Maybe you have heard the word transparency or maybe not, but our public officials have begun calling for more transparency, that is openness and less secrecy in decision-making of government agencies, nonprofits, private corporations, and even Congress itself. In a sense this is just a retooled idea for the sunshine acts, open meetings and freedom of information applied beyond government agencies. Recent IRS changes require more transparency from nonprofits concerning executive compensation, fund raising, organizational structure, and governance. This is in part due to public outcry over what were deemed excessive salaries for nonprofit executives without any accountability to the public. (see GuideStar, www2.guidestar.org). Scandals relating to the financial meltdown have increased the pressure for greater accountability and transparency by banks, loan institutions and government corporations (the SEC, Fannie Mae, Freddie Mac) and the regulators (Federal Reserve, FTC, and the Attorney General’s office). And oddly enough, calls for transparency are an outgrowth of a movement to put pressure on non-democratic countries to stem corruption, open up their decision-making, and be more accountable for the way they spend money given to them. Transparency International (www.transparency.org) regularly publishes report cards on government corruption and bribery. Befitting its goal, Transparency International places its audit, annual report, its governance process, a code of conduct, and an ethics policy on its website (www.transparency.org).
In the age of the web, this transparency ought to apply to other companies beyond banking, nonprofits and whole countries. My particular focus is on health insurance. My recent personal experience has been with a long term care insurance company. I have been assisting my parents with obtaining reimbursement. The first step was to call claims when we began to receive letters indicating that the company needed more information. This meant punching in information before you could speak to a claims rep who, in turn, asked the same information and more. This, of course, is to prevent fraud to insure you have the right to the information, but it had an unintended effect. My father grew weary of trying to get information he was entitled and he turned it over to me so he could take care of my mother.
Transparency means balancing a company’s privacy or, in this case, the policy holder’s privacy, with easily accessibility and a quick turnaround. What I encountered was a lack of accessibility and obfuscation once you got past the automated system, the reverse of transparency. I repeatedly asked for clarification, forms, or examples of the information required. The company claims reps, in turn, repeatedly told me that the providers would know what to send. When I pestered, begged, or yelled, the company hid behind privacy rules. Healthcare privacy regulations have given insurance companies an excuse not to be forthcoming. We have sent the permission form for me to make enquiries three times (known as a Hipaa form for the Health Insurance Portability and Accountability Act). In the latest round, I called to obtain the Hipaa form for a new provider. The insurance company would not fax the form or email to our chosen provider, but would fax it to me. I, in turn, faxed it to the provider. This is a form, not private healthcare information!
Transparency means accountability. When we did receive a letter from the insurance company, it was often sent namelessly making it difficult to inquire. When we did receive a letter with a name and tried to speak to that person, the claims representative could not transfer me, was not familiar with the person, had never heard of the department. Most recently I asked to transfer to a supervisor. That failed. On the web, the insurance company does have a place to email, but I have never had a response in the 3 times I have tried that.
Transparency requires a clear process. When I tried an alternative tactic of asking the company to identify providers that would meet its requirements, it did not pre-approve providers. Writing is usually the answer when talking does not help. But transparency has to be in place for this to work. The company, in fact, has two mailing addresses making for confusion, one location scans in information and the other takes calls. I wrote letters asking for explicit information on what the insurance company wanted and for providers’ names only to discover that my requests were scanned but no one replied. It’s difficult to ask for information when you have no names.
When claims were finally denied, a “nameless” letter simply stated that we were entitled to a management review. Because the company did not provide directions, I wrote an appeal winging it documenting all that we had done to seek reimbursement. I finally did receive a call from a very nice employee who was going to assist with getting an approved provider and forwarding our appeal. For the first time, I had a direct phone line. When I called back a few weeks later and got voice mail I presumed the person was on vacation. People do have the right to take time off. But when no one answered for over a month and voicemail became full, I had no recourse except to call claims. The claims rep had never heard of the liaison’s (she had no title) office or her name and again repeated that the claim had been denied. A transparent process should be seamless without a customer needing to understand the behind the scenes details.
If ever there is a case for transparency, it is with insurance companies. A requirement of public traded companies is that they have an annual report. It lists the executives, the board, and its financial status. From what I gather from the web and the annual report, the company is run by four executives and the claims representatives! The local field office representative does not handle claims (in essence refusing to assist me) and is just as much in the dark about departments and phone numbers as the claims reps.
Transparency resides along with accountability, integrity, honesty of actions, and caring about employees and the public. I feel sorry for those claims representative who are the public side of the company and who are considered so low that they do not have a company directory, a web interface to look up information, or e-mail capability. I do understand that the company cannot have policy holders calling all sorts of different people. The reality is that the web has made it possible for greater transparency to be immediate and we now demand it. Transparency is procedural transparency, greater openness in decision-making as well as the availability of information. This huge company presents itself as having an outdated claims process with little to no information on the web. It does not email anything slowing down the process. Even my 88 year old father emails! At the very least, I should be able to trace what information they have and obtain the necessary forms to submit a claim. Countless hours have been wasted by claims reps, by me, and my father when greater transparency should be the norm. Transparency makes for good customer service!
Friday, August 27, 2010
Thursday, May 27, 2010
The Demise of the Public Administration Department
This one is more personal than others. It was written for and published by the Kennebec Journal, Augusta Maine in conjunction with two alums of the University of Maine Public Administration Programs
Public administration at the
Within the greater
In a state hard-pressed to fund its services even in good times, a public administration degree is cost efficient. It is far cheaper for state employees, area town managers, or nonprofit managers to take a UM course in Augusta leading to an MPA degree than to attend short seminars, stay over a night in Boston or some other city, and lose a day or two of work. The flagship university’s courses are specific to the needs of the state for public servants who are knowledgeable about finance, personnel, planning, organizational development, ethics and many specific relevant subjects. Further, UM’s MPA is accredited which means the MPA is a value-added degree recognized nationally as having the rigor and course work identified as relevant to meet today's needs for public servants.
As public administrators, we need to respond to the public to reduce the size of government, while maintaining its effectiveness. We must also offer a solution. And there is a solution that will save money and add value. It is time to merge the public administration programs of UM with those of the University of Southern Maine (USM) and UM Augusta (UMA).
The University of Maine Augusta offers a BA and Associate degree in public administration (2 faculty); the
This solution even has a name, the
Carolyn Ball is MPA director at the University of Maine and teaches classes in Orono and Augusta; Tina Plummer is a current student in the MPA program in Augusta and has BA in Public Administration from UM Augusta and Nathan Poore, Falmouth Town Manager, has a BA in Public Administration from the University of Maine and a Master’s in Public Policy and Management from the University of Southern Maine.
Sunday, May 16, 2010
Incrementalism and Healthcare Reform
The healthcare reform, increased coverage for more people, that has taken place divided Congress as absolutely as it possibly could. Part of the problem was that President Obama took an approach of hands-off at the initial stages. To make a major non-incremental change requires major funding, leadership by the President, positive publicity and a public behind the idea rallied by the President. Non-incremental reform is rare because it much different than making other policies. Certainly, Presidents do take the lead in pushing for policy changes, but non-incremental policy making requires that not only does the President rally Congress but the public as well and have the money for the project. President Obama's biggest mistake was to leave it to Congress to develop the details of healthcare reform. By doing so he lost the ability to make any major change.
