Fairhaven, The River

Definitions matter (median income statistics)

Summary: definitions matter much more than I expected.

There have been lots of public opinions about the change in median income in the US, and what it means for policies.  It turns out that the definition of median income matters much more than I expected.

This table shows the increase in percentage from 1979 to 2007, for those who want the answer up front:

Income Included	Tax Unit	Household	Size Adjusted Tax Unit	Adjusted Household
pre tax, pre-transfer	3.2	12.5	14.5	20.6
pre tax, post-transfer	6.0	15.2	17.0	23.6
post tax, post-transfer	9.5	20.2	25.0	29.3
post both, plus health insurance	18.2	27.3	22.0	36.7

The widely reported figure is the 3.2.  This is used to argue that there has been no improvement.  All the gains have gone to the top 1%.  The middle class is being hollowed out.

The different definitions make for a more nuanced answer, and reflect difficulties in getting data.

The different terms are:

• Tax Unit is the tax filing unit.  This is what the IRS tax statistics report.
•  Household is what you would expect.  It's all the people in the house.  So everyone in the household is combined.  This captures the effects of grandparents, parents, and children all being potential earners and sharing income and expenses.  It also captures unmarried couples, shared custody, etc.  The IRS statistics don't capture this, but the monthly Census survey does.
• Size adjustment modifies the income using the same adjustment as is used for cost of living.   A family of four needs more income than a single person, but not four times more.
• The kinds of income reflect regular wages/dividends, transfer payments like social security or food stamps, and finally health insurance benefits.  These variations also reflect data gathering.  The IRS can measure some transfer income, like the EITC, but not other transfer income, like food stamps.  EITC and food stamps are two very large social welfare programs in the US.

A recent paper is interesting in that it works from the census bureau data rather than the tax data.  This lets it measure households, transfer payments, and health insurance.  The tax information can only measure tax units.  They compared their results with the tax data and confirmed that they matched when measuring the categories that the IRS can measure.

My Conclusions:

• There is no "right" number.  The proper issue is what is the question that you are trying to answer.  The shifts in households, with grandparents and adult children moving back together with parents may be a compensation for economic hard times.  These numbers show that it works and has more than compensated for income loss.  Health insurance costs have gone up dramatically, as these numbers show.  Transfer payments and a progressive tax rate do appear to have a significant effect.
• The "middle class is vanishing" is at best misleading. 

Paper is at http://www.nber.org/papers/w17164

There is some more data on trends in household sizes, etc.  There is also a breakdown of quintiles.  For the all included houehold category, the bottom quintile saw 26.4% growth and the top quintile saw 52.6% growth.  The top 5% saw 63% growth.  There is no data for the top 1% because privacy related data blinding was applied by the census bureau, and only larger aggregates are reported.

So you can argue that all parts of the population saw significant improvement, or that the rich saw a larger improvement, or that the middle class is suffering.  The data shows that the progressive tax rate (EITC included) does have an effect, transfer payments and the social programs do make a difference, and that healthcare benefits do make a difference.

 

Book Review: A Brilliant Invention: Inventing the American Constitution

"A Brilliant Invention: Inventing the American Constitution" is an interesting perspective on the creation of the US Constitution.  It concentrates on the people and process of creation, rather than provide historical analysis of causes and effects.  It's a fairly brief book at 210 pages.

It starts by setting the stage of the political context.  This is not a historical analysis with explanations and reasons.  It's a statement of what was happening politically and why the constitutional convention was called.  It covers the political context of why some people favored or opposed, attended or avoided the convention.  It also covers the technological limitations of the period, e.g., the need to organize your business affairs for being out of touch for several months because there is no telephone, telegraph, or fast post.  News and post took a few weeks to travel between cities.

Next, it covers the organization and process of the convention.  This is unusual, because it is an explanation of the organizational dynamics, not a discussion of how the convention affected history.  It explains how the documents were created, how the committees are structured, how the meetings are structured, and how this is affected by the personalities involved.  I was especially amused by the name of "Committee for Postponed Items", which reminds me a lot of DICOM's Working Group 6 in terms of it's internal structure.  You don't need to be an organizational dynamics expert to read this section.  It's at a level that the novice can understand. 

