Sunday, December 31, 2006
Chutzpah – blogs and profiles: a big story in 2006
One of the most alarming developments during the past year has been the repeated media reports about the rapidly increasing concern employers have over the blogs and social networking site profiles of job applicants and individual employees.
I have expected this kind of problem for a long time, since around 1999, partly out of legitimate concerns about confidential information or trade secrets in the workplace, and of inadvertent distraction of stakeholders – essentially a kind of “conflict of interest.” My own situation with my involvement in the military gay ban and the job I had in the 1990s had given me a lot of reason to think about this.
Some of this concern, however, may be slipping into more nebulous concerns about appearances and social conformity – something we sometimes call “reputation.” Already, companies that claim they can manage your online “appearance” and “reputation” are cropping up, and we may see a day when employers use these companies to manage what their associates do off line.
One kind of situation you often hear about is people not getting jobs because somebody saw a video of their underage drinking on their myspace or facebook profile. An employer will probably say something like this: we don’t want to interfere with free speech. You can argue for lowering the legal drinking age (or even age of consent) or even for legalizing marijuana in an essay, and that is fine. But just don’t depict yourself as doing it or having a propensity to do it (the latter part gets tricky – just look at the military gay ban and then at defamation law regarding fiction). That creates a liability risk for us if we hire you, and then our clients find you online. Another way to put it is something like this: Your personal stuff can be fun and mostly inconsequential, but if you want people to take it seriously, be prepared, because you might just get what you wish for.
Maybe. It’s easy to make false analogies here, the kind that you would miss on an SAT test. I can recall thirty years ago that people didn’t want to be “caught” on live television at gay parades or at MCC churches. In fact, going back maybe a half century, police tactics of publishing the names of those arrested in gay bar raids reflecting a similar kind of thinking.
In the past dozen or so years, the mathematics of binary searches has given the ordinary person an unprecedented asymmetric opportunity. With almost no startup cost (“free entry”) someone can put his thoughts on the Web in a personal site, blog or social networking profile, and someone in Pakistan can find it in a search engine within days thereafter. This is profound. When I worked on my first book in the mid 1990s (“Do Ask Do Tell”) I didn’t really grasp the significance of this development. This sounds like the ultimate idea for direct world democracy. But it also provides unquantifiable, although usually very remote, risks, to oneself and possibly to others around oneself, including the workplace, residence and especially family. We are beginning to question if unlimited free entry to the world public stage is such a good thing, and if there should be more rules, at least based on the kind of job you have. Already, social networking companies and blogging publishers are offering whitelisting capabilities, that would restrict the audience to a known list. And major litigation (as well as new legislative efforts) goes on regarding how to protect minors (COPA). One obvious issue is educating high school students on the legal responsibilities that come with showing up on the public stage.
Free speech as the First Amendment spells it out actually has several components, including assembly, expressive association, faith (or no faith), and, yes, individual speech and to some extent access to the press. The concepts are subject to interpretation and parsing. In practice, many people of older generations are used to a concept where the right to be heard has some functional dependence on one’s performance in taking responsibility for others (heading a family). That does not sit well with modern individualism (at least it reinforces the importance of competing in a social or political hierachy), and is questionable when applied to the First Amendment, but chutzpah certainly does challenge religious cultures and is particularly troubling in the Islamic world, as writers like Manji and Bawer have recently explained in brilliant books. (Self-published debate also challenges the hegemony of special interests and partisanship.) There certainly is a mapping between the issues of individual expressive freedom as we are encountering them now with the Internet and some of the ideological issues that are driving some of our international risks and struggles.
We enter the new year with abundance of caution.
Picture: a mock workplace drug test (the hair test)
Saturday, December 30, 2006
Filial Loyalty Burdens
Jane Gross has one of the most disturbing stories yet in the December 30, 2006 issue of The New York Times, “Elder-Care Costs Deplete Savings of a Generation,” at this link (may require online subscription or membership). She opens her story with an account of a female vice president at the Federal Reserve Bank who has depleted most of her own assets to care for a 97-year-old father.
