Why I no longer read editorials in the Oregonian

The 2016 election wasn't just a political choice, it was a moral one. 

Trump is a racist and a bigot.  His politics is to scapegoat: not to solve problems but to use them to incite hate against anyone he can mark as "Other."  Trump's political lineage flows through no American, foreign despots like Putin and Saddam Hussein are his heroes.  Trump is an affront to America's democracy and a threat to its citizens.

On that choice, the OEB had no opinion.  No opinion about a man who threatens fundamental freedoms like speech and press.  No opinion about whether women in the military should have to salute Donald Trump as their commander in chief.  No opinion on whether Trump's bigotry sbould be embraced or condemned.  No opinion on his religious tests or his threat to deport millions.  On the moral choice which is now the struggle of our times, the OEB was silent.

They are boot lickers.

I don't need to read their words to know what passes from their lips.

Presidential Leadership and how I assess it

A response to Brett about how I evaluate presidential candidates, which turned into something too long for facebook.

Before assessing candidates I filter for likely supreme court picks and electability.  These are pass/fail tests, and only Clinton and Sanders pass them.  They're the ones I'll evaluate as leaders.

I think of leadership geographically.  A good leader's task depends on understanding:

• Where we are (the real)
• An intended destination, a place they want to lead us to (the ideal)
• A route, a plan of action to go from where we are to where we should be.  That route is grounded in the real,  but looks forward to the ideal.
• Implicit in the route is an understanding of time, and some reasonable expectation of whether the route they're following takes one year, 4 years, or 20 years.
• Also implicit is an understanding that they're *leading* us down the path, not directing us.  That requires consent and confidence, and an ability to rally support even when (especially when) it feels like everyone is turning on you.

 I'll start with the ideal.  I think both Sanders and Clinton want to move us to a better place.  I think Sanders' ideal is in many ways preferable, we'd be better off with stronger social insurance and investments in education.  But I think Clinton's ideal isn't bad either, particularly on foreign policy.  I think Sanders ideal their is a United States that stays home, while Clinton's ideal is a strong global leader capable of effectively confronting global challenges.  Those challenges include climate change and trade relations as much as they do military conflicts.

Next let's look at their grasp of the real.  Here Clinton is overwhelmingly better.  I think Sanders reduces everything to a Manichean dichotomy of good guys and bad guys.  Why is the health care system the way it is?  Bad guys did it!  Why is there massive economic inequality?  Bad guys did it!  Why have Republicans dominated Congress for most of the last 20 years, and control most state governments?  Bad guys did it!  I think what Sanders dismisses as mere moderation is a view of the world which recognizes that truth may be complicated.  

I think Clinton has a much better grasp of why things are the way they are because she's more conscious of history, and how things change with time.  Women's rights are an obvious example, women today have far greater opportunities than they did when she was young.  In addition, she played a direct role in shaping history in some pretty important ways.  Health care reform isn't an abstraction to her, she knows what it's like to try developing and passing a national program and she knows how hard it is to push the status quo.

Now we get to route, and Sanders' biggest deficit against Clinton.  As far as I can tell, his plan for every issue consists of:

• Everyone will share my values, and therefore
• Everyone will do exactly what I want, and
• Anyone who does otherwise is a bad guy and will be politically neutralized by my blindingly obvious rightness and goodness.  (not only does Sanders reduce the world to good guys and bad guys, he doesn't put much thought into why the bad guys win so often)

For Clinton, I'd guess her domestic policy would be focused on stopping the Republican Congress from doing harm and helping Democrats win votes next time around, with her most important action being good picks for the courts (and getting them approved).  I think we'd see a stronger foreign policy, particularly on climate change, because that's where there's more leeway.  Those are modest steps, but they're oriented towards a better place than where we are now, they're achievable, and they're progress.   

I have no idea what a President Sanders would do, because I don't think any of his ideas work.  What do you expect of someone who promises to build a ladder to the moon?  Pretty much anything but a ladder to the moon.  That said, go back to what I said at the beginning about filtering and electability.  There's a lot I dislike about Sanders, but I'd vote for him (happily) if he were the Democratic nominee.

The difference between health care and housing policy, and why I'm inflexible on the latter

This was written in response to a friend's comment on facebook.  Published here because I hate reading long comments on facebook.

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I think there are two big differences between our discourse on housing policy and that with health care.

