Bad prices, public spending, and poverty

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Erik Kain

Erik writes about video games at Forbes and politics at Mother Jones. He's the contributor of The League though he hasn't written much here lately. He can be found occasionally composing 140 character cultural analysis on Twitter.

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  1. Avatar Jaybird
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    says:

    Would it be illuminating to ask whether health care is better today than the health care available in the past?Report

    • Avatar E.D. Kain in reply to Jaybird
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      Of course it’s better. So is education, I think. But that’s not the only issue. Music is better, too, in my humble opinion. And yet I can access way, way more of it than I could have years ago. So prices have gone down but quality has gone up. We need to achieve *that* in healthcare.Report

      • Avatar Jaybird in reply to E.D. Kain
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        says:

        The vast, vast, vast majority of music out there is music that no longer requires a musician. It just requires a facsimile machine.

        How close are we to creation of facsimile doctors?Report

        • Avatar E.D. Kain in reply to Jaybird
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          says:

          This isn’t why music is cheap. It was the same back when music was more expensive. The difference is that the record labels have lost their stranglehold over the pricing. We don’t need facsimile doctors, we need to reduce the stranglehold the supply side has on prices.Report

          • Avatar RTod in reply to E.D. Kain
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            says:

            Seconded. (For both the music and the HC parts.)Report

            • Avatar Elias Isquith in reply to RTod
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              As someone rather seriously afflicted, for his age, with the “dadrock” gene, I can’t agree. But, then again, the proposition that the past had better music is harder to defend if we don’t limit “music” to pop/rock.Report

              • Avatar Mike Schilling in reply to Elias Isquith
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                says:

                I think you mean “easier to defend”

                Bach
                Mozart
                Beethoven

                Anyone around nowadaysReport

              • Avatar Elias Isquith in reply to Mike Schilling
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                says:

                Well, you know, I can’t say that, much as I respect and often enjoy the geniuses of the classical era, I often would rather listen to them than, say, the Beatles.Report

              • Avatar RTod in reply to Elias Isquith
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                My metric has always been this: When I was in high school it was hard for a band to make it to my ears unless some record executive decided that they sounded just like REO Speedwagon, and so were a good investment. In my car’s CD slots right now: Pink Martini, Black Keys, The Shins, Branford Marsalis, Beck and a burned CD of One eskimO. Under the old system, only Marsalis even gets a recording contract. (Black Keys – maybe. But they’s have to add band members. Kids today just don’t like the two instrument thing! Also, we’ll need to hire a better looking front man. Someone the girls will want to follow!)Report

              • Avatar Rufus F. in reply to RTod
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                I’ve got mixed feelings about this music being cheap thing. I know lots of musicians. One buddy’s band is even “successful”, if we measure that by: they’re on MTV, play big shows in arenas, get on late night talkshows, and you’ve probably heard of them. This doesn’t mean that they make enough money to actually support themselves after three big albums. Used to be that was the fault of the big labels- bands would struggle until their third album or so to start turning a profit. Now? Nobody buys their records , but everyone comes to their shows knowing all the words to their songs. I read somewhere that 75% of the music “consumed” now is basically stolen. Again, mixed feelings. I just spent 25 bucks for a high quality record of the Stooges’ Funhouse, which is friggin crazy of me. But, on the other hand, what musicians do is so important to me that I refuse to steal from them. I’ll download movies, sure, if I can’t rent them through the mail. But, downloading songs? Nah.Report

              • Avatar Will Truman in reply to Rufus F.
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                I read somewhere that 75% of the music “consumed” now is basically stolen.

                I think that used to be true, but I’m not sure it really is anymore. Or, if it is, it’s a misleading statistic due to hoarding (people downloading more songs than they could ever hope to actually listen to). iTunes and the like had a definite impact. So have online music services like Rhapsody and Pandora (the former allowing you to listen to whatever you want and the latter playing more down-album songs than the radio does).Report

              • Avatar patrick in reply to Rufus F.
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                I don’t download music; not because I think I ought not, but because it’s been decided that I ought not.

