Possible Turning Point

A recent ruling in California on rescinding health insurance will hopefully have a industry wide impact on the way health insurance cases are managed. As the article notes the woman was diagnosed with breast cancer and was undergoing treatment for it. Midway through treatment, the company, Health Net Inc., canceled her policy leaving her with hundreds of thousands of dollars in debt. The reason given was that there was some weight discrepancies on her application and possibly missing information about a heart condition. This type of health care is deplorable and just another example of the dangers of for-profit health care.

The current system has Americans paying the most per capita for health care by a wide margin. (see table below). This massive discrepancy between what is spent in the U.S. and the level of health that is attained is a fundamental contradiction of our system. The fact that 50 million Americans go without health insurance (which often means going without health care) helped to increase this discrepancy. When people without insurance go for care they pay up to four times as much as those with insurance.



Source: uscs.edu

Administrative costs are also a significant reason for this vast discrepancy in spending. The bloated insurance company system makes health care less efficient as opposed to the "common sense" notions that are typically expressed around issues of public versus private. Using simplistic theories from economics may give particular policy prescriptions, but the empirical data often indicates something much different.

Many recent polls indicate contradictory factors in people's perceptions of health care. While approximately two-thirds of Americans support the idea that the government is responsible for providing health care to everyone, only forty percent would like to see the system changed to a single payer system.

The thing that I fail to understand is how Americans don't make the connection between the per capita spending and the cost of a single payer system. When we are paying significantly more for health care and receiving less benefits, it is hard to justify the current system. Due to the cultural fear of taxes present in the U.S., it is difficult to imagine an increase in taxes being a possible method of funding health care. It must shown that an increase in taxes would actually save Americans money. What they pay to insurers as well as the decreased direct pay that they receive due to the cost of company provided health care likely exceeds the tax increases that would be required to fund this system. Overall the expenditures of Americans on health care would decrease under a single payer system for a variety of factors including the ones mentioned above, but also other factors (ability to practice preventative medicine, decreased cost for prescription drugs, and increased risk sharing to name a few).

While the road to a single-payer system is neither simple or clear, it stands as the most likely and successful measure. While many countries are repealing aspects of their health care system, it is largely at the behest of those who stand to make profit. Those who require health care are often the first to decry these cut-backs. Though a single-payer health system would impose problems of its own, it is hard to imagine that it could be anywhere near as bad as the current system for the fifty million Americans without insurance and the tens of millions who are underinsured or likely to be dropped if they do get sick.

An Anticlimactic Ending

The recent departure of Castro from the position of president of Cuba fails to represent the 49 year rule that began with a thunderous revolution. While the results of his rule have been mixed, the Castro doctrine represented a fundamentally different way of viewing the world. It is hard to imagine that Cuba will not end up plodding along within the current globalized economic system much like other countries of Latin America. Their gains in social capital represent a real possibility for facilitating sustained development (in the sense of the capability approach). Hopefully the U.S. will give up our historically messy legacy now that Castro has stepped down. Removing the embargoes and travel restrictions would create the best possible opportunity for allowing actual change to take place in Cuba. Most important for Cuba at this time, in my view, is an implementation of a more democratic and representative system of governance. With it's spiritual and political figurehead out of office this seems more possible than it has in decades. Cuba is already highly globalized with its dependence on tourism and trade in sugar. By identifying and implementing appropriate legal and political changes it could take advantage of the years of progress in social capital that it has sustained.

It will be interesting to see what Castro's legacy will be. Beginning his reign as a fiery orator and general to stepping down decades too late. The gains made in Cuba in areas of health and poverty were often overshadowed by stories of repression and abuses of power (jailing homosexuals and dissidents comes to mind). Will Castro be seen as a revolutionary character that sustained Cuba? Or a petty dictator that kept Cubans from attaining a better standard of living? I assume the polemics will eventually fade and a more nuanced and ambivalent account will be the one taught in years to come. In the battle of "Socialismo O Muerte!" it appears a withering death of Cuban socialism will be the final result of Castro's grand experiment.

