Z - SynapticFire

The Damage of Unexamined Assumptions

I'm subscribed to a few little newsletters and daily feeds - certainly not as many as some people I know, but enough to feel like I'm somewhat informed.  A "Daily Stat" from a Harvard Business Review landed in my in-box, loudly declaring as a header: "Even the Very Poorest Like Mobile Banking".

The stat was drawn from this article by the McKinsey Quarterly (registration required), which was a study was conducted in the Philippines and India with the eye toward ways to accelerate tapping into emerging markets. The article/study itself was useful, and to their credit the researchers did try to look at the "whys" of the situation (asking about reasons for "bank avoidance").  They looked at contextual factors involved in the "informal credit systems"  in place and drew reasonable conclusions about the impetus for such a system and the impacts on the members of that system. I think all that work and context got lost, though, when the article was selected by an editor.

Because the stat that arrived in my email was packaged as such (this is a direct quote) : "About 65% of the lowest-income households surveyed by McKinsey in the Philippines want to use banking accounts accessed through mobile phones — contrary to the accepted wisdom that poor people tend to be indifferent to banking."

**double take**

 "Poor people tend to be indifferent to banking".  Just... wow.  I mean, I know that "accepted wisdom" is often proven wrong but it seems like that statement (taken with the header that preceded it) is just dripping with assumptions and condescension.  

While the original article focuses on the Philippines and India, the lessons learned there can be equally applied to "very poor people" in US.  Contrary to the popular belief that America is the land of milk and honey, there is crushing poverty and "expensive informal credit systems" over here, too - just ask anyone who has taken out a payday loan.

Above all, the assumption that "being poor" = "doesn't care about money" (with the not-so-hidden subtext that poor people are just too stupid to know what's best for them) is just galling.  I will admit that this is a button-pusher for me, and that this has me livid.

Did it ever occur to the creators of "accepted wisdom" that poor people have to think about money on a regular, stressful basis just as much as - if not more than - rich folk do? That living paycheck-to-paycheck means tracking finances to a degree bordering on obsession?  That banking is indifferent to poor people?  That people who are working all the time don't have the luxury of taking time off to meet with their "friendly local banker" during banker's hours?  That some of the many hidden costs of being poor include NOT having access to lower interest rates, lower minimum balances, and easy access to financial information and the energy and time to make use of it?   

Quite simply, to put this in terms of program/policy evaluation:   it's a service utilization issue - and the banks have assumed it's because financial literacy isn't WANTED, not that they, as institutions, have made access difficult.  When in doubt, blame the customer, right?

While assumptions underlying the conventional wisdom are irritating, they are also damaging -not just to human sensibilities, but economically.  The failure of financial institutions to pay attention to the poor feeds into the poverty cycle which is damaging to the greater good.   But rather than appeal to the banks to look at the greater good, how about the pocketbook? 

Mobile banking makes depositing, saving, and managing money not only easy for the customer, but CHEAP for the financial institution!  It's outsourcing the work to the customer - and the technology exists and for many banks the systems are already in place - and how much cheaper can you get for that?  The more customers empowered to make better financial choices, the greater the wealth generated by those customers. And, in turn, the greater the wealth housed in the vaults of the banking institutions, so they can leverage them into greater fortunes (won't say for who, here).
 

I think the only reason mobile banking hasn't caught on yet IS because of that "accepted wisdom" assumption - and a  good example of why, each and every time an industry (or a government!) says "these people just don't seem to care" it's important to understand the behavior and then look at how that changes landscape.

(And this is my "rah rah Suffolk" moment for this post:  This program has made me appreciate the substantial overlap between the economic/financial realms and the worlds of government and psychology.  For someone who loves analyzing a situation down to the fundamental bits and then seeing not 0nly what's impacting those pieces, but how the bits-and-bigger-pieces can be applied somewhere else, there is no place I'd rather be.)

Following the $$

So a really interesting piece of information I've gathered as a result of my Fellowship work is this:

When it comes to government money, grants are watched relentlessly.  The reporting requirements for organizations who receive grants are stringent and can be extensive.  There seems to be an obsessive quality to completing the datasets which track grant funding- the organization, the purpose, the funding program and accounts - almost very literally the whole nine yards - for every single transaction.  The categories of funding programs are much more narrow and specific.

When it comes to government contracts, however, are a completely different story.  Gaping holes in the data set you can drive trucks through.  Sometimes the vendor information is incomplete, sometimes the funding programs are not identified, other places the purpose for the contract is completely missing.  The categorical purposes are ridiculously vague and sometimes bring about some WTF moments:  Namely, what the hell is Hewlett-Packard doing getting just shy of $39 Million dollars to administer "social services"?!