Finally, it covers the conclusion and publication, without too much extrapolation into reasons for subsequent historical events.

I noticed one interesting difference between the political structure of the American Revolution and the current structure of world governments.  They had no great leader.  Today's governments are all structured around a single leader. 

The American Revolution and the creation of the constitution were driven by experienced politicians with strong legal expertise and decades of experience, but nobody was the leader.  There were always multiple leaders with their own specialties.  All of the leaders also had major weaknesses, there were powerful arguments and disagreements, and they worked out an acceptable compromise because the alternative was defeat and destruction.  The closest to a single leader was George Washington, but he resolutely stayed out of the political process.  For the rest you have names like Jefferson, Franklin, Adams, Hamilton, etc. 

They expected the country to be led by a similar structure in Congress, with multiple powerful politicians but no single leader.  They expected an efficient but subservient executive similar to George Washington, who expressed his opinions but carried out the policies decided by Congress.

They would probably have been very surprised by how long it took for this structure to collapse in the US.  It was not until the 20th century that the US shifted to it's current process of selecting a single leader to make all important decisions.   They were wondering whether the Constitution would survive for more than a few decades.

Hurricanes and Global Warming

Since there is a hurricane approaching the US coast, it's time to finally write this one.

A few years ago a paper was published in Nature that basically said:

If A, and B, and C, .... then there would be more hurricanes globally.

This is a fairly typical structure for a hypothesis.  But it struck me as odd that it was published in Nature.  Simple hypotheses like this are usually published in more specialized journals where they can attract the interest of other specialists who can contribute analysis of the proposal and data to confirm or deny the hypothesis.  The synchronized PR campaign and publicity explained this anomaly.  I've seen this before where a hypothetical is used as the basis for political campaigns. 

This particular hypothesis included two initial hypotheticals:

1. It hypothesized that hurricane frequency and intensity would increase if the temperature gradient between equator and poles increased.  This is not proven.  There are theoretical reasons that this might be the case, but there are others that would indicate the contrary.
2. It hypothesized that global warming would increase this temperature gradient.  Again, there are good theoretical arguments for and against.

After lots of publicity came the big lie, and it's a whopper.  It's another example of facts being irrelevant.  Examination of global hurricane data shows no significant change in hurricane frequency.  At the same time the press were bellowing about the increase in hurricane activity, the actual level was slightly below average.  The difference was that Katrina and a few other hurricanes hit the US.  That generates lots of publicity.

There is a recent increase in North Atlantic activity, which definitely excites lots of publicity.   There are claims that this is evidence for global warming, but the hypothesis was about global affects, not a local Atlantic effect.  The North Atlantic variability is a known weather cycle, although the underlying physics remain a mystery.  The current higher levels were first predicted in a 1955 report to the US Insurance industry.  The only reason it's a surprise to the public is the unwillingness of the public to hear the associated message about the dangers of building in dangerous locations.

But this all has nothing to do with the understanding, reality, or characteristics of global warming.   The absence of a global increase in hurricanes does not mean there is no global warming.  It might mean that global warming does not increase the temperature gradient, or that increased temperature gradient does not increase hurricane activity.

This could have been a quiet internal working paper.  But instead it was turned into a big political campaign, complete with misrepresentation of the paper, the real data, etc. 

EMR Polling, a communications disconnect

My initial reaction to the link to a recent poll analysis showing how little the public understands the value of EMRs was their intended "ignorant public" reaction.  I then shift to an "ignorant pollsters"  reaction, with a bit of wondering about whether it was ignorance or deliberate.

I think that the public answered a different question than the pollsters thought they had asked.

It seems likely that the public answered the question "who will benefit from the US government spending and regulation on EMRs", not the polling question about the "benefits of EMRs".  For obvious reasons my mind turned to GOSIP.  A similar question mismatch about "benefits of an Internet" versus "who will benefit from US government spending and regulation of GOSIP" would have a similar result.  GOSIP was a multi-billion dollar waste that caused delay and harm to the acceptance and growth of the Internet.  The US spending on EMRs could go down the same path.

As with GOSIP, the problem with the present EMR push is not with the technical concept, the problem is with the government spending and regulation approach.  I think that is what the public answers reflect.  They do not think that this government spending and regulation will have the claimed benefits.

