The Right's Media Pipeline

Last week, while reporting the Public Policy Polling study of Americans' trust in the news media, I mentioned that, contrary to the common stereotype that the media have a “liberal bias,” most studies show the media to be more conservative than the public. Not wanting to review the large and complex literature on the subject, I cited a single study. It's a good study, but one study doesn't make the case. What I prefer to do in this blog is cite new studies of media bias as they come to my attention. Here's a case in point.

Media Matters for America has analyzed all the news coverage of the proposed Keystone XL pipeline from August 1 through December 31, 2011, on three broadcast networks (ABC, CBS and NBC), three cable news networks (CNN, Fox and MSNBC) and six newspaper outlets (Associated Press, Los Angeles Times, New York Times, USA Today, Wall Street Journal and Washington Post). At issue was whether their coverage of the conflict between corporate profits and environmental protection was balanced. What was the mixture of conservative arguments for the pipeline and liberal arguments against it? Previous research had shown journalists to be to the left of the American public on environmental issues, but far to its right on economic issues.

One way to measure media bias is to examine the positions of the experts who were interviewed or cited in the news reports. Each expert was classified as either a pipeline supporter, a pipeline opponent, or neutral. Here are the results:

	Broadcast	Cable	Print
Support the pipeline	79%	59%	45%
Oppose the pipeline	7%	16%	31%
Are Neutral	14%	25%	24%

The six newspapers published 19 editorial and op-eds in favor of the pipeline and 10 opposed.

They then examined how often the media mentioned two specific arguments in favor of the pipeline and two opposition arguments. The two arguments in favor were.

1. Job creation. Pipeline proponents claimed the pipeline would create 20,000 manufacturing and construction jobs and over 600,000 “spinoff” jobs, primarily due to increased energy availability. Independent economists suggested these claims were wildly inflated. The State Department put the number of temporary construction jobs at 5,000-6,000 and said the pipeline would have little effect on long-term employment.
2. Energy security. Advocates of the pipeline said it would reduce our dependence on “foreign” (other than Canadian) oil. Since the pipeline runs from Canada to the Gulf Coast, this ignores the obvious fact that its primary purpose is to facilitate the export of oil to the rest of the world.

The two arguments against the pipeline were:

1. Environmental impact. Opponents pointed out that if the pipeline were to leak, it could do great damage to the Great Plains ecosystem. Furthermore, oil extracted from the Canadian tar sands releases more carbon dioxide than any other fossil fuel, which will have a disastrous effect on global warming.
2. State Department review. The State Department's review of the pipeline, which recommended construction, was tainted by corruption. The consulting firm which prepared the review also had Transcanada, the owners of the pipeline, as a client. (I'll bet many of you haven't even heard this criticism. You'll see why.)

Here's how often these arguments were mentioned. (Since a news report can mention more than one argument, the figures total more than 100%.)

	Broadcast	Cable	Print
Job creation potential	67%	77%	68%
U. S. energy security	22%	28%	54%
Environmental concerns	17%	34%	65%
Criticism of State Dept. review	6%	7%	20%

The news media passed on Transcanada's job creation estimates five times more often than they mentioned criticism of these numbers by independent economists.

Although all media outlets supported the pipeline, it is important to note that print coverage of the issue came closer to being balanced than television.

Why are the media so biased in favor of the pipeline? In this case, the primary reasons are probably the prevalence of energy company advertising in the media, and the fact that media conglomerates have interlocking financial relationships with energy corporations.

Why do most people falsely believe the media have a “liberal bias,” in spite of the evidence from their own eyes and ears? That's complicated. One reason is that the media keep telling us they have a liberal bias, by reporting anecdotal claims by right wing media critics while suppressing studies such as this one. One study found that the more often the media reported claims that they have a liberal bias, the more the public believed it. What could be better for mass media with a strong conservative bias than to be falsely believed to have a liberal bias? This would imply that if they were “fair and balanced,” they would be even more conservative than they presently are!

Another Miss By the Supremes

There are few other topics in applied psychology that have been more heavily researched than eyewitness identification. More than 2000 studies of the subject have been published in professional journals. Yet the influence of this research on the legal system has been painfully slow. There have been no major changes in federal law governing eyewitnesses since 1977. Earlier this month, the Supreme Court took a major step backwards.  This decision doesn't belong on the same CD with "Stop in the Name of Love."

In a series of cases between 1967 and 1977, the Supremes ruled that inaccurate identifications violate the due process rights of the defendant. Eyewitness testimony can be suppressed before it is presented to the jury if the identification is made under “suggestive” conditions. In previous cases before the Court, those biased conditions were orchestrated by the police. At issue in the present case: What happens when the eyewitness is exposed to a suggestive procedure for which the police are not responsible?

In Perry v. New Hampshire, a witness called the police at 2:30 a.m. to say she observed a black man breaking into a car from her fourth story window. The police apprehended Barion Perry, a black man, in the parking lot with stolen objects in his possession. When a policeman went to the witness's apartment to interview her, she on her own initiative went to the window and identified Perry, who was standing in the lot next to another officer. This is not a reliable identification, since the distance was great and the lighting was poor. Furthermore, the fact that Perry was standing in police custody made it inherently obvious that he was the suspect. In fact, the witness failed to pick Perry out of a photo array a month later. Nevertheless, the prosecution put her on the stand, and Perry was convicted.

Although this is counterintuitive to most people, we are not very good at identifying persons whom we observed for only a short period of time. Incorrect identifications are a common occurrence. Extrapolating from large-scale field studies, the American Psychological Association (APA), in a brief filed in the case, estimated that about one-third of eyewitness identifications are incorrect. The Innocence Project, using DNA evidence, has exonerated nearly 300 prisoners who were falsely convicted. In 76% of these cases, an incorrect identification was involved.

