Hong Hate Horoscope: Week of November 1, 2021
The Lead
How Public Health Took Part in Its Own Downfall
This was so good on public health and how we need to stop trying to be clinicians (insert me yelling about epidemiologists ignoring non-disease issues here):
This revolution in thinking gave public health license to be less revolutionary. Many practitioners no longer felt compelled to deal with sticky, sweeping problems such as poverty, inequity, and racial segregation (or to consider their own role in maintaining the status quo). “They didn’t have to think of themselves as activists,” Rosner said. “It was so much easier to identify individual victims of disease and cure them than it was to rebuild a city.” Public-health leaders even mocked their predecessors’ efforts at social reform, which they saw as inefficient and misguided. Some dismissively billed the impressive work of the sanitarian movement, which had essentially plumbed entire cities, as “a matter of pipes.”
As public health moved into the laboratory, a narrow set of professionals associated with new academic schools began to dominate the once-broad field. “It was a way of consolidating power: If you don’t have a degree in public health, you’re not public health,” Amy Fairchild, a historian and the dean of the College of Public Health at Ohio State University, told me. Mastering the new science of bacteriology “became an ideological marker,” sharply differentiating an old generation of amateurs from a new one of scientifically minded professionals, wrote the historian Elizabeth Fee.
Hospitals, meanwhile, were becoming the centerpieces of American health care, and medicine was quickly amassing money and prestige by reorienting toward biomedical research. Public-health practitioners thought that by cleaving to the same paradigm, “they could solidify and extend their authority and bring public health up to the same level of esteem and power that medicine was beginning to enjoy,” Fairchild told me.
And on why I believe we need more sociologists and economists in public health (and more interdisciplinary work!)
Even public health began to treat people as if they lived in a social vacuum. Epidemiologists now searched for “risk factors,” such as inactivity and alcohol consumption, that made individuals more vulnerable to disease and designed health-promotion campaigns that exhorted people to change their behaviors, tying health to willpower in a way that persists today.
This approach appealed, too, to powerful industries with an interest in highlighting individual failings rather than the dangers of their products. Tobacco companies donated to public-health schools at Duke University and other institutions. The lead industry funded lead research at Johns Hopkins and Harvard universities. In this era, Rosner said, “epidemiology isn’t a field of activists saying, ‘God, asbestos is terrible,’ but of scientists calculating the statistical probability of someone’s death being due to this exposure or that one.”
And on thinking beyond the disease itself but to social consequences:
But, as COVID has revealed, the legacy of the past century has yet to release its hold on public health. The biomedical view of health still dominates, as evidenced by the Biden administration’s focus on vaccines at the expense of masks, rapid tests, and other “nonpharmaceutical interventions.” Public health has often been represented by leaders with backgrounds primarily in clinical medicine, who have repeatedly cast the pandemic in individualist terms: “Your health is in your own hands,” said the CDC’s director, Rochelle Walensky, in May, after announcing that the vaccinated could abandon indoor masking. “Human behavior in this pandemic hasn’t served us very well,” she said this month.
If anything, the pandemic has proved what public health’s practitioners understood well in the late 19th and early 20th century: how important the social side of health is. People can’t isolate themselves if they work low-income jobs with no paid sick leave, or if they live in crowded housing or prisons. They can’t access vaccines if they have no nearby pharmacies, no public transportation, or no relationships with primary-care providers. They can’t benefit from effective new drugs if they have no insurance. In earlier incarnations, public health might have been in the thick of these problems, but in its current state, it lacks the resources, mandate, and sometimes even willingness to address them. [The Atlantic]
Good journalism/Cool shit
So if we try to deal with the problem of expensive health care, child care, and higher education by throwing more money at it, the result will be that although consumers will pay less, society as a whole will pay more. This is exactly what happened with student loans. The government offered people cheap student loans, which caused students to pay more for college, which caused colleges to hike their prices.
Now, you might say “That’s fine, as long as rich people are footing the bill and everyone else is getting the benefit.” America needs more redistribution, as Niskanen readily agrees.
But subsidies for overpriced sectors are a highly inefficient way of doing redistribution. If you just take cash from rich people and give it to poor people — as we did in the recent COVID-19 stimulus bills — they spend it on whatever they want. But if you distort the economy in favor of health care and higher ed and child care and so on, you’ll just end up wasting resources on these sectors. You’ll get more administrative bloat at colleges, more hospital workers and insurance industry workers doing hours of useless paperwork, and so on.
And I swear that “Noah Smith” is not my pen name, but this is exactly how I feel about some of the BBB proposals (please no Medicare dental/vision, I don’t hate old people1, I promise!).
Health care subsidies (and child care subsidies, and higher ed subsidies) are the wrong choice. Not because they’re bad — Medicare should include dental and vision, Medicaid subsidies would relieve some human suffering — but because they’re not the best things in the bill. They represent Cost Disease Socialism — relieving the economic burdens of lower-income Americans by buying them more of stuff that already costs our society too much to produce. Meanwhile, centrists are trying hard to kill the one provision in the bill that actually addresses excessive health care costs — allowing Medicare to negotiate lower prices for prescription drugs.
If it’s a choice between Cost Disease Socialism programs and doing absolutely nothing to ease the lives of the poor and the working class, then I will pick Cost Disease Socialism every time. But this is not the choice we face. We have alternatives, like Biden’s child tax allowance, that would fight poverty and deprivation in a far more effective way — by giving people cash, and letting them decide what to spend it on (We could do the same thing for retirees, by the way). We have ideas like Medicare price negotiation that could actually decrease the social costs of the overpriced services. And we have ideas like the Clean Energy Performance Program, infrastructure investment, and research funding that would make things like energy and transportation cheaper, increasing Americans’ purchasing power and giving them more money to spend on whatever they choose.
