Wellyopolis

April 15, 2010

Paying twice as much to get twice as much

I'm sure the usual idiots will be out loose on the internet soon explaining why the fact that the United States spends twice as much of its national income on health care as the average OECD country, and has a maternal mortality rate of twice the OECD average is just awesome, and actually shows the superiority of the US healthcare system (and the wisdom of the Founders etc etc), but in the real world you have to wonder ... Is paying twice as much to not even achieve good basic healthcare results worth it? Healthcare is a big ship to turn around.

(Sane and informed commentary)

Posted by eroberts at 8:24 PM | Comments (0)

April 11, 2010

Why Whanau Ora should be evaluated

If the key idea behind Whanau Ora—that social service agencies should work more closely together—was so good, it would have worked the first time. And therein lies the problem. The idea that social service agencies should work more closely together is not an innovation in social services, but a recurring staple of reform.

Of course every generation of policy makers and social service workers has to discover this for themselves, and dress up the resulting discovery in a local context. Hence the name Whanau Ora. Every decade in the twentieth century some government or social service agency in the western world was "discovering" that health, education, criminal justice, and housing problems and solutions were intertwined, and that a solution was for institutions and professionals to talk to each other, and work a little better together. Things were maybe more integrated in the nineteenth century when "charity visitors" were untrained, well-meaning middle class men and women visiting the homes of the poor to see what they could do to help. Someone could usefully write an article pointing out the long recurring history of this new idea, and make it compulsory reading for social policy analysts.

Social services became less integrated with professional training and specialization in the late nineteenth and first half of the twentieth century. The 1920s and 1930s saw lots of calls for integrated services as the first large generation of social work professionals examined their field. It was this impulse that gave New Zealand milk in schools and health camps for sick children. Same idea, different time period. And certainly not unique to New Zealand.

While you can't really question the sincerity of the ideals and ideas behind the policy the fact that we've had this laudable impulse to integrate social service before and it didn't solve all our social problems then means we need to be skeptical of the idea that Whanau Ora will work that much better than the services already in place. That's not to say that Whanua Ora will fail, just that people who are not trying to sell you a political policy should assume any government initiative is no better than what it's replacing until proven otherwise.

Whanau Ora will very likely look great in the first year or so. Positive stories of families helped and crises averted and multi-cultural harmony unfolding will be easy to uncover. Were one to do an evaluation of the old and the shiny new services, the shiny new services would look good. Social service workers, like everyone else, often throw themselves into the new thing enthusiastically. The real question is how do things compare in year 3, when this is no longer the exciting new programme that the government is supporting? I am pretty sure we'll never find out the answer to that question. There is also a near certainty that something bad will happen in at least one family receiving Whanau Ora support, and this will look bad for Whanau Ora in the Sunday newpapers. That's unfortunate too, because no social services eliminate all the nasty things that happen in families. The important question is what minimizes nasty stuff at an acceptable cost.

Calling for integrated services and a holistic focus on families is easy. Getting it to work in practice and show that it's worth the upheaval in what we currently do is more difficult. The flipside of enthusiasm for new projects and new ways of doing things is that some people doing a totally OK job of working with families in need don't like having their routines disrupted. There are lots of possible models of integrating services. The idea has recurred so often in the past hundred years that the evidence for integration is, of course, mixed. Sometimes it works OK, sometimes not so much. The specifics of the policy and practice matter. This iteration of an old idea will be different again in how it works. So it's entirely possible that moving to new service models is bad in the short-term. The point is, we don't know. We won't know unless we try and find out.

What we do know is that how the families respond is critical. One thing that's hard to do in social services is blind evaluations. People know if they are getting the new service. It's not like drugs or surgery where you can trick people into thinking they're getting treated. Since the response of families to social interventions makes a huge difference to the effectiveness of those interventions, perhaps some good will come of this. In that sense pretending to do something new in social services every few years is not a waste of time or a forgetting of knowledge, but a necessary part of making the people being served feel someone cares. But you still should find out that the reorganization didn't make things worse, or cost a whole lot more.

Good ideas and the thrill of the new are not the same as good outcomes. If the good idea of integrated social service delivery was that good we wouldn't have a century long international record of people calling it a new idea. It is a good idea, but it's an old idea whose time has come, and will come again, and again. Print this out and come back to me in twenty years, and we'll probably be onto the next integrated social service initiative.

If the New Zealand government is really committed to redesigning the way it delivers it billions of dollars worth of social services it should implement Whanau Ora in a limited way and see that it works. But that is not often the New Zealand way. There is an assumption that new programmes just work, and that it is inequitable to deny people the benefits of the unproven new thing. It makes for good politics in the short term because it looks like the government is doing something innovative to improve people's lives. But it makes for bad policy in the long-term because we don't know what really worked.