Variables that affect eyewitness accuracy can be divided into two categories: estimator variables, which take place at the time the eyewitness observes the crime, and system variables, which occur when the identification is made, many of which are, or should be, under the control of the state. Estimator variables include the length of time the suspect was observed, the distance, the lighting conditions, and whether the eyewitness is under stress, such as that produced by the presence of a gun. Cross-racial identifications are less accurate than when the suspect and the eyewitness are of the same race. System variables under the control of the police involve the fairness of the identification procedure. If a six-person lineup is used, all five non-suspects must fit the perpetrator's description, and to avoid bias, the officer who conducts the lineup should not be aware of the suspect's identity. The most error-prone identification procedure of all is the one-person showup. However, not all system variables are under police control, as Perry illustrates. Suggestive identification procedures can also be instigated by the media, or by friends of the witness.

The Perry case concerns a system variable that was not under police control, although you might argue that it should have been. The Supremes ruled 8-1 against Perry. The lead singer in this case, Justice Ruth Bader Ginsberg, writing for the majority, acknowledged that Perry's identification occurred under suggestive conditions, but said that eyewitness testimony can be suppressed only if the suggestive procedure was caused by police action. This excludes the possibility of suppressing eyewitness testimony that is unreliable due to estimator variables, or due to system variables not under police control. (Ironically, if the police officer had suggested that the witness look out the window, her testimony would probably have been excluded.) The justification for suppression of eyewitness testimony in previous cases, Justice Ginsberg argued, was to deter the police from arranging unfair or biased identifications. This is a very narrow reading of the language of previous eyewitness cases.

Justice Ginsberg noted that the defense attorney can try to discredit the eyewitness through cross-examination, making it clear to the jury that the identification took place under biased circumstances. However, research indicates that mock jurors “overbelieve” eyewitnesses; that is, they believe witnesses whose identifications are known to researchers to be false. Here's how it usually happens. The studies show that eyewitnesses are overconfident of the accuracy of their identifications. As a result, there is no relationship between their confidence and their accuracy. Jurors, in turn, base their judgments of the credibility of an eyewitness primarily on his or her confidence. Since witnesses are just as confident of incorrect identifications as correct ones, jurors are unable to distinguish between accurate and inaccurate eyewitnesses. Neither a warning from the judge nor expert testimony regarding the fallibility of eyewitnesses are sufficient to eliminate the tendency to overbelieve eyewitnesses. (See the APA brief for references to specific studies which support these conclusions.)

The only dissonant note in the case came from Justice Sonia Sotomayor. She argued that the real purpose of suppressing tainted eyewitness testimony is to prevent miscarriages of justice caused by incorrect identifications. For example, in Manson v. Braithwaite (1977), the court said that “the primary evil to be avoided” is the “likelihood of misidentification.” Deterring the police from using biased procedures is just one way of avoiding misidentifications. This suggests that the court should exclude eyewitness testimony that is a product of suggestive circumstances, regardless of whether those circumstances results from police action, police inaction, or sources other than the police.

It is profoundly discouraging to social scientists when the Supremes base their decisions on technicalities and fail to appreciate the overall implications of sound scientific research.

Too Much of a Bad Thing

I've just recently caught up with a 2007 book by journalist Shannon Brownlee, Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer. Although some of the specific policies she cites are being changed by the Affordable Care Act, her basic argument is worthy of our attention.

Most advocates of single payer health insurance are justifiably concerned about undertreatment, as represented by the 45,000 Americans who die every year from lack of adequate health care, but overtreatment is part of the problem because it drives up costs and convinces people that we can't afford health care for all. Overtreatment accounts for one-third to one-fifth of all health care spending, which amounts to $500-$700 billion in waste per year. In effect, the poor get too little health care because the rest of us get too much.

Overtreatment also leads to deaths and illnesses caused by too much medical care. The book is filled with these horror stories. In fact, almost anything that puts us in that house of confusion we call a hospital increases our risk of becoming a victim of medical error. Brownlee places the death toll for unnecessary care at 30,000 per year. (Unfortunately, although Brownlee includes footnotes, the sources of some of her statistics, including those in this and the preceding paragraph, are not cited.)

Overtreatment comes in several varieties. Unnecessary surgery is a huge problem, since it usually costs $50,00-$100,000 per operation. Heart and back surgery are the worst offenders. Researchers at Dartmouth first documented overtreatment when they noticed large regional and hospital differences in surgery rates that were not explained by illness rates in the area. Unnecessary tests cost less per incident, but are much more frequent. A special problem brought on by too many imaging tests, from mammograms to CT scans, is that reading the results is prone to error and leads to the “discovery” of non-problems, resulting in further unnecessary procedures. Finally, there are two chapters on the pharmaceutical industry, its creation of “illness” (“restless leg syndrome,” anyone?), and its marketing of ineffective and sometimes harmful drugs. (The definitive work on this subject is Marcia Angell's The Truth About the Drug Companies [2005])

Brownlee suggests several reasons for overtreatment. The Medical Institute has estimated that only 4% of medical treatments (drugs, tests, surgical procedures, etc.) are backed by strong scientific evidence of their effectiveness. Another 50% are supported by weak evidence; the rest have no support at all. In this environment, there are huge opportunities for subjective judgments by doctors, who are under pressure from all sides to do something rather than wait and see.

Our largely fee-for-service payment system is another cause of overtreatment, since the more treatment they provide, the more the medical establishment gets paid. To make things worse, both Medicare and insurance companies overpay for some treatments, especially surgery, and underpay for others, such as emergency and psychiatric care. Hospitals allot major resources to these profit centers (“centers of excellence”), while closing emergency rooms and psychiatric wards in spite of unmet demand. Brownlee labels this system “supply-driven demand.” If a hospital has too many beds, the beds somehow miraculously get filled. When the hospital spends several million dollars on a new MRI, the doctors request many more scans. An oversupply of heart specialists leads to an excess of heart surgery. Drugs advertised on television get prescribed, and so forth.  Brownlee charitably suggests that this is a result of unconscious biases.