Now it is true that many perceive what has taken place as a major change, one that means that government intrudes into an area that they have not before. This view has to do with another idea related to policymaking. That is distributive and redistributive, a couple of fancy words. Simply put distributive policies are those that have large consensus behind them and are perceived to help the general public. The bureaucracy, that is federal employees, specific Congressional subcommittees, and regular lobbying groups establish policy on and on-going basis. The classic is agricultural supports for various crops. They do not rise to a battle. Redistributive policies are policies that are perceived to take from one group and give to another, the classic is welfare policies. The president may get involved, opposing interest groups rather than simply supportive interest groups, and many members of Congress. Many of these policies get nowhere or only minor changes occur, because Congress cannot agree.
Incremental policy change is exactly what happened with healthcare reform. It was contentious and in the ultimate of divisions, all Senate Republicans disagreed with all Democrats and few Republican house members crossed party lines. And in a reversal of roles, the AMA, the hospital associations and other well-known health service associations supported reform and were opposed by new temporary interest groups forming to oppose healthcare reform along with the insurance industry.
Its incremental because the new healthcare reform did not lead the federal government into intruding into healthcare for the first time. We have a huge veteran's healthcare system (something I would argue should be eliminated in favor of veterans going to private and nonprofit hospitals that are much more readily available.) Medicare regulation is highly intrusive. It sets the standards of reimbursement that other insurance companies generally follow. It requires hospitals to calculate costs in a certain way, a very intrusive mechanism. Second, as most people know, most of us will obtain our health insurance from employers, not from the federal government.
It does require citizens to pay a tax if they choose not to be covered, perhaps the most damming and radical aspect of the healthcare reform. I do not wish to downplay this aspect.
But let us return to other aspects that are incremental. The reform will fix the doughnut hole in Medicare Part D, prescription coverage. Right now once seniors have used their prescription coverage up to a certain $ amount, they must begin paying on their own. After they pay a certain amount, then their Medicare coverage will again pay. It is good fix to end this donut hole but has nothing to do with mass coverage of the population.
It sets up a series of experiments to contain costs and has no new cost controls. And of course, one of the reasons for having health care reform was to reduce costs. It also allows parents to keep their children on their policies for a longer period of time. This expands the pool of citizens covered without costing much since college age kids are one of the healthiest groups to cover. It does nothing about the costs of illegal alien healthcare. The legislation states that illegal aliens are not covered, but indirectly they are. That is because hospitals cannot refuse to accept a patient in need. They can transfer a patient who has no insurance one stabilized. What this means is that you and I as taxpayers must support their care through our city and county public hospitals. And so, the new healthcare reform, as vitriolic as the debate was is largely a piece of incremental legislation that will be tweaked in the years to come.
Monday, March 1, 2010
Amy Bishop and Domestic Violence
Amy Bishop and Domestic Violence
In 1986 domestic violence was still a new idea. How could domestic violence be an idea? But that is what it was, an idea, only then finding its way into specific laws in the states. Amy Bishop was 21 and her brother 18. They were both living at home with their father and mother and going to area universities. If the term domestic violence were used, it wouldn't apply to sister against brother. That would still be a family dispute.
The press has reported that Ms. Bishop had a fight with her father that day. We don't know whether this is true or not, but certainly it's not unusual for parents and adult children to have disagreements , yell at each other, and even make threats that don't make a lot of sense. And there was also a gun in the home. That's not unusual either. Many people have guns. Amy was cleaning the gun, a somewhat odd thing for a college student to be doing, but perhaps she was a hunter. She pulled the trigger and shot her brother. She ran to get away from the scene.
We know that at least her mother supported her and charges were dropped. As a parent now of an only child that might be natural as well. There is nothing you can do to bring back a child so certainly protect your other child.
We also know now that Ms. Bishop had a temper and perhaps the police knew it then.
All this adds up to domestic violence: anger in the home, guns, and sometimes family members taking the side of the perpetrator rather than the victim.
So why wasn't Amy Bishop arrested and charged? Domestic violence as an enforced crime has a relatively short history. Karl Weick, the author of Sensemaking (1995), has pointed out that our understanding of words and problems evolves over time. As we speak to each other, we begin to develop common meanings. In the 21st century domestic violence connotes physical violence in the home and even in the workplace. Domestic abuse connotes psychological, physical abuse, a fear for one's safety. Battered wife implies physical force used by a husband against a wife that may lead to emotional problems. Child abuse connotes physical aggression by a stronger adult against a defenseless child. The words elder abuse brings forth the idea of adult children taking advantage both physically, financially, and emotionally their elder parents. As we begin to define the words, we begin to form an opinion of what domestic violence. Our opinions help define the need for laws, and laws help develop our opinions of what is harmful and wrong. Thus, Weick would say that domestic violence is socially enacted. Family violence comes closest to the words to describe what occurred in the Bishop home, but we still don't have words for violence between adult children or between an adult parent and adult child. Still violence between adult children (but not between juveniles) now comes under state domestic violence laws.
The situation in the Bishop home occurred just as awareness of domestic violence between husbands and wives was beginning to be recognized. For the most part, common law, rather than statutes, governed whether an assault, homicide, or battery would result in an arrest. And practice was to only arrest if an officer witnessed an incident that could be classified as a felony. Well-publicized events and reports in the 1980s began to change police practices. In particular, a suit won by a woman against the Torrington, Connecticut Police Department for failure to protect her from violence from her husband (Thurman v. City of Torrington,1984) was publicized in the law enforcement community. Connecticut's own domestic violence act went into effect shortly thereafter in 1985.
A 1984 report by the US Attorney General's office called for domestic violence to be "criminalized." A well publicized report on the police in Minneapolis to assess the value of arrest policies as a deterrent to domestic violence also had an impact on the law enforcement community. The resulting publicity, including a news story in the New York Times," virtually changed overnight" enforcement practices from one in which a majority of cases were screened out as non-law enforcement incidents or family trouble calls to one in which arrests were made.
These events and their interpretation led states to pass domestic violence/abuse violence legislation for a variety of reasons: fear of liability; political demands of the women's movement or local citizens, and, a belief in the value of mandatory arrest. Today the very terms used to define the crime –domestic violence, family violence, domestic abuse–, the relationships covered by law, and the role of arrests differ from state to state, and the types of crimes specifically covered. Just looking at New England shows the variety in statutes. Maine, Rhode Island, and Connecticut mandate arrest with probable cause in cases of domestic violence (along with New York, New Jersey, Missouri, South Dakota, Colorado, Utah, Nevada, Oregon, Alaska). In states such as New Hampshire officers have "presumptive arrest powers" and often Attorneys General, Commissioners of Public Safety or individual police departments have a protocol for arrest. In between are such states such as Massachusetts that leave domestic violence arrests to the officer's discretion with arrest "preferred." The decision to arrest is based upon whether the officer believes there is probable cause that a crime has occurred. The Massachusetts law calls for a warrantless arrest when court orders such as temporary or permanent restraining or no contact orders are violated. The array of crimes covered range from the very detailed list in Rhode Island to the broader categories in Massachusetts and Vermont. Whereas Connecticut's law is clearly related to protection of the family, Vermont's law makes no mention of family relationships in its categorization of those protected.