The story quotes a geriatrician. Robert L. Kane, at the University of Minnesota School of public health. “There is a myth out there that families abandon their elders. Instead, across the income spectrum, children are sacrificing to care for their parents to the limit of their means and sometimes beyond.” The story produces a chart showing about 8% of adult children involved in supporting eldcercare. The problem gets worse as medical care can keep the severely ill elderly alive longer but cannot always offer quality of life or independence, and as birth rates in many economic classes fall.
Tax laws add to confusion. Adult children cannot claim parental expenses (unlike a situation with spouses, where there is a 7.5% AGI threshold) unless they pay for more than half of a parent’s support. This would not apply with parents on Medicaid.
The story also quotes an elder-care lawyer Steven Schurkman, who recommends that adult children keep track of parent’s expenses from the parent’s account to establish eligibility for Medicaid. Many adult children do not do good accounting.
The story does not mention that many states (about 30) have filial responsibility laws, and could go after adult children before parents go on Medicaid, even if parents have no assets (they do go after children when give-aways have happened, and the look-back rules have been recently tightened).
This whole topic runs across profound cultural divides over family responsibility. Biological loyalty is usually much stronger in minority communities, and is extremely strong in the Islamic world. Gay rights seems like a cultural insult, since often gay people place much less personal priority on biological loyalty since often they do not procreate their own children.
My own detailed account of filial responsibility laws is at this link. We still have not had a well structured debate on this creeping issue.
Wall Street Journal story on teen caregivers, Jan. 5 2007
Clare Ansberry has an article "Daily Chores: Young Caregivers: Parents Turn to Children for Help: Many Juggle School with Feeding Tubes, IVs," The Wall Street Journal, Friday Jan. 5m 2005, p. 1. The detailed and graphic story (with many examples) cites a 2005 study claiming that over 1.3 million minors from age 8 to 18 care for disabled or seriously ill family members (parents, siblings, sometimes grandparents).
Friday, December 29, 2006
The Washington Times concluded its series on marriage with Gregory Lopes, “Work making way for family life: More employers adopt flexible schedules and telecommuting” on Dec. 28, 2006, and Gabriella Boston “’For better or worse’ takes a lot of work: Learning what to expect can help marriages last” on Dec. 29.
In many jobs, flexibility is a win-win situation for employers and employees alike, regardless of personal life circumstances. The measures can include telecommuting and flexible work schedules (4 10’s, 3 12’s, etc). This also helps save energy and reduce pollution and sounds like responsible citizenship.
More problematical is the way people use benefits according to family situation. Insurance premiums are often much higher for family coverage. But many people say that the unpaid leave of the Family and Medical Leave Act of 1993 is inadequate, and lobby for paid maternity and paternity leave, following most European countries. This contradicts the practice of making many jobs contract and piece-work or commission oriented.
One major concern about strengthening traditional marriage is the effect on the childless and on the unmarried. There have been books with varying viewpoints (Burkett, Longman) on this, because inevitably there are calls to expect the childless to help support other people’s children. One particularly troubling situation can occur in a salaried workplace, where on-call and unpaid overtime is common, because in some cases there are pressures on those “without families” to do more of it.
We do have to face a troubling Catch-22 in the way we think about marriage. That is, stable marriage, children, and religious faith do tend to shield some people (although not the “providers” and “protectors”) from the feeling that they must prove their worthiness in competition with other people. Ideas about abstinence contribute to that feeling. In modern individualistic culture, there is more tendency to judge people as if they operated on their own, apart from family. If you make the childless and unmarried defer to the needs of those with families, you have to make them second-class citizens. That just seems like an observation of merciless logic. That is the underbelly of all the arguments about same-sex marriage. If one does not have a committed family relationship to provide for others, one’s resources can seem to be up for grabs and expropriated or hijacked to meet the needs of others. Or what is worse, one can be told something like this: "We will deferentially "protect" you, even from "discrimination", but you must serve our purposes -- church and family -- before you can serve your own, because otherwise you could expose us." That does make one’s own purposes go away. It is pretty disturbing when it happens.