                Intellectual property laws are about as broken as anything can possibly be in this country. It’s not worth my time to break them, though.

                Until the music industry, or the performers, begin to deliver music the way I want to consume it, I just won’t get the new stuff. Unless it’s totally awesome, but that’s a pretty high bar to pass.

                In which case, I’ll get $15 worth of enjoyment out of it so I’ll find it somewhere legal where I can buy it for that or less.Report

          • Avatar Jaybird in reply to E.D. Kain
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            says:

            I think it very much is related to why music is cheap.

            When we moved from being a world where if you heard a song it was because you were within earshot of a performer performing it live into a world with wax records/radio, music went from being very expensive to very cheap in a very, very short period of time.

            I’d compare it to the before/after of book ownership wrt the printing press.Report

            • Avatar Will Truman in reply to Jaybird
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              The printing press comparison is spot-on. Music would be more expensive today than it was fifteen years ago were it not for the ability to mass-produce it infinitely at very low cost. This forced the music industry to make some concessions it otherwise never would have made. Because if they wouldn’t offer it to us legally…

              It’s less clear how this would work with medicine, which remains extremely capital and labor-intensive. That’s not to say that it couldn’t be cheaper than it is, but I don’t think there is a readily available MP3 revolution on the horizon. (Insert plug here for Rufus’s Wikihospital.)

              Housing is also a tricky matter. It’s not as labor-intensive, but it is dependent on factors that are non-reproducible, such as land in a particular location and with a certain set of neighbors.Report

              • Avatar RTod in reply to Will Truman
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                says:

                “Music would be more expensive today than it was fifteen years ago were it not for the ability to mass-produce it infinitely at very low cost. It’s less clear how this would work with medicine, which remains extremely capital and labor-intensive.”

                There is an additional problem: In the music industry case technology evolved that made transactions less expensive; this happened in large part because the end user was the final decision maker in the buying process, and so cheaper distribution was sought out.

                In health care, the system doesn’t work the same way. The end user (patient) is not the consumer – insurers are. And most of the costs have been hidden (until somewhat recently most people’s employers paid premiums, and most of us weren’t even aware prices were increasing at all.) So most research in technology are purely revenue driven, where cost and effectiveness are secondary. (For example, pharmaceutical companies need $ for R&D to develop new drugs. In theory this is a purely good thing for the end user. However, most R&D dollars to day are spent on ways to tweak existing solutions that are hitting the generic wall. So this research does the opposite of what it did in the music industry – it works to keep prices inflated.)Report

              • Avatar Will Truman in reply to RTod
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                All very true.

                My brother recently went to a clinic wherein he saw a Nurse Practitioner rather than a doctor. He felt stiffed. It’s a $20 copay to him, either way. For that $20, he should be able to see a real doctor!

                (Incidentally, I wonder if a light sort of xenophobia will be the answer to this. As more and more primary care docs are foreigners, people might prefer an American mid-level provider to a foreign doc.)Report

              • Avatar RTod in reply to Will Truman
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                “Incidentally, I wonder if a light sort of xenophobia will be the answer to this. As more and more primary care docs are foreigners, people might prefer an American mid-level provider to a foreign doc.”

                Good lord… right or wrong, I can’t count the number of ways that statement in depressing.Report

              • Avatar Jaybird in reply to Will Truman
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                Re: Wikihospital, there are a *LARGE* number of maladies that people are trusted to take care of themselves.

                Cold, flu, scrapes, rashes, bumps, and cuts.

                There are entire aisles dedicated to first aid in our local groceries and lots of folks know how to self-medicate any number of little maladies.

                I think that a mediwiki would help deal with many of the same things that wizened old crones helped with in the days of resurrectionists liberating corpses for medical schools.

                A *HUGE* number of problems are resolved by such things as washing your hands after you go to the bathroom, regular bathing, and fully cooking foods.

