• Questions for readers

    We are seeking feedback on some aspects TIE content. Here’s your chance to tell us what you really think. We want constructive criticism, so let us have it!

    Please answer any or all of the following. Don’t worry about your comment length on this post. We’ll waive that aspect of the comments policy. You’re welcome to message any of us privately on these issues too (see the mail icons in the left sidebar on the blog). Finally, if you’ve got thoughts about blog content that are not related to these questions, send them along anyway. These are just to get you started. And you need not answer all of them. They should get you thinking in constructive ways, though.

    1. What’s the best thing about TIE? What’s the worst?
    2. If you could change one thing, what would it be?
    3. How do you feel about the volume of posts? Are there too many per day? Too few? Not enough on weekends? Appear too frequently during the day? Etc.
    4. How do you feel about the length of posts? Too long? Not enough detail? Good mix of long and short?
    5. Are you able to understand our posts? Do we assume too much of the reader? Do we provide too much background? Or do we achieve a good mix?
    6. What TIE features do you particularly enjoy (e.g. Reflex, On The Record, Podcasts, Reading List, FAQ posts, etc.)? Which ones do you ignore?
    7. Are there subject areas you’d like to see us cover more? Or less?
    8. Is there anything about our tone  that rubs you the wrong way? Is there anything about our style you really like? (Feel free to name names as there are several bloggers here.)
    9. Do you recommend TIE to others? If so, why? If not, why not?
    10. What other blogs do you read and enjoy? To what extent and in what ways would you like TIE to be more like those? Or less?
    11. What problems, if any, have you experienced with our website or feeds (RSS, Twitter)?
    12. How do you read TIE? (via google reader, bookmark in a browser, link from twitter, facebook, other)
    13. How did you learn about TIE?
    It’d also be helpful if you’d start your response by telling us your profession (journalist, researcher, nurse, hospital administrator, student, rodeo clown, etc.) and whether you’re a regular reader and for how long.
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    • 1.
      Best: I like the breadth of health care topics presented. In fact, I have used papers I noticed on this blog in meetings with high level executives so I owe it quite a bit in terms of expanding my knowledge.

      Worst: Much too attached to the groupthink you see in health policy circles. For instance, a stunning lack of attention to how incentives play out in the actual health care world as opposed to how they are seen in DC or academia. My favorite example is a prior post on Texas’ malpractice climate. Most practicing physicians would tell you that what passes as “strict” tort reform in policy circles is absurdly weak when it comes to changing physician or patient behavior as the main costs of litigation are not in direct costs (e.g., trial costs, insurance premiums, jury awards) but in indirect costs (e.g., much more risk-averse behavior in the standard of care (why are head CT’s done for headaches?), specialties which shouldn’t exist (e.g., why are allergists in business? couldn’t fam practice handle this? also see why radiology will never be outsourced) and the massive documentation costs (4x as much admin burden in the US vs. Canada))

      2. The lack of skepticism of some of your posts. You are extremely intelligent but sometimes, speak too much as an advocate/journalist rather than as a critical thinker aware of tradeoffs. A specific example would be posts on physicians’ hand washing rates. There was no indication you were even aware of the tradeoffs involved (e.g., rising antibiotic resistance rates, workflow disruption rates, the indications for isolation, etc.)…

      3. I like your blog overall (despite the above criticisms) so if anything, I would encourage more posts.

      4. Good length so far. See #1 and #2 for improvements.

      5. The posts are clear. I would keep the level of detail similar to the current standard.

      6. I really like everything except the podcasts (mainly because I have limited access to those)…

      7. Again, would love to see you talk more about:
      –Cross-cultural comparisons that don’t favor the current pro-ACA consensus in policy circles(e.g., France has fee-for-service, Britain has a much more unregulated private medical sector, Japan has much higher rates of imaging, Germany has a similar insurance structure, NZ and Sweden with their no-fault malpractice systems, etc.)