First, the external context for the latter was much more objectively defined.  Health care had been the topic of extended national debate.  There was tremendous literature on health care reform, from academics to journalists and everyone in between.  Many of those people were self-consciously working to inform public debate, people like Aaron Carroll and Uwe Reinhardt put a lot of work into translating research results and policy discussion into layman's terms.  You and I could draw on that, it wasn't just "I think…".  Finally, when we began discussions the ACA was law, we never dealt with mutually exclusive choices where doing one thing necessarily implied not doing something else.  We also never confronted value choices like universal coverage vs. affordable care for the very sick, the ACA set the table.

None of that is the case with housing policy.  I find the literature sparse and of limited scope, and the only people promoting it in public discourse are advocates of one policy or another.  There's nothing objective to connect with.  And with that material we confront a vaster problem, the gulf between "what is" and "what should be" is bigger with housing.  For example, even before health care reform we had  backstops, anyone could walk into an ER and receive life sustaining care.  We didn't have bodies in the street.  That's clearly not the case with housing.  A bigger problem means bigger solutions, and more variability in preferred courses of action.

The second difference is that with health care, I thought both the state and the country were going in the right direction.  Political debate was focused on how best to expand access to care, there was no voice of significance arguing that we needed less access to care, or that some people should get care and others should not.  I'd liken health care discourse to a river that, while it had rocks and other hidden dangers that could turn over the unwary, would sooner or later get everyone to the right place.  In contrast, I think the housing discourse in Portland is headed to a terrible place. 

Two groups have dominated that discourse in recent years.  One is a large chunk of people interested in nothing other than preserving the economic exclusivity of their neighborhoods.  The other is a smaller chunk of people who think the problem isn't that there's not enough housing, but that the wrong people get it.  They want to take housing away from some people and give it to others.  Those two groups define political discourse in Portland, every code or policy proposal related to housing since Sam Adams left office served one group or the other.  Needless to say, I think both groups are wrong.  To go with the flow, to not contest the bogus assumptions (less housing means lower prices!  people can't live without cars!) and questionable values (I should be able to dictate the economic class of my neighbors!) they rely on, is to accept a more racially and economically exclusive Portland.  I don't want that.

At the bottom, I suspect we have fundamentally different ideas on what a community should do to define itself. I'd call one way a negative approach, to exclude those who don't conform.  How do you maintain a neighborhood of Amish people?  You refuse to allow residency to anyone who isn't Amish.  That negative approach is conservative and reactive, at best it preserves what is.  It relies on authority rather than consent.  It is sterile, incapable of building anew.

As you might guess, I think the negative approach is intensely undesirable, I'd go so far as to say it's a recipe for community self-destruction.  Such a community lasts only so long as it attracts sufficient members, and as soon as its authority or self-definition is violated it becomes meaningless.  White city neighborhoods that spilled blood resisting integration only to crumble away into suburban flight are an example.

The alternative is a positive approach, to promote public community institutions and traditions that are open to all.  Things like parks, schools, and community groups can include residents regardless of demographics.  They can demonstrate to residents what they can do, and why they should care.  That approach creates a two-way conversation, it continually challenges groups to show their relevancy and adapt as necessary.  It doesn't just maintain but increases the public good by bringing an interest to people who wouldn't otherwise be exposed to it, and in turn by being exposed to new ideas and challenges that exclusion wouldn't allow.

I think the positive approach, building more good, is what Portland desperately needs.  I think that's how Portland should respond to growth.  Not by putting up walls, but by embracing people and showing them who we are.

Aristocracy of Everyone

I finished reading Benjamin Barber's An Aristocracy of Everyone.  It was published in 1992, the same year I headed to college.  The context in which it was written- the emergence of multiculturalism, and reactionary criticism of "political correctness", brings back memories.

Barber tries to carve out a middle ground between radical and reactionary, and he does it in an interesting way.  He starts from the equation that Liberty = Education, and that a primary purpose of getting educated is to understand liberty and support it.  Barber is worried that we've lost our sense of "positive" liberty, the obligations we must accept to make self-government possible.  We're too infatuated with "negative" liberty, the right to do as we please without interference.  The latter without the former is impossible because we interact with each other too much, generally speaking we aren't hermits.

To the left Barber says that majority rule by itself isn't enough for good governance, that uneducated voters are no more than a mob waiting for their demagogue.  To the right Barber says that liberty for the masses is both possible and desirable, and implicitly they are flim-flam artists for wanting otherwise.

It's heady stuff and there's a lot of quotable material.  But it comes up short in in its prescription:  How do we educate people in liberty?  Barber's suggestion is to add a service component to undergraduate degree requirements.  This is inadequate on multiple levels.

First, as Barber ably demonstrates the problem of uneducated citizens isn't primarily a problem of youth.  The dominant systems students interact with- education, economy, culture- are largely controlled by elders.  The world outside of college is much, much bigger than the world inside of college.  Adding a service requirement won't change those systems or the incentives they create.