Thursday, December 28, 2006
All the way back to the 1980s there has been constant criticism from social conservatives (like George Gilder with his famous “Men and Marriage”,as Gilder in turn invokes Aldous Huxley and "Brave New World") of meddling with natural reproduction in married, with any artificial technology like “test tube babies” or use of stem cells, and, especially pre-natal testing.
A AP story on Dec. 28, 2006, “Babies Created with genetic defects,” by Lindsey Turner, highlights these concerns. The story reports a survey of American clinics that found that 4 (out of about 120 clinics) reported embryo screening with intention of producing babies with specific disabilities, for parents who wanted to have offspring "like them." The Washington Times reprinted the story Dec 28.
The closest concept that I could find in the dictionary was something like “line breeding.” Now we all are aware of the moral and bioethical debate surrounding all of this. It need not all be accounted for here (President Bush weighed in on it during the early months of his presidency). Vatican theology, for example, demands openness to all new life, even though this imposes potential “burdens” on other people besides the legal parents, as part of its reverence for human life.
When I first saw the story, I was a bit shocked. Yet, I can give it a context, in the way I have been able to depict myself, with a concept called “dreamcatching.” Personal judgments do not matter here.
At least, thankfully there does not exist any genetic testing scheme that can guarantee that babies will be born straight (or gay). Remember the play and film "Twilight of the Golds"?
Tuesday, December 26, 2006
Cheryl Wetzstein has a series in The Washington Times, starting Dec. 26, 2006, "U.S. out of love with marriage" that starts with a mention of this film and of how important George was to his family. Link is here.
As noted elsewhere in the blogs, the problem is existential. Is it important to be one’s own person first, or to create a committed family structure first? It is a kind of chicken-and-egg question, but we need to understand it that way.
Is marriage a public institution that we share, or is it a private experience that becomes a certain public expression? The question is philosophical, but it has tremendous policy implications for how people will do, especially LGBT people.
Some of the ideas in the Times article on p A12 include:
. preserving marriage for one man and one woman
. discouraging cohabitation
. discouraging recognizing civil unions and non marital domestic partnerships
. provide government support for marriage and abstinence education
. reduce the ease of no-fault divorce (especially when there are children); encourage covenant marriage
. reform welfare to encourage marriage
. double personal income-tax exemption for children to $6400 and child tax credit to $2000
. Provide universal tax credit per child to age 5 of $2500
. in social security, give a married mother three years of employment credit for each child
Actually, some European countries have tried to make their policies much more child friendly (especially with paid maternal and paternal leave, which we don’t have as a legally driven mandate in the U.S.) without creating social friction among the childless.
Nevertheless, it seems clear that these policies, in combination with stronger filial responsibility laws, could put people disinclined to marry (heterosexually) and function as parents at a serious disadvantage compared to people who marry and have children earlier. On the other hand, early child bearing today often puts women especially at a serious disadvantage. However, is it really good for marriage to make it (and the family bed) almost "compulsory" as a step toward social acceptability as an adult?
(Picture: from Big Bend National Park, Texas, November 1979, from a Sierra Club camping weekend)
Wednesday, December 13, 2006
Public concern about substitute teachers seems to have increased since Aug. 2006, when a former substitute teacher John Mark Karr made a false confession (later retracted when no physical or DNA evidence could be found linking him to the 1996 crime) to the JonBenet Ramsey case in Colorado. The media reported that many states and their school districts are haphazard and careless about the quality of people they put in the classroom as substitute teachers.
Most localities have shortages of substitute teachers, and have lax licensing requirements. In fact, most states don’t require teaching licenses at all for short term substitute teachers. Most have a minimum number of hours of college credits (often 60). Many times retirees are attracted, as may be artists or actors while looking for work. To some extent, this is a good thing for manyudents, who have the chance to interact more with adults who have lived in the “real world” of work.
