NUMBERS

1. NUMBERS Kiersten Adams Jay Singerman Jen Storch Ashley Thomas James Trinidad

2. Agenda • Introduction • Numbers as Metaphors • Numbers as Norms and Symbols • Hidden Stories in Numbers • Making Numbers in the Polis • Numbers in Healthcare • Questions?

3. Problem Definition • How do we know there is a disparity between social goals and the current state of affairs? • We must define a problem. • But, problem definition is not simple: it is a strategic representation of situations.

4. Problem Definition Continued • There are many ways to define problems in policy discourse. • Each mode is a language which people utilize to defend conflicting interpretations. • One common way to define a policy-related problem is to measure it.

5. Elephant example • Say I hire you to measure an elephant? • It sounds straightforward, but its not! • What information do you collect? • Weight?, height?, length?, volume?, intensity of its color gray?, number of wrinkles? • The fundamental issues of any policy problem are always contained in the question of how to count the problem.

6. Counting Elephants Round? No Yes Primary Color? Square? No Gator No Giraffe Yes Yes Red? Green? No No Yes Yes Lion Snake Monkey Elephant

7. Counting As… • Counting the problem involves a strategic representation of the situation. • Every description of a situation is a portrayal from only one of many points of view. • So, counting always involves deliberate decisions about counting as. • Counting must begin with categorization.

8. Categorization • Notice how political counting sounds? • Counting must be about: • inclusion/exclusion: terms that suggest community, boundaries, allies, enemies • Selection: terms that imply privilege and discrimination • Important characteristics: terms that suggest value judgments and hierarchy

9. Numbers as Metaphors

10. Numbers as Metaphors • To categorize in counting or to analogize in metaphors is to select one feature of something, assert a likeness on the basis of that feature, and ignore all the other features. • Counting requires judgment about inclusion and exclusion.

11. Counting Schemes • Counting schemes are subject to 2 possible challenges: • Asserting a real likeness where a measure finds a difference (Including something the measure excludes) • Asserting a real difference where a measure finds a likeness (Excluding something the measure includes)

12. Clear Rules • Often times, conflict in policy is over what legitimately counts as what • Numbers are used to settle the discussions • The need for clear rules drives policymakers to establish thresholds as dividing lines

13. Central theme • There is no universal, scientific, or objective method of problem definition. • Numbers are just one way problems are defined in politics - and politicians employ several different counting strategies to set the problem • Fancy manipulation of numbers equal claims about similarities and differences • These are the ultimate basis for decisions in public policy.

14. Numbers as Norms and Symbols

15. Measurements • Imply a need for action • Usually taken because we seek to change them or to change our behavior • Creates pressure to do something about it

16. Unemployment • 1930s- no unemployment census • 1950s and 60s- 4.6% • 1970s- more than 6% • 1980s- 7-9%

17. A Double- Edged Sword • U.S. Navy saved 2.5 billion in shipping costs • Show thrift, successful building, and good management? • Show an excess of allocated funds that could be cut?

18. Cost • Generally think of high costs as bad • Sometimes, high costs= high quality • Designer clothes, cars • Is a costly national defense system waste-ridden or extra secure?

19. Efficiency • Generally think the more efficient and productive, the better • Not necessarily so with services

20. Middles and Averages • Often the norm • Political campaigns promote to “middle class” • Depends on the categories

21. Hidden Stories in Numbers

22. Hidden Stories in Numbers • Explicit Stories • Used to authenticate a story • Identify causal relationships • Implicit Stories

23. More Implicit Stories • Frequent enough to count • Clear boundaries make numbers identifiable • Counting creates a community • Natural vs. Artificial • Political support • Numbers can stimulate conflict resolution • Dividing, weighing, balancing • Numbers are symbols of precision and accuracy

24. The Political Story • In counting, decisions must be made about inclusion and exclusion • Measuring creates norms about how much is just right • Ambiguous numbers create room for political struggles • Numbers tell stories, especially about decline

25. The Political Story • Numbers create illusions about complex phenomenon • Numbers create political communities • Counting can help with negotiations and compromise • Numbers create authority

26. Numbers in the Polis

27. Numbers in the Polis: People as numbers • People know when they are being measured • Examples of people as numbers • Social Security number, UFID, phone number, census • Bank account number and identity theft • Measurement triggers the natural desire to look good • Examples: height, business portfolio, IRS & taxes • Therefore, if our measurements do not look good, we are disappointed • Does “15th best” sound good to you? • Giving people the option of being counted as something invites people to consider choosing it • Implies inclusion and exclusion • “Check one” vs. “Please check all that apply”

28. Numbers in the Polis:Counting • Counting and measurement affect people’s behaviors and perceptions • Counting enables group (vs. individual) discrimination/mobilization • Ex. Hate crimes • A formal count normalizes rare events • Ex. War-on-terrorism and American deaths • Counting/measurement can induce dissatisfaction and change • Ex. Weight, diet, and Healthy People 2010

29. Numbers & Polis:Record Keeping • Record keeping is more intense when the records are under scrutiny or public attention • Reformers try to show that the problem is big, new, and not something that has been tolerated for a long time • Ex., Global warming • As tolerance for annoyances diminishes, then the perception is that annoyances are growing • Decreased tolerance: increasing inclusion of negatives • Ex. Child abuse • Decreased tolerance: decreasing exclusion of positives • Ex. Affirmative action

30. Numbers & Polis:Reactivity and Power • Measurement induces incentives • Measures evaluate performance, rewards, and punishment • Ex. FCAT (“teaching to the test”) • The power to measure is the power to control • The power to include is the power to exclude • Ex. Police, clearance rate (police effectiveness), & crime rate • Ex. Political campaigning and measurement of issues • Marginal cost – the cost of producing the next item • May mask the actual cost of production (e.g., Dept. of Defense) • Measurers need the people/organizations they measure • Ex. FDA and Big PhRMA • Likewise, sometimes the measured need measurement for validity

31. Numbers in Healthcare

32. Numbers in Healthcare • Alachua County Choices Program • Health care coverage for thousands of low-income people • Funding through ¼ cent sales tax increase • How much extra will the average consumer have to pay each year? • Number manipulation from both sides

33. Numbers in Healthcare • Insurance and Reimbursement Rates • Reimbursement levels for Medicaid v. private insurance • Doctors have an incentive to change their behaviors to treat more private patients • Doctors can treat fewer Medicaid patients • Doctors can spend less time with Medicaid patients

34. Numbers in Healthcare • Quality • Number of medical errors • Number of procedures performed • Number of malpractice suits • Number of unexpected deaths

35. Numbers in Healthcare • Quality- Number of medical errors • “Countability” • Do estimations accurately measure the number of medical errors? • Attention is given to things that are measured • Reactive effects- • New York state report cards for heart care • Once measured, doctor’s outcomes improved

36. Numbers in Healthcare • Quality- Number of Procedures Performed • Measure of quality- more experienced doctors should have better results • Measuring this could result in a change of behaviors • Doctors may perform procedures that aren’t medically necessary just to increase their numbers

37. Numbers in Healthcare • Florida’s Malpractice Crisis • Counting normalizes and legitimizes problems • Attention to the problem increases the number of reported cases • Highly publicized cases/large award cases

38. Questions?