November 25th, 2014
in Op Ed
by Fabius Maximus, FabiusMaximus.com
Summary: Today we have a glance at the debate about one of the most important domestic public policy debates of our time, repeated in every generation since 1945, that illuminates the moral and intellectual nature of America at this point in time. The photo below captures it perfectly, the aggressive ignorance resulting from generations of skillful propaganda on a weak people. Renewal is an inherent capacity of individuals and societies; we desperately need it (more on how to do this in another post). This is the second of two posts today.
"Of course we want to have universal health care! We aren't barbarians!"
- attributed to Margaret Thatcher, said in 1993 at Washington, DC (hat tip to Delong)
This is America today
I am applying for health insurance as a self-employed consultant, a painful experience which reminds me of three important facts about America today. Facts which reveal the basic outlines of our situation.
First, our health care system is a disgrace, a failure to adequately handle a public policy issue solved years (or generations) ago by other developed nations. It's massive cost and low effectiveness (leaving so many poorly covered, or uncovered) reveals the degeneracy of our ethics and folly of our governance. Decent medical insurance (with caps that don't cause bankruptcy) can easily cost 1/4 to 1/3 of a blue collar family's after tax income (without Obamacare's tax credits).
Also, it shows how large vital sectors (finance, defense, health care) have become parasites, consuming resources disproportionate to their role and size. It's the grifter economy, however well-intentioned the people involved (i.e., in health care and military).
Second, Republicans are the political group most responsible for this, since 1945 having fiercely fought every step to provide health care to America's poor and working poor from Medicare and Medicaid (1965) to Obamacare. Even today they fight to deprive Americans of affordable health care, with a policy of Repeal and Promise to do something someday. Rand Paul's budget proposals call for a slow strangulation of Medicare, while today some GOP governors reject expansion of Medicaid even at no cost to their State (as of September, only 27 States have expanded coverage) - and some fight even the basic terms (e.g., Kansas). It's difficult to imagine such callousness, especially as their arguments are largely bogus.
Third, it shows our weakness as citizens that alone among the developed nations Americans have not exerted ourselves to provide adequate health care to all - despite the obvious self-interest in doing so - or run this sector in a rational manner.
Here are links to the latest rounds in the "debate". Like most public policy debates in America, they're polarized between facts and delusions. With each groups taking different sides in different debates; sometimes we have bipartisan delusions (e.g, the WOT).
(a) "The Anti-Obamacare FAQ", Reihan Salam, Slate, 14 November 2014 - A fact-free "Everything you need to know about why conservatives want to repeal the president's health care law."
(b) A gentle but thorough rebuttal: "Here's Why Conservatives Will Never Give Up Their War on Obamacare", Brian Beutler, The new Republic, 18 November 2014 - Excerpt:
But in any case, none of these basic differences between liberals and conservatives explain, as Salam puts it, why conservatives are "so pissed off about Obamacare." He attributes their indignation to the belief "that Obamacare only became the law of the land because President Obama misled the public," then goes on to explain that conservatives aren't hypocrites for wanting to turn Medicare into an Obamacare-like program for seniors, or for having once supported the individual mandate; then acknowledges that conservatives are miles from consensus on how best to replace Obamacare; and finally concludes that the law should be repealed anyhow.
None of this makes the Obamacare opposition seem even a tiny bit reasonable, but it does present a few good opportunities to explain why liberals think most of this is all window-dressing for a simpler explanation: Conservatives don't just oppose distributive programs that help the poor and working class - these programs drive them batty in and of themselves. That Obamacare patched up the single biggest hole in the federal safety net, and in so doing extended government-sponsored health benefits to people through every stage of life, intensifies this reaction.
(c) A detailed and typically brilliant rebuttal by Brad DeLong (Prof Economics, Berkeley): "Continuing on the 'What Are Conservative Policy Ideas for Replacing ObamaCare?' Beat", Washington Center for Equitable Growth, 18 November 2014 - Excerpt:
I read Reihan Salam over at Slate. My first, minor, thought is that the Slate editors seriously fell down on their job in failing to demand even a modicum of intellectual consistency here. ... My second, big, thought is that there are no live policy ideas - that the Republicans are now the captives of the nihilists they have turned their activist base into, and that their only strategy now is to hope that somehow, some way, ObamaCare can be made to collapse.
... As I see it, there are three possibilities:
- Poor people don't get to go to the doctor - and die in ditches.
- Poor people get to go to the doctor, but the doctors who don't treat them don't get paid and have to scramble to charge somebody else via various forms of cost-shifting.
- The government subsidizes insurance coverage for people of modest means by raising taxes on people of less modest means.
In my view, Slate's editors seriously fell down on the job in not requiring that Salam say whether he thinks it is better to go for (2) - imposes in-kind taxes on doctors - or (1) rather than (3). The view on the left and in the center is that (1) is a non-starter. ... The view on the left and in the center and on the not-insane right is that (2) is profoundly dysfunctional and would prove extraordinarily inefficient. If Salam prefers (1), he should explain why Margaret Thatcher was a squishy leftist. If Salam prefers (2), he should explain why he disagrees with every single technocrat who knows about the health-care financing system.
(d) "The Republican Health Care Pathology", Scott Lemieux (Asst. Prof of Political Science, College of St. Rose), Lawyers, Guns and Money, 20 November 2014 - Conclusion:
If you don't believe that non-affluent people should simply be left to die needlessly from illnesses and injuries, you have have to believe in redistribution. The only question is whether it will be relatively efficient and equitable or grossly inefficient and inequitable. (Given that Salam implicitly favors the latter, his assertion that conservatives are "particularly skeptical about redistribution that isn't transparent" can only be seen as black comedy.)
The other striking thing about Salam's article is how blind all the hand-waving about "markets" is to both theoretical and empirical objections. The cliches about how markets will control health care costs seem to be unaware that Ken Arrow ever existed. And more importantly, you would think from Salam's article that health care policy was uncharted territory, that the problems presented by the American health care system in 2009 had never been addressed anywhere. In fact, every other liberal democracy has addressed them in ways that provide universal coverage for less and often much less money per capita than the American system. The burden of proof evidently lies squarely on those who would "solve" the problems of American health care by taking us further away from systems that produce better outcomes for less money. For obvious reasons, Salam just omits the discussion entirely.
Please read these. The debate about health care illustrates more clearly than anything else I know the pitiful state of The Republic on both political and moral levels. Our economic dynamism can propel the nation in a material sense, but not save The Republic from falling. Only we can do that. We can, if we try.
For More Information
(a) See all posts about Reforming America: steps to political change.
(b) Posts about ObamaCare and the US health care system:
- Beginning of the end of the Republic's solvency. Soon come the first steps to a reformed regime - or a new regime., 14 August 2009 - From accounting to death panels.
- Hidden truths about American health care, 19 January 2010
- A note about practical propaganda, 22 March 2010 - The campaign against ObamaCare shows that it works
- About the political significance of the conservatives' health care propaganda, 23 March 2010
- The core truth about our health care system, 3 April 2010 - It's quite mad.
- Affordable Care Act down the mindshaft: asking what it reveals about us, 18 July 2012 - By Chet Richards