On Queue

As I've previously written, one of the most effective ways to suppress voter turnout is to create long waiting lines at the polling place so that many potential voters will leave in frustration. This method has long been used to discourage voting in minority areas and around college campuses. It can be done by not having enough polling places or voting machines in heavily populated areas, or by creating procedural delays, such as requiring I.D. checks, but not having enough poll workers to carry out these operations efficiently.

This method of voter suppression is insidous for a couple of reasons. First, unlike other voter suppression efforts, it leaves no traces. There is no way to accurately count the number of discouraged voters. Secondly, the public often blames the victim and argues that if discouraged voters had only been more patient, there would have been no problem. Needless to say, this ignores the fact that many people have other obligations, such as work and child care, and cannot afford to spend hours in line at the polling place.

This problem is finally receiving some of the attention it deserves. The New York Times reports the results of a survey by political scientist Charles Stewart showing that blacks and Hispanics wait longer in line than whites. The survey was conducted over the internet by YouGov/Polimetrix. They contacted 10,200 people, 200 from each state and the District of Columbia, for a survey on “the quality of the voting experience.” The average self-reported wait time was 14 minutes. Here are the differences by race:

Race	Waiting time
White	12.7 minutes
Hispanic	20.2 minutes
Black	20.2 minutes

They also found significant differences by size of county, with people from larger counties—that is, urban areas—waiting longer. There were large differences by state, with Vermont having the shortest average wait time (2 minutes) and Florida the longest (45 minutes).

Is this a representative sample? YouGov/Polimetrix is a polling organization that is increasingly popular with social scientists. They provide opt-in internet survey panels. People volunteer to participate in internet surveys. They are notified by email when their participation is requested. For each completed survey, they receive points exchangeable for prizes such as movie tickets and gift cards. A recent study suggests that their results are as valid as more expensive telephone surveys, primarily because of recent declines in public willingness to participate in telephone surveys. While you might think that their volunteers would be higher in political interest than the average person, YouGov/Polimetrix actively recruits low interest respondents and can statistically weight its results to correct for this and other types of unrepresentativeness.

Another response to this survey might be, “They are lying.” That is, critics might speculate that African- and Hispanic-Americans deliberately exaggerate their wait times in order to claim the status of victims of discrimination. I doubt whether the wait time issue is sufficiently politicized to produce this type of bias, but if it is, you could claim that whites might also exaggerate their wait times in order to deny that they are beneficiaries of discrimination.

The Stewart study focuses attention of Florida, whose average wait time was 11 minutes longer than the second worst location, D. C. The Orlando Sentinal recently commissioned an engineering professor, Ted Allen, to estimate the number of Floridians who left without voting on Election Day, 2012. Dr. Allen has developed a mathematical model which predicts turnout suppression from parameters such as number of registered voters, number of voting machines, ballot length, etc. It was originally developed to measure voter suppression near the Ohio State campus in 2004. Although the model is too mathematically complex for me to understand, it is published in peer-reviewed journals.

One of Allen's more important discoveries is that you can predict turnout suppression from the number of hours the polls have to stay open after closing time. For each additional hour the polls stay open, turnout is suppressed by about 4.8%. This allows you to estimate the number of discouraged voters in each precinct. If you then assume that the discouraged voters would have voted for the candidates in the same proportion as those who actually voted at that location, you can estimate the number of votes lost by each candidate.

Based on the sample of precincts he analyzed, Allen estimated that 201,000 Floridians left in frustration on Election Day, which is 2.3% of the number of votes cast. He predicts that 108,000 of these votes would have gone to Obama and 93,000 to Romney, so Obama's margin of victory would have been 15,000 votes greater had these people voted. Obama carried the state by 74,309 votes.

There are many remedies for long waiting lines, including making Election Day a holiday, expanding early voting times, and ensuring that the number of polling places is proportional to the population. It is outrageous that, in many states, one party controls voting procedures and manipulates them to serve their interests. There is speculation that President Obama will call for voting reform in the State of the Union address. However, as long as Republicans continue to benefit from voter suppression, it is unlikely that reform legislation will get through our gridlocked Congress.