Second, what work does Barber envision students doing?  He means for work to be a component of education in democracy and its obligations, something more than charity.  What would he have students do?  Invert the question and ask how much does your company need a bunch of pre-interns who explicitly aren't actually working for you, but are instead guided by a goal of understanding democracy and its obligations?  Who, outside of non-profits, would even let them in the door?  I think the service requirement runs into a hard reality that most of our economy is private, it has nothing to do with democracy.

The answer to Barber's challenge has to focus on people who aren't students, on civic organizations that bring people together to pursue common interests.  Those interests might be political, such as with a political party, they might be local, as with a neighborhood association or PTA, or they might be issue oriented such as with advocating a cause.  What they have in common is
    • people coming together, working in concert and learning that the whole is greater than the sum of its parts,
    • coming together on a public matter, not limited by class or education, and
    • doing it in their free time, as in not subject to anyone's direction but their own.  When people are at work they aren't free, they're guided by bosses or business requirements.  Liberty exists when we aren't a Teacher or a Welder or an Accountant, but when we act on our own as citizens. 

Learning about liberty means learning that what we do "on our own" in public matters, those actions define what is public. 

Consumer choices vs. Community choices

I came across this quote in Ravitch's book.  It's part of a discussion of school choice, but I think it applies to Oregon measure 90 as well.  Emphasis mine:

The market undermines traditional values and traditional ties;  it undermines morals, which rest on community consensus.  If there is no community consensus, then one person's sense of morals is as good as the next, and neither takes precedence.  This may be great for the entertainment industry, but it is not healthy for children, who need to grow up surrounded by the mores and values of their community.  As consumers, we should be free to choose.  As citizens, we should have connections to the place we live and be prepared to work together with our neighbors on common problems.  When neighbors have no common meeting ground, it is difficult for them to organize on behalf of their own self-interest and their community.

What is the top-two concept but an attack on political parties?  And what are political parties but the vehicle by which residents organize and collaborate for political activity?  I think parties are exactly the common ground Ravitch references above.  Without that common ground, we're just a bunch of individuals screaming in the wind.

Elected Officials are not Cheeseburgers

I think there are multiple reasons to dislike this Oregon's ballot Measure 90, which would create a top two primary.  It essentially discards our current system by doing away with primaries as we know them, moving the real election to May, and relegating November to a mandatory runoff.  It tosses out a century of work at opening party primaries, replacing them with an amorphous endorsement process whose value is unclear.  If current party primaries are bad because of limited participation, how much worse will an endorsement process be which has no rules or customs?  If most people don't vote in the pre-election now how many will vote in the pre-pre-election?  And for what?  To tread water on overall voter participation?

But I want to focus on one particular aspect of arguments for Measure 90, the idea that it increases competition and that this is unambiguously good. A recent Oregonian editorial was dedicated to the concept, and it's a common element in arguments for the measure.  But is it right?  Is an uncompetitive election necessarily bad?

We have good reason to take the idea for granted.  For most consumer decisions it holds true, having more choices allows a more specific decision that better aligns with our preferences.  The more restaurants that serve cheeseburger, the more likely it is that one of them serves the exact combination of product and price that you want.  But are elected officials like cheeseburgers?  Not really.

• The decision to buy a cheeseburger is individual, one person makes the choice and immediately gets what they asked for.  Elections are a community decision.  Votes are cast by individuals, but they are cast for one office and only one individual wins.  In the end everyone will be served the same thing.
• The timing of the decision to buy a cheeseburger is entirely at individual discretion.  One can buy cheeseburgers as often as one wants, it can be centennial or hourly or anywhere in between.  Elections are on fixed schedules and the decision generally lasts for a fixed term.
• Cheeseburgers have a price constraint.  That constraint overrides any other preference, one cannot buy what one cannot afford.  The price constraint doesn't apply to voting, there is no cost to choosing one candidate over another.

Put those elements together and think about what a cheeseburger decision would look like if it had the same properties as an election.  Communities would decide by majority rule what cheeseburger everyone would have to eat, over a term of years.  They would have to make this decision without a cost constraint, so any topping, ingredient, style, or quality level would be allowed.

That would be a miserable decision even for just a married couple.  It would be miserable because in effect the only reason one couldn't get their "dream burger", one that matched exactly to what they wanted, would be the constraint of getting their spouse's agreement.  And the spouse would have the exact same problem.  Now expand the voting pool to an entire community and you can see why elections are contentious, even violent, things.  Unlike the individual's decision to buy a cheeseburger, I think communities need some structure to effectively reach a decision.  That's where parties and primaries come in.  They facilitate coalitions and compromises, they provide organization to what would otherwise be a war of all against all.