      –The impact of racial disparities, demographics and especially, genetic differences on health care costs (e.g., African Americans have much higher rates of hypertension than other groups for partially genetic reasons (ie. salt retention helped survival)) and its implications for policy (e.g., Swedish Americans have similar outcomes as Sweden’s population). Ideally, a discussion on how we can improve this area would be great…

      –The impact on incentives on physicians (e.g., if you encourage NPs, etc. why would med students go into primary care?, if you allow medical tuition rates to skyrocket and most students to study till their 30s, is there any circumstance where a rational person does not decide to maximize revenue in their short working life?)

      –The impact of tradeoffs on patients (e.g., we would expect NPs/PAs taking care of patients to lead to lower quality care (patient surveys on quality dont count as a metric) and if one allows simple patients to go to them, wont the resulting cherry picking cause physicians to specialize even more to survive (thus, raising costs)?)

    • 8. The tone is definitely a bit arrogant (applies to all posters) given the limited exposure most public policy specialists (including bloggers) have to actual medical practice.

      Given the horrific experiences with public planning and technocratic control in the 20th century in most of the world (no, Scandinavia is not representative), one would expect some degree of humility when advocating more of that in the US health care sector.

      Now as it happens I agree with the main thrust of most bloggers’ posts here (i.e. reform is needed) but from the tone of most posters, it would seem this is the only rational view which is far from true. After all, if something was seriously wrong with your health or that of anyone in your family (no matter the cause), you would have to be exceedingly courageous and/or stupid to leave the United States medical system (despite its problems). For example, no matter how much money or power you have getting a liver transplant in even a wealthy, sophisticated country like Japan is riskier…

      9. I would recommend this blog to others given that it at least tries to take a reasoned approach to advancing health care reform. All of the above improvements I suggested are common issues I would say to any group of smart, motivated and opinionated experts…

      10. Marginal revolution is a great blog, whose style I think would bear emulating. Tyler Cowen, et al. do not necessarily shy away from mentioning evidence that does not support their favored positions on hot button issues (e.g., immigration, stimulus, IQ, entitlement reform, etc.)

      I also really like Yglesias because he presents his arguments in a very effective style, even when they are contradicted by empirical evidence.

      11. No technical issues.

      12. Google reader.

      13. Linked to from other blogs

    • Engineer – regular reader for about 2 months or so. Came here from Krugman/DeLong/Yglesias/Klein link. I can’t remember which one.

      I mostly read this for added depth of knowledge on health care economics. I’m finding I’m skipping the wonkier posts now but I really like Dr. Frakt’s posts about being a practicing doctor.

      I could never put this into words in a way that truly applied to any post so I’ll tell you now. The one thing that irks me about our debate in cutting health care costs is that no one is coming right out and saying what we all need to hear. In order to cut costs, someone has to have less. Hospitals/doctors need to be paid less or device manufacturers need to be paid less or insurance companies need to take less out of the system or drug companies need to earn less or people need to use less health care.

      I understand most of your posts about savings are about specific ways to cut the above costs. However, I think skipping over the fact that someone ends up with less actually makes it harder to sell the public on something. I think driving that point home relentlessly will, eventually, make people recognize the inevitable. I’m afraid without that, all we’re going to be able to manage is some tweaking around the edges instead of the real reform we need.

      Thank you.

    • Med student. Reading since May-ish.

      Excellent overall. The back and forth bickering between bloggers and commenters is unnecessary and the response posts are overly defensive. Post length is ok. There’s a good variety of topics. However, sometimes posts are hard to follow if they’re on a very narrow topic or coming from another field that is only peripherally related to healthcare policy. Perhaps adding links to background info would be good in such cases. The FAQ section is great, but it could be a much more complete resource with external links to other sources as well.

      As it is often challenging to find information on health policy that is evidence based (rather than opinions playing to emotional appeal), this blog is a refreshing break from the norm.

      Cheers

    • 1. I find that the best thing about this blog is the comments. The thoughtfulness and interest of the comments far exceeds what I have come to expect on other, even very good, blogs.

      5. I have found the level of explanation to be just about perfect.

      6. I really enjoy the Reflex posts. I generally ignore the FAQ (since I almost always have previously read the referenced posts), the On The Record posts, and Podcasts.