Tom Corbett to PA's Working Poor: "Drop Dead!"

Part 1. Medicaid Improves Health and Saves Lives

On Tuesday, PA Governor Tom Corbett stated that at this time he cannot recommend accepting $38 billion in federal funding to expand Medicaid under the Affordable Care Act, thereby denying medical assistance to more than 700,000 Pennsylvanians. This series of posts will consider the implications of that decision.

It is difficult to arrange a definitive test of whether a social policy such as Medicaid is effective in achieving its goal of better health. In order to demonstrate causality, you must run an experiment with a randomized control group design, in which some people are randomly assigned to receive Medicaid (the experimental group), while others are randomly assigned to not receive it (the control group). Random assignment is critical. You can't compare Medicaid recipients to all non-recipients because to be eligible for Medicaid, you must be poor, and poor people have worse health outcomes. Since Medicaid is voluntary, you can't compare people who sign up and receive Medicaid to other eligible people who don't sign up, because people seek out health insurance when they are ill. While these flaws may seem obvious, you should be careful. Opponents of government health insurance will sometimes cite these flawed comparisons to convince people that Medicaid is counterproductive.

Assuming that a randomized control group design is not possible, there are two general ways to evaluate a social reform such as Medicaid expansion. In a time series design, you measure the outcomes of a group of people from before to after the change is implemented. The main problem with this design is that other events may occur at the same time as the reform, and they may serve as alternative explanations for the results. In a comparison group design, you compare the outcomes of a group of people who receive the treatment to a comparison group that does not receive it. Outcomes are measured at the same time. The problem with this design is that the two groups may not have been equivalent at the beginning of the study. Any irrelevant difference between the two groups can be an alternative explanation for the results. It is possible to combine the good features of both these designs in a time series design with a comparison group. However, it is still possible that some outside event that coincides with the treatment is affecting one group more than the other.

 All rights reserved by forwardstl

I will discuss two studies, both published in 2012, that evaluate Medicaid outcomes. Since these two studies are superior to any that have gone before, previous studies are basically irrelevant. A study by Benjamin Sommers and others, published in the New England Journal of Medicine, utilized a time series design with comparison groups. One of its strengths is that it used three experimental groups and four comparison groups. In 2001 and 2002, three states, New York, Maine and Arizona, substantially expanded Medicaid by relaxing their eligibility requirements. For example, in New York, you could previously apply for Medicaid if you were below the federal poverty level. In 2001, people were allowed to sign up if their income was at or below 150% of the poverty level. For each of these states, they selected geographically close and demographically similar comparison states that did not expand Medicaid access. New York's comparison state was Pennsylvania, Maine's was New Hampshire, and Arizona's were Nevada and New Mexico. Since they were interested in whether Medicaid saved lives, the primary outcome measure was the mortality rate, which in this country is reported at the county level. All the outcomes were measured from five years before the change until five years after.

The results showed that prior to Medicaid expansion, there were no significant differences in mortality between the expansion and comparison states. After they implemented the expansion, these states showed a 6.1% reduction in mortality relative to the comparison states. Additional analyses showed that, as you might expect, the decline in mortality was greatest among the poor, minorities and older adults. Survey data showed that Medicaid expansion was associated with a 24.7% increase in Medicaid coverage, a 21.3% decrease in the rate of delayed care due to cost, and a 3.4% increase in number of people saying their health was “excellent” or “very good.” The authors calculated that one life per year was saved for every 176 adults that were added to the Medicaid rolls.

As impressive as these results are, they do not prove that Medicaid caused these health improvements.  A critic might argue that these three states—especially New York, which showed the greatest drop in the death rate—are not typical of the rest of the country, and thus the study exaggerates the benefits of Medicaid. Fortunately, circumstances have given us a randomized control group design with which to evaluate the effects of Medicaid. This is the “gold standard” for social policy research. In 2008, Oregon attempted to expand its Medicaid program, but didn't have enough money. They invited people who were eligible to apply. Ninety thousand people applied, and 10,000 of them were randomly selected to receive Medicaid in a lottery. Amy Finkelstein and her colleagues are conducting an ongoing survey comparing the lucky winners to those who applied but were turned away. They reported some preliminary results last year.