As an example of how this plays out consider approval ratings.  Who would you guess has higher ratings, an incumbent running unchallenged or a newly minted freshman who won a narrow victory?  Which election did the public feel better about, George W Bush's ultra-narrow victory in 2000 or the dominant wins by Reagan in 1980 or Obama in 2008?  The closer an election, the more competitive it is, the more people necessarily are unhappy with the outcome.

When measure 90 supporters uncritically support competition they are using the wrong model.  Elections aren't consumption decisions, elected officials aren't cheeseburgers.  An election is much more like a hiring decision, the community is hiring someone to do a job.  Competition isn't totally irrelevant to making a good hire, but it's significance depends on the circumstances:  is it an open position or already filled?  If the latter is the person competent?  Are they so incompetent that it warrants firing them in favor of an unknown?

Looking at it that way it's easy to see why many elected offices aren't always competitive, it's because voters are reasonably good at filling them.  What's wrong with that?

Special Sessions comment

I was irked by today's op-ed lauding Oregon's recent special session as a model for the future. Below is a comment on the story, with the intended formatting. The O's commenting system has a grudge against paragraphs. 

Special sessions are a poor way to run a government.

The recent special session was the embodiment of "quick and dirty" solutions.  It valued short term results- a short term boost and in revenue, a short term boost in school funding- in return for long term, unknown liabilities.  How much of the PERS reform will survive court challenge?  What impact will the tax cut on S corporations have if businesses reorganize so as to take maximum advantage of it?  And in the mix of that short term thinking was pure pork:  a GMO bill that had nothing to do with taxes, nothing to do with education, and that in no way was an emergency requiring immediate intervention.

Oregon may well face an extended period of relative scarcity, where tough decisions that cross traditional interests become routine.  But that makes it more urgent to make such decisions carefully, with full consideration of costs and benefits and long term outcomes.  There are times when leaping before you look may be a good thing.  The management of long term contingent liabilities is not one of them.

Deliberation not only allows for better decisions, it allows the public through its legislative representatives to take ownership of those decisions.  That matters if one believes in democracy and self-government.  What good is a compromise reached only because legislators didn't vote their conscience?  Plus it improves the chances of continuity, and that efforts at reform will be sustained until the underlying problem is solved.  The governor now says PERS reform is off the table.  Is PERS no longer a problem?  Is school funding no longer a problem?

Instead of careful deliberation backed by citizen support what we got in the special session was a plate of spaghetti thrown at the wall.  We can and should do better.

An open letter to Governor Kitzhaber

Governor Kitzhaber,

I'm writing to express disappointment with your use of the power to call the legislature into special session.  Twice now you have called for sessions based not on emergencies but based on political advantage.  I believe the outcome of these sessions is poor legislation with inadequate consideration of long term goals and consequences.

Last year, a few weeks before Christmas you called the legislature into special session to provide a tax perk to Nike.  Reporting in the Oregonian shows that you were in active discussions with Nike several months prior to December.  You had ample time to advise the legislature of Nike's request and to allow a more deliberate and public discussion of the costs and benefits of Nike's proposal.  You chose to call a special session not out of need but out of convenience.  After being called, the legislature faced a fait accompli.  There was no time to consider alternative mechanisms that could accommodate Nike and other businesses, the legislature's choice was to accept the demand or risk driving the underlying investment out of state.  

The resulting legislation had immediate negative consequences as other large employers wondered why they hadn't received similar consideration.  And the long term consequences of the Nike deal- a 30 year dispensation from state tax law backed by an insurance contract underwritten by the state- are utterly unknowable.  No one knows what state tax law will look like 30 years from now or what liability this created for Oregon.  Fortunately, the legislature was wise enough to include a sunset provision that voided this power without additional legislation.  In the 2013 session there was not even a proposal from either party to renew this power unaltered.  That strongly suggests that when the legislature had time to think about it they found the "Nike Bill" to be a bad idea.

The current special session, called for September 30th, is only marginally better grounded.  The "grand bargain" of PERS reform and tax changes was actively considered in the 2013 regular session.  But that just shows that the use of an emergency session is even less justified.  Neither PERS nor taxes are new.  Neither PERS nor taxes is going away.  So why can't a grand bargain wait until next year?  