First Tutorials

After finishing my first few weeks of tutorials I can say it was much better than I thought. I was particularly concerned about early semester jitters making discussion difficult. They seem like good groups and we have had quite good discussions with all but a couple people making regular comments. I try not to push the shy folks too much, especially since they usually seem to be engaged with what others are saying but have that deer-in-headlights look whenever I look at them after asking a question. I really thought that it would be more difficult to fill up two hours of time, particularly when I am only facilitating discussion as opposed to lecturing. All or nearly all of the students seen to read each week, though the past week had a lot a of reading and I overheard many saying they didn't get through all of it.

The tutorials are definitely more work than the lab consultation position I had for SA 355 but I think it is good to have a change of pace. Also, chairing meetings of the SA grad caucus makes facilitating discussion less of a daunting task. I am enjoying the opportunity to do something new. It is funny to have the students ask directly for my opinion on the topics on which I am facilitating discussion. I don't mind giving my opinion but I am afraid it will cut discussion short if I say too much so I usually am brief and turn it into a question. This seems to work well. I realized I had established rapport with my students when one said "see you later, man." I can't imagine him calling the professor "man", but I could be wrong. Also funny is the student that wants to know the exact structure of the final paper and final exam on the first day of class. The instructions will mean more to you once you have at least completed the first assignment and even the mid-term. I also have a student who takes all the key terms out of the books and makes flash cards for them, now that is my kind of student.

An Informed Discussion

As with much of American politics, the current immigration debate is filled mostly with polemics and demagoguery. It is often difficult to find a nuanced discussion of the issues and the wider context in which they exist. Luckily over the holiday break I was able to dive into two books on the subject, both of which provide a very contextualized account of central issues and controversies and where they reside in the course of debate.

The first one I read is They Take Our Jobs: And Twenty Other Myths About Immigration by Aviva Chomsky. It was a great book. Chomsky identifies key myths that are pushed about immigration from both pro and con positions. It places the immigration issue within the larger context of neoliberal reforms. While I wish some of the entries were longer, always good to leave the reader interested in finding out more, the book really stands out as a critically engaged account of the issues. One thing that particularly stood out was the role of marginalized labor and its place in the U.S. economy from the time of the American Revolution.

Ex Mex: From Migrants to Immigrants by Jorge Castañeda, a former foreign minister of Mexico, examines the historical context that situates the current debate. He also provides an excellent discussion of possible policies and the likely proponents and opponents to these policies. Examining the ways immigration from Mexico has changed, but also how it remains remarkably similar to previous decades, helps to identify that what we face is nothing new. Also noteworthy is that it provides a Mexican perspective on the issue, particularly from a person who has had a lot of influence and experience dealing with this issue at the highest levels of government.

While these are just two of many possible books that provide accounts of the current immigration debate, they are both very accessible and well-written. A proper discussion of immigration and its ramifications must start somewhere and these are good resources for that discussion.

New Semester

This week is the first real week of TAing this semester for me. I will be teaching my first three tutorials. It will be interesting because the tutorial system is not something I ever ran into in my undergraduate education. Apparently it is quite common at Canadian universities.

In the tutorial system there is one lecture held by the professor, generally near the beginning of the week, which all the students attend. Then students come to a tutorial section where there are around 10-15 students. These tutorial sessions are taught by the TA and are for in-depth discussion of topics discussed in lecture. Previously TAing the quantitative methods course I was only responsible for helping folks in lab sessions. I think it will be interesting to facilitate discussions and have a more dynamic interaction. I have three tutorials each week and they are each two hours long. It will be interesting particularly because the first few weeks deal with things such as epistemology, ontology, and research ethics. As the students are Sophomores (or 2nd year as they say up here), this will be one of their first experiences with learning specific research methods. It is both a qualitative and quantitative course and so it will be interesting to see what biases people come in with and how they come to terms with different methods. With the SFU Sociology and Anthropology department being so qualitative in focus, I look forward to hearing students' concerns.