A visit to usaspending.gov (a ridiculously useful site, by the way) and few clicks later, it was more apparent that HP is getting the funds because they (well, a California-based subsidiary called the NHIC) won the bid to process Medicare/Medicaid A&B claims in MA, ME, CT, NH, VT and RI.

Considering the contract is from the Department of Health and Human Services "social services" makes sense.  But it's not really what they're doing.  HP is providing QA tech support for claims processing.

And then there's the issue of "location of service":  The company is based in CA, but "place of service" is listed as MA.  That does add a layer of complexity in terms of property and corporate taxes, etc.  And makes it even harder to track the money.

I applaud the efforts of the government to make things more transparent, accountable, etc. etc. But why the double standard of grants vs. contracts?  Grants are not "free money"; recipients jump through ridiculous hoops to get them and keep them even as they are delivering needed services to the public.  Or adding useful and crucial knowledge to the body of scientific evidence.  It seems almost as much of a pay-for-service system as contracts...  Why are contractors not equally scrutinized?  

Or is there that nasty belief still present that if you work with the poor you might be tempted by all that free money?  Or that if you work with ex-convicts you're a criminal yourself? 

Transparency is great.  But let's not pretend that we're actually following all the money, or even all the money we're supposed to.

New Direction

Sorry for the radio silence.  I have been thinking deeply about this blog, and where I want to take it and what I want to say.  Perhaps that is something that could have been done here, in this space.  =\  Thanks for hanging in.

As I was posting last semester I began to realize that by habitually omitting reference to large parts of my experience from my posts, I was truncating a large portion of my graduate school life.  While nothing earth-shattering in the grand scheme of things, it has lead to shifts in my experiences, shifts that I have been hesitant talking about because it has some potential, and potentially unknown, consequences to do so.  

But it's become really, really important to me to talk about being a graduate student at Suffolk - who has Attention-Deficit Disorder. 

I was tasked to tell the naked truth about my graduate school experience at Suffolk.  I am enthusiastic about the school and the program but because I was too timid to mention anything about my ADD, so much of what I was going through I self-censored to the point of inanity.

Then I realized doing so was self-defeating.  I'm not exactly shy about it in real life, why would I be so on my blog? Seems dumb, even to me.

I really do enjoy sharing thoughts about my professors, my assignments, directions I'm heading in professionally, and ways graduate school is filling my head with all sorts of cool ideas; now you'll also hear about my frustrations with organization, exact ways in which "time management" is a pipe dream, and basically what it's like to have executive functions that can randomly go off-line every now and again.

It's not all-consuming, nor is it going to be All ADD All the Time, but it's a better story when it's the entire story.  And at the risk of sounding really "rah-rah Suffolk", it is an incredibly supportive environment for an adult ADDer.  Which makes writing about it here that much easier.

So. I'll be updating weekly again. For now, though, I have to finish a paper. (yes, at 11pm on a Sunday. Hush.)

Note to Self

Starting a Saturday class at the end of the semester and basically dive-bombing a law class in the middle of everything else you've got going on is not a bright idea.

Looking Ahead

For a less-ranty - and maybe more coherent? - change of pace.

Applications for Practicum placements were handed out last week; we have been instructed to have our placement sites lined up by February to start our Practicums in the Fall of 2010.

I understand the idea of needing to plan ahead, and the importance of lining up a supervisor and site and interviewing as many as possible until you find the place that will work and a supervisor you can work with.  I get it, I really do. And usually, I'm all for getting things settled sooner rather than later - it's one less thing I need to worry about.

At the same time, there are so many decision points for me related to my "non-school" situations between now and then.  I can peer into to the future as much as possible and plan to the best of my ability, but there are some decisions I simply cannot make until other things - which are ultimately completely outside of my control - fall in to place. Or until the probability lines get clearer, anyway. 

Things like (but not exhaustively):  Will my partner find a new job soon after the year?  Will we need to move?  Will I still be working with the company I am now, or will the other opportunities I have in the works pan out?  Coming up on the holiday rush means that, likely, none of these things will be answered "in time", so I have to navigate a little bit blind.

Luckily, I'm adaptable so I know that anything that happens, I'll be OK.  I just have to admit a certain level of discomfort in making such big decisions without solid bearings.

Money & Medicine

Health Care and Public Policy

 

Time for a soap-boxy post. 

