RWL #163 - Skew, Hierarchies, & Work requirements
Greetings from the University of New Hampshire! We had a yucky storm this week - about five inches of snow followed by freezing rain. That made trying to blow the snow like scooping a milkshake. In the process, the blower’s auger stopped working, which for those you who live in warm climes, means the blower stopped picking up snow. So I had to shovel the rest of the super wet, mushy snow with a shovel. It turns out the auger driver belt is worn out and it jumped. Above is what a partially disassembled snowblower looks like. It’s a little sad - like it melted into the floor. I’ve got a new belt ordered, but we’re due another storm on Wednesday, so I may have to put the worn out belt back on if the new one doesn’t get here in time. Hopefully it will make it through the storm if I do. That’s life in rural New Hampshire my friends!
Anyway, on to the links and have a great week and do amazing things!
Read
What: AMA Journal of Ethics, The Median Isn’t the Message, Stephen Jay Gould, PhD
https://journalofethics.ama-assn.org/article/median-isnt-message/2013-01
Why: This article was forwarded to me by J.P. in response to the Gawande Bell Curve article I posted last week. In this article, Stephen Gould discusses one of the errors we are likely to engage in when we are provided with basic descriptive statistics, such as mean or median. In particular he talks about skew. If right now you are saying to yourself, “I hate statistics, moving on”, I would say all the more reason to give this article a try. It will both provide you a better intuition about descriptive statistics and humanize them. It’s a short read, too.
Watch
What: Why Did I Say "Yes" to Speak Here? | Malcolm Gladwell | Google Zeitgeist (19 minutes)
Why: This is a brilliant talk by Malcom Gladwell. It might actually be one of the most insightful things I’ve heard him talk about, and I’ve listened to him and read quite a bit of his work.
He talks about the cost of being at the bottom of a hierarchy, regardless of whether the hierarchy you are in is an elite hierarchy. So if you are a poor person in a rich community, you suffer. If you are the dumbest person at a smart school, even if you are smarter than anyone at the dumb schools, you suffer. There’s a famous public health study called the Whitehall Study that discovered this effect many years ago.
As a management professor who does a fair amount of qualitative research, I spend a lot of time hanging out with subjects who make 3-10 times as much as I do during a year. I genuinely like most of my subjects - it’s not an accident that they are successful leaders. But sometimes I step back and realize how much social distance there is between me and them. So I have to go kayaking while they are at work and think about it. See - that’s how I rationalize the disparities away. We all make choices, and it’s important to come to terms with the consequences of those choices. But actually Gladwell’s insight is deeper than that. Hierarchies are a fundamental truth that arise from our pack animal origins.
Listen
What: The Commonwealth Fund, What Happened When One State Made Having a Job a Requirement for Medicaid
Why: Several years ago I invited Rich Silveria, then the chief financial officer for Boston Medical Center, Boston’s safety net hospital, to be part of a policy panel we were hosting here at UNH. He said a couple of things that struck me. First, he said that BMC gets about 80% of its reimbursement from Medicaid. In case you don’t know, Medicaid pays pennies on the dollar relative to commercial insurance. Hospitals struggle if their payer mix includes a high percent of Medicaid patients, and by high I mean 30% or 40%, not 80%. So that speaks to the remarkable nature of BMC that it is able to stay solvent given this financial challenge. The second thing he said was that the application for Medicaid in Massachusetts is 28 pages long. I’ve got a couple of graduate degrees, and the idea of filling out a 28 page application sounds daunting to me, never mind if I was poor, relatively uneducated, and struggling to keep myself and my family fed and sheltered. To compound this, many individual’s financial status fluctuates and they come on and off the Medicaid rolls, forcing the individual to re-apply.
I am a fiscal conservative, so I am sympathetic to the spirit behind social benefits like having a work requirement for Medicaid. My inclination in this matter is if you are in any way able bodied, you should not be collecting tax payer funded safety net benefits. However, I have to acknowledge the reality is more complicated than my simple inclinations make me want to believe. The process of determining eligibility itself is so onerous, never mind understanding work requirements, this whole thing sounds like a mess. And that’s what this study found. So if you’re a fiscal conservative like me, you should listen to this podcast.
Thanks for reading and see you next week! If you come across any interesting stories, won't you send them my way? I'd love to hear what you think of these suggestions, and I'd love to get suggestions from you. Feel free to drop me a line at mark.bonica@unh.edu , or you can tweet to me at @mbonica .
Also, if you find these links interesting, won’t you tell a friend? They can subscribe here: https://tinyletter.com/markbonica
See you next Friday!
Mark
Mark J. Bonica, Ph.D., MBA, MS
Assistant Professor
Department of Health Management and Policy
University of New Hampshire
(603) 862-0598
mark.bonica@unh.edu
Health Leader Forge Podcast: http://healthleaderforge.org
"I know of no more encouraging fact than the unquestionable ability of man to elevate his life by a conscious endeavor." - Henry David Thoreau