Bedlam Reborn – Canadian Prisons and Mental Health

There have been a sad series of articles in the Globe and Mail recently, but due to their enhanced comment mechanism it is now almost impossible to post a targeted comment. And in the best modern tradition, who do you call? and is it intentional?

But back to the point — the articles have been about the rising tide of mentally ill that are ‘flooding’ into the prison system, with terrible consequences. There is much hand wringing about the need for more funding and the mistaken apprehension by judges, it seems, that since there are no community mental health services any more that treatment can be obtained in prison. Not there either, if one reads these articles or depressing books about the prison system like ‘The Slammer’.

Lets face it. We are rebuilding the pre-Victorian world of combined prisons/mental hospitals like the infamous ‘Bedlam’. This is but a part of the drift into a more feudal society where most of the wealth goes into the hands of a few, with the blessings and assistance of the government, and there are two sets of laws — one for them and another, harsher code for the rest of us.

In Ontario, under the Harris conservatives, the system of residential mental hospitals that existed to care for those folks who could not function in society were dismantled. I think the handwave was that it was too expensive and the ‘community’ was better able to care for these people. Under the current government we continue to slash social programs and pare back acute care facilities so the mentally ill get even less. And the dedicated staff who work in these social services are just being ground into nothingness. But in healthcare it seems that there is always plenty of money for more bureaucracy, expensive consulting studies by people who are far removed from real work and of course lavish travel and retirement for ones with the best connections. Meanwhile, these ill people get less and less and sooner or later commit crimes and end up in prison.

If the person is smart, prison can be like a graduate school where their skills can be improved. And if not, they simmer until the end of their sentence, unless they die in prison. And so the cycle repeats.

Seems that like education in a broader sense, we don’t have the money to help people learn to cope and perhaps develop skills that will make them functioning members of society. But we have plenty of money to punish them when they fail to do so on their own. Note where the current Harper government is putting its money — prisons and war.

There is a general lack of empathy for the mentally ill in government circles. They are ignored until they become criminals, then thrown into the (expensive) prison to improve their skills and enhance their rage. And yes, violent offenders are likely to be mentally ill. So we systematically strip the mechanisms which earlier and more compassionate regimes had built up to address the problem. And we replace it with more expensive facilities that only exacerbate the problem. And the reason is that we cannot afford to head things off when they are relatively cheap but have plenty of money for expensive constraints later. A very curious sort of economy indeed.

Carbon Trading Indulgences

Last night I was watching CBC and endured yet another discussion of why does Canada not implement Carbon trading to solve our pollution problems. ‘Let the market set a price on carbon’ and poof, all the issues are dealt with. Problem is, I have yet to read anything that explains how the carbon credit and trade process will actually address the problem. Then it hit me — these things are indulgences. Churchmen sold these things to anyone with the promise that all their sins past and future would be forgiven. The money went to the erection of that splendid edifice called the Vatican.

With these modern day equivalents, polluters can purchase forgiveness for their environmental sins. But now it is the non-polluters who will (in theory) profit by being able to sell their credits — as will the middlemen and others. I guess that the total population is supposed to shrink over time and the cost of the indulgences go up to provide financial incentives to invest in cleaning up the process. Yeah, sure. Once they get the idea that forgiveness can be bought that will probably be the end of the story.

Personally, I think the whole business is just nonsense. Another Enron-type scheme to help people make money from a broken situation. If there is no business justification for cleaning up (or abandoning) a dirty process it just won’t change. All the carbon trading stuff will do is perpetuate the situation and raise prices for everyone. (Did anyone notice that this might make less money available to do any cleanup?) But their sins will have been forgiven. And we will all have to pay.

Further Myths of the Market

The Competition Myth –

Paul Krugman had an interesting column this morning in the New York Times about regulated and unregulated economies. What he hinted at was questioning the values of decisions to increase profits by exporting jobs. The same applies to the Cons on the north side of the border. Seems, like with many things, our leaders play games with the numbers. Business profits are up when jobs get exported — but interestingly, does the same thing happen to GDP when all the associated costs are factored in? I have a theory that in a sense there is a sort of zero sum game — the extra profits come at a societal cost because of the displaced workers. These folks are left on their own to find other work — some will, some won’t. The company does not continue to pay the social benefits to support these people once they are discharged. So in effect the company profits were stolen from the taxpayer — who gets the bill for the ‘side effects’.

This may be why more regulated economies have weathered the latest financial crisis a bit better — there may be fewer societal costs swept under the rug. Speaking of which, there was another interesting article in the web site ‘ScienceDaily’ called ‘Obesity Linked to Economic Insecurity’. The Oxford researchers found a correlation between ‘free market’s and broad-based obesity. The article had a number of good points which related to my own experiences in the job market over the last half century. The authors suggest that chronic stress from the increasingly uncertain job market may contribute to overeating — and eating unhealthy foods. They noticed that obesity rates seemed to follow the move to more unregulated business practices.