 

Aside from being something I’m wrestling with this week on a personal level, it’s clear:  Those who create public policy surrounding health care have completely missed the point.  There could be any number of reasons why they’ve done so.  Personally, I think it happens to be that they have simply neglected to examine what the ACTUAL cost of health care is – they are too busy bickering about ideology and are completely willing to just look at the monthly premiums offered by health insurance companies and say “Of course that’s affordable!”  They neglect to factor things in like co-pays, or prescription cost, or any number of other things that add to the out of pocket expenses in addition to premium cost. 

 

Here’s the general gist:  My partner is slated to lose his job at the end of the year.  He’s been given adequate notice and overall they’ve been incredibly fair, so no complaints there.  What that does mean is we will lose his (absolutely fabulous) insurance.  SO, we have to find our own.

 There are a number of other parts of the financial situation that complicate things – I work part-time, which means my share of the premiums through my company plans are more than if I were to work full-time.  My company’s options are - to put it nicely – crap.  I’m a grad student – I’m broke.  But between the two of us, we (thankfully, because it would be really hard otherwise) make too much money to qualify for any subsidized plan through the state (assuming he gets another job in a similar range which, while not impossible, will take time and doing).  

 

Overall we’ve got a clear idea of how much health care we use and need.  Since my partner’s current insurance is unbelievably good, we’ve been pretty spoiled.  By “spoiled” I mean “gone to the doctor when needed” (annual physicals and 2 additional visits to treat my sprained ankle; tooth cleaning once; and mental health visits to treat our learning disabilities).  So we’re pretty much low-users of the policy, overall. 

Keeping all of those variables the same – doctors visits, prescription coverage, and even adding in vision care (because I’m blind as a bat), we’ve crunched the numbers and it’s simply ridiculous – and not worth the money! (Provided, of course, that nothing catastrophic happens but if it does all bets are off, anyway…)

 

Here’s where public policy gets it so very, very, VERY wrong. 

 

I’ve evaluated a number of plans for per-month cost, after adding up premiums, co-pays, deductibles, etc.  The cheapest INSURED option – the cheapest “individual + one” plan, among all, even those offered by the state – comes out to cost us, out of pocket, a mind-numbing  $6,101.16 per year, or $508.43 per month.   Which also is way, way, under the $8,000 “out-of-pocket” limit on this particular plan, because (naturally) the monthly premium doesn’t count. There are a few other options that are approximately $650 per month in costs after all is said and done. 

 

That’s the cheapest “most affordable” option.  I have a LOT more than a lot of people and I’m not trying to plead poverty, but on what planet is 50% of my net take-home pay – affordable? That’s working 2 weeks of my part-time job JUST to afford health care.  Wha?!

 

What’s really ironic is that, in crunching the numbers and using the same variables, that if we were to self-pay for *everything* (using the self-pay rates I’m used to dealing with all of those years I was without health insurance) AND pay the full extent of the tax penalty for BOTH of us next year, we would wind up with only, out of pocket, $468.83 per month in expenses.  BUT WITHOUT the tax penalty, we would pay only $290.83 per month in health care costs – for everything.

 

Because here’s what’s really sick – I added up the cost of EVERYTHING my partner and I would normally use in medical expenses throughout the year.  Estimated, of course, but not lowballed. 

 

On our own, without insurance at all, we would spend $3,490 in medical care in a year. 

The CHEAPEST premium we have available to us, through the state, would cost us $5,745.96 per year. 

 

We lose over $2,300 a year just in the act of buying insurance – and that’s before a SINGLE CO-PAY OR DEDUCTIBLE.

 

I understand what Massachusetts was trying to do here.  To make insurance “affordable” to all, widen the risk pool through mandated participation to include those who would normally not carry insurance because they don’t need it (healthy, young, trust fund, whatever).

 

But the initial premise is inherently flawed.  Health insurance companies exist to make a profit, NOT to provide health care.  All “widening the risk pool” has done is allow them to charge the same insane rates to everyone and make even MORE of a killing, because the vast vast majority of those who don’t need it won’t even come close to using even the value of their premium in health care costs!!  All widening the risk pool does is guarantee the insurance company a fatter bottom line.

 

So I don’t understand is why, after all of this common-sense number crunching, the idea of a universal, single-payer health care system is so inherently frightening to so many people. 

 

You want to talk about widening the risk pool?!  THAT’S how you widen the risk pool – everybody’s in.  Everybody pays taxes (and thank god we’re still a progressive system, although my professor argues it’s getting more regressive every year), and everyone chips in.  Not everyone will need massive levels of care. Most people won’t even use what they have.  But it will be there when you need it. 

 

IF you still insist insurance companies can have a piece of the pie (and they will, because there is always risk and that’s what insurance does, it mitigates risk), then there is no reason I can see at the moment that a single-payer system can’t work in tandem with catastrophic health insurance policies that cover massive expenses as a result of accidents or something.

