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Elizabeth Warren 2020


Hugo Stiglitz

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Just now, Mojo Hand said:

The way it would work is that hospitals are given an incentive to make black women a priority.   If the message is being pushed and thereby more present in the minds of doctors and nurses, they may be more cognizant of the disparities in care as they are providing and work to address those disparities.

honestly, i don't care if they have racially condescending propaganda on the wall spelling out how important it is to treat everyone equally, as long as it makes them get better at it.

there's obviously the bigger issue of public/private hospitals, differing levels of insurance, and "medicine as a business" (again, another problem that is too big for the warren thread).  we don't even know if the treatment is a result of racial subconscious or a mandate from the higher-ups about prioritizing people with certain high-end insurance (insurance that may not be as available to woc or lower income types in general).

do the studies show if it's definitely a white/non-white issue, or does it often come down to rich/poor?  (i haven't read all the thread or the linked articles).

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7 minutes ago, Mojo Hand said:

The way it would work is that hospitals are given an incentive to make black women a priority.

1) Vague stuff like cutting funding to the hospital or giving more money to the hospital won't influence the individual actions of doctors and nurses. They aren't a hivemind.

2) As I've already demonstrated, it's not really the maternal care of the women at the time of birth that accounts for the disparity.

It's not the racism of doctors and nurses killing these women, it's the structural racism of our entire society.

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Just now, bad_teammate said:

1) Vague stuff like cutting funding to the hospital or giving more money to the hospital won't influence the individual actions of doctors and nurses. They aren't a hivemind.

2) As I've already demonstrated, it's not really the maternal care of the women at the time of birth that accounts for the disparity.

It's not the racism of doctors and nurses killing these women, it's the structural racism of our entire society.

What about the studies on the overuse of C-sections with black women?   And the time of birth isn't the only issue — doctors are involved with prenatal and postnatal care, which is also extremely important. 

Nobody is suggesting that this will be a panacea, but I'm not seeing a persuasive reason not to try it as just one of many policy initiatives we should try. 

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10 minutes ago, Mojo Hand said:

What about the studies on the overuse of C-sections with black women?   And the time of birth isn't the only issue — doctors are involved with prenatal and postnatal care, which is also extremely important. 

Why on earth would prenatal care improve because of bonuses based on the results of birth and postnatal care? How does that incentive chain even make sense?

The overuse of C-sections sounds like something that might be impacted, so why not just enact policy that directly addresses that specific issue?

This policy, just like the education policy that it mirrors, is us saying, "I don't know, fix it" while tossing some money vaguely in the direction of the problem. Perverse incentives hurt people, and in this case, it will kill people.

This is a capitalist trying to use capitalist means to fix a problem that capitalism created/fostered/exacerbated.

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Nobody is suggesting that this will be a panacea, but I'm not seeing a persuasive reason not to try it as just one of many policy initiatives we should try. 

Because it will naturally lead to cuts in funding for poor/rural areas since those are the places most at risk already. And once that cycle starts (which it already has before the program begins due to structural inequality) it will only get worse.

If we ACTUALLY CARE about the lives of black women (hint: as a society, we don't), we would directly improve the material conditions of the black community.

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45 minutes ago, bad_teammate said:

Why on earth would prenatal care improve because of bonuses based on the results of birth and postnatal care? How does that incentive chain even make sense?

The overuse of C-sections sounds like something that might be impacted, so why not just enact policy that directly addresses that specific issue?

This policy, just like the education policy that it mirrors, is us saying, "I don't know, fix it" while tossing some money vaguely in the direction of the problem. Perverse incentives hurt people, and in this case, it will kill people.

This is a capitalist trying to use capitalist means to fix a problem that capitalism created/fostered/exacerbated.

986.jpg

Because it will naturally lead to cuts in funding for poor/rural areas since those are the places most at risk already. And once that cycle starts (which it already has before the program begins due to structural inequality) it will only get worse.

If we ACTUALLY CARE about the lives of black women (hint: as a society, we don't), we would directly improve the material conditions of the black community.

You still haven't explained why it would lead to cuts, other than to suggest that some random unrelated anomaly could cause black maternal mortality rates to spike.   OK.  Even assuming that it is remotely likely, it doesn't sound like she wants to cut existing grants of money, but would just deny additional money, in which case I don't see the risk.  

The incentive here is for hospitals to put resources into making this issue a priority.   Making the issue a priority will focus doctors and nurses on being cognizant of disparities in care, leading to better care.   It may not work, but it is fairly straightforward. 

What exactly is the perverse incentive at play?   Explain that incentive chain. 

