Sunday, March 30, 2014

World Migration Chart

I'm blogging this link in order to see a larger image. 
Where everyone in the world is migrating—in one gorgeous chart



It’s not the poorest who migrate the most

While the results of the migration study aren’t particularly groundbreaking, there are two interesting insights:
1) Adjusted for population growth, the global migration rate has stayed roughly the same since around since 1995 (it was higher from 1990-1995).

2) It’s not the poorest countries sending people to the richest countries, it’s countries in transition—still poor, but with some education and mobility—that are the highest migratory contributors.
“One of the conclusions they make in the paper, is the idea as countries develop, they continue to send more migrants, and at some point they become migrant-receiving regions themselves,” says Fernando Riosmena, a geographer from the University of Colorado, who did not contribute to this research, but is collaborating with one of the authors on a future paper.

A few other noteworthy results:
1) The largest regional migration is from Southeast Asia to the Middle East. This is largely driven by the huge, oil-driven, construction booms happening on the Arabian Peninsula

2) The biggest flow between individual countries is the steady stream from Mexico to the US. (In fact, the US is the largest single migrant destination)

3) There’s a huge circulation of migrants among sub-Saharan African countries. This migration dwarfs the number leaving Africa, but the media pay more attention the latter because of the austerity-driven immigration debates in Europe.

Tuesday, March 25, 2014

Tuesday, March 18, 2014

HCR -- Patient-Centered or Profit-Centered?

Two recommended readings this morning were brought to my attention by a comment left at The Health Care Blog yesterday. What the Work of the Inspector General Tells Us about Patient Safety… by Dr. Ashish Jha is the first reading. 