The main finding is that the Medicaid group is 25% more likely than the control group to report themselves in “good” or “excellent” health, as opposed to “fair” or “poor” health. More importantly, 40% fewer people in the experimental group reported a decline in their health over the last six months. (The reason this difference is so much greater than in the Sommers study is that Finkelstein only compared Medicaid recipients to those who were turned away, while Sommers' data estimated the health of everyone in these states regardless of whether they were enrolled in Medicaid.) As you would expect, the Medicaid group reported more doctor and hospital visits, more preventive care, and fewer unpaid medical bills.

The number of people in the Oregon study is too small to detect meaningful differences in mortality. Nevertheless, the two studies converge to give us the best evidence we have ever had that Medicaid improves its recipients' health and saves some of their lives. In the next post in this series, I will look at cost considerations.

You may also be interested in reading:

Tom Corbett to PA's Working Poor:  "Drop Dead!" (Part 2)

Tom Corbett to PA's Working Poor:  "Drop Dead!" (Part 3)

Tom Corbett to PA's Working Poor:  "Drop Dead!" (Part 4)

The Pain of Paying

This is an easy post.  I'd like to call your attention to an interesting video by social psychologist Dan Ariely about "the pain of paying."  The pain is greater when you must pay cash, and when you pay at the time of consumption.  It can influence your decisions about what to buy and your enjoyment of the product.

What's the most socially significant innovation intended to reduce the pain of paying?  I nominate the credit card.

Why This? Why Now?

At the top of the front page of this morning's Pittsburgh Post-Gazette is a reprint of a Washington Post article by Craig Whitlock (“Missteps by U. S. in Africa revealed”) reporting that in 2003, the U. S. had an opportunity to assassinate Mokhtar Belmokhtar, alleged mastermind of last month's attack on an Algerian natural gas facility in which 38 hostages were killed. The attack was “vetoed” by the U. S. ambassador to Mali, Vicki Huddleston.

“I'm really frustrated right now because I think we blew it,” said retired Air Force General Charles Wald, exhibiting perfect 20/20 hindsight. If you read far enough into the article, you find that Ms. Huddleston gave three reasons for blocking the proposed air strike: (1) Belmokhtar had never attacked Americans; (2) ten years ago, he was considered only a “minor figure;” and (3) it was “unclear” whether he was actually in the proposed target area. I'm not a terrorism expert, but those sound like three very good reasons not to bomb somebody. The article, however, presents this as a huge blunder by Ms. Huddleston.

The first thing to note about this article is that it is unlikely to have resulted from an independent investigation by the Post reporter. It is there because somebody leaked it. The Pentagon is proposing to expand American strikes into Africa by unmanned aircraft (drones). The article implies that our only mistake is not doing targeted assassinations of Africans soon enough. This story is a public relations triumph for the Pentagon under any circumstances, but it appears in the context of several recent developments related to American military policy.

• A memo giving a “legal defense” of the American policy of assassinating U.S. citizens suspected of terrorism has been leaked to NBC reporter Michael Isikoff. The defense can be charitably described as inadequate, and raises more questions than it answers. Here is Rachel Maddow interviewing Isikoff. It is well worth watching.
  
  
  
  
• President Obama has claimed the right to unilaterally engage in acts of cyberwarfare (computer sabotage) against American enemies, including the right to carry out preemptive cyberstrikes.
  
  
• The Senate will hold a confirmation hearing Thursday on the President's appointment of John Brennan to head the CIA. Brennan is strongly identified with support for drone strikes against enemy targets. He will almost certainly be questioned about the policy—but probably not very aggressively.

This Just In . . .

The British government has just awarded a $31 million contract to Prox Dynamics of Norway for development of a nano-drone, to be used for surveillance in Afghanistan. The miniature helicopter is four inches long and weighs 16 grams. It is part of a trend toward ever smaller drones.

Use of a nano-drone for surveillance is outrageous enough, but equipping them with powerful nano-bombs is said to be only months away. How long will it be possible to keep these devices out of the hands of private citizens? Will a future U. S. president be assassinated by a nano-drone?