The solutions are fairly obvious. They will be costly to implement, but will pay off in the long run. First of all, research on the effectiveness of medical treatments is badly needed.  It must be conducted not by the manufacturers of drugs and medical devices, but by disinterested university-based researchers whose work is supported by the government. Secondly, organizations such as the Veteran's Administration and Kaiser-Permanente have been shown to reduce costs and improve treatment outcomes by coordinating patient care. This is accomplished in part by good computer tracking. It also requires assigning each patient to a general practioner who knows the patient well enough to recognize her in the grocery store. Brownlee strongly believes we need more generalists and fewer specialists. Finally, it requires a reimbursement system that rewards doctors for producing good patient outcomes, rather than paying them a piece-rate for each procedure.

Overtreated belongs on everyone's short shelf of books about health care policy.

An Unlucky Number for Blacks

Social psychologists have been studying racism for 65 years, but the emphasis has always been on prejudice rather than discrimination. The relative lack of convincing research on institutional racism allows those in positions of authority to deny its existence. A new article by Braucher, Cohen and Lawless (2012)--two lawyers and a social psychologist—examines discrimination in the context of filing for personal bankruptcy. It's complicated, but please bear with me.

A person or family filing for bankruptcy has two options, Chapter 7 and Chapter 13 bankruptcy. Chapter 7 is a relatively quick process by which, in theory, debtors liquidate their assets, pay off creditors where possible, and begin again with a clean slate in about six months. The asset liquidation is largely symbolic, however, since about 90% of Chapter 7 filers have no assets after exemptions are excluded. Chapter 13 is a longer process by which debtors keep most of their assets, but agree to pay their debts over a three to five year period according to a schedule arranged by the court. About two-thirds of families who elect Chapter 13 fail to complete the process and are forced to start over under Chapter 7. Chapter 13 bankruptcy generates $2500-$3000 in lawyer's fees, while Chapter 7 bankruptcy typically costs about $1000.

Since Chapter 7 bankruptcy forgives the debt, why would anyone choose Chapter 13? One practical reason is that they may have assets worth protecting. In addition, some people may feel a moral obligation to pay back their creditors. Since most people have little knowledge of bankruptcy law, the researchers presumed that they rely heavily on their lawyers for advice on “chapter choice.”

Previous research had suggested that African-Americans were more likely to elect Chapter 13 bankruptcy than other ethnic groups. Braucher and her colleagues did two studies—a survey and an experiment. Study 1 was a national survey conducted by the Consumer Bankruptcy Project of 2314 randomly selected households that filed for bankruptcy in 2007. As expected, the rate of Chapter 13 bankruptcy was significantly higher among African Americans (54.7%) than among all other groups (28.2%).

The survey included 20 control variables that were intended to evaluate alternative explanations of the race difference. The control variables were in four categories: (1) financial characteristics, such as total assets; (2) informal attempts to negotiate debt load; (3) demographic characteristics, such as number of adults in the household, and (4) local legal culture, represented by the percentage of Chapter 13 filings by non-African-Americans in the same district. The relationship between race and type of bankruptcy was still significant after all these control variables were statistically held constant.

A survey is a correlational study; it does not indicate the cause of the race difference. Was it self-selection or attorney bias? The authors hypothesized that lawyers were channeling Black clients into the less advantageous Chapter 13. However, it's possible that Blacks, for some unknown reason, prefer Chapter 13. Study 2 was an experiment which ruled out debtor choice as an explanation.

A total of 262 randomly selected bankruptcy attorneys were given a detailed vignette describing the financial situation of a hypothetical young married couple seeking bankruptcy and asked how they would advise them. Attorneys were randomly assigned to one of three racial conditions. While no explicit mention of race was made, the clients were identified as either “Reggie and Latisha” (Black), “Todd and Allison” (White), or by the initials “R. and L.” (Control). Everything else about the vignette was the same. Because attorneys might make different assumptions about the preferences of Black and White clients, a second variable was added. Within each race of client, one-third of the questionnaires specified that, although they hadn't decided, the clients were leaning toward filing under Chapter 7, one-third said they were leaning toward Chapter 13, and one-third said they had no preference.

The results were striking. 47% of the lawyers advising Reggie and Latisha recommended that they file under Chapter 13, while only 32% of the lawyers advising Todd and Allison recommended Chapter 13. In the control group where race was not specificed, 36% of the lawyers favored Chapter 13. Surprisingly, the couple's initial chapter preference had no significant effect. In fact, more attorneys suggested that the Black couple leaning toward Chapter 7 file under Chapter 13 (45%) than recommended it to the White couple that initially favored Chapter 13 (37%)!

In addition, the attorneys were asked several questions about how they perceived their hypothetical clients. The questions measured the clients' competence and whether the lawyers thought they had “good values.” The white couple was perceived not only as more competent, but also as having better values, when they preferred Chapter 7. The black couple, on the other hand, was rated as having better values and greater competence when they preferred Chapter 13.

The attorney's recommendations accounted for about two-thirds of the real world difference in chapter choice between African-Americans and Whites in a situation similar to that described by the vignette. This is consistent with the authors' assumption that the attorney is the primary factor in chapter choice. The attorneys' recommendations were racially biased. The option they were more likely to recommend to Black clients was less advantageous to the client, but of more benefit to themselves, since they received a higher fee.

This is consistent with previous research showing financial discrimination against Black customers. For example, they pay more for new and used cars, and receive less favorable terms when applying for a mortgage than Whites with the same assets. Apparently African-Americans are assumed to be less sophisticated customers, and salespeople attempt, often successfully, to take advantage of them. The present study also suggests to me that these lawyers rate both Black and White clients more favorably when the client's behavior conforms to their stereotypes: that Blacks are altruistic but stupid, and that Whites shrewdly pursue their self-interest with little concern for others.