The thing that worries me about all this is the accumulation of unemployed and underemployed people, the reduction in social spending under the various ‘con’ regimes for both unemployment and education and the long term prospects for these societies. We are either moving backwards into a neo-feudal society with a permanent underclass or preping for a revolution — possibly both. I am hopeful that with the rise of automation and robotics we might have the courage to break the link between work and living and find a path into a new kind of society. Only time will tell and given the typical longevity of recent civilizations I wonder how much we have?

The Toilet Seat Index

Remember toilet seats? Those utilitarian objects that pretty much we all use every day to ease our biological processes? Used to be that these things were pretty much indestructable and we changed them when the bathroom was redecorated or the hinges just got too corroded to stand looking at. And I am sure that all the ones I have used were probably made in Dayton or some other bastion of western civilization.

Well, times have changed — all the toilet seats we have bought over the last few years from our local big box retailer were made — guess where. They look nice and were inexpensive enough but they all manifested a common problem. They break. So far the failure rate is 100%, some within  the ‘warranty’ period. It has been the poor metallurgy of the hinges mostly — cast material that was visibly crystalized. But the latest failure was the ‘wood’ of the seat which when it broke revealed itself to actually be some cast material that looks suspiciously like bakelite resin and sawdust.

So we are looking for a source that can provide us with an old fashion toilet seat of real materials that will just sit there and do its job. Hopefully we will not have to plumb the depths of the Habitat Resale Store. But this regular failure is just downright boring.

It occurred to me that this issue with the toilet seats is probably a metaphor for contemporary civilization. We still produce the appearances of the old quality but we have gutted the manufacturing centers and shipped the production to places for which the number of units are more important, no matter how shoddily built, than the quality. After all, very few tourists are likely to come by to see where their toilet seats were made. Are we playing at being a civilization now? My toilet seat index seems to suggest that we are — there is the appearance of quality but its just rotten inside. I hope I am wrong.

Conservatives and the Myth of the Market

Today’s Globe and Mail had an article about the upcoming collision between the as yet not implemented ‘Obamacare’ and the resurgent Republican ‘Boehnercare’ concept of a market-driven solution for healthcare. It was the phrase ‘market-driven’ that caught my eye and got me wondering why conservatives are so enamored of this idea.

The concept of a market, at least in my simple view, is one where informed buyers and transparent sellers agree on price for an exchange. To be able to agree implies that there is a choice that is open to the buyer and that the seller freely discloses all the information necessary for the buyer to make that choice. It also goes without saying that to be effective the buyer must be smart enough to understand the offered information and so make a rational choice based on their needs and desires. This process makes sense when I am trying to decide where to have lunch. Possibly even where I put my retirement funds for the next few hours. But it doesn’t make any sense if I am having a heart attack or want to turn on the light.

Healthcare and utilities seem to be two areas where right wing governments have been in love with putting in place the illusion of a market-driven process to improve cost-efficiency. But these areas both seem like the least suited due to the characteristics of the industry and the lengthy capital investment process needed before one is able to offer anything.

In the case of electric power, governments everywhere appear to be enraptured by the prospect of establishing competitive utility markets — and that this will somehow make power more available and cheaper to drive economic prosperity. We are doing this to make things better, right? The model for this was Enron, I believe. But building a power plant or electrical distribution network is not an overnight process — it takes years, even decades and is wildly expensive. So the only real incentive to get ‘investors’ interested is to raise prices and make it more profitable. That was the reason behind what Enron did, was it not? So with this illusion of competition being put in place we have rising prices, reduced availability, and not surprisingly, diminished economic activity as jobs move elsewhere. Seems that the original intent for establishing Ontario Hydro was right on, a pity we forgot…

There is the same kind of fairy story being tossed about down South regarding the healthcare system. That somehow market-driven solutions will make it more cost-effective that a government-operated monopoly. But as with Canada, there is an entangling of interests that obscure the different processes involved and make it more difficult to separate the variables. But I will try…

The key to the healthcare system is the trained practicing professional — doctor, nurse, whatever. These folks have invested 10, perhaps 20 years of their life learning a body of knowledge and acquiring skills to be able to heal others. Most of them paid their own way because of their vocational leanings. Their activities require a lot of special tools and workspaces — and because we currently believe in specialization, care requires a number of different specialities. So their aggregate workplace and dormitories for the people being cared for we call hospitals. This is also a convenient place to bring people in serious distress — the heart attack victim, for example.

Like a power plant, the hospital and the staff who work there require a long time to build and a huge capital investment. For this reason they typically cover a geographic area with little effective overlap — so for acute, critical care the opportunities for competition are limited. But from the perspective of the emergency patient, who may have limited opportunities for reflective contemplation of the alternatives, that is probably just as well.

But more important, the decision to engage the healthcare service is driven by urgent need, not volition. And the service makes precious little information available, and what is there is suspect, that would enable a prospective patient to intelligently choose the best outcome. Even the stock market that conservatives point to as a model of efficiency is rife with faulty information and often has the appearance of the deck being stacked in favor of the insiders. So being able to choose is of limited utility for the acute care-requiring person.