                This, of course, results in making room for other things to go wrong…Report

              • Avatar Will Truman in reply to Jaybird
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                I dunno, the result of WebMD has been been increased visits to the hospital. Aggressive self-diagnosis and all that, as well as a laundry list of treatments they read about that are available and may be quicker than “get some rest, drink lots of water.”Report

              • Avatar RTod in reply to Jaybird
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                says:

                “A *HUGE* number of problems are resolved by such things as washing your hands after you go to the bathroom, regular bathing, and fully cooking foods”

                Also by eating whole foods and not consuming enormous amount of crap. But look how well campaigns to address any of these things are treated.Report

              • Avatar Kolohe in reply to Will Truman
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                It’s less clear how this would work with medicine, which remains extremely capital and labor-intensive.

                Actually, the problem with modern medicine (that is the problem with modern medicine costs) is that parts are labor intensive, other parts are capital intensive, but it’s hard as hell to disaggregate the two.Report

  2. Avatar RTod
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    says:

    To follow through on my earlier thoughts of pragmatism vs. ideology:

    Why do the liberals not trumpet these findings as proof that a semi-socialist society actually works quite well, and why is the Heritage Foundation not publishing this report and saying “Wow, we may have been wrong about how successful a lot of that New Deal stuff might have been?”Report

  3. Avatar Elias Isquith
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    I find the whole line-of-thinking Heritage is proposing here to be asinine. I mean, what’s the answer to “So what?” is it, “So let’s stop with all the silliness about reducing inequality or increasing social justice?” Or is it, “So let’s just acknowledge that, compared to the full gamut of the human experience throughout history, even the impoverished in America have it pretty good”? If it’s the latter, then: ok, sure. Moving on.Report

    • Avatar Mike Schilling in reply to Elias Isquith
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      So let’s stop whining about taxes, because you’ll still be ridiculously rich, even with significantly higher marginal rates.Report

    • Avatar Jaybird in reply to Elias Isquith
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      If the argument is that poverty is relational and we need to address inequality between the folks at the bottom and the folks at the top, then the issue is one that could just as easily be resolved through increased ignorance. Hey, if you don’t *KNOW* about the inequality, it’s not going to be as bad, right?

      If, however, the issue of poverty is one of a lack of resources where there is an amount above which we can say “someone with these things is no longer impoverished”, then we should see if there is a vector that is providing these resources to people and, if there is, explore the best ways to speed that vector up.Report

      • Avatar Jesse Ewiak in reply to Jaybird
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        Yes, that vector is massive advances in computer technology over the past fifty years that have decreased prices. Go find me a Moore’s Law on health care costs and then we can use it. Until then, stop comparing apples and vacuum cleaners.Report

        • Avatar E.D. Kain in reply to Jesse Ewiak
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          I’m not. Do you honestly think nothing can be done to increase the supply of healthcare? Do you think that we are all doomed forever to pay $250 to have little pieces of ribbon removed from our children’s noses? It would have cost $50 to go to the emergency room. Are we talking about a sane pricing system? Does that mean no sane pricing system exists? We don’t require a Moore’s Law to get past layers of opaque pricing and protectionism. Furthermore, unless we fix the pricing we won’t be able to afford to keep spending so much public money on healthcare. The two are inextricably bound.Report

        • Avatar Jaybird in reply to Jesse Ewiak
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          says:

          Is there a way to leverage computer technology when it comes to medical care?

          Actually, when it comes to costs, I start talking about how “price is a function of the rate of growth of supply vs. the rate of growth of demand” and discuss ways to increase the rate of growth of supply while doing what we can to retard the rate of growth of demand and thus put downward pressure on price.

          Which, insofar as you see price as signal, both apples and vacuum cleaners are very, very much in the same ballpark.Report

      • Avatar patrick in reply to Jaybird
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        What if the issue isn’t either? I suspect it’s neither.Report

    • Avatar Burt Likko in reply to Elias Isquith
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      The argument, of course, is that we do not need to increase, and possibly can decrease, spending on social welfare programs because “the poor” don’t really have it all that bad: for the most part, they have enough to eat, they have somewhere to live, they have households that offer things that at one time were considered luxuries.