A New York Times article on this research included comments on the studies which downplayed the possibility of discrimination against Blacks. The president of the National Association of Consumer Bankruptcy Attorneys said, “The study does not adequately control for the numerous complex factors that dictate chapter choice.” (In other words, “Give it up, social scientists; our work is just too complicated for you to study.”) A representative of the Woodstock Institute, a research and policy group, appeared to blame the victims by suggesting that Blacks' choice of Chapter 13 was explained by “a combination of higher attorney's fees and a filer's desire, or advice that elevates a filer's desire, to preserve as many assets as possible.” He failed to explain why a group known to have fewer assets is more interested in preserving them. More importantly, while Black preference is a possible explanation for the results of Study 1, it is ruled out as an explanation for the discrimination found in Study 2.

Incidentally, this is one of many studies that has subtly but successfully manipulated race by using first names frequently chosen by Black and White families. The discrimination found in these studies makes it clear that when parents choose stereotypically Black names, they handicap their children in certain situations.

Two Different Worlds

By now, just about everyone has seen this clip of Newt Gingrich in the final South Carolina debate among the presidential candidates of the Elephant Party.

First of all, the moderator, John King, asked Gingrich the wrong question. Does he want to respond to his ex-wife? Of course not! The question should have been about the hypocrisy of carrying on this affair while leading the charge to impeach Bill Clinton and marketing himself as a family values politician. Secondly, Gingrich knows how to work a room full of Elephants: by appealing to their contempt for the news media, in this case for ABC and CNN.

On January 17, Public Policy Polling released its second annual survey of trust in the TV news media. It was a telephone survey with 700 respondents and a marging of error of + or -3.7%. For each of eight networks, participants were asked whether they trusted it, did not trust it, or were not sure. Their press release stressed that PBS had the highest overall ratings, and that Fox News was both the most and least trusted news outlet. However, as Kevin Drum of Mother Jones pointed out, the most interesting finding involves a comparison between conservatives, moderates and liberals. Liberals and moderates trusted all the networks except Fox, while conservatives trusted only Fox.

I constructed the table below by subtracting the percentage who distrusted each network from the percentage who trusted it. Thus a positive number indicates that the majority in that ideological group trusted that network, while a negative number (or shaded cell) indicates a majority distrusted it. (To make the table fit, I omitted Comedy Central and MSNBC, but they showed the same pattern as the other five non-canine networks.) The results show that conservatives differ greatly from liberals and moderates, but liberals and moderates do not differ very much. Do conservatives live in a different world from other Americans?

	ABC	CBS	CNN	NBC	PBS	Fox
Very liberal	43	25	64	64	60	-57
Liberal	32	45	43	53	64	-49
Moderate	39	38	34	45	55	-27
Conservative	-44	-41	-30	-40	-11	47
Very conservative	-66	-68	-61	-66	-45	70

Cognitive psychologists have identified two types of rationality: instrumental and epistemic. Instrumental rationality refers to behaving in such a way as to maximize the chances of getting what you want, or in other words, making the choice with the highest expected utility. For example, if your goal is to make money on the stock market, do you choose stocks that increase in value? Epistemic rationality refers to how well your beliefs correspond with reality. Claiming not to “believe” in global warming or evolution is a failure of epistemic rationality. Bill Maher was talking about epistemic rationality when he quipped that Gov. Jon Huntsman—now out of the race—was the only one of the Elephant presidential candidates who believes that when an apple falls out of a tree, it hits the ground.

I certainly don't want to imply that all the other TV networks except Fox are free of errors and biases. News bias is difficult to measure, since there is usually no absolute standard of accuracy with which to compare a news story. Available research suggests that journalists, with the exception of Fox, are slightly to the left of the public on social issues, and slightly to the right of the public with respect to economics and foreign policy.

Centrism can also be a bias. One symptom of centrist bias is false balancing, in which the news media, apparently trying to be fair, claim that liberals and conservatives, Jackasses and Elephants, are equally extreme in their opinions, or routinely engage in equal amounts of deviant behavior. But if examples are given, they often show that the two sides are not really equivalent. Carrying a loaded gun to a political rally, for example, is not the same as carrying a rude sign.

For better or worse, the nightly network news represents a social consensus about what the most important events of the day were and what they mean. People who call themselves moderates find these newscasts, with the exception of Fox, to be largely trustworthy. So do liberals. By this criterion, conservatives live in an alternate universe from the one occupied by moderates and liberals.

Taming the Gift Culture

As Paul Ricci noted last week, one point about which supporters of single payer health care agree with conservative critics of the Affordable Care Act (ACA) is that it doesn't do enough to contain costs. That's where the agreement stops. We disagree about the major reasons that health care costs so much more in the U.S. than other industrialized countries; hence, we disagree about how to reduce costs. Advocates of single payer note that costs are certain to be higher when both medical care and health insurance are provided by corporations that are motivated to maximize profits.

To be fair, however, the ACA does contain some provisions to reign in costs, but without altering the basic economic structure of the system. One of these reforms was announced the other day. Manufacturers of drugs, medical devices and medical supplies used by Medicare and Medicaid patients will soon be required to report all payments and gifts they make to doctors or teaching hospitals. The data will be posted on a government-run website that will be searchable by the name of the doctor.

The New York Times reports that 25% of doctors report receiving cash payments and two-thirds report receiving gifts from drug and medical device manufacturers. This includes research and consulting fees; food, travel and entertainment; free samples (“the first bag of heroin is free”); plus all those incidentals such as pens and tote bags with the manufacturer's name on the side. (One doctor's son said that it wasn't until he was eight years old that he realized not all frisbees had the word “Merck” printed on them.) These gifts can result in doctors prescribing expensive new drugs that are no more effective than generics, or requiring tests and procedures that have no real benefit to the patient.

Doctors are embedded in what anthropologists call a gift culture, a network of reciprocal favors in which there is no explicit agreement as to when and how the favor will be repaid. These favors create feelings of obligation to the benefactor, obligations that may be repaid many times over, but the lack of an explicit quid pro quo reduces awareness of the corruption that is actually taking place.

