medical licenses and state lines

December 27th, 2014

Still closing tabs. This story about efforts to make it easier for doctors to get licenses to practice in different states makes an interesting little study of irrationality in our intergovernmental system. Since state laws differ considerably, regulating legal practice at the state level makes some sense… but medicine?

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historic hampton roads photos on a map

December 20th, 2014

I’m not good with bookmarks. Or with closing tabs.

The OneTab browser extension is thus a lifesaver. I’m working on paring down the 700 or so links I’ve built up over the last several months, though… and I’m running across a few things that I don’t entirely need to bookmark for frequent use, but also don’t want to lose. Blogging appropriate, right?

One is this map that links Virginian-Pilot archive and Norfolk Public Library collection photos to their geographic locations. So, for example, you can easily find a photo taken from the railroad trestle a block from here from circa 1924. Just cool.

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who gets to talk?

December 18th, 2014

I ran across this post this morning, citing a Media Matters study’s findings that only 9% of the evening cable news guests who are brought on camera to discuss education issues are educators. I shared without thinking too much. Nine percent, after all, sounds frightfully low.

But later in the morning, I got to thinking a little more. What IS the right stakeholder share here?

While the story in question is talking about media representation, this is a constant issue for public administration in a democracy. As I struggle to become an expert, finding ways to properly balance expertise and wider stakeholder opinion is one of the big questions to grapple with. I really like Tom Nichols’ piece, The Death of Expertise, and yet. How many of our talking heads about education should be teachers? And how many parents, and how many politicians and students and business leaders and researchers and concerned community members? How much weight to one set of perspectives is too much?

Maybe there’s another question, too: are any of these guests listening to each other, giving expertise weight where it’s deserved while balancing it against broader concerns?

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ebola

November 30th, 2014

My podcast queue generally stays a bit backed up. I tend to pick off the can’t-wait stuff like Serial (eeek, insta-addiction!), then go back to everything else when I’m running enough or doing enough housework to need more listening material.

And I just wanted to express total amazement at a sudden realization: somewhere in that couple months that I’m behind, we’ve gone from FREAKING OUT over ebola to… almost no noise.

The google trends line showing search interest across 2014 says this probably isn’t just my personal Facebook friends.

Meanwhile, it’s still happening. The recent news stories I found weren’t particularly reassuring — cases declining or stabilizing in Liberia and Guinea, but surging in Sierra Leone. To the extent that international fundraising was working, I’d bet it’s trickling off. In a few minutes of lazy searching, I can’t even find a nice recently updated graph of new cases to compare to the google search.

Limited public attention resources in action. Meanwhile, the Red Cross gets in trouble when it gets a public outpouring of donations for one cause and shifts some of the money to other purposes… this story gives pretty good coverage of the main points from the Planet Money episode that got me thinking about this, limits of rationality, and some of the risks associated with relying on philanthropic funds and fundraising pushes to solve big public problems.

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on not buying obamacare

March 31st, 2014

I signed into the website. I looked.

I’m in the odd little demographic of people who were already buying their independent health insurance. Before I quit to go back to school full time, the office-subsidized insurance got REALLY expensive. It was a small office, and a lot of the young and healthy individuals were married to people in the military; when I checked, it turned out that going off on my own, I could get a similar plan through the same company without subsidization for about half the price to me. I hated to make our small pool even worse by leaving it, but I couldn’t afford to stay in it on that salary. The independent plan is a little heavy on teaching assistant salary, but I kept that plan when I dropped the old job since ODU doesn’t offer grad students health insurance.

When I looked at the plans available on the Exchange here, a plan similar to mine — AND AGAIN THROUGH THE SAME COMPANY — slightly higher deductible ($4250 instead of $3500), HMO instead of PPO (so broader choice of doctors) but with a lower coinsurance rate (so 80% after deductible instead of 100% on most things) was $235/month… before subsidies. After, my income’s low enough that it would be $44 a month instead of the $90 that I pay, but that’s a lot to ask the taxpayers to help out for a plan that actually seems a little worse unless I get in a situation where I can’t control where I go. So far, I’ve been profitable to insure — my biggest medical expense the last several years was walking into a glass door and breaking my nose, which earned me a $300 band-aid (tetanus shot included) covered entirely by me. (Add a sinus infection, I think I hit $400 toward the $3500 deductible that year? The insurance is routinely more expensive than the healthcare, but a bike wreck or health issue could easily fix that…)

I do have to compliment the healthcare.gov website. The plan comparison is one of the clearest I’ve seen — I love that each plan has an estimate of what the consumer costs of a pregnancy or managing diabetes would be on the plan… but even with that our system is still so complicated and anticipating healthcare needs is so uncertain that the choices (including tax penalty or shop elsewhere!) are a bit overwhelming.

So I’m not buying into the Exchange because it seems silly to me to let the same insurance company collect more than double the money for no added benefit, even though it’d be cheaper to me until my income goes up. But these systems being what they are and needing the big pools to make them work, I don’t know if staying out on my own is actually better or worse for the American taxpayers as a whole. Would one more heavily subsidized but (usually) healthy sign-up improve or hurt the system’s chances of being viable?

I feel like I have a pretty high level of policy literacy, and I still have no idea. Good luck to the whole crazy endeavor.

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