The second is the comments thread, focuses on the connection between what professionals euphemistically call "sentinel events" (another way of referring to often preventable circumstances leading to often fatal results) and how they are paid for (or not).

~~~~~~~~~~~~~~~~~~~~~

A couple weeks ago while waiting for my wife to undergo a hospital procedure I read an unsettling link about (you guessed it) patient safety in hospitals. It was not a pretty picture and I urge others to check it out.
>> The OIG looked at care for a national sample of Medicare beneficiaries and what it found was unexpected: 13.5% of Medicare beneficiaries suffered an injury in the hospital that prolonged their hospital stay, caused permanent harm, or even death. 
An additional 13.5% of Medicare patients suffered “temporary” harm – such as an allergic reaction or hypoglycemia – things that are reversible and treatable, but quite problematic nonetheless. Taken together, these data suggest that 27% of older Americans suffer some sort of injury during their hospitalization – much higher than previous numbers. 
There are three more statistics from the OIG report that should give us all pause: First, they estimate that unsafe care contributes to 180,000 deaths of Medicare beneficiaries each year. This is a stunningly high number. Second, Medicare pays at least an additional $4.4 billion to cover the costs of caring for these injuries. And finally, about half of these events are preventable based on today’s technology and know-how. 
I suspect that if we actually make safety a priority, many more events would become preventable over time. And yet, although hospitals are supposed to identify, study, and track adverse events, the OIG says it mostly isn’t happening. At least not in any systematic way. <<
That should be enough to whet your appetite. But a comment left yesterday about the connection between the PRICE of medical care (I refuse to say "cost" which is quite different from "price") and outcome statistics reminded me of Dr. Jha's post, which I would rather forget.
>> What is really disgusting is that these errors, i.e. “adverse events” are NOT reimbursed by CMS or GAP and Advantage Insurers. Medicare/Medicaid patients (most prone to suffer from adverse events) who pay Medicare and Social Security taxes their whole working lives have NO IDEA that they are the victims of errors and “charity” patients for the hospitals —and that they may be hastened unto death for fiscal expediency and to hide the errors. 
Disgracefully, our Congress, HHS, CMS and Big Insurance, when they developed the policy to NOT reimburse hospitals/physicians for adverse events, made no law that protects the patients and that requires hospitals, physicians, or Medicare to notify patients that they are the victims of errors and “charity” patients for the hospital. Often, these elderly/disabled Medicare/Medicaid patients are hastened unto death with covert/overt (default DNR Code Status) for the fiscal expedience of Big Insurance and the hospitals. 
This is what happens when you have “profit-centered” health care and not patient-centered healthcare. The epidemic of unilateral covert/overt(default DNR Code Status) that is extrapolated into the hospital charts of elderly/disabled Medicare/Medicaid patients to limit/withhold life-saving and life-extending treatments that won’t be reimbursed is a national disgrace. <<
There is more at the link. Much more, including a raft of supportive outlinks as well. I trust the reader to follow the trail, drill into the links and in the end, as they say, follow the money. 

Sunday, March 16, 2014

About That "Government Workers" Trope

I can't decide which group bothers me more, Conservatives or their Libertarian cousins.  Another of my Facebook links triggered this rant.

Sorry. He lost me with that first sentence.
"It is probably safe to say that government workers are nowhere near as efficient as private sector workers either."
It is NOT safe to say that. And anyone who paints with such a large brush needs to be painting fences in the country, because up close he's pretty sloppy.

I have had mixed impressions of "government workers" but by and large those who are deep in the woodwork are quite competent at what they do. My Social Security enrollment was an unexpected pleasure once I got past the long wait in the waiting area. The young woman who did the work was no only friendly and proficient, when she learned my wife and I had birthdays eleven days apart she picked up the phone and took my wife's application over the phone. This was at her initiative, not mine.

My experience with Medicare has been limited but the few times I have contacted them by phone the wait was long but the service was excellent. When I signed my mother up for Medicaid it was the same thing -- the caseworker was dedicated to the file and more empathetic than I expected would be the case.

I could go on, but this trope about government workers being no good is a pernicious, widely-repeated lie. And while I'm ranting, I wonder if the writer has stopped to think that every man and woman in the military service, either in uniform or in some civilian capacity, is a "government worker."

Now, having got that off my chest...

When I went from the for-profit sector (with which you are well aware, I'm sure) into the so-called NOT-for-profit sector I had the same experience that this writer described when his civilian buddy went from the coast guard to the private sector. Except the person making a transition was me leaving one part of the private sector and moving to another.

I was shocked at the attitudes about work that I found in the non-profit place where I worked. There were plenty of experienced, dedicated, competent people around me, but there were also many whom I would call deadbeat, putting in their time, watching the clock and taking the path of least resistance when there was any option.

Worst of all, the place was awash with money and nobody -- even supervisors and department heads -- ever mentioned any dollar amounts. Everything was about The Budget, as though the target for good performance had little or nothing with waste or efficiency, but everything about "meeting the budget" no matter what that might mean.

