The debate about healthcare isn't actually about healthcare anymore. It's amazing the lengths to which some Americans will go to further an agenda.
Of course, EVERYONE has an agenda. It just appears that the right are far more comfortable playing shell games with theirs.
The American healthcare system, like the environment, is broken, no matter what the right wing says. The ridiculous thing is that the Republicans can have their way, if they want it. The idiot Democrats want a healthcare bill, ANY healthcare bill, just so long as they can say they "fixed" healthcare (which will not happen). All the Republicans have to do is float a few token votes (from Congressmen and Senators from "safe" districts, such as Dick Lugar) on an industry-friendly bill. The representatives who need to can vote against it for the sake of their culture warrior t-bagging constituents. Viola! An industry-friendly cosmetic fix gets passed on the Democratic watch, the insurance bandits are safe, the Democrats say they "fixed" healthcare, and Republicans who need to can say they voted against it. Everybody's a winner!
Instead, the Republican party has decided to commit their future to the culture wars. The ends (political victory) justify the means (lying). They have once again, Rove-style, taken control of the debate. We're not talking about healthcare anymore: it's all code.
On second thought, maybe I'm OK with this ludicrous argument. It's looking more and more like any bill that will be passed will be worthless. It looks like a few more people will have to be arbitrarily denied coverage or drown in the bureaucracy of their private sector health plans before we really fix this thing.
In the meantime, it saddens me just how many people believe we are actually talking about healthcare.
9 comments:
Hey Bill, I hope all's well with you and yours. I've been patiently waiting for you to blog about healthcare since it's hard to find someone who is both reasonable and cares to discuss it. So, here goes.
"The debate about healthcare isn't actually about healthcare anymore."
Let's take a step back and first ask, "What is 'healthcare' about?" Is it really about improving the health of persons or is it about showing persons we care? I highly recommend Robin Hanson's paper on the subject. hanson.gmu.edu/showcare.pdf At best, the intent of most public policies seems to be to right perceived societal wrongs. Unfortunately, this is often done without any regard to whether these policies will actually achieve the desired outcome. I'd argue most public policy isn't concerned with altering a situation for the better but rather is concerned with appealing to the feelings (assuaging guilt, doing what's "right," etc) of those desiring change.
"The American healthcare system, like the environment, is broken, no matter what the right wing says."
If you don't think this statement requires some qualification (not to mention empirical support) then you're every bit as dishonest/delusional as those you're trying to criticize. How, for example, can the environment be "broken?"
"Instead, the Republican party has decided to commit their future to the culture wars. The ends (political victory) justify the means (lying). They have once again, Rove-style, taken control of the debate. We're not talking about healthcare anymore: it's all code."
Aren't references to "culture wars" and Karl Rove just "code?" You're not talking about healthcare, either. You're simply tossing about the usual Democratic bogeymen as though doing so constitutes a valid argument. And don't bother trying to argue that Democrats are any less guilty of lying than Republicans. You know that's not true.
I know these are just blog entries. But, I think you should try to be a little more careful about your use of terms and your reliance on assumptions. If you're goal is to preach to the choir, that's your business. But, I'd like to expect something more from someone as smart as you. ;)
"It looks like a few more people will have to be arbitrarily denied coverage or drown in the bureaucracy of their private sector health plans before we really fix this thing."
Great Caesar's ghost! I don't know how I missed this one. First, give an example of "arbitrarily denied coverage" and explain how the government's bureaucracy will avoid this. Second, if you're dissatisfied with the bureaucracy of private sector health plans what exactly do you expect from the government's? Are you not in the least bit concerned by the "efficiency" of existing government-run healthcare bureaucracies such as the VA and Medicare?
Hey Josh, great to hear from you again. I live in a new house now - you should come visit.
1. I don't disagree with your first point, but I think that it is not relevant. People do things for different reasons, some bad, some good. I have every reason to believe that some support healthcare only to win votes, and some oppose it for the same reason. Some people are idiots, some people aren't (on both sides, before you take that as a partisan statement).
2. The environment is evolving in a way that is becoming less hospitable to humans. I'm sorry, this is like gravity to me, so no, I don't think the environment question requires qualification, even if "broken" is inaccurate.
Quick side note: I have a scrap about the environmental movement, and how it is more about people than the earth. The best thing for the earth is if we go on our merry way. Pollution/resource depletion is the chemotherapy, we are the cancer. When the earth shakes us off, it will be fine. Not that I am advocating that course, mind you.