Many years ago, social psychologist Bob Cialdini reported how a little gift can go a long way. Hare Krishna disciples who handed out paper flowers at airports, for example, were paid back many times over by voluntary contributions from recipients. There are several studies showing that this works in a medical context. For example, Orlowsky and Wateska (1992) examined the effects on doctors of free trips to seminars in sunbelt locations sponsored by the manufacturers of two relatively new prescription drugs. Their data showed significant increases in prescriptions of the two drugs in comparison to other hospitals, and in comparison to other drugs having the same effects. Interestingly, 17 out 20 doctors in the study stated unequivocally that the free trip would not influence their behavior.

This disclosure requirement is certainly a step in the right direction. My question is whether it goes far enough. Lawrence Lessig, in his new book about political corruption, Republic Lost, calls transparency a “reform that doesn't reform.” Have you ever looked at one of those lists of contributors to a political campaign? Did it help you? Most of them are people and organizations you've never heard of. The list provides little information about what these contributors wanted or how they were repaid after the election.

Similar lists of medical company gifts and payments may not be very useful to consumers. How many of them will consult the website in advance of a visit to the doctor? Even if they do, the fact that General Electric is on a doctor's list of contributors only helps if you know that GE manufactures the device that will be used to scan your internal organs. The fact that a drug company is on the list is useless unless you have memorized which drugs that company markets. In some cases, the absence of a corporation from the list may be more meaningful than its presence.

This website may be useful to researchers and investigative reporters, and this could benefit consumers indirectly if their studies are reported by the media. The existence of the list could also embarrass some doctors into refusing gifts, although I wouldn't count on that, since almost all doctors erroneously believe that gifts have no effect on their decisions.

But the real problem is that this is only a half-baked reform. Since we know the unfortunate effects payments and gifts have, they should be banned, not reported on some obscure government website.  

Circle of Jerks

Let's start out by acknowledging the obvious.  When U. S. Marines urinated on the dead bodies of Afghan citizens, that was stupid. Really stupid.

The sight of pixilated penises brings back memories of Abu Ghraib. But I suspect this was a more spontaneous demonstration of contempt for the enemy. You'll recall that the Abu Ghraib atrocities were traced to explicit communications from commanding officers about how to interrogate prisoners, the paper trail eventually leading back to the White House. (For a thorough analysis of the situational forces influencing the Abu Ghraib defendants, I strongly recommend social psychologist Philip Zimbardo's The Lucifer Effect.)

Predictably, as soon as the golden shower video went viral, the Obama administration's propaganda machine went into full outrage mode. Gen. Martin Dempsey, Chairman of the Joint Chiefs of Staff was “deeply disturbed” by the incident. Secretary of State Hilary Clinton expressed “total dismay.” Not to be outdone, Defense Secretary Leon Panetta called it “utterly deplorable.” What hypocrites! Where's the outrage over more than ten years of U. S. occupation in which we have humiliated, terrorized, maimed and killed unknown but substantial numbers of Afghan civilians?

The administration also claimed the scandal would hurt our reputation with the Afghan people. But this claim assumes that, prior to the pissing contest, the Afghans had a high enough opinion of Americans to allow room for it to drop. Hasn't anyone at the White House heard of the floor effect?

Here's a promise to anyone reading this blog. If you happen someday to run across my dead body, you have my permission to pee on it as much as you want. I won't mind at all.

Let's hope the military isn't too hard on these guys.

Gekkonomics

You won't be surprised to learn that the University of Pittsburgh Medical Center's (UPMC) out-of-network fees are way above the national average. According to data compiled by the Center for Medicare and Medicaid Services, UPMC charges more than many of the nation's most highly regarded hospitals, such as the Cleveland Clinic, and twice as much as its only real competitor, Allegheny General Hospital (AGH). In 2010, UPMC's average charge for inpatient care was $121,765, compared to $74,406 at the Cleveland Clinic and $55,205 at AGH.

Out-of-network fees originated in the 1980s, when Medicare and Medicaid began reimbursing hospitals prospectively rather than after-the-fact for some procedures. Insurance companies then began to negotiate discounts for their subscribers, in exchange for channeling those subscribers to “approved” doctors and hospitals. By 1990, only people without health insurance and international visitors were charged the “full cost” of medical services—the out-of-network rate. For people with health insurance, the “full cost” is really just funny money—an unrealistically high charge that appears on their statement. Health insurance pays only a fraction of that cost, and the remainder is waived.

However, in June 2013, out-of-network fees may become real money for many Western Pennsylvanians if UPMC, the region's largest hospital chain, carries out its threat not to negotiate an agreement with Highmark, the region's largest health insurance company.

If we accept the Medicare reimbursement rate as the real cost of hospitalization plus a modest profit for the provider, then UPMC has an average markup of 850%. Dr. Gerald Anderson, a health policy expert at Johns Hopkins University, is quoted as saying, “I think they have an ethical problem in trying to say they should be paid eight times more than what it costs to provide the service.”

This brings us to the presumed motive for UPMC's and Highmark's behavior—monopoly control and the ability to fix prices. Large corporations move toward monopolies through two types of integration, horizontal and vertical.

Horizontal integration occurs when companies buy out competitors that provide the same product or service, thereby increasing their market share. For the last decade, UPMC has been aggressively buying other hospitals in the region. AGH is its only major remaining competitor. If it provides an essential service and has no competitors, it can charge whatever it wants.

Vertical integration occurs when a company controls several stages in the supply chain that produces a product or service. For example, a company that sells natural gas to consumers may also own gas wells and control prices by speeding up or slowing down production. Or a movie studio may own a theatre chain which preferentially books its films and refuses to book films by competitors. In 1998, UPMC started its own health insurance division, the UPMC Health Plan. Highmark retaliated by agreeing to purchase AGH. Of course, both hospitals and insurance companies can use the threat of out-of-network fees to pressure clients to purchase the complementary service from its own affiliate.