Zero Thirty Darkness

I've seen Zero Dark Thirty. The first and last 45 minutes were intensely involving for all the wrong reasons. As for the rest, it was actually fairly dull, showing that real police work doesn't necessarily translate into an interesting movie.

I come down squarely on the side of those who believe the film takes the position that torture was effective in gathering the information that led to the assassination of Osama bin Laden. The director, Kathryn Bigelow, and the screenwriter, David Boal, argue that the film does not support or endorse torture. They claim to be merely presenting the facts, and that it is up to viewers to draw their own conclusions. Boal says, “It doesn't surprise me that people bring political agendas to the film but it doesn't actually have a political agenda. It's agenda is to tell these people's stories in the most honest and factual way we know how . . .”

First of all, the film doesn't report everything that happened during those ten years. It is necessarily selective. One of the things it completely leaves out is any debate over either the efficacy or morality of torture. (You could argue that an even more significant omission is it failure to present events that occurred before 9/11, which would reveal bin Laden and al-Qaeda to be “blowback” from previous CIA activities in Afghanistan.)

But let's stick to what is in the film. As filmmakers, Bigelow and Boal should be well aware of the basic elements of the cinematic code. A film is a visual argument. Montage—that part of the film that takes place during editing, the arrangement of successive shots—can suggest relationships between people and events that may or may not exist in reality. As Russian director and teacher Lev Kulashov pointed out, A + B can equal something entirely different. Kulashov showed viewers an identical shot of a man's face and asked them to describe his emotional state. When intercut with shots of a plate of soup, a woman in a coffin and a little girl playing, his emotion was described as hunger, sadness and joy, respectively.

Zero Dark Thirty contains a scene in which a prisoner, Ammar, is having lunch with two CIA agents, Dan and Maya. He gives them valuable information that eventually leads to bin Laden's courier and bin Laden himself. Prior to this, we saw scenes in which Ammar was brutally tortured—waterboarded, hung by ropes, and locked in a small box—by Dan as Maya watched. It is virtually automatic that an experienced media consumer will to draw a causal connection between the two scenes—that Ammar gave them the information because of the torture, and to avoid further torture. In fact, Dan reminds him that he could be tortured again. (Boal claims that a scene of Maya in her research room shows that all the important information was already available from detainees who were not tortured, but I would suggest that this scene is not very salient and its meaning is unclear.)

Another Russian filmmaker, V. I. Pudovkin, said montage is “the method which controls the 'psychological guidance' of the spectator.” It is possible, if you have the necessary information, to counterargue with this natural tendency—to tell yourself that the filmmaker's implication that torture is effective is false. However, it is unrealistic to expect very many viewers to draw this conclusion. The film could impact public opinion, as some would argue the fictional television drama already 24 has. Although the reasons are unclear, the percentage of Americans who say torture is rarely or never justified has shown a small but steady decline, from 53% in 2004 to 42% in 2011.

Filmmaker Michael Moore defends Zero Dark Thirty, arguing that the average viewer “will be repulsed” by the torture scenes: “After watching the brutal behavior of CIA agents for the first 45 minutes of the film, I can't believe anyone of conscience would conclude that this is morally NOT right.” But Moore is ignoring the possibility that we have already been desensitized to torture scenes by years of fictional programming. He is also making the egocentric assumption that other people will have the same reaction to the film as he did. But the torture scenes are embedded in a narrative in which the torturers are the heroes and their goal of killing bin Laden is one of which the audience strongly approves. To make things worse, the heroine, Maya, who the film suggests may have been responsible for the death of one prisoner, is is ignored and patronized by her CIA colleagues, making her ultimate triumph a victory for feminism as well.

Below is a discussion of some of these issues that appeared on the PBS News Hour.  

There has been little comment about last 45 minutes in which the Navy Seals fly by helicopter to bin Laden's compound, break into the buildings, and kill bin Laden and several other people. Here again, the problem is omission. No one raises the question of whether the U.S. government had the right to execute bin Laden and several others suspected of lesser crimes without due process of law. Zero Dark Thirty implies, however, that the alternative of bring him back alive for trial was never seriously considered.