      A concomitant challenge is asking what index we will use to define poverty. Is it simply income? Is it quality of life, and if so what metric will be used to define it? At your blog, I observed that if quality-of-life is measured by amenities in one’s household, my relatively affluent household would look worse off than the median household of below-the-poverty-line households surveyed by the Department of Commerce.

      The data and conclusions of the study might not be correct. The factual observations underlying the study are subject to challenge — is it really true that only .06% of Americans do not have enough food to eat? Is it really true that there is so very little homelessness as the study claims? Is it right to count a refrigerator as a “luxury” amenity? After all, without one, food tends to spoil much faster raising the possibility that hunger would increase and nutrition would decrease.

      But the whole article does raise a set of worthwhile questions and observations — perhaps it is not unreasonable to say that a person with enough food to eat is “less poor” than someone who routinely goes hungry, and it might be the case that our social safety net is such that there really are only a small number of people who are routinely hungry. If that is truthfully the case, then perhaps it’s reasonable to suggest that, at least, we may hold at least some portion our government’s social welfare spending at its current level without violating principles of social justice.Report

      • Avatar Michael Drew in reply to Burt Likko
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        I don’t think there is any pro-welfare-state advocate who wouldn’t profess satisfaction with the outcome of “hold[ing] at least some portion our government’s social welfare spending at its current level.” Granted, some would be even more satisfied if a version of outright welfare were restored, but my impression is that progressive priorities have switched decisively away from that hope – as van Dyke pionts out, he thinks devastatingly, to issues around relative power rather than levels of absolute deprivation. Given current fiscal projections, my impression is the progressives are more than occupied with the task of merely protecting “some protion[s]” of existing welfare spending from drastic cuts in the near or medium term, making your reasonable request of them something more like a maximal reasonable hope for them to maintain. The actual state of the political-policy trend over the last few decades is not such that a modest “perhaps the Liberals can be convinced to accept that halting the inexorable growth of the welfare state is acceptable now that we’ve shown that true poverty is something of a near-myth.” That is simply not the state of play that will exist in American welfare politics over the coming decades. Rough maintenance of the status quo would amount to a clear progressive victory, as the records of our recent Democratic presidents are seeming to show.

        Much, of course, rides in a discussion like this on one’s particular meaning in using the phrase “at current levels.” I’ll assume you are being reasonable and not playing games with that question by asserting “current level” means something like a fixed nominal dollar number, rather than something relating to population or economic growth, or, gasp, some consistent, reasonable measure of the level of need for assistance that exists over time.Report

        • Avatar Will Truman in reply to Michael Drew
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          Much, of course, rides in a discussion like this on one’s particular meaning in using the phrase “at current levels.” I’ll assume you are being reasonable and not playing games with that question by asserting “current level” means something like a fixed nominal dollar number, rather than something relating to population or economic growth, or, gasp, some consistent, reasonable measure of the level of need for assistance that exists over time.

          I don’t think he’s playing games, but that’s exactly what I took his comment to mean. Maybe adjusted for inflation, but certainly not according to need. The difference, in my mind, between maintaining “spending levels” and maintaining “benefit levels” to current levels.Report

          • Avatar Michael Drew in reply to Will Truman
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            Spending, as much as benefits, can be measured in relation to whatever other number one wishes to measure it against. To say otherwise, that’s one game right there. If he is talking about an absolute dollar number, or defining current levels of spending in terms of inflation, or even as a percent of GDP, regardless of the growth of the size of the population that would receive benefits under current law, much less their objective conditions (welfare spending surges because of increased need in recessions), then he is not talking about holding anything essential about “welfare spending” “at current levels,” and is instead talking about drastic cuts to the welfare state as it currently exists, and he should out it that way. Like, you know, even Paul Ryan does.Report