Anyway, you are right when you say I have to be more explicit about how the health care system is broken, especially when it seemingly works fine for the majority of the people in the country. I will probably be posting more about this soon, including my sometimes Kafkaesque encounters with the healthcare system.
3. You probably won't give me this one, but I don't consider the mention of Karl Rove and (especially) the culture wars to be code. Culture wars is specific and value neutral. It speaks simply of pitting one set of cultural markers against another set. Both sides do it. As far as Rove is concerned, I will admit to a certain amount of shorthand by citing his name, but it is not a mis-characterization in the same way "death panels" is, for the simple reason that Rove is actively involved in this fight as a consultant, and he does work with a specific and predictable set of skills and techniques (not unlike, say, James Carville, to site someone from the other side). It would have been out of bounds to invoke Dick Cheney, but not Karl Rove, in my opinion. Still, you are right when you say the "Rove-like" image has a lot of baggage, so I'd be happy to drop it. "Culture wars", on the other hand, is the absolute best way to describe what's going on.
4. You are absolutely correct to call me out about "arbitrary". No one is ever "arbitrarily denied coverage"; they are denied coverage because it hurts the insurance company's bottom line. Sometimes (I would say most of the time) these denials are reasonable. But, when they aren't, they have results which can range from bankruptcy all the way to death. The insurance company's fundamental motivating source is profit. They do not exist to serve humanity on any level other than that of a consumer. That's fine for car companies, but not health insurance companies. I can always get by without a car, but the next time I have a kidney stone, my choices are whatever insurance they give me or $100,000 worth of debt.
Let me be very clear: yes, I do think the government can do healthcare better than the private sector. I am an advocate for a single payer system. The market does not function here, at least not until we get down to the level of lasik, erectile dysfunction, and boob jobs. If the government's too big, then fine: privatize the post office. That's long overdue.
At the end of the day, I don't really care who runs the healthcare system, but I fully believe the private sector will not take reform seriously until single payer is a real possibility.
What is amazing to me is the idea that somehow private bureaucracy is benevolent and that public bureaucracy is malicious. Are you more free because corporations run your life rather than the government? Josh, there is no way that our lives are more restricted by the "public" sector than the "private" sector. And maybe you don't even disagree with that - maybe you are just trying to keep even more control out of our lives. If so, great. But the markets are answerable only to themselves. We need something that, however imperfectly, is answerable to us - to get Marxist about it, something that provides use value instead of exchange value.
By the way, the offer still stands if you want to post on the blog proper. I feel like I'm on the bully pulpit when you are relegated to the comments. Pretty fucking pathetic, though, as far as bully pulpits go.
Hi Bill, yeah, would love to come visit. Just gotta find the time and money. Anyway, I just wanted to apologize if I sounded a little smug. Working in the College of Medicine in a large, state-run university in a decidedly liberal town means I spend much of my work day biting my tongue, smiling, and nodding my head. (And, yes, that makes me a hypocrite.) I'm sorry if I'm spilling my pent-up piss and vinegar on you. Anyhoo...
1. If the goal of a massively expensive and paradigm-changing public project is to simply make people "feel" better, that's very different than if the goal is to materially change the lives of citizens for the better. I don't support government efforts to effect either outcome but I'd rather pay for something more tangible than "feelings."
2. So, you're in the "I hate people crowd," are you? That's fine. But don't you think that being a misanthrope hurts your credibility when prescribing what we should do to make the planet more hospitable for people? Kinda like letting the fox guard the henhouse, no? If anything, I'd think misanthropes would welcome a situation where the planet becomes hostile to humans. Isn't that what they want? The fact that they are urging for action against climate change makes me think they don't believe climate change will kill us off soon enough and we need to take action to accelerate the process. Even if my theory of a misanthropic environmentalist conspiracy is hot air (hehe), the evidence for apocalyptic climate change (don't call it "global warming" because that's verifiable) is dubious. And the evidence for anthropogenic global warming is becoming increasingly hard to defend. For that matter, our theories of gravity have gone through dramatic changes over time and continue to. I don't think unproven theories and possibilities justify mandating that we all materially alter the way we live in ways which undermine freedom and increase authoritarianism.