 

Oh, wait.  We already have something like that.  It’s called accident insurance, and it’s nowhere near as costly as health insurance.  So it seems like the risks are calculated and mitigated, according to market forces. 

 

It’s time for me to stop ranting.  I think I will bring this up in class and ask my finance professor’s opinion.  I’m not saying that as a lame tie-in, either – I am genuinely about curious what he has to say about this situation.

 

 

 

Why Day Planners & I Don't Always See Eye To Eye

Ideal vs. Reality - time spent during a typical weekday.

“Ideal”

8:00 am: Get out of bed, put in contacts, dress. Have time for makeup, hair, accessorizing.

8:30-9:00: Leisurely breakfast and a nice cuppa, chatting with my partner as I double-check my things for the day.

9:05: Begin commute via T; read entire chapter for following day’s lecture.

9:45: Arrive at work with time to spare, boot up computer and mentally organize for day. Enjoy tea and biscotti (brought from home) while sorting and responding to the day’s email.

10-3:30: Able to work on projects in the order I’ve designated them; crossing off more things from my task list than are added.

3:45: Board T to Suffolk for class.

4:15-7:00: Engaging lecture full of insightful discussion and new concepts.

7:20: Home after class, change into gear to run.

7:30: Run/shower.

8:30: Healthy dinner, conversation about the day and classes with my partner.

9 or 9:30: Read/study/write as required.

11:00: Indulge in one of my relaxing crafty hobbies for a short while.

11:30: Bed

 

“Reality”

8:00 – 8:30 am: Alarm goes off.  Hit snooze button. Doze and chat with partner.

8:40 am: Alarm goes off.  Check time.  Mutter about how late it is and begin to brave the day.

8:50 am: Contacts finally in eyes, try on 3 different outfits before finding one that works. 

8:55 am: Gather all of my things while my partner makes me tea in my travel mug, and packs my lunch.

9:05: Wolf down breakfast. Leave prepared tea on kitchen table.

9:10: Arrive at T station to find it’s a slow train day.  Read chapter for following day’s lecture.

10:00: Get to my desk and find three new tasks I need to follow up on.

10-3:35: Put out fires started through no fault of my own.  Fight with a stubborn desktop and irritatingly slow network connections.  Leave work wondering how I could be so busy and get nothing done.

3:50: Board T to Suffolk for class after waiting on platform for what feels like eternity.

4:15-7:00: Engaging lecture full of insightful discussion and new concepts.

7:45: Finally home after another ridiculously long wait for train.

8:30: Run if I’m lucky. 

                Alternate:  Dishes, cat box, bills, homework, emails, etc…

9:30: Dinner.  Frozen pizza is a balanced meal, right?  Conversation about the day and classes with my partner.

9:45: Read/study/write as required.  If I’m completely brain-dead, we’ll Netflix an episode of junky TV.

12:30 am: Bed

This is why, even though I view day planners as essential and I’d be lost without Google Calendar (as well as a host of other gizmos and systems), I haven’t quite gotten the hang of them. 

Well, at two things in my life are consistently not chaotic.  =)

Insert Hokey Parable Here

My partner and I ran a marathon this past weekend (the 18^th).  It was a first for both of us, and the jury’s still out on if it will be the last.  We finished pretty much exactly ahead of one-third of the pack, at a pace that was actually not that much slower than our normal longer training runs – which is noteworthy only because we had never run further than 16 miles before the marathon (Graduate school cut into training more than I expected.  Yes, my partner told me so).

Remarkably, it was easier than I expected.  Not easy by any stretch of the imagination.  A monster hill around mile 22 had me in tears because my hip flexors were so sore any forward motion was near agony.  So no, not easy.  But overall, looking back at the race and the experience, it was much easier than I had anticipated.  I was asked after the race if I had ever thought of quitting – and the answer was immediate:  No.

 It never crossed my mind to step off the course.  It never even occurred to me there was the possibility I wouldn’t finish.  It was simply a matter of getting to the next corner, the next mile marker, the next aid station, the next hilltop, the next walk break.  This incremental approach wasn’t really conscious - more like a complete surety that we would always be able to make it to the next whatever. We knew inherently that we’d be at least able to make it that far.  The finish line was some vague place in the far distance, and it was in many ways surprising (but undeniably welcome) when we crested the last small rise and saw the banner marking the end of this particular journey. 