The nominal reason, to provide immediate funds for the current school year, is poorly considered.  It is well known that public employee unions will challenge any changes to PERS in court, including those already passed in 2013.  What happens when the court, as is quite possible based on past experience, overturns some portion of the reforms?  What happens to schools which spend money this year that they don't actually have?  It has been a longstanding complaint of districts that their budgets are unstable, leading to constant cycles of hiring and firing teachers.  Your use of the special session here ensures that problem will continue.

The short term education dollars bought with a special session may prove more costly in the long term.  In my school district, it is estimated that the grand bargain would provide an additional 40 teachers this year.  That's nice, but there are 78 schools.  Given ludicrously high class sizes, an extra half-teacher per school isn't an adequate remedy.  Getting class sizes down to something reasonable will require a larger conversation with teachers about the connections between compensation, class sizes, work environment, and ultimately their work output.  Even great teachers become bad teachers when classes are too big.  Having that conversation requires a great deal of trust and respect, it requires that the public and teachers speak and hear each other.  Rushing PERS changes through the legislature and depriving unions of input makes that conversation less likely.

Emergency legislation should address what is truly an emergency and nothing more.  That is not how you've used your power to call special sessions, and in my view your use of that power has hurt the state more than it helped.  I urge you to use greater discretion, and have more respect for the legislative process.

Thoughts on Why Leaders Lie

I just finished reading John Mearsheimer's Why Leaders Lie: The Truth About Lying in International Politics.  It's a short easy read providing a taxonomy of the kinds of lies leaders tell and their possible consequences.  Two things struck me.

First, nothing encourages lying like war.  Since war is a matter of survival, successful prosecution of war is a moral imperative that overrules prohibitions against lying.  Plus, the government takes risks and has consequential screwups in war more often than in any other venture.  There are fewer penalties for lying in war and much more to lie about.

Second, lying has bad consequences for democracies.

• It impairs the ability of voters to act on their interests at the ballot box.  Informed choices are impossible without good information.
• It impairs the ability of government itself to function as agencies learn to distrust each other.  Everyone has to devote extra resources to verification and they won't always get it right, either missing a lie or assuming something true is false.  As with voters informed decisions requires good information.
• Lying undermines the rule of law.  When it becomes commonplace it's hard to hold anyone accountable, the excuse that "so-and-so got away with it so why shouldn't I" looms larger and larger.  Plus, frictional costs weigh down the system.  IL governor George Ryan banned the death penalty not because it was wrong but because lying was so prevalent in prosecutions that it could not be fairly applied.
• Finally, it breeds cynicism in the public and dissolves respect for democracy.  A nation with a cultural of lying is vulnerable to authoritarianism.

Putting those two ideas together you have to wonder, what happens to a democracy that embraces permanent war?

Republicans and ineffective medicine: The saga continues

The love affair between Republicans and ineffective medicine grows ever more torrid.  Last week it was seeking to undermine the US Preventative Services Task Force, this week it's eliminating health services research.

These attacks on effectiveness research are bizarre.  Republicans claim to support market solutions to health care, but one of the biggest obstacles to that is that people have no idea what they are buying.  Are they buying a Cadillac treatment that delivers 100% satisfaction with no side effects or a 1979 Pinto that will blow up in their face?  When people can't tell the difference between shit and shinola there is no market and you can't have market solutions.   If Republicans are in any way serious about markets they should be advocating for more effectiveness research, not less.

So what explains the attraction?  Why do Republicans seek to protect treatment that doesn't work, like widespread PSA screening?  It's almost like they're afraid of the paradigm of using evidence to guide decisions.  Probably because in the real world so much evidence goes against them...

Why CCO's may not fail like HMO's

In response to @ChargerJeff, who asked why CCO's would fare any better than HMO's:

HMO's did succeed at cost control, which is a primary purpose of CCO's.  Where HMO's failed was in working cooperatively with doctors and patients, CCO's if they are to last will have to do better.

Reasons to think they will:

• We already have managed care, particularly in OHP.  The distance between where we are and where CCO's are going is shorter than the distance between indemnity plans and HMO's.

• The distance between doctor patient interactions and financial authority is shorter, you're less likely to see the kinds of coverage conflicts for which HMO's were notorious. 

• There is more cost awareness among providers now than there used to be.  Concepts like variation and evidence-based medicine are gaining growing acceptance, even if they are not entirely mainstream.
• Maybe most important, providers have no choice.  CCO's are an attempt to control costs by empowering providers, if they fail the alternative is to control costs by disempowering providers and stripping them of authority over treatment.  Think about the ER restrictions that Washington considered (and that for-profit hospitals have implemented), or more direct interventions in provider pricing.