3. Ok, maybe I'm not hip enough to the lingo. Whenever I see "culture warrior" used it seems to be code for "bigot," regardless of who's using it. If it's value-neutral, as you claim, then what's the problem with Republicans or anyone else engaging in it? All decisions, preferences, et al can be seen through the lens of culture. If it's value-neutral what's wrong with putting things in this context? I'll give you "Rovian" if you want it. But, I'd prefer to avoid using loaded terms when possible. You're a writer. You can do better than lazy shorthand.
They do not exist to serve humanity on any level other than that of a consumer. That's fine for car companies, but not health insurance companies. I can always get by without a car, but the next time I have a kidney stone, my choices are whatever insurance they give me or $100,000 worth of debt.
Bill, no one, neither the state nor private sector, can overcome the existential fact that wants and needs are unlimited while resources are scarce. A state-run healthcare system will not be able to satisfy all persons' needs all the time. And when you factor in the concept of efficiency (which we know is not the state's strength) a state-run entity will always provide a lower return on investment than an entity that is subject to the profit-loss mechanism. All state-run healthcare systems are forced to make decisions regarding whom to treat, when to treat, and how to treat. There is no plausible way to avoid this. Moreover, I reject the notion that saving anyone's life at any given time is always the best decision. We have to accept that death is inevitable. There are lots of things we can prevent; death is not one of them. Wouldn't it be better to expend resources trying to prevent the unpleasant things we can prevent rather than using all available resources trying to delay the unpleasant things (assuming death is unpleasant) we can't?
Let me be very clear: yes, I do think the government can do healthcare better than the private sector. I am an advocate for a single payer system.
On what basis? How do you explain the obvious shortcomings of VA healthcare and Medicare compared to private-sector equivalents?
At the end of the day, I don't really care who runs the healthcare system, but I fully believe the private sector will not take reform seriously until single payer is a real possibility.
I.e., the private sector won't change until someone (the state) puts a gun to its head. I won't deny that the threat of force is effective. What you're leaving out is that the state is already involved via Medicare. 40% of Americans are on Medicare. The state already "competes" with private insurers and of course it uses the threat of force to achieve its objectives (price controls, etc).
What is amazing to me is the idea that somehow private bureaucracy is benevolent and that public bureaucracy is malicious.
I, for one, have not attached any moral value to any bureaucracy. Red herring!
Are you more free because corporations run your life rather than the government?
Aye, here's the rub. Corporations don't "run" my life unless the government enables them to. Only the state has a monopoly on the use of force. Wal-Mart cannot force me to shop, invest, or work at Wal-Mart. The government, however...
But the markets are answerable only to themselves. We need something that, however imperfectly, is answerable to us - to get Marxist about it, something that provides use value instead of exchange value.
What is your understanding of a market? The only exchanges which can reliably represent that the value expectations of both parties has been met are voluntary exchanges. Use value is implicit in every voluntary exchange. If I agree to give you $5 for a hamburger it follows that I valued that hamburger more than the $5. Granted, I may have had other reasons, but the bottom line is that I freely chose to exchange $5 for a hamburger. Are you trying to say that if you hold a loaded gun to my head and offer not to pull the trigger if I give you $5 dollars that this is a better expression of "use-value" than the former? Marx was wrong on value theory. People value what they value as they value it. There isn't an objective measure of value.
I'd love to blog here. However, I want to warn you before you agree to give me unlimited blogging priviliges that I am a bit of a blog-addict. I can almost guarantee more traffic because I'll link back when I post elsewhere. But, I will probably post more than you and I'll attract a number of people like me. Caveat emptor!
Yeah, I feel your pain, being surrounded by people who never question their own assumptions. Even a lot of people I mostly agree with can be as insufferable as ranting idiots who push all my buttons.
I was a bit confusing about my environmental stance. I do believe that humans are a cancer on the earth, but speaking as a cancer cell, I'm all for our continued survival, and doing what we can to keep the environment hospitable to humankind. I just think we need to understand that environmentalism is about us, not about the earth - and I don't have a problem with that.
The inadequacies of the VA and Medicare are easy to explain. The whole basis for insurance is the spreading of risk across the largest pool of consumers possible. The VA and Medicare and Medicaid have a pool of consumers that are the least healthy of all the populace - the poor, the aged, and veterans. They also, unlike private plans, can not drop people when they become too expensive. Since they can not cut expenses by trimming their rosters, the best they can do is cut corners and squeeze the providers. On the other hand, if the entire population of the US were on the same plan, then the risk would be properly spread, and the per person cost to the government would decline radically. If the Lakers were limited to taking only players that nobody else wanted, then even Phil Jackson couldn't get them into the playoffs.