Glenn Greenwald maintains that Zero Dark Thirty is U. S. government propaganda directed at American citizens. Peter Maass refers to it as “a troubling new frontier of government-embedded film-making.” Unlike other branches of government, the CIA is forbidden to distribute propaganda in this country. However, this is nothing new for the Defense Department. As David Robb argues in Operation Hollwood: How the Pentagon Shapes and Censors the Movies, film studios usually require military cooperation in order to produce technically realistic-looking war movies. In exchange, the Pentagon is given script approval—veto power over points it disagrees with and the right to insert its own ideology into the films. The predictable result is films that arguably distort history, i.e., Blackhawk Down, or function as recruiting videos for the services, i.e., Top Gun.

But Zero Dark Thirty takes this process a step further. The opening title claims that the film is “based on first hand accounts of actual events.” That is, they received privileged access to classified information of the type that the CIA usually prosecutes people for revealing. But the CIA's claim that torture was instrumental in the hunt for bin Laden is at odds with conclusions drawn by other branches of government, such as the FBI and Congress, and may conflict with the views of a minority of CIA employees. We are getting not the government's point-of-view, but that of a subgroup within the government. The effect is to empower the most brutal and reactionary ideology within the “defense” establishment—the Cheney-Rumsfeld plan for fighting terrorism. The film propagandizes the American people in an effort to get them to accept war crimes by their own government.

Football's Days Are Numbered

I had to write this post today because I was disgusted to see Chris Hayes, who just a week ago led an insightful discussion of football brain injuries, sign off this morning by telling his audience to “enjoy the game (the Super Bowl).” This was followed by the hopeless Melissa Harris-Perry wearing a football jersey. Yech! I can't put off this topic until next Fall.

Football is America's most popular sport. The National Football League (NFL) makes an estimated $9.5 billion a year. (No one knows the amount spent on gambling.) How can its days be numbered? I have a one-word answer: “Boxing.” I can remember when boxing was the fourth most popular sport in this country. It was on television almost every night, even though we only had a half-dozen channels. Sports fans knew the names of the champions of all the weight divisions. In the '60s, Muhammed Ali was said to be the most well-known celebrity in the world. Can you name a current boxing champion? Who's the last heavyweight champ you remember? (Mike Tyson effectively ended his career when he bit Evander Holyfield's ear in 1997.)

Muhammed Ali had more to do with boxing's decline than anyone else. The entire world has seen his struggle with Parkinson's disease, and we rightly attribute it to the blows to the head he took in the ring. I suspect many Americans decided that, if this is the consequence of being a boxer, not only would they not allow their children to box, they didn't want to be implicated in this self-destructive behavior by supporting the sport with their time and money.

We now know from studies of posthumous brain samples that football injuries can cause chronic traumatic encephalopathy (CTE), whose symptoms include headaches, memory loss, lack of impulse control, depression and dementia. We don't yet know the percentage of former players who will suffer these symptoms because the samples came from former players who were known or suspected to have CTE. Boston University researcher Chris Nowinski suggests that 20% is a “conservative” estimate of the number of players in today's Super Bowl who are playing with incipient dementia. Ten percent of NFL players are diagnosed with concussions each year. We also don't know whether the risk is primarily due to concussions, or whether CTE is also caused by the cumulative effect of chronic routine hits.

But the situation is changing quickly. Researchers are now able to diagnose CTE in living patients (45 years and older) using PET scans. As these diagnoses gradually move forward in time, we may get answers to these important questions. How will these answers affect willingness to play the game?

 All rights reserved by Harry Funk

The argument is often made that the players know the risks they are taking, and that they are well-compensated for their services; therefore, they are responsible for their own victimization. The over 4000 retired players who have filed damage suits against the NFL point out that they never gave truly informed consent, since they were never advised of the risks of head injuries. At present, what the NFL knew about head injuries and when they knew it is contested. We may eventually find a coverup similar to the tobacco industry, but then again, we may not. Two things can be said about this debate:

• The present generation of players is much more aware of the risks, and it hasn't affected the ability of the NFL to recruit players. I suspect this has something to do with players' ability to rationalize that these negative consequences will not happen to them.
• The monetary argument does not apply at all to the far greater number of college and high school football players, who receive little or no compensation for the risks they are taking. And can football players under 18 legally give their informed consent?