It appears that both UPMC and Highmark are trying to obtain monopoly control of the health care system in Western Pennsylvania. Since our very lives are at stake, if either of these “nonprofits” achieves their goal, they will be in a position to make us what organized crime calls “an offer we can't refuse.”

Of course, this kind of outrageous profit-taking would disappear under a single-payer health care system.

Policy by Anecdote

On Monday, the Pennsylvania Department of Public Welfare (DPW) announced that, as of May 1, 2012, they will begin an asset test to determine if citizens are eligible for aid under SNAP, the Supplemental Nutritional Assistance Program, better known as food stamps. People under 60 will be ineligible for food stamps if they have more than $2000 in personal savings or other assets. Three items do not count toward the $2000 limit: their home, their retirement benefits, and one car.

In other words, if you lose your job and have $20,000 in the bank, you are not eligible for food stamps until you've spent $18,000 of your savings. This is not just mean-spirited, it is counterproductive. Prevailing theory and research on poverty suggests that poor people are trapped in a vicious cycle of poverty in which low income results in little or no savings, leading to intermediate outcomes such as poor health care and less education, which ultimately cause poverty to persist. Forcing people to be destitute before they qualify for public assistance makes it less likely they will ever break out of cycle. Since poverty has so many social costs, i.e., crime and urban decay, the new policy is not only harmful to poor people, but to society as well.

Pennsylvania's action is unusual during these economic hard times, since many states have eliminated their asset tests. The Rendell administration eliminated Pennsylvania's asset test in 2008. A total of 35 states have no asset test. Pennsylvania will join ten other states allowing maximum assets of $2000. The other four states have higher maximums.

What's going on? The change doesn't seem to be motivated by a desire to save money. SNAP is supported by the federal government. DPW only pays the cost of administering the program. But those costs will go up, because case workers will now have to survey each applicant's assets to determine whether they are eligible. If enforcement of the $2000 limit turns out to be sporadic or inconsistent, as certainly seems possible, this may permit prejudice and discrimination to influence whether people are eligible for food stamps.

What's really going on? Deep into the Post-Gazette article, we find a clue:

Some say the sudden call for an asset test coincides with the widely publicized story late last year of a Michigan man who won millions in a lottery but retained his food stamps.

DPW spokesperson Ann Bale acknowledged that they “constantly” hear from citizens complaining of food stamp abuse. However, Pennsylvania has one of the lowest food stamp fraud rates in the nation—one-tenth of 1%. Perhaps DPW gets phone calls not because of actual fraud, but due to stories such as this one on Fox News.

This case reminds me of Ronald Reagan's campaign fable about a Chicago “welfare queen” who allegedly cheated the government out of $150,000 and drove a new Cadillac. The story inspired a hit country and western song, “Welfare Cadillac,” by Guy Drake. It was a good story, but it was exaggerated and entirely unrepresentative of welfare recipients in this country.

Social psychologists point out that people are more easily persuaded by anecdotes than by statistical evidence. Belief in a statement, such as, “the food stamp program is widely abused,” depends largely on the ease with which we can recall or imagine examples that support the statement. Media exposure is a major source of the availability of anecdotes.

The anecdotes don't have to be true. For example, Melanie Green and Tim Brock did a study in which participants read a story, “Murder at the Mall,” about a young girl being killed by a recently released mental patient. Some were told the story was true; others were told it was a fictional short story. Both groups were more opposed to releasing former mental patients into the community than a control group that didn't read the story at all. There was no difference between those who were told that the story was true and those who were told it was made up.

I suspect Reagan's “welfare queen” played a role in Bill Clinton's eventual acquiescence to the pressure to "end welfare as we know it.” The problem, of course, is that you can make up an anecdote to “prove” virtually anything. In this blog, I'll argue that that public policy should be based on research evidence.

Update (2/1/12)

On February 1, the DPW announced a change in the asset limits.  People under 60 will be able to retain assets of up to $5,500, while those who are over 60 or disabled can keep up to $9,000.  

Romney's Gaffe

Governor Mitt Romney's statement, "I like being able to fire people," has been widely misinterpreted.  He did not say that he enjoys firing his employees. The reality is much worse. The remark was made in the context of a discussion of health insurance. It shows how out of touch Romney is with the health insurance system in this country.

Please read this comment by Aaron Carroll, from The Incidental Economist blog.  He points out why most Americans can't fire their insurance company. I have nothing to add. I just wanted to call it to your attention.

Housekeeping

In December 2011, before starting this blog, I published five articles on health care policy on the PUSH (Pennsylvanians United for Single-Payer Healthcare) blog. I also did two trial blog posts relating to science and human sexuality. I have added these seven blog posts to the end of this blog roll, in the usual inverse order of when they were originally written.

In the future, any blog entries about health care will be cross-posted here and at the PUSH website.

Kicking Assessments

This post deals with a local Pittsburgh controversy. My apologies to out-of-towners. Maybe Pittsburgh's political buffoonery is similar to foolishness taking place elsewhere.

The following was written on Friday, December 30:

Judging by media coverage of our tax reassessment controversy, Pittsburgh property owners will soon be marching on city hall with torches and pitchforks. I'd like to take a step back to see whether all this confusion and anger is really justified.

Property values in Allegheny County have not been reassessed since 2002. When there is a long time between reassessments, this places an unfair burden on people whose property values are static or declining, while unfairly benefitting those whose property has increased in value. Since the second group is generally more affluent than the first, failure to reassess is a Robin-Hood-in-reverse social policy. It steals from the poor to give to the rich.

Our politicians and the media have stoked fears that reassessment will lead to tax increases, but it shouldn't if our elected officials follow the law. State law prohibits windfall profits from a reassessment. Municipalities are required to adjust their millage rates downward to ensure the changes are revenue neutral. The magnitude of the tax increases that our more affluent citizens must pay should be balanced by declines in the taxes of less affluent residents.

That doesn't mean Allegheny County's reassessment will be completely fair. Any errors will be heavily publicized by the media, but the appeal process is intended to remedy them, provided they are random and not so numerous as to overwhelm the system.