The National Education Association has a state-by-state discussion of the licensing or expiration requirements for substitute teachers, at this link. The following states do have meaningful licensing requirements for substitutes: CO IA MI MN ND PA . Typically, unlicensed substitutes (or substitutes without permanent positions) have no teacher's union bargaining power and often no benefits, and in some states the pay is quite low.
In secondary schools, regular teachers usually leave lesson plans, which often involve administering examinations or showing films and relatively little actual instruction. Substitutes often are not content experts in the particular classes filled. In fact, most school districts will allow any substitute to fill almost any position.
Many school districts have “three strikes and you’re out” or similar rules for substitutes. That is, a principal or school administrator may request that a substitute not return to that school. The administrator does not have to give a reason for the removal. In some cases, with a serious enough situation, a substitute could be terminated after one such request. But if an administrator gives an “illegal” reason for trying to remove a substitute, the school district may well not honor the request. An example could be an issue involving off-duty free speech, where there is a history of rather complicated case law balancing free speech of employees (and students) with the need for safety and discipline in the schools. More common reasons for removal might be failure to follow lesson plans or, particularly in lower grades or with disadvantaged students, inability to maintain classroom discipline (the popular euphemism is “poor classroom management”). In practical, sometimes administrators do not make specific "do not send" requests but instead start canceling future (system-generated) assignments, hoping that the particular sub will take the hint.
From a job performance perspective, then, the substitute considers two issues. One is her own content mastery. But this is normally seen as less critical with substitutes than with regular teachers. The other is connecting to and “managing” students – “The Kids!” School systems tend to look at substituting as babysitting jobs. They expect the substitute to come to the job with some degree of socialization and ability to connect with immature students. Normally this experience is obtained in the home – first of all in marriage, as by raising one’s own family, or by taking care of younger siblings-- or by some other kind of volunteer socializing experience. The issue is more critical with retirees, who may have a lifetime which others may have expected to have included raising a family. With younger teaching employees, instruction or coursework is more likely to be effective in developing connection skills. Of course, no one says this openly.
Often substitutes are retired are part-time teachers with licenses, so in many districts administrators may not know which subs are licensed and which are not (or they may even mistakenly believe that they are all licensed). Often, individual teachers and administrators come to prefer certain subs that they know, and it is quite believable that a particular unlicensed individual is effective with more mature kids in a number of subjects – literature, social studies, technology, and especially mathematics – because of workplace and life experiences, even (for social studies) experience with political activism or, for English, personal experience as a writer (including technical or grant writing).
This gets to the enormous divisions within The Kids themselves. At certain grade levels, between say 7 and 11, most adolescents begin to grasp self-interest as an abstraction that is separate from their immediate comfort and gratification, and even distinct from family position or peer popularity. An article by Paul Tough in The New York Times Magazine, Nov. 26, 2006, “What It Will Really Take To Close the Education Gap,” discusses the shism, that occurs much earlier with upper middle class kids. This “maturity” is what the teacher recognizes is the kid’s ability to “do the right thing” without excessive supervision, both from the point of view of his own well being and out of ethical respect for his community (such as avoiding plagiarism and cheating). Usually the kids that learn this earlier are more likely to appear in Honors and AP Advanced Placement) or IB (International Baccalaureate) classes. There are correlations with race. Generally, because of cumulative historical advantages, white and Asian children have outperformed African Americans and Hispanics, which has led to metrics for improvement under No Child Left Behind that affect individual teachers. The challenge in teaching is often called “differential instruction”, which is tailoring the teaching methods to the individual child’s level of cognition and response.