Posted by eroberts at 11:04 PM | Comments (0)

April 8, 2010

There was no golden age of original content

Interesting discussion at Crooked Timber about how much original reporting there is on the internet. Not much. Or maybe a lot. All depends what your prior expectations are, I suppose. There is certainly a lot of recycling of content, and probably there always was.

Now that we are lucky enough as historians to have access to lots of digitized text we can see the scale of this problem historical question more easily. A decade ago or more when I first got my hands dirty in original research, I used to think there might have been some golden age in the nineteenth century where newspapers and magazines had a high proportion of original content.

Why the nineteenth century? I suspect that publications with lots of original content are going to come in highly literate societies with printing presses, but despite that relatively limited communication to the outside world. Now, this does describe some significant parts of the world in the nineteenth century, Australia and New Zealand, parts of the American Midwest and West, and South America; the "regions of recent settlement" to quote an imprecise but known scholarly phrase.

But once you get cheaper transport, and then the telegraph, I suspect that the books and magazines of these regions are going to start reprinting material from elsewhere. And why not? The locals (recent in-migrants) wanted to know what was happening elsewhere, where they'd come from, where their friends and relatives had gone, and where they might move too. Indeed you have whole sections in nineteenth century newspapers labeled "News on the latest ship" or "News from the wires" (or something like that).

Not only that but the nineteenth century is full of books that are nothing but reprints of extracts from newspapers and magazines.

The other thing the digitization of magazines and newspapers has shown me is that it wasn't only news that was reprinted and not original (tho' it might have appeared original), it was, of course, also opinion pieces. The obvious successor to the political pamphlet was the newspaper column. Small town and city newspapers were particularly rife with this kind of reprinted stuff.

In short, reporters have long been rewriting someone else's copy and passing it off as new. I'd start with the hypothesis that this is an historical constant and not a decline in modern standards.

Posted by eroberts at 8:56 PM | Comments (0)

Flying business class: like a youth hostel in the sky

The latest episode in Duncan Garner's exposing of Chris Carter's travel shows two like-minded men really made for each other. Both men have opted to appear to be doing their job, rather than really doing it.

For a little-bit-lazy political journalist, what an easy story. Politician flies business class to Europe! Something few experience, but many can understand, having glanced at the forward cabin as they board the plane. And the sums involved are comprehensible, thousands rather than millions of dollars. But lets not romanticise business class travel. Sure, it's nicer and more expensive than economy, but you can have a lot more indulgence on the ground. If long haul economy flying is like sleeping in a tent on a hill and being served reheated food, business class is like sleeping in a youth hostel and being served slightly better reheated food. It's nicer, but it's not that nice.

But most people don't travel business class so it's easy to foment indignation at a politician getting a slightly better deal than others. Even in business class you can't avoid the fact that changing time zones rapidly screws your body clock. Nothing you can do but wait to adjust. The only thing that business class gives you nowadays is the option to sleep flat on your back. Especially if you're a tall guy, like Chris Carter. And if you really have to perform straight off the plane, then business class is probably worth it. It's just a little hard to believe that an opposition spokesperson going on a 3 week trip to Europe has to perform straight off the plane. Fly economy, and add an extra day to the trip, and it would all be OK. Probably no nasty TV3 coverage.

So it's easy to write a story like this, the information is all out there in public, and you don't really have to understand anything. Politician travels better than the public. But no-one should think that flying business class to Europe is a bunch of jolly good fun. You could have much more fun at taxpayers expense by going to a nice restaurant in Wellington and claiming that off the taxpayer. But $200 here and $200 there isn't quite as obvious a story as $10,000 on airfares.

Both are lazy stories. The real scandals, the real waste of millions of dollars are hidden, not in corruption which is easy to understand, but in bad decisions about government policy (like this one for example). But you have to do some digging and thinking and investigation to find out where millions of dollars are being wasted.

In much the same way as Duncan Garner appears to be doing his job as a journalist by exposing the easy stories Chris Carter appears to be doing his job as Labour's Foreign Affairs spokesman by going overseas. What could advance foreign affairs more? Except that once you've gotten over the jetlag is there really much to be gained by meeting some foreign officials? Not really, not for an opposition which is trying and not always succeeding at being an effective critic of the government.

The big challenge for Labour in opposition is not to know more about foreign affairs and be able to say you've met obscure foreigners, but to come up with some effective criticisms of the government, and some alternative policies. You can do that just as well, better, sitting on a chair in Wellington or Waiheke reading books and newspapers, and thinking a bit. Meeting obscure foreigners is great preparation for being in government, but it doesn't help you get out of opposition. Carter's criticism of the government's whaling "strategy" will do far more for Labour than any trip to Europe.

So, two men, Garner and Carter, misdirecting their professional energies into the appearance of doing their job, they are made for each other.

Posted by eroberts at 4:02 AM | Comments (8)