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b_t, I think the notion is that you start with a baseline (last year's numbers) and then going forward incentivize improving those numbers year-over. So you eliminate bias by asking them to beat themselves, not richer hospitals.

 

I can see some validity in that. And it actually gives poor hospitals more upside because they have more room for improvement.

 

However I still generally (gasp) agree with you that incentivizing these types of things would lead to unintended results that might be worse than the benefits. I doubt the incentive money is enough to force any real process changes for the for-profits. They will do a cost/benefit and see that the cost is greater. So all you'll get is management putting downward pressure on the employees which is almost always a terrible idea except in very short stints.

 

Another issue is that it's a bit unfair to poor and rural hospitals who already do a good job and outperform expectations. They only have room to go down. Only so much juice in the onion.

 

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1 minute ago, Mojo Hand said:

You still haven't explained why it would lead to cuts, other than to suggest that some random unrelated anomaly could cause black maternal mortality rates to spike. 

Not a random anomaly; the effects of systemic inequality continuing to play out in a way that led to the disparity in the first place.

Poor/black maternal mortality has been trending in the wrong direction, yes? If we institute this policy, which does nothing to materially improve the lives of poor/black populations, that trend will continue. So, as maternal mortality gets worse, the incentive system sees that as a failure of the hospital and cuts funding for the hospital.

Also, bonuses for other hospitals are de facto cuts to hospitals that do not receive the bonuses. The hospitals receiving the bonuses will improve their facilities and increase pay, attracting staff and motivated patients away from underfunded hospitals, who will then get even worse, trapping those stuck there to worse and worse outcomes. A death spiral.

If we actually cared about this, which we don't, failure would lead to an INCREASE in resources and attention.

(Again, this is mirrored in the fraudulent and destructive character school system that NCLB school reform has created).

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The incentive here is for hospitals to put resources into making this issue a priority. 

Why are we assuming it is not already a priority? Have we asked the hospitals and doctors and nurses about this?

 

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Just now, bad_teammate said:

Not a random anomaly; the effects of systemic inequality continuing to play out in a way that led to the disparity in the first place.

Poor/black maternal mortality has been trending in the wrong direction, yes? If we institute this policy, which does nothing to materially improve the lives of poor/black populations, that trend will continue. So, as maternal mortality gets worse, the incentive system sees that as a failure of the hospital and cuts funding for the hospital.

Also, bonuses for other hospitals are de facto cuts to hospitals that do not receive the bonuses. The hospitals receiving the bonuses will improve their facilities and increase pay, attracting staff and motivated patients away from underfunded hospitals, who will then get even worse, trapping those stuck there to worse and worse outcomes. A death spiral.

If we actually cared about this, which we don't, failure would lead to an INCREASE in resources and attention.

(Again, this is mirrored in the fraudulent and destructive character school system that NCLB school reform has created).

Why are we assuming it is not already a priority? Have we asked the hospitals and doctors and nurses about this?

 

You're in the weeds on policy details we don't yet have.  For example, the consequence you cite could easily be avoided by pegging the results to the existing trend line at the hospital. Nobody would be penalized if the program does nothing and the rates continue on the same path they were already headed.   

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6 minutes ago, Mojo Hand said:

You're in the weeds on policy details we don't yet have.  For example, the consequence you cite could easily be avoided by pegging the results to the existing trend line at the hospital. Nobody would be penalized if the program does nothing and the rates continue on the same path they were already headed.   

You've also got sample size issues. Parkland (which is like the 8th biggest campus in the country) has about 8000 births per year. Average rate is about 0.6%. So you'd expect about 50 deaths per year. One bad bug going around, a sudden influx of hard drugs, or just a series of flukes could drop a hospital from top tier to bottom tier real fast. 

But this is getting way too detailed for the spirit of this thread. I do appreciate her raising the issue but this strategy just seems half-baked to me. But at least someone is talking about it and as mentioned upthread, has us talking about it too.

Edited by BradInATX
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Some context on the Biden/Warren beef, for those who need it. 

Quote

“Actually, senator, bankruptcy cases are not heard in Delaware chancery court.”

Biden quickly corrected himself—bankruptcy cases are heard in bankruptcy court—but the exchange was emblematic of things to come. For the next 14 minutes, running well over Biden’s allotted time for questioning, he and Warren debated the role of government in a way that felt personal.

It was not the first time the pair had clashed, and it wouldn’t be the last. Long before their Capitol Hill clash, Warren called out Biden by name in op-eds and in her first book, accusing him of carrying water for the big corporations that called his state home and kept his campaign coffers full.

...

Warren first began publicly taking on Biden in 2002, when she wrote a paper for the Harvard Women’s Law Journal suggesting that his position on bankruptcy had been effectively bought.