The advertised functional goals for the EMR are twofold:

• Reduce costs, and
• Improve patient outcomes.

I will believe that a project will reduce costs when the project plan includes a proposed layoff size.  We are past the "let's build one and see what happens" stage for EMRs.  By now there should be a reasonable plan for layoffs of staff that will result from the EMR installation, where these layoffs result in savings that exceed the cost of installing and operating the EMR.  I'm not asking that these be perfect.  I've seen how things change as projects progress.  But if layoffs are not even in the plan at the beginning, there is no credibility for claims of cost savings.

I have seen plans like this in RIS/PACS installations and some EMR installations.  The systems are justified by layoffs of couriers, elimination of staff overtime, the elimination of warehousing, equipment maintenance, etc.  The results don't always match the plan, but in general there are real savings. 

I will believe the goal of improved patient outcomes when there are clinical trials and statistical evidence that show a reason to expect improved patient outcomes.  A blind faith of "technology will save us" is not accepted elsewhere in medicine, and should not be accepted here.  There is plenty of potential, but does it work in the field?  This needs to be evidence based.

Again, in RIS/PACS/EMRs there are sometimes situations where equipment is installed because it improves patient outcomes.  There are clinical trials and there is statistical evidence gathered showing that these technologies do improve patient outcomes. 

I will believe an outcomes motivations for an EMR project when I see sound scientific evidence in the justification for project features.

Book Review: Myth of the Rational Voter

I enjoyed The Myth of the Rational Voter: Why Democracies Choose Bad Policies by Bryan Caplan (ISBN-13: 978-0691129426)

He starts with an analysis that is a fair starting point for his thesis, although he debunks it in favor of a more complex and subtle thesis toward the end.  A "rational" voter will realize that their vote means nearly nothing.  It doesn't really matter.  Their one vote will not determine the outcome of anything.  So, to deal with the cognitive dissonance raised by the effort of voting, they choose their vote based on psychological satisfaction.  The "rational" voter does not attempt to consider their self-interest in the policy outcome.  They pick a vote that lets them leave the voting booth feeling happy.

This is followed by a fairly extensive analysis of data regarding public perceptions vs informed perceptions of various economic issues.  From there, various voting strategies and political strategies are considered against observations.  The "rational" voter described above is not a fully accurate predictor of voting behaviors, but it captures the general theory.  There is a kind of cascading of specificity both by politicians and voters.  For example, voters may select the "feel good" vote for the politician who does something for "jobs".  They don't inquire closely into the later decision that "jobs" means a regulatory deal to favor a particular industry and particular unions.  The politicians, industry, and unions understand that they cannot break the feel good illusion, but it will be safe to employ corruption to ensure that these jobs go to the highest bidder.

The book is primarily expository and tries to explain the voting thesis, explain the supporting material, and discusses some of the weaknesses of the theory.  It's not trying to push a "solution".  It's describing and explaining observed behavior, not selling any particular policy.

Second round rail transportation grants are more intelligent

The first first round of federal transportation grants was mostly PR and favored consulting grants, together with lots of federal employee funding.  More than half is for bragging rights over whose passenger trains are fastest.  These are a good way to funnel money to civil servants, consultants, and publicity agents.  This is all crucial to the re-election campaigns of congressmen who need that PR and public support.  But they are not what has been demonstrated to maximize utility.

The biggest improvement for the dollar comes from eliminating bottlenecks.  The Acela does not hit any speed records.  It spends most of its time running at 200 kph or below.  It made its big gains through taking slow turns a little faster, eliminating stops, better acceleration and braking, and eliminating the engine change in New Haven.  This cut the NYC-WAS time by about 30 minutes (with no change to top speed compared to the predecessor Metroliner), and the NYC-BOS time by about 1 hour.  Analysis of schedule impact continues to show that the biggest wins will be through upgrading the very slow track and signaling on NYC to New Haven, and through replacing worn out bridges and sections that require go slow orders.

Similar improvements in California have dramatically increased capacity and ridership in both the LA-SAN traffic and OAK-SAC traffic. 