Sports hot takes
The Punter That Was Promised Has Arrived
Would you like to read about punting? [The Ringer]
How the Buffalo Bills pulled off the greatest comeback in NFL history
Love this story (it’s an oral history, so yeah). The set-up:
Levy: "[Reich] just nodded his head, like, 'Yeah, sure.' When we're walking back up the tunnel, our [quarterbacks coach] Jim Shofner said, 'Coach, the greatest comeback was 28 points, we're only down 25.' And I said, 'Oh, Frank doesn't know that.' The first play the second half, he threw an interception for a touchdown."
And the punchline:
Levy: "After all the celebration in the locker room after the game, Frank finally said to me, 'Coach, I knew you said I'd lead the greatest comeback, that's why I threw that interception.'" [ESPN]
70 points in 17 minutes? ACC surprise Wake Forest has evolved into sport’s buzziest attack
Fun article on the…. Wake Forest offense? [Yahoo]
Derrick Henry Isn’t Just Defying Football History. He’s Making It.
On Derrick Henry:
This may sound odd, but Henry’s statistical legacy reminds me a bit of Dan Marino’s. If you look at the all-time passing leaderboard, virtually everyone on the lists played in the past decade—other than Marino, who apparently played full-fledged modern football 30 years ago. The top 20 seasons in passing yardage have all happened since 2008—except Marino’s 1984 campaign, when he became the first QB to eclipse 5,000 yards. Nobody would join him for 24 years. The top 10 seasons in passing touchdowns have come since 2004—and then there’s Marino’s 1984 and ’86. Marino even stands out in rate-based stats like adjusted net yards per attempt. The top 10 seasons there have all come since 2004 … except Marino’s 1984.
Henry is doing the same thing, just in reverse. His career shouldn’t be possible in the modern era. He’s putting up stats better suited for 1985 than today. But he’s putting them up all the same. [The Ringer]
Health, politics, and academia
Where Facts Were No Match for Fear
Well this is terrible. [New York Times]
This edition of the Hate Horoscope, like almost all of them, is sponsored by Noah Smith. Sadly, I do not get commission.
Hate reading
Why upzoning in gentrifying neighborhoods like Langley Park isn’t always a good idea
lmao no (trigger warning: trump)
Langley Park is a low-income neighborhood with a large, socially vulnerable population. Upwards of 80% of its residents are Hispanic or Latino, and many of those are undocumented. Almost 90% of households speak a language other than English. Over 45% of the population under 65 does not have health insurance. And, the area’s poverty rate (19%) is more than double the county’s rate (8%).
Langley Park’s tenants are also vulnerable because many residents live in aging buildings that suffer from disinvestment from landlords. I’ve written severalposts about Bedford and Victoria Station apartments tenants’ struggle with their absentee landlord who refuses to fix ongoing leaks, treat rodent infestations, and replace broken heating and cooling systems. In July several residents of the complex filed suit against the owners of their building claiming the Bedford and Victoria Station apartments homes “have been neglected as part of a systemic confluence of policies to commoditize and harvest profits in low-income neighborhoods while delaying reasonable management or maintenance of properties until strategically and financially beneficial to shareholders, all to the detriment of the tenants.”
Uh why do you think this is buddy? Because THERE IS NO HOUSING AND THESE PEOPLE DON’T NEED TO MAKE IMPROVEMENTS TO COLLECT MONEY.
There are good reasons not to upzone Langley Park right now. If Langley Park’s tenants lose their homes en-mass and within a short time frame, it will have dangerous knock-on effects for the county, including homelessness, increased poverty, education loss for young people, and increasing domestic violence. There’s also a moral argument to be made. Langley Park’s tenants have been asking the county do something about its slumlords for years.
While they waited, their landlord has charged them as much as $1,500 a month to live in rodent infested units with collapsing ceilings, broken appliances, and mold. The county didn’t create this problem, but it hasn’t fixed- it either, and arguably let it get worse as a consequence. Upzoning would amount to a pile on these tenants don’t deserve.
ha ha ha. you’re SO CLOSE to getting it. build more housing → there are more places to live → these people can no longer get away with charging these bullshit prices → people’s housing improve
so what’s the proposed solution?
So, how to do this while also helping Langley Park’s current tenants. For starters, Prince George’s needs to beef up its housing enforcement office with more staff. It also needs to sharpen its enforcement tools. Prince George’s County has a rent escrow program for tenants living in properties with major housing code violations, for example, but it lacks teeth. It should model its program on the one run in Los Angeles. There, properties with major code violations are automatically enrolled in the program. And until their properties are brought up to code, tenants’ rent not only go into escrow, but are also discounted (between 10 and 50%).
The county may also want to consider lawsuits. DC Attorney General Karl Racine just successfully sued to have a Columbia Heights landlord pay $640,000 in restitution to tenants living in deplorable conditions. And, he used consumer protection laws to make it work. Bedford and Victoria Stations tenants are currently suing their landlord, but they shouldn’t have to bear the legal burden alone.
lol yes, more enforcement and lawsuits. good one. something that doesn’t solve or improve the housing stock or quality at all. sweet. awesome. good job.
Et cetera
Viewing website HTML code is not illegal or “hacking,” prof. tells Missouri gov.
lol
Recipe of the Week
I’ve posted this before I thing, but this apple cider donut loaf is a perfect fall recipe (I made some yesterday).
that much