What will happen in the next few years? I expect the NFL to lose some of the lawsuits filed by former players, but the settlements will amount to only chump change for this $9.5 billion institution. They will make a few public relations gestures, like the one announced yesterday. The NFL is spending $50 million to partner with General Electric to develop better brain imaging technology and safer helmets. There will be highly touted but minor rules changes in the name of safety. The NFL will make excessive claims about safety improvements, knowing that they may not be fully testable for decades. In the end, Dave Zirin is probably right when he says, “There is no making football safer.”

When real change comes, it will have to come from the bottom up—which is why it will take a while. I see two promising possibilities.

• President Obama has said, “I have to tell you, if I had a son, I would have to think long and hard before I would let him play football.” Change will come when more parents begin having this conversation with themselves and other parents. Willingness to let their sons play high school football will decline.

• Colleges football is a key step in the system. Some colleges and universities have medical schools. Almost all of them have biology and psychology departments. Their faculties will understand the latest head injury research and transmit it to the rest of the community. I expect them to start putting pressure on college administrations to reduce their involvement in football.

In the end, however, the meat grinder that is football depends on our willingness to watch. To quote Dave Zirin again, “If people are disgusted by the violence visited on these players, they should vote with their feet and stop watching.” If we would not play football ourselves, or let our sons play it, shouldn't we be embarrassed to watch young men from poor families take these risks merely because football offers them a small chance of getting rich?

Eventually, only the most callous and morally obtuse among us will be proud to call ourselves “Steeler fans.” I would rather be ahead of than behind that curve.

Tom Corbett, Privateer

“I'm all about privatization,” says Pennsylvania's Governor Tom Corbett. In case that wasn't clear, his chief of staff Kevin Harley adds, “The governor is a proponent of bold privatization. That has been his consistent position from day one—and it hasn't changed.”

Yesterday, Gov. Corbett announced his plan to sell or auction off the state liquor store system and expand the number of outlets permitted to sell liquor, wine and beer. He optimistically claims this will raise a one-time windfall of over $1 billion as follows:

• $575 million from the sale of liquor licenses.
• $224 million from auctioning off the 1200 state liquor stores.
• $107 million for new wine and beer licenses.
• $112.5 million for licenses allowing beer distributors to sell liquor.

Apparently, the governor is not confident that this proposal will survive on its own merit, so he has tied it to the more popular cause of education. The $1 billion will be used to fund block grants for school districts, to be targeted to four areas: safety, early education, individualized learning, and STEM (science, technology, engineering and math) programs.

Gov. Corbett claims the new system will be “revenue neutral” in the long term, but the numbers don't appear to add up. Currently, since the state owns the liquor stores, they take in revenue from both profits (the difference between wholesale and retail liquor prices) and taxes on liquor sales. If they are going to give up the profits, they are going to have to sell a lot more booze (at higher prices?) to make up for those lost profits with additional tax money. Maybe he is indirectly asking Pennsylvania residents to get drunk more often “for the sake of the children.”

Less than three weeks ago, the governor announced the sale of the Pennsylvania state lottery to Camelot, a British firm that promises to increase gambling revenue, so Pennsylvanians are already being asked to throw more of their money away for the sake of our senior citizens.

 Some rights reserved by The Rick Smith Show

Gov. Corbett also supports expanding our reliance on charter schools, another form of privatization. We should not necessarily assume that all of the $1 billion will go to public schools, since local school districts are required to pay charter school tuition for students in their districts. And what exactly does the governor mean by “individualized instruction?”

Blackmail is usually defined as threatening “to make a gain or cause a loss to another unless a demand is met.” In his first two years in office, the governor has cut back sharply in state funding for public schools. Apparently, to get some of that money back, Pennsylvanians must agree to his liquor privatization plan.

Mike Crossey, president of the Pennsylvania State Education Association, the public school teachers' union, commented, “It's nice that the governor has acknowledged that he created a school funding crisis, but our students shouldn't have to count on liquor being available on every corner in order to have properly funded schools.”