There will also be families whose personal circumstances do not match those of their neighbors, i.e., people on fixed incomes living in prosperous neighborhoods. Whether their tax increases are unfair is debatable. People benefit from living in a nice neighborhood regardless of the value of their own home. The homestead tax exemption is a partial solution to this problem. We can also take perverse comfort in the fact that Pittsburgh is highly segregated by social class, thus minimizing these mismatches.

Both the outgoing and incoming Allegheny County Executives, Dan Onorato and Rich Fitzgerald, have argued that the county should not be required to reassess its properties unless the rest of Pennsylvania is also forced to do so. I agree that the other counties should be required to update their assessments, since that is fairer to the residents of those counties. However, if frequent reassessment is a beneficial social policy, Allegheny County should do it regardless of what other counties are doing. The only people harmed by this policy are homeowners who are currently getting a free ride. Their taxes will be higher than if they lived in some other county. But their taxes should be higher. To call this unfair is a bit like saying that if Allegheny County enforces laws against DUI but Butler County does not, this is unfair to the drunk drivers of Allegheny County. Is this really a compelling argument?

Our public officials, nominally members of the Jackass Party, have wasted our time and money by refusing to implement the reassessment. This would seem to be a clear indication of their class loyalties. The working poor seldom make campaign contributions. While their rhetoric is intended to mislead us into thinking they are trying to protect poor people from losing their homes, it is the wealthiest persons (and “corporate persons”) who benefit from the delay.

These class loyalties would be more obvious if the news media did a better job of presenting the issues involved in reassessment. Unfortunately, the Pittsburgh Post-Gazette and the other media have added to people's confusion and anger by framing their news stories primarily as “the looming threat of a tax increase,” rather than using the more accurate frame of “restoring fairness to our tax system.”

Fortunately, I didn't post the preceding note because I hadn't yet worked out some of the kinks in my blog. Since then, there have been several developments that have added some nuance my opinion.

It was announced that Pittsburgh residences have increased in value by 46% due to the reassessment. The average for commercial properties is 71%, for an overall average of 57.89%. This should give homeowners an idea of whether their taxes will increase or decrease and by how much. For example, my assessment went up 76%. Subtracting 58% from 76%, I should expect my taxes to increase about 18% as a result of the reassessment. Chris Briem has analyzed these changes in value and found that approximately two-thirds of Pittsburghers will see their taxes drop, while fewer than 5% will be hit with a tax increase of 100% (double) or more. If this is true, Pittsburghers have been hit with an epidemic of false consciousness.

There are some indications that inconsistencies in the reassessment are not random. Rich Lord of the Post-Gazette analyzed the new values in three neighborhood blocks. In increasing order of affluence, they are Sheffield Street in Manchester, Pius Street on the South Side Slopes, and Saint James Place in Shadyside. Contrary to what we might have expected, the assessments increased by 118% in Manchester, 66% in on the Slopes, and only 21% in Shadyside. The average assessment exceeded the average recent sale price in Manchester, but was lower in the other two locations.

Ruth Ann Dailey, the P-G's most conservative local columnist, has suggested there was social class bias in the reassessment: “I'd bet dollars to data entry clerks that we'll find this situation holds true throughout the city—the percentage increases in poor neighborhoods' assessments will be much greater than the increases in the wealthier ones, because assessors can't conceive that anyone's home could be worth so little.”

It is important to find out if this allegation is true. The P-G's sample is far too small to draw a firm conclusion. Someone should analyze a much larger sample of reassessments randomly selected from around the city. If there is evidence of social class bias, they must be all discarded.

Ms. Dailey's benign explanation for class discrimination is not entirely convincing. If data entry clerks were systematically mistaken, I'd bet dollars to campaign contribution checks that these biases were somehow transmitted down the food chain from the politicians at the top. As Lily Tomlin said, “No matter how cynical you get, it's impossible to keep up.”

This morning's paper reports that Rich Fitzgerald has “thrown out” the reassessments. Our 2012 tax bills will use the old rather than the new values, setting up a confrontation with Judge R. Stanton Wettick, Jr., who ordered the reassessment. Fitzgerald has said he will go to jail rather than give in. Judging from some recent reports of conditions in our state prisons, it might be a good idea for all incoming government officials to spend a few nights there, just to give them an additional perspective on how some of their citizens live.


Update (1/14/12)

On Thursday, Allegheny County Executive Rich Fitzgerald faced off against Judge Stanton Wettick. Wettick blinked. The reassessment has been postponed for a year. Poor people will continue to pay more than their share of taxes while rich people and corporations will continue to benefit. Fitzgerald calls this “a great victory.” Next year, they will fight the same battle again. In Pittsburgh, nothing ever gets settled.

After the commercial property assessments were released, the business community, with the help of its friends at the Post-Gazette, went into a front-page, full-court press. We were told that the reassessments of the downtown skyscrapers had no rhyme or reason, and that if corporations were forced to pay their fair share of taxes, they would leave Pittsburgh and throw the city into another recession. The one-year delay gives their high-priced lawyers an opportunity to appeal the reassessments. Should they win some of these battles, reductions in the assessed values of $200 million buildings will have a significant impact on the overall 58% increase in value of city property. If that percentage drops, homeowners will pay more taxes.

One helpful development is that some local journalists, notably Len Barcousky and Brian O'Neill, started to get it, and to inform their audience that the majority of Pittsburghers would have been helped, not hurt, by the reassessment. Blogger Chris Briem's analyses played an important role in spreading that message.

Fitzgerald says he will use the next year to persuade state government to order a reassessment of all the real estate in Pennsylvania. With the Elephants in total control of every branch of state government, it's hard to believe he's serious.

The G.O.P. Olympics and the Blame Game

This post originated with an article entitled “The Ten Craziest Economic Policy Ideas of 2011.” In October, Florida State Representative Ritch Workman, a member of the Elephant Party, introduced a bill to end the state's ban on dwarf tossing. (In case you're wondering, I scanned several articles about Rep. Workman's proposal, and none of them suggested that he was any less than completely serious.)