These laws and the guidelines to handle domestic situations are now inclusive of workplaces or any other place in which one or two people with a relationship cause the other harm. Massachusetts just updated their guidelines in 2009. Fleeing the scene as Ms. Bishop did would add to the likelihood of arrest. And if a gun is involved, that can trigger gun license revocation. Certainly, in 2010 Amy Bishop would have been arrested. Whether she would have been tried for some sort of domestic violence will be forever unresolved.
In 1986 domestic violence was still a new idea. How could domestic violence be an idea? But that is what it was, an idea, only then finding its way into specific laws in the states. Amy Bishop was 21 and her brother 18. They were both living at home with their father and mother and going to area universities. If the term domestic violence were used, it wouldn't apply to sister against brother. That would still be a family dispute.
The press has reported that Ms. Bishop had a fight with her father that day. We don't know whether this is true or not, but certainly it's not unusual for parents and adult children to have disagreements , yell at each other, and even make threats that don't make a lot of sense. And there was also a gun in the home. That's not unusual either. Many people have guns. Amy was cleaning the gun, a somewhat odd thing for a college student to be doing, but perhaps she was a hunter. She pulled the trigger and shot her brother. She ran to get away from the scene.
We know that at least her mother supported her and charges were dropped. As a parent now of an only child that might be natural as well. There is nothing you can do to bring back a child so certainly protect your other child.
We also know now that Ms. Bishop had a temper and perhaps the police knew it then.
All this adds up to domestic violence: anger in the home, guns, and sometimes family members taking the side of the perpetrator rather than the victim.
So why wasn't Amy Bishop arrested and charged? Domestic violence as an enforced crime has a relatively short history. Karl Weick, the author of Sensemaking (1995), has pointed out that our understanding of words and problems evolves over time. As we speak to each other, we begin to develop common meanings. In the 21st century domestic violence connotes physical violence in the home and even in the workplace. Domestic abuse connotes psychological, physical abuse, a fear for one's safety. Battered wife implies physical force used by a husband against a wife that may lead to emotional problems. Child abuse connotes physical aggression by a stronger adult against a defenseless child. The words elder abuse brings forth the idea of adult children taking advantage both physically, financially, and emotionally their elder parents. As we begin to define the words, we begin to form an opinion of what domestic violence. Our opinions help define the need for laws, and laws help develop our opinions of what is harmful and wrong. Thus, Weick would say that domestic violence is socially enacted. Family violence comes closest to the words to describe what occurred in the Bishop home, but we still don't have words for violence between adult children or between an adult parent and adult child. Still violence between adult children (but not between juveniles) now comes under state domestic violence laws.
The situation in the Bishop home occurred just as awareness of domestic violence between husbands and wives was beginning to be recognized. For the most part, common law, rather than statutes, governed whether an assault, homicide, or battery would result in an arrest. And practice was to only arrest if an officer witnessed an incident that could be classified as a felony. Well-publicized events and reports in the 1980s began to change police practices. In particular, a suit won by a woman against the Torrington, Connecticut Police Department for failure to protect her from violence from her husband (Thurman v. City of Torrington,1984) was publicized in the law enforcement community. Connecticut's own domestic violence act went into effect shortly thereafter in 1985.
A 1984 report by the US Attorney General's office called for domestic violence to be "criminalized." A well publicized report on the police in Minneapolis to assess the value of arrest policies as a deterrent to domestic violence also had an impact on the law enforcement community. The resulting publicity, including a news story in the New York Times," virtually changed overnight" enforcement practices from one in which a majority of cases were screened out as non-law enforcement incidents or family trouble calls to one in which arrests were made.
These events and their interpretation led states to pass domestic violence/abuse violence legislation for a variety of reasons: fear of liability; political demands of the women's movement or local citizens, and, a belief in the value of mandatory arrest. Today the very terms used to define the crime –domestic violence, family violence, domestic abuse–, the relationships covered by law, and the role of arrests differ from state to state, and the types of crimes specifically covered. Just looking at New England shows the variety in statutes. Maine, Rhode Island, and Connecticut mandate arrest with probable cause in cases of domestic violence (along with New York, New Jersey, Missouri, South Dakota, Colorado, Utah, Nevada, Oregon, Alaska). In states such as New Hampshire officers have "presumptive arrest powers" and often Attorneys General, Commissioners of Public Safety or individual police departments have a protocol for arrest. In between are such states such as Massachusetts that leave domestic violence arrests to the officer's discretion with arrest "preferred." The decision to arrest is based upon whether the officer believes there is probable cause that a crime has occurred. The Massachusetts law calls for a warrantless arrest when court orders such as temporary or permanent restraining or no contact orders are violated. The array of crimes covered range from the very detailed list in Rhode Island to the broader categories in Massachusetts and Vermont. Whereas Connecticut's law is clearly related to protection of the family, Vermont's law makes no mention of family relationships in its categorization of those protected.
These laws and the guidelines to handle domestic situations are now inclusive of workplaces or any other place in which one or two people with a relationship cause the other harm. Massachusetts just updated their guidelines in 2009. Fleeing the scene as Ms. Bishop did would add to the likelihood of arrest. And if a gun is involved, that can trigger gun license revocation. Certainly, in 2010 Amy Bishop would have been arrested. Whether she would have been tried for some sort of domestic violence will be forever unresolved.
Monday, August 31, 2009
Policing in the United Arab Emirates
Comparisons with the United States
I had the opportunity to visit Sharjah Police Research Centre recently on my February visit to the Dubai in the United Arab Emirates (UAE). My purpose was to better understand policing in a predominantly Muslim country but one that is diverse in ethnicity and religion in its population. How different is policing or similar is policing?
A Brief History
Sharjah sits between the better known Emirates of Dubai and Abu Dhabi. It has the 3rd largest city in the Emirates. The Emirates are a loose confederation of seven states each governed by a sheik. The Emirates are positioned to take advantage of trade sitting at the mouth of the Persian Gulf running into the Gulf of Oman and then to the Arabian Sea. Up until 1968 the Emirates were sleepy little places where pearl diving was a major source of income as well as a little trade. In 1968 oil was found. In 1971 the Emirates won their independence from Britain and instituted their own constitution. Dubai was already transforming itself as a major mid-east hub for tax free trade, tourism, and most recently for healthcare while Abu Dhabi, the Emirate with the most oil, was becoming the hub for the oil industry. Sharjah sits in between these two major hubs.
Today, the country is a very wealthy, highly urbanized country from Dubai to Sharjah to Abu Dhabi. Women work and drive and wear western to traditional clothes. Male Emirate citizens often wear the traditional dress, a white flowing robe called a dishdashah. Alcohol is served at restaurants. Beaches are filled with those wearing western style bathing suits. And the country has a typical American problem: too many cars. While I was there Dubai was testing out an automated monorail system to alleviate traffic.
Law
The Emirates are monarchies governed by codified criminal and civil law. According to Shane Sayers and Kennedy, a British law firm, the codes draw from Egyptian and European law. If there is no relevant law, the judge relies upon Islamic law particularly the Mejelleh, a 19th century codification of Islamic law. Civil courts were created in Sharjah in 1971 to handle commercial, labor disputes, and some criminal matters. The remainder of cases are handled through a federal system that includes a supreme court.