      9. I have made quite a campaign of recommending TIE to others through Facebook, blog comments, and e-mails. I think you do the best job on the Web of discussing the topics within your scope.

      11. I blog that I read regularly that reminds me of TIE is Language Log, particularly because there is also an emphasis there on evidence vs. opinion. I also read a variety of general economics blogs.

      I access TIE through Firefox. I am a retired pharmaceutical researcher. I have been reading TIE for about a year, and I read virtually every original post.

    • Retired college professor, regular reader for about a month.

      I like TIE because it makes me aware of new research and arguments that are not readily available to me elsewhere. You perform a valuable service that I appreciate.

      The thing I like least about TIE is your apparent naivete about the role of corporate campaign contributions and lobbying in determining health care policy. Even when explicitly discussing topics such as the “feasibility” of single payer, the fact that our political system is little more than legalized bribery is barely mentioned. In my opinion, recent developments such as the Citizens United decision, may be rendering your field of specialization almost obsolete. Future governments may no longer need social policy specialists, but only accountants to keep track of the total campaign contributions received or anticipated from each stakeholder.

      As an example, you recently noted that raising the eligibility age for Medicare would double the cost of health insurance and care for those affected by this change. You ended by asking, “Why would anyone want to do that?” The answer seems fairly obvious if you ask the simple question, “Who benefits?” and examine the contributions of these corporations to the politicians who are supporting the proposal.

      Since you guys are otherwise pretty bright, I sometimes suspect that you are pulling your punches for fear that speaking more candidly would endanger your funding sources.

    • I used to be a health policy analyst for a Representative (now I’m just another law graduate looking for work), but perhaps my biggest suggesion would be to have an easier to navigate archive. Yall have had some great and informative posts/links and it would be a shame for them to be lost to the bowels of the internet. Plus, I’m sure yall are tired of reiterating the same things regarging Medicare, block grants, etc…

      Other than that, this is one of my favorite blogs out there. Truly informative and the differing qualities of analysis are truly helpful. There is deep, wonky stuff as well as broad overviews. A few posts about fried butter from the Indiana State Fair are nice breaks as well.

    • Forgot to state my affiliation at the start of my post(s)–I am a physician and management consultant.

    • I am pretty happy with things as they are. My only request would be more input from the retail side of medicine. I have this feeling, unsubstantiated I will grant you, that we are missing a lot of info from the marketing and retail guys who sell medicine. Not sure from whom or where you would get that input.

      FTR- I am a physician. Follow you on Twitter, but read you on the net (bookmarked on my bar).

      Steve

    • What’s the best thing about TIE? What’s the worst?

      I’d say you biggest strength is that the content is presented in such a way that non medical professionals can understand. The worst is those times when its not…

      If you could change one thing, what would it be?

      Improve the history search function.

      How do you feel about the volume of posts? Are there too many per day? Too few? Not enough on weekends? Appear too frequently during the day? Etc.
      How do you feel about the length of posts? Too long? Not enough detail? Good mix of long and short?

      Volume seems about right, weekends get a little lean but I expect that, Length also seems good

      Are you able to understand our posts? Do we assume too much of the reader? Do we provide too much background? Or do we achieve a good mix?

      As someone who doesn’t work in the health field, there are posts that leave me in the dust. Sometimes I feel like I’d need to go back and retake my stats courses or something to process the studies cited. That’s probably more of a “me” problem though..

      What TIE features do you particularly enjoy (e.g. Reflex, On The Record, Podcasts, Reading List, FAQ posts, etc.)? Which ones do you ignore?

      I think the podcasts are a terrific addition to the blog. I tend to skim the reading list as often its I think, more suited to industry professionals…

      Are there subject areas you’d like to see us cover more? Or less?

      I think you do a good job covering the waterfront…

      Is there anything about our tone that rubs you the wrong way? Is there anything about our style you really like? (Feel free to name names as there are several bloggers here.)