All of this bears back on the issues of the teacher shortage, which is accompanied by the substitute teacher shortage, which is quite severe in many school districts and which accounts for the lenient job requirements. It is true that there are shortages in the upper levels in math and science areas, and President Bush has proposed special initiatives to address these shortages separately. That could mean that positions (both permanent teachers and substitutes) for upper end students should be restructured separately, with more emphasis on academic and workplace preparation. But the majority of the shortage seems to have to do with the average and below average students, who demand more personal attention from teachers. There is a tendency for these students not to respect substitutes, and to believe that they will have “easy days” when the “authority figure” teacher is out. (On the other hand, advanced students often like to benefit from hearing “real world” substitutes tell them what the real world will be all about.)
What to do about all of this, and improve the substitute pool? I think one way is to have expiration dates or periods for unlicensed subs. Let them try the job out for twelve to eighteen months, after that make them make decisions about obtaining licensure. But rather than make them go to a college campus to get the classroom clock hours required for licensure, offer the course work on the school properties on-line, with instruction application network software. (They should be closed intranet applications rather than offered on the open Internet or Web). Provide some in-person instruction, but bring professors to school properties. It should also be possible for “apprentice teachers” to dial in from home into the applications over wireless or high-speed connections. Obviously, this needs money, but more than that, it needs a lot of planning, thought, and determination.
Along these lines, it should be noted that schools often do offer long-term substitute positions (including summer school) to unlicensed persons with enough academic credentials. Sometimes they offer permanent positions with temporary or provisional state licenses, and can provide the hooks for the necessary clock hours of instruction while the teacher has the position, but this can become grueling.
It should be added that besides substitute teachers, there are also positions for teaching assistants and resource assistants. But most often, these assistant work directly, sometimes one-on-one, with special education students. To be successful in this role, the substitute (or regular assistant) needs to be comfortable with connecting with students who are not on an adult-like level of cognition.
Original discussion on doaskdotell at this link.
Update: March 12, 2009
The NEA link on state requirements for subs seems to get a 404 error right now. I hope NEA restores this table, since it says it is redesigning its web site. In the mean time, here is another website (Mahalo: "How to become a substitute teacher") with links to state requirements, but it is harder to use. I'll check later and see if NEA has restored the table.
(Picture: Map of St Mary's City colony, MD)
A report by David Brown in the December 13, 2006 The Washington Post, "1918 Flu Epidemic Teaching Valuable Lessons: Actions Taken Apparently Were Effective", at this link,
itself based on new data presented at the Centers for Disease Control in Atlanta, suggests that the stringent public health measures taken in 1918 to close schools and public gatherings, require masks and excluding people who coughed from theaters (as shown in Peter Jennings's book The Century) may have been more effective in controlling the mortality rate that previously thought.
This kind of a finding is important, because large scale quarantines and closings could have devestating social and ecnomic effects in urban areas, and cause major rethinking of what we call "family values". This is indeed "an inconvenient truth," which was exaggerated in the TV film this spring from ABC, "Fatal Contact: Bird Flu in America". I have correspondence from Congressman Jim Moran on this and it is not that reassuring. The link for these letters is here.
There is an interesting comparison to HIV in the 1980s, where public health officials had to repeatedly reassure the public that it could not be casually transmitted, despite wild speculations from the religious right, sometimes from the media shows ("there's always a first time!") and even a careless remark in 1983 from NIH reported in Randy Shilts's book "And the Band Played On". (There were some speculations in Robert Gallo's 1989 book "Virus Hunting".)
There is also an interesting comparison with other horrifying bloodborn viruses like Ebola and Marburg (Robert Preston's "The Hot Zone"). There is an Ebola epidemic among gorillas in Africa, and there was a scare in 1989 about "Ebola Reston."
The CDC's site is pandemicflu.gov and that has a link to a World Health Organization (WHO) site that considers us at Phase 3 ("No or very limited human-to-human transmission, link here.)
Tuesday, December 12, 2006
“You don’t have to be married,” the matronly Barbara Bush (wife of the first George Bush) said during the 1992 presidential campaign (that would be lost to Bill Clinton). “But if you have children, they have to be the first priority of your life.”