Perhaps a third of the first round of grants went to this kind of project.  They tend to be small, plebian projects that add sidings, straighten track, bypass bottlenecks, add overpasses, etc.  Only the locals notice the improvement.  These are hard sells to national politicians.

The second round seems to have done much better.  The details are in their report (PDF).  In addition to eliminating passenger bottlenecks, it is funding many projects that eliminate freight bottlenecks and road-rail interference.  Replacing some at grade crossings with overpasses can eliminate long traffic delays on the roads and allow heavy freight traffic during commuting hours.  Both sides win.  The Long Beach port improvements several decades ago were the first to exploit this kind of improvement.  The CREATE project around Chicago is the current largest of these coordinated projects.  There are several smaller such projects also in progress and an East Coast corridor analysis looking at a huge series of bottleneck improvements for the Virgina to Massachusetts corridor of rail, road, sea, and air traffic.

Why digital signatures don't work

At Tuesday's town planning committee meeting we had one applicant for a parking waiver.  He made a quick presentation showing how they planned to add another office space to a warehouse and add a couple parking places for it.  This just involved putting marks on the warehouse driveway.  It doesn't require a zoning change.  It's just a change to the registered building plan.

The chair asked the consulting engineer for his report.  He listed changes A, B, C, ... and G between the plans he was given and the new plan.  Two board promptly started talking about changes B and C.  They had a bunch of doubts and questions.  The applicant answered some questions and dug through his documents.

As the two board members got going he put up another plot plan and asked:  "Why are we talking about this again?  You agreed to this back in November.  See, here are your signatures on the approved plan.  It shows those changes."

The consulting engineer said he had been given plans dated July for comparison.  A quick look and he agreed that the only change between the signed November plan and the proposed plan was the office space layout and parking places.  The two board members walked up, saw their signatures, and sat back down.

The office space and parking change was agreed to be minor and the new plans approved.

Signatures exist in large part to make board members and applicants shut up and sit down. 

This works for several reasons. 

First, there is a signing ceremony.  This ceremony involves ritual motions, ritual words, public observation, and sometimes other steps.  The ceremony is a recognized and understood end point.  It ends social acceptance your ability to make changes.  It is important that the the ritual motions be unique.  A physical signature is a ritual motion that you almost never use for any other purpose.  It is not just an emotional or intellectual difference.  The physical movements are unique, non-trivial, and not accidental.  You must use muscles and eyes to perform it properly.  It leaves behind a physical artifact that you personally recognize.

Similarly, the witnesses are physically there and can observe and confirm this ritual motion.  After a while, they also have the ability to immediately recognize the resulting physical artifact.

For plot plans there is more to the ritual.  Not only are there the signatures of the board, this is preceded by stamping the plot pages with the official stamp, the signatures are on the stamp, and after the signatures are there the paper is sealed with a press that bends, dents, and selectively tears the paper that was stamped.  All of this is something that can be recognized and confirmed by those present.

Second, the board members immediately recognized the physical results of that ceremony and recognized the social power.  They shut up.  This was not some arguable computer magic.  They were able to perform their own immediate verification.

Perhaps some day the digital signature will reach the level that these physical signatures have reached.  There will be the ceremony that ensures that all the participants recognize that they are agreeing to an endpoint.  Pushing a button on a computer is not a unique ceremony with witnesses.  It is not a unique motion used for no other purpose.  A whole ceremony process needs to be invented for the digital signature that it presently lacks.

Issues of ceremony, social witnessing, etc. are malleable.  Ceremonies change.  So the digital signature can reach general acceptance, but the endless fascination with esoteric internal implementation details is not creating a proper ceremonial process.  In fact, the current user interfaces for computers make it quite a large challenge to create a proper family of ceremonies.  Physical signature ceremonies are rather adaptable and cover the range from the quick initialling in a hurry to the formal multiparty signing ceremony with stamps and seals that is used for building plan approvals.  Digital signing ceremonies will need to provide that same spectrum of ceremony.

The validation of signatures is similarly immature.  There is no technological barrier to the quick verification of physical signatures.  Those two board members took less than a second to confirm their own signatures.  They could have argued forgery.  Forgery is unlikely because of the high cost of creating the forgery and the near certainty that it would be discovered because other duplicate copies of the plans are kept in storage at various locations.  A successful forgery would need to substitute those also.  Getting approval for an office and some parking does not justify all that expense and risk.