      I’ve followed Dr. Carroll since he rolled his old blog out, so I’m biased to like him. That said, I’m also really enjoying a lot of what Austin posts. Austin’s stuff, IMO tends to be a little more wonky than Aaron’s, so that leaves me struggling to keep up…

      Do you recommend TIE to others? If so, why? If not, why not?

      Yes…I feel that Dr. Carroll/IE do a great job at laying out an issue and providing a reasoned, digestible discussion. I also like that cheap shots are kept to a minimum. I’ve linked to several articles from IE on my blog. I feel I can trust you two to lay out both sides of an issue fairly.

      What other blogs do you read and enjoy? To what extent and in what ways would you like TIE to be more like those? Or less?

      Don’t go there…don’t water down what you have going. Its good.

      What problems, if any, have you experienced with our website or feeds (RSS, Twitter)?

      None…

      How do you read TIE? (via google reader, bookmark in a browser, link from twitter, facebook, other)

      Its one of my goto sites…I check it a few times every day. I’ll usually listen to the podcasts at least twice to make sure I take it all in.

      How did you learn about TIE?

      Followed Dr. Carroll from Rational Arguments…

      It’d also be helpful if you’d start your response by telling us your profession (journalist, researcher, nurse, hospital administrator, student, rodeo clown, etc.) and whether you’re a regular reader and for how long.

      I am a professional musician in SW Ohio. I post at my own blog, “Reasonable Conversation” and touch on health care issues from time to time.

    • Intern in internal medicine at Duke, regular reader since September 2010.

      3. I like that there is always something new to keep up on. On the flip side, when I get too busy to check in daily I then feel like I’m “falling behind.”

      5. There is a good mix. I find that posts which are graphic-driven are always easy to understand, and get very good bang-for-the-buck in terms of information per unit length.

      6. The only posts that I generally skip over are the ones that get very deep and techincal into legislative details. I feel guilty for doing so, because I know the information there is important, and that I’m not going to find it explained better anywhere else. But I usually just don’t have the time.

      9. I recommend it far and wide, especially to all of my medical colleagues. It is the only forum I have found (thus far) that tries to address the problems within health policy from a reality-based perspective. I find very little straying from “what the data show,” which is a breath of fresh air among all of the partisan bickering everywhere else.

      10. Marginal Revolution
      Overcoming Bias
      Bleeding Heart Libertarians
      Modelled Behavior

      12. Bookmark in browser

      13. Link to Aaron Carroll’s series on costs back in Sept 2010.

    • I’m a current medical school applicant with some experience in policy research and journalism, and I’ve been reading TIE for the past few months.

      What’s the best thing about TIE? What’s the worst?

      Best thing: clear analysis of important health policy issues from a variety of perspectives

      If you could change one thing, what would it be?
      It seems like there’s a bit of a consensus among the authors here (which I often agree with), but I would be interested in hearing other viewpoints.

      How do you feel about the volume of posts? Are there too many per day? Too few? Not enough on weekends? Appear too frequently during the day? Etc.

      The volume’s great, the more the better.

      How do you feel about the length of posts? Too long? Not enough detail? Good mix of long and short?

      Overall the mix is pretty good, but sometimes I find myself wishing for a little more explanation/analysis from some of the shorter posts.

      Are you able to understand our posts? Do we assume too much of the reader? Do we provide too much background? Or do we achieve a good mix?

      I find I’m able to understand most of the posts pretty well, though there are some topics (especially some of the more econ-focused posts) where I don’t get everything. Background is always helpful, and even if it’s not in the body of every post, I like it when you link to previous posts that provide an intro/explanation to what you are discussing.

      What TIE features do you particularly enjoy (e.g. Reflex, On The Record, Podcasts, Reading List, FAQ posts, etc.)? Which ones do you ignore?

      I like most of the features, particularly reflex and the reading list. I listen to the podcasts as well.

      Are there subject areas you’d like to see us cover more? Or less?
      Is there anything about our tone that rubs you the wrong way? Is there anything about our style you really like? (Feel free to name names as there are several bloggers here.)