In modern urban civilization, we have supported the idea of marriage as a celebration of love and of having children as a voluntary choice that we take responsibility for. In past eras (as well documented in the film Marie Antoinette) (review) marriage was a way to make political alliances and “justify” the passing or property.
But then look at the debate spurred by the article “Childless by Choice” by Leslie Fulbright of the Seattle Times (April 1, 2003). The article discusses organizations for child-free couples and singles, such as Child Free by Choice, No Rugrats, To Breed or Not to Breed Brats, and No Kidding!. But then the article goes into areas and quotes that highlight the cultural tension among those whose lives revolve around family and those whose don’t. “’Any healthy culture is child-centric because the future rests with our children,’ said Allan Carlson of the Family Research Council. ’These (No Kidding!) people are copping out on the future, refusing to accept the standard obligation for responsible membership in our society. I would describe them as childish, immature and irresponsible.’”
Here are some URL’s: (1)
Well, that puts it bluntly. I’m part of the problem, a freeloader, Even Dr. Laura isn’t this blunt.
“Virginia Rutter, a sociologist at the University of Washington, sees the opposition to the child free as both psychological and political. She says there are two issues: caring for children and a societal level and the choice at an individual level. ‘People think that those who don’t (re)produce are somehow the source of the lack of child care that we have as a society. When facing an extraordinary stress, they are angry and seem to direct that at individuals rather than the system. They see themselves as morally superior because they are dealing with the hardship.’”
Indeed, hardship and the possibility of failure tends to encourage self-righteousness, and the desire to make up or derive from religion a moral code (like abstinence outside of marriage) that eliminates competitive possibilities from others.
“In contrast, many No Kidding! Members—often called selfish—see child-bearing as narcissistic and don’t understand why society equates reproduction with responsibility.”
The battle over childlessness has been creeping up in books. The most famous is Elinor Burkett’s “The Baby Boon” (2000), (review) but there have been a number of “pro-family” books emphasizing the difficulties that parents have in an laissez-faire, individualistic adult society, such as Jennifer Roback Morse. “Love and Economics: Why the Laissez-Faire Family Doesn’t Work..” (review) But a recent concern in the past ten years or so has been the lowering birthrate in more affluent classes (especially in Europe) as presented by Philip Longman in "The Empty Cradle", (review) in combination with increasing lifespan and an elderly population with increasing needs for custodial care. Occasionally in the 1990s social conservatives would call for “the family wage” and it is likely that those calls will increase in the future.
It has gradually become apparent that child care and eldercare needs to be born by all, not just those who have children. At least indirectly, the competitive culture and open Internet raises issues about how the expressive behavior of uncommitted adults (or of affluent adults) affects other people’s children, especially in lower income groups. Compared to ten years ago, more jobs today proportionally could have caretaking duties (and note the shortage of substitute teachers, to be discussed in an upcoming post).
This leads to a logical conundrum. We want people to feel free to choose consenting adult significant others, and I have proposed this as a “fundamental right” in my own books. Yet, these “private choices” are becoming increasingly public in consequence. A number of resolutions can be enumerated. We can make procreation and child rearing a strictly voluntary personal responsibility choice. That was the pure libertarian position, though it has become unstable. Many people who have children seem to need help (and deference) from others to raise them. We can expect caring for the next generation to be shared by everyone, but embrace the idea of same-sex couples as parents and of single parent adoption. That supports equality for gays but would seem to undermine the supposed “birthright” of a mother and father for every child. Or we can design public policy to encourage many more conventional heterosexually married couples to adopt and offer foster care, while excluding same-sex couples and singles. It sounds extravagant, but maybe it is conceivable. But then one is left with the idea that the “non marrying kind” will be forced into a subordinate role, deferring to the needs of people with more “responsibility.” That hardly supports the idea of marrying just for love.