Dwarf tossing is a contest usually held in bars in which participants compete to see who can throw a dwarf the farthest. The dwarfs wear padded clothing and are thrown onto a mat. In a variation, they wear Velcro clothing, are tossed at a Velcro-coated wall, and the goal is to see who can toss them the highest. Finally, there is a low-rent variation in which the dwarfs are tossed into the waiting arms of the audience. (If you're curious to see what a dwarf toss looks like, you can check it out on You Tube.)

Photo by djmarmite

For reasons about which I hesitate to speculate, this sport caught on in Florida in the 1980s. In 1989, after pressure from the Little People of America, the Florida legislature passed a bill banning the practice. Violators may have their liquor license revoked. The bill was probably helped along by the death of a dwarf, of alcohol poisoning, during a contest. There were also reports of injuries to dwarfs, including paralysis. (Little people are particularly prone to back injuries.) Dwarf tossing is also banned in New York state. To the best of my knowledge, the rest of us are free to practice the sport, if we can find a willing victim.

As the article suggested, Workman justified ending the ban on economic grounds: “All that it does is prevent some drawfs from getting jobs they would be happy to get. In this economy, or any economy, why would we want to prevent people from getting gainful employment?”

However, Workman may have also been expressing his libertarian philosophy: “I'm on a quest to seek and destroy unnecessary burdens on the freedom and liberties of people. This is an example of Big Brother government.”

By coincidence, I used to ask college students to discuss dwarf tossing as a way of introducing the ideas in John Stuart Mill's essay, On Liberty (1859). As you probably know, Mill argues that people should be free to do whatever they want, provided they do no harm to others. The state has no right to restrict your freedom merely to prevent you from harming yourself, either physically or morally. Presumably, the tossees in a dwarf toss are willing participants in exchange for money. Mill would say that it is paternalistic for the state to protect them against their will.

While I did not collect any data, it appeared to me that only a minority of students thought that dwarf tossing should be banned. These students were concerned not only about the risk of injury, but the fact that it is degrading and dehumanizing to treat physically handicapped people in this way. Of course, an individual who agrees to prohibit dwarf tossing is on a slippery slope. This opens up the possibility that other dangerous or humiliating activities (i.e., drug taking, prostitution, high school football) might also be restricted in the interest of public safety or the moral order.

However, in my experience, the majority of students opposed any restrictions on dwarf tossing. They emphasized the point that the dwarfs didn't have to agree to be tossed. They had a choice, and it is wrong to take that choice away from them. Maybe that's why so many politically engaged college students describe themselves as libertarians and support Ron Paul for president.

The problem, as I see it, is that they overemphasized the “choices” dwarfs make and failed to recognize how much those choices are constrained by factors beyond their control. The physical stature and poor general health of little people limits their job possibilities. They often work as spectacles in the entertainment industry and are the subject of negative stereotypes. While many dwarfs qualify for disability-related social security, this hardly provides a standard of living to which most Americans aspire. All of these factors limit the amount of choice little people have and channel them into making the “decision” to be a tossee.

American middle class ideology emphasizes individualism, independence and freedom of choice. We fail to take into account the fact that, for many people, the only “choices” available are all quite similar or almost equally undesirable. We don't recognize how much our own and—especially—others' choices are limited by our social environment.

Social psychologists are beginning to study the effects of this free choice ideology on our social and political attitudes. For example, in 2011 studies by Savani, Stephens and Markus, and by Savani and Rattan, the authors reminded participants of the concept of choice by having them either write about their own past choices or identify choices in the behavior of others. Compared to control participants who performed similar tasks not involving choice, those participants for whom choice was primed:

• Show decreased empathy and increased victim blaming for disadvantaged people.
• State less support for social policies that promote social equality (i.e., affirmative action) or public benefits (i.e., reducing air pollution), but greater support for individual rights (i.e., drug legalization).
• Were less disturbed by income inequality, and less willing to support policies that redistribute income more equally (i.e., progressive taxation).

These studies imply that the concept of choice is sometimes used to justify discrimination. For example, it is said that women deserve less-than-equal pay because they “chose” to take time off to bear and raise children.

The next time you go into the voting booth to choose between two candidates whose policies are virtually identical, and with whom you disagree on most issues, you might want to remember that, if you don't like the outcome of the election, you have only yourself to blame, since, after all, you had a choice!

Here's a talk by Nicole Stephens on social class differences in the understanding of choice. (It is posted in three parts, each about nine minutes long.)

I managed to toss that dwarf quite far, didn't I?

New Year, New Blog

I've been meaning to do this for a long time.

This blog's title is inspired by Daniel Kahneman's 2011 book, Thinking, Fast and Slow.  In it Kahneman presents the theory, well accepted in social psychology, that our thought processes can be described as if they are organized into two systems.  System 1 is automatic, effortless and outside our awareness.  It consists of innate responses to external stimuli and well-learned patterns of behavior.  It is likely to make errors, such as overreacting to our fears.  System 2 is deliberate and effortful.  It is what we recognize as the content of our consciousness.  While System 2 can also make errors, careful thought offers our best hope of responding rationally to an increasingly difficult environment.  Here's a link to a recent lecture (about an hour long) by Kahneman on the subject of his new book.

We live in a country in which a major-party candidate for President has implied that allowing gay people to have sex will lead people to have sex with animals.  It is hoped that this blog will encourage more rational thought.  Specifically, I hope to apply the best available knowledge to the solution of our many social and political problems.  And to have a good time doing it.

Since I'm a social psychologist, many of my examples will come from that field.  However, I will touch on many other fields, including sociology, economics, political science, communications media, and the environmental sciences.  Since no one can be an expert in all these areas, I hope you'll bear with me and correct me when I'm wrong.

The posts are intended for general audiences, so if you find them either too technical or too simplistic, please let me know.

Your comments and suggestions are always welcome.