“His energetic work on behalf of the credit card companies has earned him the affection of the banking industry and protected him from any well-funded challengers for his Senate seat,” she wrote. With a touch of snark, she added, “This important part of Senator Biden’s legislative work also appears to be missing from his Web site and publicity releases.”

And in a New York Times op-ed that year she called the bankruptcy bill “unconscionable,” singling out Biden for his work on it. “Apparently many politicians believe they can remove the last safety net for families facing financial disaster (many of which are led by women) so long as they can find another highly visible issue that lets them proclaim their support for women,” she wrote.

DRAG HIS ASS LIZ

 

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13 minutes ago, Js1 said:

Fuck yeah, this Boss Bitch knows what's up.  Ninfa's > El Tiempo

 

 

I mean we’re splitting hairs here, both are excellent and owned by the same family. 

Personally I like el tiempo better, but this has to be one of her only decent policies. 

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You're god damned right she does!

At the Bernie launch party I went to today a guy in his 30s said something like, "I like Warren, but I don't know if she's electable" and it took every piece of my self-control to simply be annoyed when I responded instead of violently apoplectic.

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Yep.  I also get a yearly personal property tax bill for several hundred dollars on the value of our two cars.   When they were new it was like a grand in taxes, going down a bit each year as their value diminishes.  Wealth tax. 

Edited by Mojo Hand
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1 hour ago, Hugo Stiglitz said:

That’s great salesmanship and framing.  I swear to gawd if Elizabeth Warren were a man she would be running away with this thing. 

She is amazing.  I agree with more of Warren’s policy positions than any candidate I can recall.  She thinks deeply and cuts through the bullshit.  

But anyone who thinks Warren with play in Peoria doesn’t understand how hopelessly lost the dipshits in middle America are.  Actually fixing their problems through smart policies is of no interest to the rubes.  They prefer flags and guns and anger.  

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57 minutes ago, David Dennison said:

Ninfa's on Navigation is no longer owned by the Laurenzos.

Interesting. Anybody been before and after to see if there is a noticeable difference?  The last couple times I went it could have just been off days or had a bad server, but the food was always good, just not as good as what I had at Tiempo which also has consistently great service.  

Splitting hairs, both are great.  

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Last time I went to ninfas on navigation it was off, that was a couple of years ago and the time before that was easily 10 years prior. Got my first real waiter job at a ninfas. During their heyday it was solid Tex-mex.

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I’m still stuck on the student loan issue but reading the response from@brickhorn about her made me stop and spend some time thinking and reading and I agree the student loan, early education and housing proposals coupled with the wealth tax is probably the most thoughtful and least intrusive way to handle the wealthy inequality in our country. It’s a remarkably well thought out plan. I just happen to have significant issue with the idea of debt forgiveness and free for higher ed.

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34 minutes ago, troph said:

I’m still stuck on the student loan issue but reading the response from@brickhorn about her made me stop and spend some time thinking and reading and I agree the student loan, early education and housing proposals coupled with the wealth tax is probably the most thoughtful and least intrusive way to handle the wealthy inequality in our country. It’s a remarkably well thought out plan. I just happen to have significant issue with the idea of debt forgiveness and free for higher ed.

If this wasn't happening, you'd probably see more people agree with you.

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Student loan forgiveness brings back the old fashioned moral hazard conundrum. Basically encouraging graduates to neglect paying down loans in hope of a bailout, analogous to the mortgage crisis. Also this bailout punishes folks who have been responsibly spending, saving, and deleveraging. 

The responsible thing to do is to make student debt interest fully deductible regardless of annual income. This is a solid first step to helping folks with high debt load. 

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14 minutes ago, 6th Street said:

Student loan forgiveness brings back the old fashioned moral hazard conundrum. Basically encouraging graduates to neglect paying down loans in hope of a bailout, analogous to the mortgage crisis. Also this bailout punishes folks who have been responsibly spending, saving, and deleveraging. 

The responsible thing to do is to make student debt interest fully deductible regardless of annual income. This is a solid first step to helping folks with high debt load. 

Funny, that argument doesn't stop us from giving huge tax breaks every decade or so to corporations who have keep profits overseas.   That actually has the consequence that you identify. 

Student debt forgiveness, not so much.   Nobody is going to subject themselves to the dire financial consequences of not paying back their student loans on the slim hope that another debt forgiveness bill comes down the pike for the second time ever.   People will pay their loans to the extent they can.   What it may do is encourage more people to take out loans to go to college, but this isn't a standalone policy.  She has other proposals addressing the cost of education. 

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