Over the holiday break Heather found me reading an article titled "Rethinking Critical Pedagogy and the Gramscian and Freirean Legacies: From Organic to Committed Intellectuals or Critical Pedagogy, Commitment, and Praxis." It is about creating non-hierarchal relationships in the classroom. As soon as she saw the title she just walked out of the room. I have to say it is a pretty good read if anyone is interested... Some how I think I am alone on this one.

Overall, I am really excited for this semester. I am beginning to work on the results section of my thesis, in many ways the key section, and look forward to completing the entire thesis on time (defending in July or August). I really enjoy working on my thesis and think the two RA projects I am working on are both really interesting.

A People's Economist

A recent article by Joseph Stiglitz, a noted economist, provides a concise and directed critique of the havoc created by the Bush administration. He details the economic mismanagement and financial audacity that has damaged the U.S. and will require significant effort to redact. He provides a good starting point for a discussion of the steps to be taken to fix this problem.

As far as economists go, I find Stiglitz to be one of the one's I admire most. He doesn't accept many of the "facts" spun out by economists and has worked to increase nuance among economic analysis of the "invisible hand" by identifying informational asymmetries and their role in markets.

While he still represents a more mainstream view than I would ascribe to, I find value in his analysis and his work for social change and justice. His recent involvement in the independent film "The Big Sellout" was excellent. In this film he commented on the commodification of goods and the negative effects that it had on various countries. It was a really good movie and provided some clear examples where the Washington Consensus was failing those it claims to be "developing".

Coming Up For Air

I am beat. After grading eleven 15-20 page quantitative methods papers for one class, twenty 30-40 page papers for another quantitative methods class, entering forty-three 175 variables surveys, and grading 20 essay final exams in the course of a week I think I am ready for the holiday break. This is the first day in a while I haven't had to have 6 things on my mind at once. Luckily we leave tomorrow for Fargo. It will be a nice break and I look forward to seeing my cats. The first leg of the trip is a long one for me and I am hoping to get in some good pleasure reading time (despite the fact that the books I read for pleasure are on my thesis topic).

In other news, after invigilating (that is what they call proctoring up here) one of my classes' exams, I was informed that they were all heading to the bar on campus and begged me to come. I was honestly sad to decline, but I had to because I needed to get grading otherwise I wasn't sure I would get done in time. I also felt bad saying no because the students were saying things like "but you'll never see us again," "just one drink," and "don't worry we will help you grade at the bar." Ok not so much the last one, those sneaky little bastards. Overall, I would say it was my favorite class that I have TAed for. It is also the last time (probably) that I will TA quantitative methods.

Next semester I have decided to TA a new course: intro to research methods (seriously I think the department is in love with me, I always get first choice of the TAships while everyone else bitches about their assigned courses). From what I hear, the course is about 80% qualitative and 20% quantitative. I think it will be a good switch. My undergrad experience was definitely mixed methods and it will be enjoyable to get back into that sort of work. I enjoy TAing because it requires me to gain a certain level of expertise in a fast amount of time in a subject that I may only be familiar with. I have to be able to know the stuff well enough to have multiple ways to explain it and answer tough questions on the spot. It's a challenge that I think has made me understand why people enjoy teaching. Another big difference with SA 255 (intro to research methods) is that I will have three two-hour tutorials. In the Canadian university system for big classes it is common to have one lecture during the week and then a bunch of tutorials led by grad students.

So my advisor Fernando De Maio, is the professor for the course. He will hold a two hour lecture on Mondays and then there will be six two hour tutorials spread out around the week. He will take one, I will be responsible for three, and the other TA for the course will have two. In the tutorials you lead discussion and help them engage with the material in a more collegial atmosphere. A lot of people say they get really nervous about their tutorials but I am kind of excited to see how it goes. I am just hoping I don't end up regretting asking for the three tutorials instead of the two.