      I’d say my favorite thing about the content here is that it is interdisciplinary (resulting from the makeup of the writers here), which gives a nice range of perspectives. As mentioned previously, at times I feel there is a bit of a consensus here that may prevent me from seeing the full spectrum of ideas, so I would love to see you guys address some ideas/arguments from other viewpoints.

      Do you recommend TIE to others? If so, why? If not, why not?

      I do recommend TIE to others interested in health policy because I find it does a great job at explaining these complex issues in ways that somebody who is not an expert in the field can understand.

      What other blogs do you read and enjoy? To what extent and in what ways would you like TIE to be more like those? Or less?

      I try to read blogs across the spectrum to try to broaden my intake. My regular reading includes TIE, Ezra Klein, John Goodman, Avik Roy, Kaiser, etc.

      What problems, if any, have you experienced with our website or feeds (RSS, Twitter)?

      None so far

      How do you read TIE? (via google reader, bookmark in a browser, link from twitter, facebook, other)

      Google reader

      How did you learn about TIE?
      A college friend sent me this post, which discussed a class we both took at Amherst
      http://theincidentaleconomist.com/wordpress/medicaid-planned-parenthood-and-the-law/

      Keep up the great work

    • I’m an MD/PhD student who studies health policy. I love your blog. It is a wonderful public good and a unique gem. Love the reading lists, love the references to literature, arguments in the blogosphere, current events.

      Sorry for not having a more thorough set of comments, but I think one area for further improvement depth/volume balance. Sometimes I feel as though there are just too many posts. I do appreciate it when you write well-organized multi-day posts (ex. flood insurance). However, sometimes you have multiple posts across the span of a few days about the same recent paper, news item event, blog spat, or in response to comments from an earlier post. I find these types of posts generally don’t have as rich a content level as your others. Better to respond to comments in the comment section unless you really are thinking of something new. Other times, I think it would be fine to exclude some posts that are timely in order to have a more thorough post on the topic later. Not to pick on Austin, but as a regular reader, I get that he loves competitive bidding. Instead of reading a post with a few paragraphs about competitive bidding every time it is relevant to a news item, I would prefer to have either super short posts on the topic when it comes up (with links to older, more comprehensive posts), or to have instead a more comprehensive post once in a while.

    • I’m an economist in economic consulting and former regulator.

      What I appreciate about TIE is keeping up with the policy discussion and aspects of health economics on a whole host of issues (from specific papers on outcomes to health systems to cost issues in Massachusetts). I’ve used your posts for work in sharing knowledge with colleagues and I’ve cited articles I find here in my own writing. I think the worst aspect of TIE is the volume of the posts lately. While I love the content in many posts, I now find myself just skipping them to find time to work. And I’m weeks behind in Google Reader. If I could change things I’d have you guys make different RSS feeds for different series. In terms of understanding posts there’s no problem – some of the medical posts aren’t nearly as accessible as your summaries. Your summaries also save me time and allow me to process more information quicker. I really enjoy Reflex and On the Record is almost always useful and Reading List occasionally so. Kevin’s posts on legal issues and current policy in MA and Don’s on the cost of smoking have been great. I’ve used FAQs for work and for policy discussions as well. I’ve never looked at a podcast (it’s not easy while you work). I’m not all that psyched about the class you’re blogging about but I only skimmed the posts. The tone is great – I can tell who wrote most articles from their tone, but no problems there. Austin’s wanting everything from a peer reviewed journal somewhat annoys me, especially as some of us work with privileged data we get through companies or as regulators that cannot be published in journals (I know it’s sometimes harder to assess methodology that way). For example, I’ve authored reports to Congress when in federal service, but they’re not peer reviewed. I do recommend TIE to others – it’s a little more specialized than more general policy blogs, but it’s a great niche. I’m not sure how I learned of TIE – probably a link from Ezra Klein or the Finance Buff a few years ago. I must have picked up Aaron’s old blog from here too, but I’m not sure.

      FYI – the contact form on your website disappeared.

      • I’ll break my silence on these responses to ask two follow-up questions: (1) What gives you the impression I want everything from peer reviewed journals? (2) The contact form is working for me. Would you mind testing it again and, if you can, be more specific about what you see and how it fails?