Liveblogging policy paradox
Aug. 30th, 2022 07:48 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
walkitoutThis is another paper book that I’ve been meaning to read for a really long time. A book review will almost certainly follow, and it will almost certainly be favorable.
But I do have some issues!
In the discussion of “relative need”, “Malcolm Gladwell argues that health insurance should be considered a necessity in the U.S. today…”If your teeth are bad, you’re not going to get a job as a receptionist, say, or a cashier. You’re going to be put in the back somewhere, far from the public eye.” Bad teeth “are an outward marker of caste.” Health insurance counts as “a necessary” as Gladwell sees it, because without the ability to pay for dental care, people are ashamed to appear in public.”
Basic idea: dental care is a necessity in the US today.
But this paragraph! First health insurance in the United States is nearly universally _separate_ from dental care. So if you are talking about “health insurance”, you are NOT talking about paying for dental care. And a lot of people think that this is a good thing, in part because health insurance is so mind-bendingly expensive and dental care in many respects is not. I understand someone is going to come at this in the comments, but having paid for someone to get a bunch of fillings and so forth done without any coverage, at least as of the writing of this book, dental care really _is_ so much cheaper than health care that it’s legit shocking. Dental care in terms of _actually having fairly complicated and extensive work done_ is cheap _compared to somewhat reasonable health insurance monthly premiums_.
Lots of secondary and other issues with front of the house / back of the house, social stigma, pay rates, “ashamed to appear in public” etc. comments.
The Gladwell article the quotes are from can be found here:
https://www.newyorker.com/magazine/2005/08/29/the-moral-hazard-myth
I don’t see any indication in the Gladwell piece that he understands that dental insurance is virtually always sold separately from health insurance. You can’t look at ACA coverage and critique Gladwell’s piece or this book for failing to understand how ACA handles dental (mandatory offer for children’s plans but not for adult plans, and, like the rest of ACA, it has tiers), because ACA did not yet exist at the time of the New Yorker piece or this book. The New Yorker piece, in general, is an absolute hot mess, but I’m not going to get into that here, because I’d rather read this book and get it out of the house.
ETA: OK, I can’t leave it alone. Look, everyone should have access to affordable health and dental insurance and honestly, we’ve taken the whole choice thing quite a lot farther than we really should have. BUT I also want to point out that I know people who work in health insurance and I know people who work in property insurance, so I have some connectivity to both industries. And straight up, people who work in those fields will figure out ways to “get their money’s worth” in ways that absolutely constitute “moral hazard”. I know a person in health insurance who made absolutely certain to get enough chiropractic and massage and similar to make sure it worked out to her monthly premium _every month_. Saying this is not a problem is bullshit. But it is _also_ a stupid reason to make poor people suffer with broken bones and missing teeth. I really cannot emphasize how much this is not about people being “good” versus people being “bad”. This is competing moral values. Frugality drives people to fully utilize whatever they paid for … which means some people are going to be “frugal” about their insurance premiums in a way that is going to be viewed as “moral hazard” or “perverse incentives” or whatever. It’s not. It is people trying to “get their money’s worth”. If you want to counter that issue, the way you counter it is not by framing it as something else and condemning that. You tackled the “money’s worth argument” head on OR you restructure payments and benefits. I don’t really care, honestly. I disapprove of frugality in general, altho I’m only very recently starting to appreciate just how much I disapprove of frugality.
“In Norway, Sweden and Denmark, government finances paid parental leaves for new mothers and fathers, a policy that recognizes family-keeping as an essential aspect of the human experience.”
Uhhhh. They were really worried about the drop in birth rates, that suggests pretty strongly that family-keeping is NOT an essential aspect of the human experience, but kind of optional, and people were picking that option at a level incompatible with the continued existence of the state over time using primarily natural replacement (versus, say, immigration).
Next up:
I’m going to assume this is poorly written. It could be due to some worse problem, but I’m prepared to give her the benefit of the doubt until that is no longer tenable.
After a discussion of people who assess risk by multiplying How Bad by How Likely, and how obnoxious those people can be (it is true, we can be very obnoxious!):
“If it’s HIV you’re worried about, you might well take precautions in your intimate relationships as if the chance of getting HIV were a certainty — and no doctor would judge you insane or unsensible.”
Let’s take it apart!
First, this book is NOT new! This printing / edition is 2012, but the underlying text starts out in 1988. Bear in mind that in early revs of this, therapeutics were not yet available.
Second, let’s consider that “doctor” literally. True! And even now, never mind back then, doctors are not only human, they are overly compliant humans with less than awesome judgment who tend not to think things through all the way. If you are worried about HIV in a time frame between 1988 and 2012, insisting on testing and/or condom usage for casual intimate relationships is a really good choice and that is almost certainly what is meant.
But you can read this to basically suggest that, you know, never have a child because having a child would involve unprotected sex and that would potentially expose you to HIV (or, I guess, maybe only via artificial insemination using tested sperm?).
By now, of course, if you are in a high risk relationship / dating environment, going and getting a prescription for Prep and using it also makes sense!