Early on I asked a few people where the money came from and got a blank stare as though I had asked why the sun rises every morning. "It's in the *budget*" was the answer.
"So who makes the budget?"
"They make it up every year."
"But where does the money come from?"
"...."
Finally..."It's in the budget!"

After a while I gave up asking. It was like asking a kid where food comes from. "The store" of course is the answer. Forget farming, shipping, cooking. etc. It's a child's grasp of a question too big to answer.

All that I have just described is NOT a part of "government." It is solidly in the private sector, probably more solidly than the for-profit outfits who at least pay taxes. I would love to see some numbers comparing how many for-profit companies go bankrupt compared with the non-profits. I be the two lists would be ridiculously uneven. I can't recall offhand ever hearing of a non-profit going bankrupt except in the case of fraud or other criminal activity.

Sorry for the rant. Some things push my button. As I said, that "privatization is better" is not just partly if not mostly wrong, it's also just stupid.

If anything is wrong with government, it's wrong with us. One of the uncomfortable realities we need to face is that we DON'T live under tyranny. Whoever is in charge is up to us, the voters who put them there. (Which is why every time I hear Senator Sanders I want to move to Vermont so he can be one of my Senators.)

Conservatism is a Belief, Not an Ideology

Pew research returns this fascinating factoid
[There are] five sites that are among the most shared on Facebook, but do not rank among the most visited sites. All five are conservative-oriented news sites: theblaze.com, breitbart.com, washingtontimes.com, mrconservative.com, and wnd.com. 
These sites have relatively modest audiences, with mrconservative.com at the bottom of the list at 772,000 monthly unique visitors....Indeed on average, the four, conservative digital political sites (excluding the legacy washingtontimes.com) got 22% of their traffic from Facebook referrals – far more than any other grouping of news sites.
Chris Cillizza advances this idea at Wapo:
What explains how those five conservative news sites are so actively shared on Facebook but come nowhere close to the raw traffic numbers of some more mainstream media sites? 
Here's my theory. Conservatives are a remarkably well-organized and tight-knit group. It's why every book from a conservative author shoots to the top of the best-seller list. It's why Fox News Channel's primetime programming regularly doubles that of its cable competition. It's why Rush Limbaugh has no talk radio equal among liberals. It's not terribly surprising then that organizational closeness extends to the digital space where conservative use Facebook to share stories/links from a handful of conservative websites.
This link came up in my Facebook newsfeed and I have a different take on this little nugget.

"Tight-knit and well-organized" is a generous way to describe a brainwashing feedback loop. To they resemble a cult more than any other kind of assembly. At the nether edge of respectable conservatism are all kinds of ignorant nut cases for whom beliefs transcend facts. 

They are like my father was, so hard set in their beliefs that they are unable to change, much like people with a substance abuse problem. My Dad was a good man, decent and likable in every way. But his blind spot was his inability to discern the difference between opinion and fact. He *could* change his opinion about something, but only if he was presented with a mountain of incontrovertible evidence to the contrary.

The challenge was most intractable when it came to the civil rights movement. We were from Kentucky where there were not many black people. But the ones we knew we really did know. They were treasured neighbors and friends, some of whom worked with my family in some capacity. The next farm down the road from my grandfather was owned by a black family and I can remember as a child Miss Lee inviting my Dad and me to come in for a visit and she served him some of her homemade wine. I also have memories of being taken with a handful of my Dad's family to a black church or two to hear and experience gospel singing, which could be more intoxicating than any wine. That was what my growing up was like in the Fifties.

But when the Civil Rights Act of 1964 was being debated, my family, like nearly all white Southern families, saw it as something essentially immoral, a departure from the way they felt God had organized the family of man. Their racism was serious and deep, a manifestation of their faith as much as any social convention. The fact that they had allowed me to play among the children of our black neighbors was never interpreted to be anything other than the way neighbors behaved decently to each other. But just because somebody lives nearby, that was not any reason, in my father's estimation, that they were suitable candidates to be an actual part of the family -- and that was the ultimate fear he faced. He never said the words, but I have heard them from more places than one: "Would you want your sister to marry one???" (I didn't always get to answer, but when I did my reply was "Which one did you have in mind? I can think of many I would love to have in the family if they would allow me to join theirs.")

What we have learned to call "Conservatism" is not really an ideology as much as it is some form of faith. It is based more on beliefs than facts in the same way that my Dad's opinions were always so embedded that they were not open for discussion. Arguing with a parent or role model about a belief is tantamount to breaking one of the Commandments, the one about honoring one's parents. And even in the New Testament can be found Paul's teaching in Romans that civil authorities are put in place by God, and it is now our place to question them. Conservatism and its cousin, Libertarianism, are tough belief systems to overcome. And that is why I see both as belief systems  rather than political ideologies.

(One of the most curious of contradictions is the attraction Ayn Rand the atheist laissez-faire capitalist has for Christian Conservatives whose faith teaches love and caring for the poor -- those core Christian principles that are making the new pope so controversial in Conservative religious circles.)