The cultural change, over the past few decades. toward individual meritocracy does make it harder to address the needs of the vulnerable within any family. Frankly, many careers outside of the technical, artistic and entertainment areas do require a lot of the content-independent social manipulation skills that generally comes from marrying and raising kids. We are not well prepared to take care of an increased population of profoundly disabled elderly, who can be kept alive longer, in view of the lower birthrates and smaller families, apart from the possibility of preventing or treating medically many of these disabling disases (Alzheimer's, etc.) We are also not prepared for the sacrifice that can come from other exogenous sources, like global warming. It is likely that the childless will be called up to bear much of the slack for all of this, and we are not prepared for the moral implications of the problems.
(Family Leave: unpaid in U.S., paid in many other countries)
One practical issue is paid maternal and paternal leave, which most advanced countries outside the U.S. offer, without that much social tension over the implicit sacrifice by the childless. There is a lot of controversy over the effectiveness of unpaid family leave in the U.S. workplace. Cindy Skrzycki, “Door Opens to Changes in Family Leave,” Dec. 12, 2006, link.
(Picture: at Liberty University, Lynchburg VA)
Monday, December 11, 2006
In early December, the House approved a bill raising the tax-free Health Savings Account deduction from $2700 to $2850 for a single and from $5450 to $5650 for a family. The Washington Post sotry Dec 11, 2006 is by Jeffrey Birnbaum and Lori Montgomery, p A4, “GOP Lawmakers Add Provision to Passing Tax Package: Measure Expands the Amount That Can Be Given Tax-Free to Health Savings Accounts.” Link is here.
The U.S. Treasury has a website, including FAQ’s, on how Health Savings Accounts work. Generally, you have to have a high-deductible health policy with a qualifying company (or employer). Generally, money from them can be spent only on qualifying medical or dental expenses (sometimes even to help purchase long term care insurance), but they can be spent on family members. Presumably this includes parents (probably if they had been declared as dependents on the tax return—check with a tax advisor). (This would seem to be an issue with same-sex marriage debates, as presumably they could not be used for partners since this is a federal deduction; one would have to research this with a tax accountant.) In general, the money may be invested, and it accumulates; it does not have to be spent the year it is deducted. It is controlled by IRS rules. The website is this link.
The issue is still heavily politicized, as it seems to remove pressure from employers that unions seem to want. I wonder if HAS’s can address the problem of providers charging more for procedures from uninsured patients. If a patient “buys” a health care service from his own HSA funds, does she pay more than if a group insurance company pays for it under volume-discount pricing?
I know with my own dentist, this issue (of individual surcharges) came up with extraction sutures (where I had to pay more), and later with an oral cat scan (where I did get the discount from a retiree health policy). Presumably HSA’s could be set up to deal with this problem, but the underlying structural problems of hospital financing (which I became familiar with in 1989 when I worked on a model that dealt with hospital Medicare operating margins) remain.
Monday, December 04, 2006
Amy Joyce has an article, "Shifting Risk, Responsibility: New Health Plans Move More than Costs to Employees," on Sunday Dec 3, 2006, in the Washington Post, here.
One small company in Rockville, MD, TeraTech, made a switch from a Blue Cross Blue Shield Plan to a health savings account, which shields $5250 for a single and $10500 for a family from taxes. However, the money must be spent within a certain time period, which encourages preventive care. It is particularly effective with known expenses, such as a pregnancy, or possibly for recurring conditions like HIV or diabetes.
HR Magazine, December 2006, has an article by Susan J. Wells, "Will Employees Orchestrate Their Own Health Care? Consumer-directed health coverage requires employees to make wise decisions on care and spending. But will it improve health and cut costs?" The acronym for these plans is CDHP.
Friday, December 01, 2006
There was a sensational story in the major media today to the effect that Homeland Security is keeping a database of scores on travelers, a kind of FICO like (or CLUE like) score that assesses their potential "threat".
Right now, members of the general public do not have the right to see or to challenge their scores.
Scores tended to be based on travel-related details like method of payment, iteneraries (esp. overseas), seat assignment, even meals. It was not completely clear if this list is limited to persons (including US citizens) arriving from international flights at least once since around the beginning of 2002.
The CNN story is here.