Unlike the US system, there are no jury trials. There is a practical reason for it. Only about 20 to 25% of the population are actually citizens of the Emirates. Court decisions by judges is not unlike some European countries such as Italy in which judges handle more of the work of the courts from investigation of criminal matters to rulings.
Law Enforcement
Research on community policing including my own research has shown that the public perceives one of the major problems, if not the major problem for law enforcement, to be speeding. Citizens want speeding controlled, although perhaps not their own speeding. For law enforcement in Sharjah and the Emirates as a whole, traffic related problems are also a major problem. Law enforcement has a particularly difficult time because residents come from so many different countries with different degrees of enforcement and the extended family of the sheiks are often given special treatment. Since this is Ramadan, they also face citizens who may be fatigued from fasting and officers may be fatigued as well. Muslims do not eat or drink between sun up and sun down when until they “break fast.” Officers may choose to break the fast while they work just as officers take meals in this country or if they have family obligations, they may switch a shift with another officer.
At the other end of the spectrum are more complicated problems that require the use of technology and more sophisticated policing techniques and strategies. Because most of the working population are “expats” as legal residents are called, immigration problems are a constant issue. Many construction and related workers come to UAE by paying a company to secure a job. Upon arrival, the worker may find his or her passport stolen, underpaid for work, or without work. Without a job a worker cannot stay in the country beyond six months, but without money, the worker cannot return home. Law enforcement must try prevent and deal with the perpetrators of the scams as well as the resulting illegal aliens. Further, because UAE is a wealthy country, law enforcement must deal with financial scams, banking fraud, and drug trafficking. At the federal level this means upgrading computer technology to work with other countries.
Planning
In the UAE, planning for excellence is an important part of society. The Sheik of Dubai, for example, invites companies to develop a university or a hospital after having identified those excellent companies or organizations. Planning often involves clustering similar businesses or services. (Whether this is a wise idea to cluster all similar services depends upon your point of view. I went through an area in Dubai that was all auto repair functions and an another area that was all health care functions.) Many emirate universities are clustered in one location creating a different relationship from the typical town-gown relationship in the United States. Both the Sheik of Dubai, His Highness Sheikh Maktoum Bin Rashid Al Maktoum and the Sheik of Sharjah, His Highness Dr. Sultan bin Mohammed Al Qassimi mandated clusters to promote higher education partnering with excellent universities in Europe and the United States.
Law Enforcement and Universities
In the case of Sharjah, this education cluster includes the newly built police academy and research centre and a teaching hospital. The Sharjah Police Academy and Research Centre are newly built. The four year academy to train law enforcement, both women and men, is more similar to a college and sits in the same area as other universities. (Unfortunately, housing for students is not available on the campus.) The Academy recruits students who speak a variety of languages, but they must speak either Arabic or English as well. Instruction is in Arabic, but students who speak only English receive a translator.
According to Dr. Mamdouh A. Abdelmottlep, my host, a professor of criminal justice, and senior researcher at the Research Centre, students receive training in the law, forensics, national security, leadership, protection for the safety of the community, traffic enforcement, and search, fire and rescue techniques. Although students learn about community policing concepts, the trend since 2001 has been to place more and more focus on security issues. This is also, in part, due to the fact that most Arabic countries including the UAE do not have the different levels of policing as in the United States. For some Arabic countries informal policing of communities may be established by a village elder. For the Emirate of Sharjah, the Sharjah police is the primary police presence.
Community policing may take the form of a special project in the community that may or may not have police involvement. When there is a security problem, police do try to get to know the community, particularly important since they must build trust with people from many, many countries. “Expats” may be from India (and may be Hindu, Muslim or of other religions), Bangladesh, Iran, Kenya, Malaysia, Oman, Pakistan, Philippines (predominantly Christian), Yemen, and many European countries.
The reduced emphasis on community policing is unlike Maine and Vermont’s academies (and possibly all) that continue to focus of community policing. But even in New England, the curriculum is beginning to change to reflect the new emphasis of all levels of law enforcement on security. Connecticut, for example, has added a section on terrorism and suicide bombers and immigration law.
The Police Research Centre researches current issues and publishes a regular academic refereed journal relevant to the students at the police academy and to law enforcement officials. It is published in Arabic but the titles of the article and summaries are published in English so that parties who may not speak English can have them translated. They are published on the web and in print to make them more accessible. And the topics may sound familiar to those who work in public safety on university campuses, such as public attitudes towards police, theft crimes, and domestic violence.
The research staff is composed of senior researchers from Egypt, Russia, and Oman who have advanced degrees. The research assistants, all women from the Emirates, have degrees from leading universities including the University of Michigan. All speak Arabic and English with various degrees of fluency plus additional languages of their home countries.
Surprisingly, police officers are unlikely to be citizens of the country. The UAE recruits students from throughout the mid-east to enter the academy and serve as police officers. This puts enormous pressure on the academies to inculcate students in the culture of the UAE and in understanding the culture of so many “expats” who reside there. A solicitor for a person accused of a crime is more likely than not to be an “expat.” Still, this is slowly changing. The research center director is a citizen of the United Arab Emirates and a police officer. Most UAE citizens do not need to work because the country is so wealthy but the sheiks are increasingly encouraging citizens to take professional positions to help direct the country.
Future
The Constitution of the UAE places paramount importance of the safety and security of its citizens. As Dr. Mamdouh points out, policing at the administrative level has changed fundamentally in Arabic countries as it has in the United States since 2001. Arab law enforcement agencies are upgrading computer systems at the behest and with the assistance of the United States, Saudi Arabia, and Egypt. The US Department of Homeland Security as it affects the citizens and law enforcement of this country also affects the politics and law, the professionalism of law enforcement, and the community of Arabic states, including the UAE. Dr. Mamdouh writes that Arabic police agencies are and should focus efforts on 1) protecting the safety of citizens, residents, and visitors, 2) building trust, confidence, and communication with the community, 3) encouraging residents to report crimes to make safer communities, 4) improving police performance through technology and science, 5) using research to improve police strategies, and 6) obtaining equipment and physical structures for law enforcement. Campus public safety professionals certainly understand these latter concerns for infrastructure as they educate administrators who in the past might have downplayed the needs of campus public safety.
For further information
Abdlmottlep, Mamdouh. “Fear of Police. Public Attitudes Toward the Police.” Sharjah Police Research Centre Journal. 136 (2007): 1-131.
Abdlmottlep, Mamdouh. “Arabic Police.” Sharjah Police Research Centre Journal.” 139 (2008).
Ball, Carolyn. “Accommodating Islam in Law Enforcement.” Law Enforcement Executive Forum. (May 2005): 29-34.
_____ and Akhlaque Haque. “Diversity in Religious Practice: Implications of Islamic Values in the Public Workplace.” Public Personnel Management. 32 (June 2003): 315-331.
_____ and Akhlaque Haque. “Accommodating Islamic Religious Practices in the Workplace.” PA Times. November 2003, p. 5.
Ball, Carolyn and Kenneth Nichols. “Domestic Violence at the Top of New England: Law Enforcement Incident Reports from Aroostook County, Maine.” New England Journal of Public Policy. 17 (Spring/Summer 2002): 39-54.
Ball, Carolyn. "Rural Perceptions of Crime." Journal of Contemporary Criminal Justice. 17 (February 2001): 37-48.
