not use its siren so as not to wake his three sleeping daughters. What it taught her about kindness:

I have called it an act of kindness, which I think it was. It was considerate in a way I cannot begin to understand; generous in a way no one would expect, much less demand. Years later I still do not comprehend how in what very well might have been the final moments of his life, my father thought to ask for quiet so that his daughters might continue sleeping.

Kindness is like an ice cube in your hands. It stings, but then the cold dissolves; what at first you could barely hold becomes something you cannot let go. My father’s request for a quiet ambulance came from a man so familiar with kindness that the sting was completely gone: the ice was no longer cold, but one with the flesh.

She goes on to riff on being kind in the Internet age:

[K]indness is not always as heavy as action: it can be as light as speech or as invisible as inaction. Sometimes the kindest thing we can do is to exercise self-restraint: not posting a nasty comment on an article, leaving a mean-spirited tweet in the draft folder, keeping quiet to listen to whatever unfamiliar or opposing opinion is being offered.

The Internet has offered us many facile ways of expressing approval (like, favorite, share) but few ways of being kind. It might be that the greatest act of kindness on the Internet is to be quiet. Not to be forever silent, but at least listen and learn before expressing outrage or anger, and to realize that kindness will not always take the form of approval. My father’s quiet ambulance was one act of kindness, but so too was rebuking me not long after when I fought with one of his hospital nurses about visiting hours.

Read the Dish round-ups on George Saunders’s commencement speech about kindness here and here.