None of this is to say that CCO's are a sure thing, there's a reason the feds made their funding contingent on results.  But the cost of trying in my view is much smaller than the cost of doing nothing and hoping that a 40 year history of medical inflation will somehow reverse on its own.

The cost of scapegoating

A good quote from "Since Yesterday" (emphasis mine),

A good deal of the bitter anti-Roosevelt talk could not, of course, be taken at its face value.  Often it was a form of conscious self-indulgence in the emotional satisfaction of blaming a personal scapegoat for everything that went wrong.  When, as in a New Yorker cartoon, a group of ladies and gentlemen sallied forth to the trans-lux theatre "to hiss Roosevelt," they enjoyed the sort of release that many liberals had enjoyed when they blamed all the ills of the economic system on the personal wickedness of bankers, or that Nazis enjoyed when they blamed all the ills of Germany on the Jews.  To find a scapegoat is to be spared, for the moment, any necessity for further examination of the facts or for further thought.

Yet to the extent that it stopped factual inquiry and thought, the Roosevelt-hating was costly, not only to the recovery, but to the haters themselves.  Because as a group (there were many exceptions) the well-to-do regarded the presence of Roosevelt in the White House as a sufficient explanation for all that was amiss and as sufficient excuse for not taking a more active part in new investment, they inevitably lost prestige among the less fortunate.  For the rich and powerful could maintain their prestige only by giving the general public what it wanted.  It wanted prosperity, economic expansion.  It had always been ready to forgive all manner of deficiencies in the Henry Fords who actually produced the goods, whether or not they made millions in the process.  But it was not disposed to sympathize unduly with people who failed to produce goods, no matter how heart-rending their explanations for their failure.  Roosevelt-hating thrust the owners and managers of business into inaction--into trying to resist the tide of affairs, to set back the clock.  It made them conservatives in the sense that they were trying to hold on to old things, whereas before 1929 they had been, in their own way, innovators, bringers of new things.  It made them, as a group, sterile.  And they were soon to learn that sterility does not stir public applause.

I think this says a lot about right wing politics today...  especially the word "sterile."

Putting numbers on Provider Price Increases

I thought this story out of Boston was pretty striking:  A state house leader putting a number on what the average provider price increase should be.  It is impossible to imagine an Oregon politician (much less one in a leadership position) making such a statement today.  Heck, I can't even see a mainstream reform advocate saying that out loud.  And yeah, prices matter.
 
It shows that while Oregon in some ways is ahead of the game in promoting health care reform it still has a long, long way to go.

Gender and Transit continued

I've been searching for any materials discussing gender issues and transit.  I haven't found anything Portland specific yet, but this post from a Seattle blogger pointed me to this study, part of a project called "Gendered Innvoations".

The GI study was mostly about how traditional metrics don't capture the full usage of transit by women because they are more likely than men to "chain" their trips, making multiple stops on the same excursion.  Because of the mismeasurement, transit agencies risked over emphasizing commuter service in ways harmful to women.  That's interesting, but not what I'm after.


The GI study also Included a chart showing women consistently utilizing public transit at higher rates than men, across ethnicity, I wonder how it looks when you break it down by income or age.  People who have no choice will use public transit, that isn't saying anything interesting.  What I'd like to know is, are there gender differences in how people who have a choice decide between driving and alternate transportation?

The most helpful part of the paper was a footnote describing safety improvements at stops and stations, referencing Schulz et al., 1996.  That reference is to this paper, Women and Transit Security: A New Look at an Old Issue.  It includes a history of efforts to safeguard women on public transit, beginning with attempts (that failed) to reserve the last car on New York Subway trains for women only, and other more successful ventures:

Those familiar with Progressive Era concerns about white slavery know that creation of such groups as the Traveller’s Aid Society were directly related to demands that women be present in train stations to protect young women, often runaways or working-class immigrants, from the clutches of those perceived as ready to lure them into lives of prostitution. Early policewomen, too, spent much of their time patrolling train stations, with the expressed aim of saving women from the perils believed awaiting them there. Thus concern about women and their safety in and around transit systems has a long history and plays an important role in women’s demands for public positions in both the social service and criminal justice fields.

The description of the Traveller's Aid Society strikes me as very relevant to Portland today, and the concept that women's entry into law enforcement and public transit are connected is interesting in a different way, but neither is what I'm after right now.  What I'm after is this reference included in the Schulz paper,

S. Rosenbloom and E. Burns, Do Environmental Measures and Travel Reduction Programs Hurt Working Women? (Tucson, AZ: Roy P. Drachman Institute for Land and Regional Development Studies, 1993)

 Sadly, that paper appears to be really, really hard to get.  But I found a review of it, which helps (emphasis mine):

Rosenbloom and Burns looked at surveys of workers conducted as part of employers' efforts to reduce solo driving by their employees in Phoenix and Tucson, Arizona in 1990 and 1991. They discovered that women, especially women with children, are more or as likely as men to be solo drivers and that women take longer to get to work despite their shorter commute distances.