El-Sadig M, J.N. Norman et al. “Road Traffic Accidents in the United Arab Emirates: Trends Of Morbidity And Mortality During 1977-1998” Accidents Analysis and Prevention. 34(July 2002):465-76.
Sharjah Police. United Arab Emirates. http://www.shjpolice.gov.ae/en/index.html
I had the opportunity to visit Sharjah Police Research Centre recently on my February visit to the Dubai in the United Arab Emirates (UAE). My purpose was to better understand policing in a predominantly Muslim country but one that is diverse in ethnicity and religion in its population. How different is policing or similar is policing?
A Brief History
Sharjah sits between the better known Emirates of Dubai and Abu Dhabi. It has the 3rd largest city in the Emirates. The Emirates are a loose confederation of seven states each governed by a sheik. The Emirates are positioned to take advantage of trade sitting at the mouth of the Persian Gulf running into the Gulf of Oman and then to the Arabian Sea. Up until 1968 the Emirates were sleepy little places where pearl diving was a major source of income as well as a little trade. In 1968 oil was found. In 1971 the Emirates won their independence from Britain and instituted their own constitution. Dubai was already transforming itself as a major mid-east hub for tax free trade, tourism, and most recently for healthcare while Abu Dhabi, the Emirate with the most oil, was becoming the hub for the oil industry. Sharjah sits in between these two major hubs.
Today, the country is a very wealthy, highly urbanized country from Dubai to Sharjah to Abu Dhabi. Women work and drive and wear western to traditional clothes. Male Emirate citizens often wear the traditional dress, a white flowing robe called a dishdashah. Alcohol is served at restaurants. Beaches are filled with those wearing western style bathing suits. And the country has a typical American problem: too many cars. While I was there Dubai was testing out an automated monorail system to alleviate traffic.
Law
The Emirates are monarchies governed by codified criminal and civil law. According to Shane Sayers and Kennedy, a British law firm, the codes draw from Egyptian and European law. If there is no relevant law, the judge relies upon Islamic law particularly the Mejelleh, a 19th century codification of Islamic law. Civil courts were created in Sharjah in 1971 to handle commercial, labor disputes, and some criminal matters. The remainder of cases are handled through a federal system that includes a supreme court.
Unlike the US system, there are no jury trials. There is a practical reason for it. Only about 20 to 25% of the population are actually citizens of the Emirates. Court decisions by judges is not unlike some European countries such as Italy in which judges handle more of the work of the courts from investigation of criminal matters to rulings.
Law Enforcement
Research on community policing including my own research has shown that the public perceives one of the major problems, if not the major problem for law enforcement, to be speeding. Citizens want speeding controlled, although perhaps not their own speeding. For law enforcement in Sharjah and the Emirates as a whole, traffic related problems are also a major problem. Law enforcement has a particularly difficult time because residents come from so many different countries with different degrees of enforcement and the extended family of the sheiks are often given special treatment. Since this is Ramadan, they also face citizens who may be fatigued from fasting and officers may be fatigued as well. Muslims do not eat or drink between sun up and sun down when until they “break fast.” Officers may choose to break the fast while they work just as officers take meals in this country or if they have family obligations, they may switch a shift with another officer.
At the other end of the spectrum are more complicated problems that require the use of technology and more sophisticated policing techniques and strategies. Because most of the working population are “expats” as legal residents are called, immigration problems are a constant issue. Many construction and related workers come to UAE by paying a company to secure a job. Upon arrival, the worker may find his or her passport stolen, underpaid for work, or without work. Without a job a worker cannot stay in the country beyond six months, but without money, the worker cannot return home. Law enforcement must try prevent and deal with the perpetrators of the scams as well as the resulting illegal aliens. Further, because UAE is a wealthy country, law enforcement must deal with financial scams, banking fraud, and drug trafficking. At the federal level this means upgrading computer technology to work with other countries.
Planning
In the UAE, planning for excellence is an important part of society. The Sheik of Dubai, for example, invites companies to develop a university or a hospital after having identified those excellent companies or organizations. Planning often involves clustering similar businesses or services. (Whether this is a wise idea to cluster all similar services depends upon your point of view. I went through an area in Dubai that was all auto repair functions and an another area that was all health care functions.) Many emirate universities are clustered in one location creating a different relationship from the typical town-gown relationship in the United States. Both the Sheik of Dubai, His Highness Sheikh Maktoum Bin Rashid Al Maktoum and the Sheik of Sharjah, His Highness Dr. Sultan bin Mohammed Al Qassimi mandated clusters to promote higher education partnering with excellent universities in Europe and the United States.
Law Enforcement and Universities
In the case of Sharjah, this education cluster includes the newly built police academy and research centre and a teaching hospital. The Sharjah Police Academy and Research Centre are newly built. The four year academy to train law enforcement, both women and men, is more similar to a college and sits in the same area as other universities. (Unfortunately, housing for students is not available on the campus.) The Academy recruits students who speak a variety of languages, but they must speak either Arabic or English as well. Instruction is in Arabic, but students who speak only English receive a translator.
According to Dr. Mamdouh A. Abdelmottlep, my host, a professor of criminal justice, and senior researcher at the Research Centre, students receive training in the law, forensics, national security, leadership, protection for the safety of the community, traffic enforcement, and search, fire and rescue techniques. Although students learn about community policing concepts, the trend since 2001 has been to place more and more focus on security issues. This is also, in part, due to the fact that most Arabic countries including the UAE do not have the different levels of policing as in the United States. For some Arabic countries informal policing of communities may be established by a village elder. For the Emirate of Sharjah, the Sharjah police is the primary police presence.
Community policing may take the form of a special project in the community that may or may not have police involvement. When there is a security problem, police do try to get to know the community, particularly important since they must build trust with people from many, many countries. “Expats” may be from India (and may be Hindu, Muslim or of other religions), Bangladesh, Iran, Kenya, Malaysia, Oman, Pakistan, Philippines (predominantly Christian), Yemen, and many European countries.
The reduced emphasis on community policing is unlike Maine and Vermont’s academies (and possibly all) that continue to focus of community policing. But even in New England, the curriculum is beginning to change to reflect the new emphasis of all levels of law enforcement on security. Connecticut, for example, has added a section on terrorism and suicide bombers and immigration law.
The Police Research Centre researches current issues and publishes a regular academic refereed journal relevant to the students at the police academy and to law enforcement officials. It is published in Arabic but the titles of the article and summaries are published in English so that parties who may not speak English can have them translated. They are published on the web and in print to make them more accessible. And the topics may sound familiar to those who work in public safety on university campuses, such as public attitudes towards police, theft crimes, and domestic violence.
The research staff is composed of senior researchers from Egypt, Russia, and Oman who have advanced degrees. The research assistants, all women from the Emirates, have degrees from leading universities including the University of Michigan. All speak Arabic and English with various degrees of fluency plus additional languages of their home countries.
Surprisingly, police officers are unlikely to be citizens of the country. The UAE recruits students from throughout the mid-east to enter the academy and serve as police officers. This puts enormous pressure on the academies to inculcate students in the culture of the UAE and in understanding the culture of so many “expats” who reside there. A solicitor for a person accused of a crime is more likely than not to be an “expat.” Still, this is slowly changing. The research center director is a citizen of the United Arab Emirates and a police officer. Most UAE citizens do not need to work because the country is so wealthy but the sheiks are increasingly encouraging citizens to take professional positions to help direct the country.