What’s oddest about this is that, despite my impulse to brag to everyone I know, the reality that I ran 26.2 miles the other day hasn’t quite settled.  More specifically, it does odd things to your perspective when you are focused on a particular goal and you work toward it for months and months.  For one, the idea of “running a marathon” becomes completely achievable, and eventually becomes in many ways part of your identity.  For me, this seeped into my everyday existence - aside from the actual running -  in the form of the magazines I had subscriptions to, in knowing marathoners (one of them elite), and talking about training and progress with my partner and others.  So it strikes me as a bit odd when someone congratulates me on running the marathon, or exclaims anything from “wow, I’m impressed” to “that’s nuts!” – because it doesn’t seem at all out of the ordinary.

Everything I have said so far is true is grad school, too:

This is a marathon endeavor – that is easily accomplished (although still not easy) by focusing on one goal at a time until you reach the finish line.  Being absolutely certain that your goal is within your grasp is key – there is little room or time for self-doubt.  Surrounding yourself with people who support you, love you, and who contribute to your improvement – in short, those who are invested in your success – is essential.  Finally, respect the work you are doing - it does take time, effort and dedication.

But it's worth it.

 (As a final aside, I will admit I like half-marathons better – still enough distance to allow for challenges and meditative rhythm, but not quite enough to leave me sore for 3 days afterward.)

Thinking of New Possibilities

As I believe I've mentioned before, I am impressed with how much of  a "no brainer" the combination of Master's of Public Administration and Master's in Mental Health Counseling is.  These two disciplines dovetail so nicely - why is this joint degree program so sparsely populated?!

/ahem/  Moving on:

My Fellowship has really opened my eyes to the possibilities for program evaluation - and the utter, dire NEED for such things.  There are so many programs out there which are designed to help government, non-profit, and private sectors alike address what is needed in the world.  And it seems there are so few competent evaluations of those programs to see if they're actually working as intended.

Which brings me to another thing - program design.  The intent of programs are often very noble.  But... often, us do-gooder types will waltz into an area which we have determined "needs help" and start flinging ideas around without addressing what's actually needed.  OR the best way to deliver what's actually needed.  OR addressing the underlying psychological factors that drive the NEED in the first place.  So many programs are designed with glaring flaws that overlook important factors that *will* impact the success of a program from day one. 

The more I learn about public administration  - and reflect on the nature of counseling and care - the more I'm beginning to understand that to manifest the type of change I want to implement in the mental health care and medical fields, I will have little time for actual one-on-one counseling.  I hope that I'm wrong in some respects - but facing that reality is also relieving in others. 

The MSMHC training (and clinical work for licensure after that) will give me the tools I need to, above all ask the right questions. What are we trying to do?  Why?  Is this needed?  What do we need to do to find out what's needed?  If it didn't work as expected, why not? What are we missing?  What are those intangible factors that we're forgetting?  If this program is in place, what then?  How do we work collaboratively with the people we're working for in order to address the underlying causes?  What are the psychological impacts of anything we're looking at?  What's the most salient factor? How can we address that?

So I think I need to spend some time with my faculty supervisor and begin to ask if there are agencies out there that specialize in this kind of work - the evaluation of companies, non-profits, and social services to determine if what we want to do is a) actually getting done and b) actually the work we should be doing in the first place.

I see room for me in all sorts of places if I take this tack - the research end, of discovering gaps in service (hell, I've already started down this career path because I've recognized a massive abyss of a service gap for families dealing with TBI).  The program creation end, of implementing new programs and embedding evaluation tools from the very beginning.  The evaluation aspect - picking apart a program and asking if it can be accomplished in different and better ways that work with those we are serving.

I can't wait to see what's out there!

Lazy Teaching? (a minor rant)

I understand that people have varied "learning styles".  I understand that for some, lecture isn't their cup of tea.  I really do get that discussion and dialectical approaches are useful for many.

But can we please get a handle on "group discussions" in classes? It's like a plague these things are so common - read the material, get separated into groups to "discuss" the perspectives each of us can bring to the material as it pertains to a particular set of questions.  Lather rinse repeat. 

It just strikes me as lazy teaching.  Perhaps I'm biased because of a particularly lousy instructor I had while in undergrad who frequently employed this "learning exercise".  Frankly, though, it comes across more often than not (to me) as "I didn't feel like preparing a lecture today, so why don't you teach yourselves?" 

I'm all for learning from the rich and varied experience of my classmates, and having a classroom environment that is open to comment and discussion.   But I am here (in class, at Suffolk) for the expertise and experience of the faculty.  If I crave discussion or my peer's thoughts, there are - I'm certain - at least a dozen forums online that I can join to get "perspective".

Because, really: If I wanted to join a book club I would have done so. 

/rant