The authors hypothesize that women with children and domestic duties use cars more because they find alternatives such as buses unsafe and impractical. The surveys did not ask respondents about "linked trips" (stopping at daycare on the way home from work), but the authors suggest that linked trips explain women's more time-consuming travel and their preference for solo driving. They offer the anecdote of the woman who worked across the street from her home but reported that it took her 15 minutes to get to work, because she had to first drive her children to daycare.

Rosenbloom and Bums assert that working mothers (about one third of women surveyed) will be hard hit by trip reduction programs aimed at reducing solo driving. "Many women will continue to drive," the authors suggest "accepting new expenses [financial penalties for solo driving], because driving still costs less than the additional child or eldercare needs created by longer commutes, or because they cannot obtain the needed care, or because they must use the time to conduct their domestic responsibilities, or because they cannot find or do not feel safe taking public transit Other women will change modes, but at some cost to the well-being of their families."

So they observe the same phenom noted in the GI paper about chaining trips, but connect it to what I think is a very logical preference for auto transport even without the safety issues.  The review concludes with this summation, again with my own emphasis:

While this report suffers from its authors' biases--they believe that the car is the best all around transport mode, that transit is unlikely to conquer the suburbs, and that "bicycling is largely a male mode," apparently not for women--their basic point needs to taken seriously by the environmental community. If working mothers' concerns are ignored, the road/auto lobby can claim that environmentalists care more about the earth than about women and children. Let's prove them wrong.

 Are we proving them wrong, Portland? 

Also, are there any more recent studies that follow up on this issue?

Gender and the City

Two recent posts in the O highlight the absence of gender in the Portland urbanization discourse.  A story on the increase in biking revealed the fact that men outnumbered women 2 to 1 among bicyclists.  And a letter to the op-ed page lamenting the absence of free parking included this passage:

By removing four blocks of free, albeit unsafe, parking, the number of available spaces within walking distance of my apartment has been cut in half. Think about the implications for safety and work schedule: For a woman who returns from work after dark, it does not appeal to abandon a car under the I-405 bridge.

That the cost of parking should be increased is an axiom among urbanists, but how often do you see an acknowledgement that walking, biking, or taking public transit as opposed to driving poses different trade-offs for different genders?  Do urbanists have anything more to say to women concerned with the safety implications of abandoning the car beyond, "Grin and bear it"?

What Opt-In Does

Nick Christensen does a write-up on how Metro councilors view Opt-In, a registration-required online survey tool.  I think this gets at what this service really does, and what it replaces:

Metro spent $76,000 on Opt In in 2011, generating  more than 20,000 responses – about $4.50 per completed survey.

By comparison, said a staff report for Tuesday's work session, Metro spent about $400 per open house attendee during the 2010 roll-out of then-Metro chief operating officer Michael Jordan's growth and policy recommendations; those numbers soar to $2,800 per completed survey at each of those open houses. The agency also spent $35 per attendee at the dozens of stakeholder meetings Jordan attended.

Opt-in is a new way of connecting with citizens, in a way that allows two way communication- both Metro and citizens learn from the interaction.  And look at the number of people reached, a recent survey had 4,000 respondents.  How many public meetings or open houses have you seen that attracted 4,000 people?  How about a meeting where 4,000 people got to get up individually and express their view?

Some councilors expressed concern that their hands would be tied by the surveys.  How could they justify a vote that went against "majority opinion?"   Even aside from concerns about the opt-in demographics, councilors have a pretty solid excuse:  Voters elected them, not a survey.

The people who should be nervous are the interest groups who make up most of the participants at conventional public meetings.  They are the people most motivated to attend, and most likely through pooling and coordination to have a representative available to attend a meeting at 9am on a weekday.  Most individuals don't have the time or interest for that.  That dynamic gives interest groups a dominant role in reflecting "the public", quite independent of how much popular support their positions actually have.  As Metro President Tom Hughes said,

"Public hearings are an avenue for getting public input, but they're imperfect at best," Hughes said. "They're usually repetitive, not very helpful and usually the people who show up are the people who are absolutely directly involved – you don't get a sense of what the public wants."

Opt-in offers a potential check on interest groups, it creates an opportunity for a truer test of the popular will.  Whether it fulfills that potential depends on participation.  If the only people who sign up are the same people who would otherwise be represented by interest groups, nothing changes.  So if you're a Metro resident not already signed up, please consider it.  Especially if you disagree with me.