What gets substituted in both universes are a choice of payment systems — for utilities they are power marketers, for healthcare they are insurance companies. The power marketer, like Direct Energy or Bullfrog Power, provides the illusion of choice by offering a variety of purchase plans and prices — but in the end they all get electricity from the same generation stations and distribute it across the same wires. In theory the price we pay may be less (or more) that what we would otherwise have spent if we bought power directly from the utility distribution company. In practice it seems that all we do is provide income for these intermediaries and their profits are added to the underlying costs.

Insurance companies work much the same way. Remember, the idea of insurance is that we make a bet that something bad will happen. If we win, the insurance company will have to pay out a lot of money. But if we loose, we pay the insurance company a smaller fee over a long period of time and they profit. The fee is set by the insurance company to ensure that they will make money over time and build up a pool of capital that will allow them to cover the costs of the occasional winner. Regardless of how low the ‘premium’ on this bet is, it must always be equal or greater than the total cost of payouts plus operating expenses and profits. So there is an incentive for the insurance company to make it difficult to ‘win’. I guess this is the attractive part of the idea for conservatives — that the insurance company will fight to reduce payouts. But let us not forget that the recipient of the payment is the hospital, not the individual. And they can go after the individual for the deficit. So while the insurance payout is a constraint it does not really cap costs. Then add lawyers into the mix and allow legal action for imperfect results…oh, my.

My problem simply is that I don’t see how a market-driven solution will have a good effect in either the utility or healthcare areas. They are both areas with long lead times, huge capital costs and limited choices. And our knowledge of how to make the best choice is at best limited when we do have the luxury of reflective shopping. All it will really do, in my humble view, is to raise costs and reduce availability. The one job our elected representatives can do is build a mechanism do deliver good service at a cost we can afford — they are uniquely positioned to address the needs of many different communities. But I fear that what we will get is actually the opposite — ever higher costs and reduced availability. But then the real choice is who funds their election campaigns, isn’t it?

Paypal and the Loss of Privacy and Control

I have had a couple of interesting collisions with the outside world these last couple of days. To begin with, the CBC, that much maligned (by the minority party in power) news agency, has changed its account registration rules. Used to be that one could register to be able to post comments and this would persist from day to day, so one only needed to re-log in fairly infrequently. The new policy, it seems, is to mandate a log in for every attempted comment. So if there is more than one article meriting response one has to sign in for every posting. But there is an alternative — one can signon using your Facebook or Gmail account. Interestingly, if you try this, one of the items you must agree to is to give the CBC access rights to your entire Gmail contact list. What does this have to do with identifying myself for the purpose of posting a comment? Is someone building a ‘fellow travellers database’? Shades of Senator Joe and the 1950s..

The other interesting collision has been with Paypal — I have had an account for years and use it infrequently for making donations and the occasional odd payment. It is linked to my credit card, verified of course, and has made a sensible extension to that instrument — since credit card charges are a real nightmare for the small business. Well, it seems Paypal has a new idea — it is no longer sufficient to pass my transactions through to the underlying credit account. Now they want access to my bank accounts as well — as a condition of continuing to pass credit card charges along. Not that there has ever been a problem. But since they do not (and never will) have access to my bank, I am now re-classified as an ‘unverified’ account with a lifetime maximum amount of business with Paypal. I tried to call Customer Abuse about this, but all I got was a snippy little babe who said if I didn’t give them access to my bank account I could not use Paypal — those are their rules now, so tough. Ok, so I will close my Paypal account and just use my credit card — when Paypal extended my financial reach it was a help. And I didn’t have to worry about some rogue stealing my credit card info and running up bogus charges. Oh, no — now I have to worry about some rogue stealing the bank access info from Paypal (we will assume for the moment that Paypal itself is above reproach) and draining my retirement funds.

Paypal may have delusions of transforming themselves into a bank, but to impose harsher rules than the banks on my doing business with them they have guaranteed one less customer. And one more person warning others about the dangers of excess and unjustified information requirements. Doesn’t seem like we are moving in a good direction.

What I found interesting after having this encounter was the number of people with similar or far worse experiences who told their stories on the web. And some You-tube clips where the customer abuse agent was recorded telling the poor unfortunate similar tales.  With this going on its hard to understand why there has not been a news media expose — as we used to say in Chicago, the fix is in.  And if one has a KIVA account, my wife tells me, the way to get money back from your microinvestments is to create a Paypal account — then hope, I guess, that the money ever gets back to you.  Guess the marketing barrage to cover up the dark side is pretty typical — as is the difficulty of getting any non-automated attention, even for abuse.  One wonders if we are all being viewed as potential candidates for the Island of Lost Boys — enthralled by the glitter and marching unknowingly into the abyss to become yet more jackasses to be sold and abused.