Future
The Constitution of the UAE places paramount importance of the safety and security of its citizens. As Dr. Mamdouh points out, policing at the administrative level has changed fundamentally in Arabic countries as it has in the United States since 2001. Arab law enforcement agencies are upgrading computer systems at the behest and with the assistance of the United States, Saudi Arabia, and Egypt. The US Department of Homeland Security as it affects the citizens and law enforcement of this country also affects the politics and law, the professionalism of law enforcement, and the community of Arabic states, including the UAE. Dr. Mamdouh writes that Arabic police agencies are and should focus efforts on 1) protecting the safety of citizens, residents, and visitors, 2) building trust, confidence, and communication with the community, 3) encouraging residents to report crimes to make safer communities, 4) improving police performance through technology and science, 5) using research to improve police strategies, and 6) obtaining equipment and physical structures for law enforcement. Campus public safety professionals certainly understand these latter concerns for infrastructure as they educate administrators who in the past might have downplayed the needs of campus public safety.
For further information
Abdlmottlep, Mamdouh. “Fear of Police. Public Attitudes Toward the Police.” Sharjah Police Research Centre Journal. 136 (2007): 1-131.
Abdlmottlep, Mamdouh. “Arabic Police.” Sharjah Police Research Centre Journal.” 139 (2008).
Ball, Carolyn. “Accommodating Islam in Law Enforcement.” Law Enforcement Executive Forum. (May 2005): 29-34.
_____ and Akhlaque Haque. “Diversity in Religious Practice: Implications of Islamic Values in the Public Workplace.” Public Personnel Management. 32 (June 2003): 315-331.
_____ and Akhlaque Haque. “Accommodating Islamic Religious Practices in the Workplace.” PA Times. November 2003, p. 5.
Ball, Carolyn and Kenneth Nichols. “Domestic Violence at the Top of New England: Law Enforcement Incident Reports from Aroostook County, Maine.” New England Journal of Public Policy. 17 (Spring/Summer 2002): 39-54.
Ball, Carolyn. "Rural Perceptions of Crime." Journal of Contemporary Criminal Justice. 17 (February 2001): 37-48.
El-Sadig M, J.N. Norman et al. “Road Traffic Accidents in the United Arab Emirates: Trends Of Morbidity And Mortality During 1977-1998” Accidents Analysis and Prevention. 34(July 2002):465-76.
Sharjah Police. United Arab Emirates. http://www.shjpolice.gov.ae/en/index.html
Wednesday, July 29, 2009
Shame on Sotomayor, Shame on the Supreme Court
Shame on Sotomayor and her colleagues. Judge Sotomayor and her fellow appeals court judges did indeed dodge a bullet in the debate over how we create equal opportunity of employment in the United States. The appeals court on which she sits wrote a short paragraph approving of the district court’s decision. That decision agreed with the district court that the City of New Haven was correct to throw out test results that supported the promotion of white firefighters (and one Hispanic) but no black firefighters. To do so would have a disparate impact on minority firefighters when other types of testing are available.
But shame on the Supreme Court as well. Courts do indeed make policy even if Sotomayor stated in her hearings that she simply interprets the law. In fact, at times courts are ahead of public opinion, behind public opinion, and even at odds with Congress. In fact, Congress amended the Civil Rights Act in 1990 after a series of Supreme Court decisions appeared to change proof of discrimination.
But on behalf of Judge Sotomayor and her colleagues, to rule for the white firefighters would be equally a problem. That is because many of the most important employment and related civil rights cases result in a divided opinion by the Supreme Court. The Supreme Court has continually left employers up in the air about how to actively recruit and promote minorities but at the same time not discriminate against majority members. The mixed signals have led the public to be hostile to affirmative action fearing that that affirmative action creates “reverse discrimination,” a term not used by the courts.
The Supreme Court has now overruled the court on which Judge Sotomayor sits ruling that the white firefighters (and one Hispanic) were discriminated against when they did not receive their promotions. They took valid promotional tests, both oral and written tests. The Civil Rights Act prohibits “norming” the tests scores based on race so New Haven had two choices: to use the results or to not use them risking a court case by the white firefighters. The case will again return to a lower court for implementation in light of the Supreme Court decision.
Unstated in all the discussion is that New Haven has not been able to promote any firefighters in over five years. Captain and lieutenant positions are now being filled on a rotating basis (because of shift work) based upon seniority. These firefighters are, of course, receiving additional pay and additional payments into their retirement for their added work. Still this would not be an acceptable situation in most businesses.
In New Haven case Justice Kennedy gave the opinion of the court but there were two concurring opinions and one dissent. The press identifies this as a 5 to 4 decision. A concurring opinion is one that agrees with the majority opinion but has different reasoning. Again, this makes it difficult for employers to decide what is correct. Justice Kennedy held an employer may discriminate against the majority if “the employer [has] a strong basis in evidence to believe it will be subject to disparate-impact liability if it fails to take the race-conscious, discriminatory action.” Kennedy glossed over the fact that the City of New Haven actually did fear liability for disparate impact on minorities Kennedy held that the evidence presented on the process of developing and validating the tests superseded the concern of liability and so the City of New Haven violated the rights of the white figherfighters under the Civil Rights Act but not the equal protection clause of the Constitution.
The court leaves in place the guidelines that made it so difficult for New Haven to decide what to do. Disparate impact occurs when a test which on its surface appears fair is, in fact, discriminatory. The Equal Employment Opportunity Office (EEOC) states that any employment condition, hiring, firing, promoting, testing, terminating in which the balance of individuals is greater than 80% for one group than another group is a prima facie case of discrimination. That is exactly what happened in New Haven.
The trend of the courts has been to prohibit discrimination of the majority in favor of the minority, but always in a fashion that leads employers (and educators) to wonder what they should do. Perhaps, one of the most important cases related to the rights of the majority versus the minority is the Bakke case. Bakke, a white male, won the right to attend medical school after the Court (1978) ruled that setting aside openings for minority students violated the Civil Rights Act and the equal protection clause of the Constitution. In that case, there were six separate opinions with the “majority” opinion not totally by any other justice. The court ruled, that is one justice ruled, that race could be considered a plus factor in determining entrance for diversity purposes, but quotas or set asides were prohibited. Racial classifications are subject to strict judicial scrutiny to determine if there is a compelling reason for them. Otherwise, they violate the Equal Protection Clause of the 14th amendment of the Constitution. Still in 2003, a big 10s undergraduate and law school admissions methods were tested. The Court, again, ruled that race could be used as one aspect in deciding admissions to promote diversity for the law school without violating the equal protection clause or the Civil Rights Act (in an opinion again yielding 6 opinions for the nine justices, but admission points for race used in undergraduate admissions violated the Equal Protection Clause of the Constitution and the Civil Rights Act. This split in the court’s opinion created a majority of one with concurring opinions in part and 3 dissenting opinions.