What life looks like without effectiveness research

Via healthcare economist, a gooznews post on why patient advocacy groups are unlikely to promote comparative effectiveness research even though such concerns are of central interest to patients.

Compare the crying need that gooz describes with the mission of PCORI as described by its Chief Operating Officer:

Q: Can you give an example of how you envision people using the kind of research that PCORI will fund?

A: Let’s say someone is trying to decide if they should have Procedure A versus Procedure B. You give them all this information, but what the patient is saying is, "Well, what’s really important for me is that I’m very afraid of pain. What procedure is going to be the lowest pain option that still gives me the benefits that I need?" Somebody else is going to be very interested in what will give them the longest life. Somebody else may say, "Well, what’s really important to me is whatever procedures I have, I am a working parent and I can’t really afford a lot of time off from work, so what procedure is really going to take care of this condition, but get me back to work as quickly as I can?"

So, then we [at PCORI] are trying to think of the different options that are available to us, not only looking at research that says, "If you do this cardiac procedure versus this cardiac procedure, here's what the outcome is." But now: here’s what the outcome is in terms of pain, here’s what the outcome is in terms of days off from work, here’s what the outcome is in terms of longevity. So then you, as the patient, have the information to make that comparison and make really a tailored decision that meets your needs.

There are a lot of problems in health care, but it isn't like we can't solve them.  We just have to learn how to ignore yahoos who get in the way.

Good Quote on legal challenges to Health Care Reform

The Times ran an op-ed refuting some common arguments against the legality of the individual mandate.  I thought this quote was particularly good (emphasis mine).

Opponents of the new mandate complain that if Congress can force us to buy health insurance, it can force us to buy anything. They frequently raise the specter that Congress might require us to buy broccoli in order to make us healthier [...]

That certainly sounds like a stupid law. But our Constitution has no provision banning stupid laws. The protection against stupid laws that our Constitution provides is the political process, which allows us to toss out of office elected officials who enact them. This is better than having unelected judges decide such policy questions, because we cannot toss the judges out if we disagree with them.

Nor are all required purchases stupid. It is not stupid to require us to buy air bags for our cars and pensions for our retirements. Nor would it be stupid to require us to buy life and disability insurance to make sure we have provided for our children. Whether the law should is up to our political process, not judicial second-guessing. 

 This gets at one of the reasons I find the conduct of congressional Republicans so inexcusable.  They claim to be serious about reducing the deficit and managing long term liabilities, but they are utter cowards when it comes to building actual legislation.  Their preferred approach is to find a bomb (payroll tax cut, debt limit, federal budget) and threaten to set it off unless Democrats pass their legislation for them.  Republicans do none of the hard work of gaining support through compromise, they consign that to "not my problem" status.  The thing is, making political choices is exactly their problem, that is what they are supposed to do.  If they want deficit reduction then come up with a deficit reduction package that can get the needed votes and pass it.  It may or may not be popular, but casting such votes and living with the consequences is the core definition of their job.

I've criticized Occupy protesters for not understanding civics, but at least they have the excuse of being joe-schmoe citizens.  What excuse do Republicans in Congress have for not understanding their job description?


H/T White Coat Notes

As the swallows return to Capistrano...

so Republicans rush to defend ineffective medicine.  What is it with these guys?  The PPACA funds the Patient Centered Outcomes Research Institute (PCORI) with a $2 per person per year tax on health insurance policies.  $2 a year is about half the cost of a latte and about 1/200th of the cost increase in the average annual premium for an individual from 2010 to 2011.  That's really not that much to pay to avoid having your (or someone you love's) hip shredded, or to avoid an unnecessary radical mastectomy.  Think about it...

Interesting New Years Healthcare Retrospective

by John McDonough.  He touches on the irony of  the potential rebirth of provider rate regulation on the 20th anniversary of its execution.  He condenses decades of history into a paragraph:

In the late 1980s, reducing the size of the hospital system was an unattainable policy obsession, and in the 1990s, the deregulated market made it happen with stunning efficiency. This is a clear-cut case of "be careful what you wish for, because you just might get it." While the downsizing eliminated excess capacity, it also enabled market consolidation triggering widespread hospital payment and health insurance cost inflation over the last ten years.

 I wish Oregon had someone of his caliber and commitment to public engagement writing about healthcare.  What could such a person tell us about Kitzhaber, about CCO's or the insurance exchange?

As a followup question, that's the first reference I've seen to a  perception in the 80's of excess capacity.  What's that about?