To me, healthcare is about security. I'm much more likely to be affected by health problems than terrorism - everyone in the US is more likely to face serious and expensive health problems than loss of life or limb via terrorism. And yet, we are dumping absurd amounts of money into our War on Terrorism. You wanna pay for healthcare? Let's start by stopping production on sci-fi weapons systems, and maybe spending less money on overseas "police operations". Wait, that was "overseas contingency operations", wasn't it?
There are some things that the government is better at doing. I don't want private armies and private police forces. Though I attended mostly private schools my whole life, I think public schools are absolutely necessary (any child of mine will go to public school). The federal highway projects were a pretty good idea as well, though a combination of public roads and private toll roads are fine with me. I will probably post more explicitly along these lines at a later date, though that will end up being primarily a Galbraith rehash.
If I didn't know you, I would take severe exception to the "government putting a gun to their head" image. That is, in my mind, irresponsible speech when you have clowns showing up to town hall meetings with guns on their hips and those Timothy McVeigh "tree of freedom" T-shirts. The government is NOT GOING TO PUT A GUN TO ANYBODY'S HEAD. You and I both know there are more effective systems of control anyway.
And besides, I think private health insurance companies would survive a switch to national healthcare. There are companies that make good money on extended warranties even though everything you buy comes with a manufacturer's warranty. We know that any national healthcare plan would need to balance services and costs, and there would be a market for a lot of people who want better services than what the government would offer. For instance, I'm sure the government would want to put limits on cosmetic surgery, and maybe fertility treatments, so that would be a potential parallel market. It's the guy who thinks ahead that will be in position to make money in the future, not the guy who just tries to guard his stash.
And as far as "culture warriors", though it is value neutral, it is, nonetheless, political gaming. Frankly, our particularly American version of the culture wars is just stupid. If people would worry less about political affiliation and more about what they agree (as well as disagree) on, then things would work out much better. There are rumors around of this happening: for instance, Christian fundamentalists who take their (human centric, as noted above) stewardship of the earth seriously are teaming up with the hippie environmentalist crowd to try to solve specific problems and get specific legislation passed.
And as far as use value v. exchange value, I think you are dead wrong, but I'll have to get back to that. As far as posting, I am thinking that I would want to have your responses to my pieces posted in the blog proper. With your permission (I will ask each time), I will copy your longer responses from the comments and put them up on the blog proper. But yeah, I do still want this blog to be mostly mine. And how about I post some of your new poetry?
Dude, you gotta see the house. Anyway, take care, and hey to the posse.
If you've got some pics of the house, send 'em along. You've got my email address. As for posting my stuff, that would be fine. Just let me know first so I can make them a little more blog-worthy. Same goes for any poems. Feel free to post any of the recent ones I sent you as they're more or less finished products.
Your defense of Medicare is not convincing. Yes, Medicare is at a disadvantage by not being able to deny coverage. But your claim that Medicare suffers from having a disproportionate number of unhealthy customers is invalid because Medicare gets to charge even persons (like you and me) who don't consume Medicare services at all. This is even better than having a pool of healthy and unhealthy users because even healthy people use some healthcare services. Medicare also has a significant advantage over private insurers in that it can dictate to providers what it's willing to pay and force providers to accept it. As with almost all state-run entities, Medicare's biggest problem is operational inefficiency. I think you said it best, "Since they can not cut expenses by trimming their rosters, the best they can do is cut corners and squeeze the providers." A national healthcare plan that is obliged to cover everybody will run into exactly the same problem without the benefit of being able to extract revenue from non-users.
If I didn't know you, I would take severe exception to the "government putting a gun to their head" image. That is, in my mind, irresponsible speech when you have clowns showing up to town hall meetings with guns on their hips and those Timothy McVeigh "tree of freedom" T-shirts. The government is NOT GOING TO PUT A GUN TO ANYBODY'S HEAD. You and I both know there are more effective systems of control anyway.
Really? I don't think it's irresponsible speech at all. I'm far more worried about the clowns with guns on their hips and badges on their chests who show up at townhall meeetings to tase, cuff, and lock up anyone deemed "un-American." The government has never been shy about the use of force. I honestly don't think "gun to the head" imagery is over-the-top or even inaccurate. The road to totalitarianism runs down a steep and slippery slope and we are most certainly on it.
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