In the case of a city setting aside a certain percentage of contracts for minority contractors, the Court ruled (1989) against such a policy. There was no history presented of discrimination by the City. In this “6-3 opinion,” no judge supported the “majority opinion in toto,” with 3 other concurring opinions and two dissenting opinions. When a contractor sued the Department of Transportation over its set aside policies to hire minority contractors, the Court ruled (1995) 5-4 that any racial classifications used in hiring contractors for state work are subject to “strict scrutiny” and must be justified. This led the DOT to create a program to promote the provision of contracts to economically disadvantage contractors rather than use the wording women and minorities.
Perhaps, showing just how difficult it to balance the rights of majorities and minorities is a case that went to the Supreme Court but was settled by the parties before the case was heard. In Taxman v. Board of Education of the Township of Piscataway (1995), an appeals court ruled that a white teacher was not discriminated against when she was laid-off and a black teacher to continue. The teachers were hired on the same day, had equally favorable evaluations, and taught the same subject. What would you do?
Despite changes in the composition of the Supreme Court, the justices remain divided, and that is likely to continue to be true when Judge Sotomayor becomes Justice Sotomayor. Interpreting the law, that is making policy, is extremely difficult.
But shame on the Supreme Court as well. Courts do indeed make policy even if Sotomayor stated in her hearings that she simply interprets the law. In fact, at times courts are ahead of public opinion, behind public opinion, and even at odds with Congress. In fact, Congress amended the Civil Rights Act in 1990 after a series of Supreme Court decisions appeared to change proof of discrimination.
But on behalf of Judge Sotomayor and her colleagues, to rule for the white firefighters would be equally a problem. That is because many of the most important employment and related civil rights cases result in a divided opinion by the Supreme Court. The Supreme Court has continually left employers up in the air about how to actively recruit and promote minorities but at the same time not discriminate against majority members. The mixed signals have led the public to be hostile to affirmative action fearing that that affirmative action creates “reverse discrimination,” a term not used by the courts.
The Supreme Court has now overruled the court on which Judge Sotomayor sits ruling that the white firefighters (and one Hispanic) were discriminated against when they did not receive their promotions. They took valid promotional tests, both oral and written tests. The Civil Rights Act prohibits “norming” the tests scores based on race so New Haven had two choices: to use the results or to not use them risking a court case by the white firefighters. The case will again return to a lower court for implementation in light of the Supreme Court decision.
Unstated in all the discussion is that New Haven has not been able to promote any firefighters in over five years. Captain and lieutenant positions are now being filled on a rotating basis (because of shift work) based upon seniority. These firefighters are, of course, receiving additional pay and additional payments into their retirement for their added work. Still this would not be an acceptable situation in most businesses.
In New Haven case Justice Kennedy gave the opinion of the court but there were two concurring opinions and one dissent. The press identifies this as a 5 to 4 decision. A concurring opinion is one that agrees with the majority opinion but has different reasoning. Again, this makes it difficult for employers to decide what is correct. Justice Kennedy held an employer may discriminate against the majority if “the employer [has] a strong basis in evidence to believe it will be subject to disparate-impact liability if it fails to take the race-conscious, discriminatory action.” Kennedy glossed over the fact that the City of New Haven actually did fear liability for disparate impact on minorities Kennedy held that the evidence presented on the process of developing and validating the tests superseded the concern of liability and so the City of New Haven violated the rights of the white figherfighters under the Civil Rights Act but not the equal protection clause of the Constitution.
The court leaves in place the guidelines that made it so difficult for New Haven to decide what to do. Disparate impact occurs when a test which on its surface appears fair is, in fact, discriminatory. The Equal Employment Opportunity Office (EEOC) states that any employment condition, hiring, firing, promoting, testing, terminating in which the balance of individuals is greater than 80% for one group than another group is a prima facie case of discrimination. That is exactly what happened in New Haven.
The trend of the courts has been to prohibit discrimination of the majority in favor of the minority, but always in a fashion that leads employers (and educators) to wonder what they should do. Perhaps, one of the most important cases related to the rights of the majority versus the minority is the Bakke case. Bakke, a white male, won the right to attend medical school after the Court (1978) ruled that setting aside openings for minority students violated the Civil Rights Act and the equal protection clause of the Constitution. In that case, there were six separate opinions with the “majority” opinion not totally by any other justice. The court ruled, that is one justice ruled, that race could be considered a plus factor in determining entrance for diversity purposes, but quotas or set asides were prohibited. Racial classifications are subject to strict judicial scrutiny to determine if there is a compelling reason for them. Otherwise, they violate the Equal Protection Clause of the 14th amendment of the Constitution. Still in 2003, a big 10s undergraduate and law school admissions methods were tested. The Court, again, ruled that race could be used as one aspect in deciding admissions to promote diversity for the law school without violating the equal protection clause or the Civil Rights Act (in an opinion again yielding 6 opinions for the nine justices, but admission points for race used in undergraduate admissions violated the Equal Protection Clause of the Constitution and the Civil Rights Act. This split in the court’s opinion created a majority of one with concurring opinions in part and 3 dissenting opinions.
In the case of a city setting aside a certain percentage of contracts for minority contractors, the Court ruled (1989) against such a policy. There was no history presented of discrimination by the City. In this “6-3 opinion,” no judge supported the “majority opinion in toto,” with 3 other concurring opinions and two dissenting opinions. When a contractor sued the Department of Transportation over its set aside policies to hire minority contractors, the Court ruled (1995) 5-4 that any racial classifications used in hiring contractors for state work are subject to “strict scrutiny” and must be justified. This led the DOT to create a program to promote the provision of contracts to economically disadvantage contractors rather than use the wording women and minorities.
Perhaps, showing just how difficult it to balance the rights of majorities and minorities is a case that went to the Supreme Court but was settled by the parties before the case was heard. In Taxman v. Board of Education of the Township of Piscataway (1995), an appeals court ruled that a white teacher was not discriminated against when she was laid-off and a black teacher to continue. The teachers were hired on the same day, had equally favorable evaluations, and taught the same subject. What would you do?
Despite changes in the composition of the Supreme Court, the justices remain divided, and that is likely to continue to be true when Judge Sotomayor becomes Justice Sotomayor. Interpreting the law, that is making policy, is extremely difficult.
Thursday, June 25, 2009
Choice and Healthcare
Managed care plans, pharmacy benefit management companies, behavioral health managed care, capitation rates-physician incentives to see more patients, to see fewer patients, pre-approval for second opinions, non-emergency "emergency" visits, hospitalizations, pharmaceutical company purchase of prescription lists to use for marketing, wellness incentives, diagnostic related groups (DRGs). These are a few of the layers behind your choice of health insurance.
The purpose is to attempt to control your behavior (such as wellness incentives for stopping smoking or losing weight) or your doctor's behavior. For example, insurance companies (also known as PPOs, IPAs, HMOS and assorted other names) reimburse doctors by setting a target to see more patients or to see fewer patients by limiting physician visits or laboratory and other types of outpatient procedures.
As we debate whether we want all citizens to be covered by health insurance including a choice of a government health insurance plan, it turns out that we are actually limited in our choices. The choice that all of us want is for a relationship with our chosen physician.