Digital verification might reach that same degree of universality some day, but it will take decades or centuries.  It's not just a matter of computer access.  What the board members were verifying was that the plans that they saw had been signed.  If a computer were involved you must figure out how to ensure that the photons emitted correspond to the digital signatures.  The relationship between photons and signatures is inherent in the physical processes of paper and light.  If this were a plan being projected by a computer, how do I know that the digital signature corresponds to the projection?  If I do not trust the presenter, why trust the projection.  This means that I need the document to be provided to me so that I can use a computer and projection system that I trust.  Lack of trust can go both ways, so this comparison of photons can become very difficult logistically.  Every participant must have their own trusted viewing system and verification system.  It's a rather huge investment in equipment and facilities to reach the point where everyone has this and can confirm signatures to their own satisfaction in less than a second.

For now, that piece of paper and those physical signatures are meeting the signature goal.  The investment in physical resources and new scial ceremonies will not happen just to improve signatures.  The improvement is not that valuable.  It will happen when other reasons and purposes have justified the investment in computers, etc.  Then social ceremonies can be created and digital signatures finally become practical.  (Assuming that something better has not been invented first.)

Hostility to risk analysis

I found this old quote in Nature:

The widespread hostility to the use of benefit-cost and risk assessment analysis is based on an absolutist health-only positionj that virtually no one is willing to embrace in the real world. 

Hammond, P.B., and Coppock, R. (eds) Valuing Health Risks, Costs, and Benefits for Environmental Decision Making (National Academies Press, 1990)

In this case the issue is particulate pollution, but the same hostility can be found in all sorts of health related policy discussions.  It's very hard to get any kind of rational discussion of risk, or cost-benefit, or even simple concepts like maximizing return on investment.  The polemics of win/lose and absolutist evaluations seem to dominate.

(A frustrating Thanksgiving of fruitless political arguments may be part of the inspiration to post.)

Good Hurricane Forecasts Considered Harmful

Good hurricane forecasts may have reached the point of doing more harm than good. Since 1970 the American Meterological Society has editorialized against the bad hurricane policies of the US. In particular, the coastal development planning and regulation emphasizes evacuation and encourages people to live in areas at risk. Evacuation is a brittle protection. Failures are complete, not partial. The recommended policies are mitigations that reduce risk and provide partial protection even when the hurricane overwhelms the protections.

This is a subject that simple linear text handles poorly. So I'm experimenting with a diagram of the interactions.

(My first experiment was with SVG. That doesn't work so well with Typepad. It puts in a nice link that you can follow, so if your browser supports SVG you then get to see it. This diagram does OK as an image, so it's in as an image with thumbnail.)

Repeat and Unnecessary Exam

I've heard a lot of claims recently about a high rate of repeat and unnecessary diagnostic exams. The claims range from 5% to 50% of exams are unnecessary. This is then used as justification for whatever change is being proposed. Most recently it was used as justification for implementing a RHIO.

I have a complaint with proceeding based on such vague and sketchy information. What is their definition of repeat or unecessary? How were the results obtained? What was the test environment? This information is available in the literature. For example, see this report. If you track through its references, you find that all of their reported errors were within hospital errors. None were the result of failure to convey information from one hospital to another. They did not even measure that category.

Was this one of the studies being used to get that unnecessary exam figure? I don't know. These decisions are being made on a social and emotional basis, not on the basis of measurements and observations. It's representative of the immaturity of the quality system. Some of the measurements needed are being taken and are available. The decision making process has not reached the maturity level of including those measurements accurately.

My own reaction is to focus more energy on the relatively easier task of improving the internal processes, and less on the much harder task of regional and national data networks. This is based on a) the observation that fixing the internal systems eliminates a huge source of error, and b) the delivery of reports will merely deliver them to the still broken internal system. So most of the gain from regional sharing will not be available until after the internal systems are working well.

Politically and socially, the big regional networks are more attractive. They mean lots of money, which attracts politicians, the press, and the beltway bandits. Plebian fixes like "lets show the prescribing physician contra-indications automatically" mean lots of grunt work, not much money, and no publicity.

Update: Fixed the link to point to the right report