        • Avatar Michael Drew in reply to Michael Drew
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          That openinig claim is misleading the way I put it, because it suggests that I think the left would be happy with all but just a few programs being significant cut (in wahtever the terms we would agree cuts would be defined). Of course, Burt was suggesting the reverse: that, in general, the welfare state is expanding, and the left should merely be asked to accept a halt to that growth in some areas. My point was to say that no realistic welfare-focused American lefty would see generally holding the line across the board on the various parts of the welfare state for the foreseeable future (in some reasonably relative terms) as anything less than a major victory given the political and fiscal context that has been set in the past fifteen and especially three years. If you could assure protectors of the welfare state that, in terms of relative levels of redistribution, the current status quo was broadly acceptable politically and all that reformers were asking would be for them to accept an assurance that the means would be found to maintain that indefinitely, and you could convince them that you could and would deliver on that promise, you would suddenly find yourself at the head of an army of hard-left welfare-statist converts to whatever Political Team Name you wanted to give your new Better-Than-The-Democrats-At-Protecting-Entitlements(TM) political party. That’s the political reality with respect to the American welfare state and its future political and fiscal fortunes.Report

          • Avatar Burt Likko in reply to Michael Drew
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            I’m not trying to play games and I’m sorry if you thought I was. If you like to play games, I post a trivia question pretty much every week and this week’s seems to be stumping people so far. This, however, is a serious policy discussion.

            FWIW, my read of the progressive left is rather different than yours. Progressives, it seems to me, are coming to terms with accepting inflation-adjusted “constant” numbers of entitlement spending as a barely-digestible compromise. But significant expansion of social welfare support is a very real and immediate goal of that quarter of our political spectrum, an expansion to be “paid for” preferably by way of slashing military spending. To be “progressive” means, in no small part, to be commited to the idea that an expanded and strengthened regime of social welfare policies is in the national interest. Naturally, someone with that would react with revulsion at this study from Heritage.

            Given that definition of what it is to be a progressive, I do not count myself among their number. I can make common cause with them on some other issues but not this one. That does not, however, mean that I dismiss poverty as an insignificant social and economic issue. I see evidence of real poverty and its tangible effects on peoples’ lives every day I go to court. I don’t pretend to have a silver bullet to solve the problem, either.Report

            • Avatar DarrenG in reply to Burt Likko
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              I think you’re both completely misreading the ‘progressive left’ agenda.

              The obsession with specific levels of spending, in relation to GDP or not, is almost exclusively a right-wing frame that barely exists on the left.

              Most self-styled progressives have no attachment to particular spending levels, and instead focus on benefits or outcomes. For example, they have no problem slashing Medicare spending if it means decreasing reimbursement rates for pharma companies or hospital chains. They do object to reducing benefits or eligibility, though.Report

            • Avatar Michael Drew in reply to Burt Likko
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              The question I was attending to was not whether perhaps to be progressive is to advocate in a best-of-all-worlds context for the expansion of the scope of the welfare state beyong that of the existing one. The question is what the actual state of political play is and will be with regard to the political and fiscal fortunes of the existing American welfare state, and more particularly, in that what outcomes actual defenders of the existing American welfare state would regard as not just acceptable, but, again, in that context, a significant victory. And I maintain that mere maintenance of the existing scope-as-relates-to-societal-need is in fact clearly a maximalist goal for any realistic U.S.-Welfare-State defender goal given fiscal projections and political realities. That “progressives” (and, really, the preferences of progressives had not bee the subject of the discussion until now, so it seems to be peripheral on just that score in any case) might in theory prefer further expansion of the scope of the welfare state is completely beside the point of what outcomes they would be satisfied with given the constraints of reality, namely maintenance of the current scope.

              Of course, as I’ve shown “current levels of spending” can mean many things, but if it in practice means “significant adjustments to the scope of the current welfare state over time,” then that is what it means, and it seems to me more transparent to describe it that way, sincce, if you are in the business of being a welfare state, it seems to me that the relevant question for you really is what the parameters are for the scope of welfare you maintain, not what level of spending compared to the economy is required to maintain it. Or in any case, if both are relevant, both concepts should be clearly indicated in language used to lay out various visions for each question, each kept clearly in its own lane, not one used to obscure the other.