Political scientists, (particulary John Kingdon) have described policy making as a process in which three streams come together a problem stream, a solution stream, and a political opportunity stream. The problem stream includes many problems that deserve attention but only some get on the political agenda and there are many solutions out there but only some get on the agenda. With the many problems out there to solve, many solutions to problems available, a political opportunity must be available to create a policy. When a policy window opens, all three streams come together. The window in the case of health care reform is the beginning of the new term of a president. The problem has been defined as too little health insurance coverage, the solution, some sort of universal health insurance, and political will to make it happen from interest groups, Congress, and the major proponent, President Obama.
I'm not so concerned about whether I have private health insurance choice or a government run plan. These choices are minor. I'm concerned that the way we run health care now and undoubtedly will continue to run health care has created a huge health insurance bureaucracy all in the name of cost control moving more and more people and agencies between me and my doctor.
The purpose is to attempt to control your behavior (such as wellness incentives for stopping smoking or losing weight) or your doctor's behavior. For example, insurance companies (also known as PPOs, IPAs, HMOS and assorted other names) reimburse doctors by setting a target to see more patients or to see fewer patients by limiting physician visits or laboratory and other types of outpatient procedures.
As we debate whether we want all citizens to be covered by health insurance including a choice of a government health insurance plan, it turns out that we are actually limited in our choices. The choice that all of us want is for a relationship with our chosen physician.
Political scientists, (particulary John Kingdon) have described policy making as a process in which three streams come together a problem stream, a solution stream, and a political opportunity stream. The problem stream includes many problems that deserve attention but only some get on the political agenda and there are many solutions out there but only some get on the agenda. With the many problems out there to solve, many solutions to problems available, a political opportunity must be available to create a policy. When a policy window opens, all three streams come together. The window in the case of health care reform is the beginning of the new term of a president. The problem has been defined as too little health insurance coverage, the solution, some sort of universal health insurance, and political will to make it happen from interest groups, Congress, and the major proponent, President Obama.
I'm not so concerned about whether I have private health insurance choice or a government run plan. These choices are minor. I'm concerned that the way we run health care now and undoubtedly will continue to run health care has created a huge health insurance bureaucracy all in the name of cost control moving more and more people and agencies between me and my doctor.
Sunday, May 31, 2009
Sotomayor and Affirmative Action
Affirmative Action (AA) has long been a controversial topic. This is mostly due to the fact that it is very misunderstood. Affirmative action isn't even a law. At the federal level, it is an executive order that applies to the actions of federal agencies and any lower level government agency or private contractor (such as those that supply computers, any equipment, build roads) to government. What it requires is that gov't agencies have a plan to actively recruit qualified minorities and women. It doesn't require quotas but realistic goals to recruit those groups. It requires that agencies compare their workforce to the appropriate demographics for the job.
For example, almost all hospitals take federal money through Medicare (the health program for the elderly) and Medicaid (a federal program administered and partially funded by states to provide health care to the poor). As an affirmative action employer, a hospital must devise a plan to recruit those who are underrepresented in its workforce. In a hospital, that would be male nurses. About 95% of nurses are female. And about 95% of nursing graduates are female. So it is tough to recruit male nurses so a realistic goal might be to try to increase the numbers by a half-percent by a certain time. Since all hospitals are competing for this small pool of male nurses, one can see how difficult it would be. It might mean paying for current employees of the hospital to go to nursing school. Hopefully, a male employee might wish to attend. But the hospital can't discriminate. It can't discourage its female employees from applying.
The odd thing about affirmative action is that every president whether supportive or unsupportive of AA has had the power to rescind it since President Johnson signed the first one in 1965.
What courts rule on is not affirmative action but whether the action of an employer (or school, union) violated the Constitutional equal protection clause (14th amendment), right of due process, and the liberty interest of a government employee in his/her job, the Civil Rights Act of 1964 and its amendments, or the Civil Rights Acts of 1866 and 1871. Affirmative action is never the issue, yet underlying the court question is AA.
The Ricci v. DeStefano states very little. This is the case that appeared before an appeal's panel on which Judge Sotomayor sits. It simply affirms the lower court ruling agreeing that it was appropriate to stop testing of New Haven firefighters when few minorities were able to pass the test. But this by its very nature is inflammatory even if it says very little. And Judge Sotomayer is in for a rocky ride when she appears before the Senate Judiciary Committee.
The courts in the past have ruled as far back as Griggs v Duke Power (1971) that tests must be valid and job related. The 1991 amendment to the Civil Rights Act further indicated that tests cannot be norm based. That is tests cannot have different passing score for whites, for blacks, for others. If indeed, the New Haven test is a validated test by psychometrists according to the Equal Employment Opportunities Uniform Guidelines, then differences in passing rates may be justified. Alternatively, the courts can find seek an alternative that would be equally suitable and have less impact on minorities.
Since this case will now pass to the Supreme Court, the decision will rest on the larger question of whether New Haven violated the civil rights and constitutional rights of white firefighters, city employees. Again, to the layperson, this is a case of reverse discrimination. The courts never have used this term and are not likely to use the term.
For Sotomayor, this case will certainly tarnish the proceedings and incite a lot of talk radio discussion about affirmative action.
For example, almost all hospitals take federal money through Medicare (the health program for the elderly) and Medicaid (a federal program administered and partially funded by states to provide health care to the poor). As an affirmative action employer, a hospital must devise a plan to recruit those who are underrepresented in its workforce. In a hospital, that would be male nurses. About 95% of nurses are female. And about 95% of nursing graduates are female. So it is tough to recruit male nurses so a realistic goal might be to try to increase the numbers by a half-percent by a certain time. Since all hospitals are competing for this small pool of male nurses, one can see how difficult it would be. It might mean paying for current employees of the hospital to go to nursing school. Hopefully, a male employee might wish to attend. But the hospital can't discriminate. It can't discourage its female employees from applying.
The odd thing about affirmative action is that every president whether supportive or unsupportive of AA has had the power to rescind it since President Johnson signed the first one in 1965.
What courts rule on is not affirmative action but whether the action of an employer (or school, union) violated the Constitutional equal protection clause (14th amendment), right of due process, and the liberty interest of a government employee in his/her job, the Civil Rights Act of 1964 and its amendments, or the Civil Rights Acts of 1866 and 1871. Affirmative action is never the issue, yet underlying the court question is AA.
The Ricci v. DeStefano states very little. This is the case that appeared before an appeal's panel on which Judge Sotomayor sits. It simply affirms the lower court ruling agreeing that it was appropriate to stop testing of New Haven firefighters when few minorities were able to pass the test. But this by its very nature is inflammatory even if it says very little. And Judge Sotomayer is in for a rocky ride when she appears before the Senate Judiciary Committee.
The courts in the past have ruled as far back as Griggs v Duke Power (1971) that tests must be valid and job related. The 1991 amendment to the Civil Rights Act further indicated that tests cannot be norm based. That is tests cannot have different passing score for whites, for blacks, for others. If indeed, the New Haven test is a validated test by psychometrists according to the Equal Employment Opportunities Uniform Guidelines, then differences in passing rates may be justified. Alternatively, the courts can find seek an alternative that would be equally suitable and have less impact on minorities.
Since this case will now pass to the Supreme Court, the decision will rest on the larger question of whether New Haven violated the civil rights and constitutional rights of white firefighters, city employees. Again, to the layperson, this is a case of reverse discrimination. The courts never have used this term and are not likely to use the term.
For Sotomayor, this case will certainly tarnish the proceedings and incite a lot of talk radio discussion about affirmative action.
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