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?

Medicare and the Development of Rate Setting

Via Incidental Economist and White Coat Notes, I found a pretty good paper on the developments that led to Medicare's Prospective Payment System (PPS) in 1982.  PPS is the price setting mechanism that specifies what price hospitals are paid for the services they render.  Under PPS they get a per diem rate set by the federal government.  Prior to the advent of PPS Medicare just paid cost- hospitals sent in the bill and Medicare paid it.

The paper describes how Medicare from inception was beset with massive price inflation, with expenditures running at 5 times what was expected a mere 8 years after full implementation.  That inflation quickly led to cost control efforts, first with Nixon in 1972.  Though ineffective at controlling prices, that reform enabled state pricing regulation such as Maryland's all payer system.  Coincidentally, they were the first state to seek out pricing regulations and they are the only state that kept them.

Carter took another bite at the apple but whiffed, with hospitals successfully killing his proposal in Congress.  Carter's efforts were not for naught however as the price hospitals paid was a commitment to voluntary cost controls.  The voluntary effort showed modest success for two years, before hospitals fell off the wagon at roughly the same time Reagan came into office.  The outcome of this combination was not what you'd expect.

Republicans had hung their hats with the hospitals against Carter and been made to look like fools.  Their antipathy for government spending overruled their hatred of regulation, with some added incentive that Social Security was bankrupt (and I mean "we don't know where next month's payments will come from" bankrupt).  This led to a monster Social Security reform bill, part of which involved robbing the Medicare trust and paying for it by using PPS to bring costs in line with the balance.  Most legislators didn't even know what a DRG was, to them it was just a Social Security bill.

Some lessons to draw from this:

• "Single Payer" means absolutely nothing when it comes to reining in prices.  What matters is political consensus and the will to enforce it.
• Compare how Reagan and Dole reacted to their challenges to say, George W Bush and Tom Delay.  The GOP has fallen a long, long way.
• That said, cost control reform doesn’t happen without major bipartisan support.  72 and 82 both involved mixed leadership.  Carter's efforts failed in large measure because Republicans made hay by standing with the hospitals.
• Major reform involves lots of actors with lots of motivations.  Republicans put aside their antipathy to regulation when it allowed them to save money.
• Successful reform requires provider participation.  They won't come to the table unless you hit them with a really big stick first, one big enough that whatever reform you seek looks like pain relief to them.  TEFRA served this purpose with PPS.
• All reform is temporary.  Providers will eventually subvert any cost control regime given enough time, as Medicare's current finances demonstrate.
• Finally, crises really are opportunities.  The Social Security debacle was the backdrop for PPS and it gave everyone more backbone then they would have had otherwise.