So I think that this is a How It Was Worded problem, not a OMG wrong people worried in a way that accelerated homophobia problem. But it sure gave me pause.
But I do have some issues!
In the discussion of “relative need”, “Malcolm Gladwell argues that health insurance should be considered a necessity in the U.S. today…”If your teeth are bad, you’re not going to get a job as a receptionist, say, or a cashier. You’re going to be put in the back somewhere, far from the public eye.” Bad teeth “are an outward marker of caste.” Health insurance counts as “a necessary” as Gladwell sees it, because without the ability to pay for dental care, people are ashamed to appear in public.”
Basic idea: dental care is a necessity in the US today.
But this paragraph! First health insurance in the United States is nearly universally _separate_ from dental care. So if you are talking about “health insurance”, you are NOT talking about paying for dental care. And a lot of people think that this is a good thing, in part because health insurance is so mind-bendingly expensive and dental care in many respects is not. I understand someone is going to come at this in the comments, but having paid for someone to get a bunch of fillings and so forth done without any coverage, at least as of the writing of this book, dental care really _is_ so much cheaper than health care that it’s legit shocking. Dental care in terms of _actually having fairly complicated and extensive work done_ is cheap _compared to somewhat reasonable health insurance monthly premiums_.
Lots of secondary and other issues with front of the house / back of the house, social stigma, pay rates, “ashamed to appear in public” etc. comments.
The Gladwell article the quotes are from can be found here:
https://www.newyorker.com/magazine/2005/08/29/the-moral-hazard-myth
I don’t see any indication in the Gladwell piece that he understands that dental insurance is virtually always sold separately from health insurance. You can’t look at ACA coverage and critique Gladwell’s piece or this book for failing to understand how ACA handles dental (mandatory offer for children’s plans but not for adult plans, and, like the rest of ACA, it has tiers), because ACA did not yet exist at the time of the New Yorker piece or this book. The New Yorker piece, in general, is an absolute hot mess, but I’m not going to get into that here, because I’d rather read this book and get it out of the house.
ETA: OK, I can’t leave it alone. Look, everyone should have access to affordable health and dental insurance and honestly, we’ve taken the whole choice thing quite a lot farther than we really should have. BUT I also want to point out that I know people who work in health insurance and I know people who work in property insurance, so I have some connectivity to both industries. And straight up, people who work in those fields will figure out ways to “get their money’s worth” in ways that absolutely constitute “moral hazard”. I know a person in health insurance who made absolutely certain to get enough chiropractic and massage and similar to make sure it worked out to her monthly premium _every month_. Saying this is not a problem is bullshit. But it is _also_ a stupid reason to make poor people suffer with broken bones and missing teeth. I really cannot emphasize how much this is not about people being “good” versus people being “bad”. This is competing moral values. Frugality drives people to fully utilize whatever they paid for … which means some people are going to be “frugal” about their insurance premiums in a way that is going to be viewed as “moral hazard” or “perverse incentives” or whatever. It’s not. It is people trying to “get their money’s worth”. If you want to counter that issue, the way you counter it is not by framing it as something else and condemning that. You tackled the “money’s worth argument” head on OR you restructure payments and benefits. I don’t really care, honestly. I disapprove of frugality in general, altho I’m only very recently starting to appreciate just how much I disapprove of frugality.
“In Norway, Sweden and Denmark, government finances paid parental leaves for new mothers and fathers, a policy that recognizes family-keeping as an essential aspect of the human experience.”
Uhhhh. They were really worried about the drop in birth rates, that suggests pretty strongly that family-keeping is NOT an essential aspect of the human experience, but kind of optional, and people were picking that option at a level incompatible with the continued existence of the state over time using primarily natural replacement (versus, say, immigration).
Next up:
I’m going to assume this is poorly written. It could be due to some worse problem, but I’m prepared to give her the benefit of the doubt until that is no longer tenable.
After a discussion of people who assess risk by multiplying How Bad by How Likely, and how obnoxious those people can be (it is true, we can be very obnoxious!):
“If it’s HIV you’re worried about, you might well take precautions in your intimate relationships as if the chance of getting HIV were a certainty — and no doctor would judge you insane or unsensible.”
Let’s take it apart!
First, this book is NOT new! This printing / edition is 2012, but the underlying text starts out in 1988. Bear in mind that in early revs of this, therapeutics were not yet available.
Second, let’s consider that “doctor” literally. True! And even now, never mind back then, doctors are not only human, they are overly compliant humans with less than awesome judgment who tend not to think things through all the way. If you are worried about HIV in a time frame between 1988 and 2012, insisting on testing and/or condom usage for casual intimate relationships is a really good choice and that is almost certainly what is meant.
But you can read this to basically suggest that, you know, never have a child because having a child would involve unprotected sex and that would potentially expose you to HIV (or, I guess, maybe only via artificial insemination using tested sperm?).
By now, of course, if you are in a high risk relationship / dating environment, going and getting a prescription for Prep and using it also makes sense!
So I think that this is a How It Was Worded problem, not a OMG wrong people worried in a way that accelerated homophobia problem. But it sure gave me pause.