              I should note, I did not mean to suggest that you whole-heartedly accept Heritage’s view of the imprtance of household appliances to the question of poverty — I realize you merely suggested that it might cause us to consider how to view the necessary size of the welfare state. My ‘poverty as a myth quip’ was meant as a light-hearted exaggeration, as I know even they don;t hold that position. I don’t take you to be on board with them in that analysis all that much in any case.

              The only parts of your analysis I really took issue with was, first, your description of the state of play in current politics over the fate of the welfare state (regardless of what Progressives’ preferences for it in an ideal world would be); second, the resulting implication about what defenders of the current welfare regime would accept as an acceptable outcome (i.e that mere maintenance of the current scope would be anything less than a clear victory, given the more or less settled nature of WJClinton’s welfare reform), and hence that they are less reasonable and more expansionist, in practical political terms, than they in fact are; and lastly your couching the idea of an adjustment in the scope of the appropriate welfare regime for our country in terms of merely maintaining “welfare spending at current levels,” when by your very argument (or Heritage’s, with you sort of provisionally joining for argument’s sake, for the moment) what you are actually suggesting is that we revisit the fundamental question of the basic scope of our public welfare-provision mission in a qualitative way in light of changing patterns of and ideas for measuring affluence and poverty.

              …Sure, it so happens that we have a generational boom which allows you to say that the seemingly unimpeachably reasonable goal of “hold[ing] at least some portion our government’s social welfare spending at its current level” (again, this is such a fraught formulation in any case when it isn’t more specifically defined than that). But the fact is that you are really advocating an explicit conceptual reevaluation of how we do welfare (another one). You do that overtly in the same comment, so it is odd that you then move to obscure that after the fact by using this language of nominal numerical constancy, a question that is really more or less beside the point of your previous advocacy. But you do, and, again, that is the last of the three things I object to in your comment. Granted, all of these rhetorical implications are the result of just one short phrase within a larger comment that I mostly agree with, but the fact is that these implications are all present, whether intended or not. Some seemingly simple characterizations of complex problems are beguilingly meaningful, and I feel it was worth drawing out those meanings in this instance, since so many parts of the context for this discussions were implicated in that short phrase you used.Report

              • Avatar Michael Drew in reply to Michael Drew
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                Sorry, slight edit: …Sure, it so happens that we have a generational (and, of course, health-cost) boom… that allows you to represent an adjustment to the scope of the welfare state as merely the maintenance of a constant level of spending (by some measures). But that is merely an artifact of the challenging fiscal realities these programs face, to which their defenders are coming to terms politically, such that welfare expansion is now essentially off the table, and mere maintenance of scope is now, as contra what you suggest, essentially an optimistic, even maximalist goal. (But the fact is you are advocating…)Report

        • Avatar DarrenG in reply to Michael Drew
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          I doubt you’d find broad agreement on your claim that “we’ve shown that true poverty is something of a near-myth.”

          And to forestall a semantic argument over the definition of “true poverty” I’ll assert that many people find the extant conditions in, say, West Baltimore, South L.A., rural Ohio and West Virginia, and many other parts of the country that evince widespread violence, substance abuse, insecurity in food, shelter, and health care to be a problem worth addressing.Report

          • Avatar Burt Likko in reply to DarrenG
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            It’s not my claim, it’s Heritage Foundation’s claim, and that strikes me as something of an overstatement of the claim Heritage is making. I don’t think Heritage is arguing that there is no poverty anymore. Heritage’s real and more modst claim, I think, is that the social welfare system is doing all the good it is ever going to be able to do right now, and extending it further will result not only in diminishing returns but increasing abuses.

            My claim is that Heritage’s data is suspect. It’s not reasonable to measure affluence and quality of life on an index that has one-third of its measurements based upon television and things that support it. It’s not at all clear to me that hunger and homelessness are truly as rare as Heritage claims. And when these programs are cut — by which I mean absolute dollar spending on them will decrease — it’s going to suck, suck, suck, because there are lots of people who rely on them to meet the minimal quality-of-life needs like “having enough food to eat” and “living in a structure sheltered from the elements.” But I am convinced that we’re going to have to do it anyway because if we don’t do it now, we’re going to have to do it later, and at that point we’re going to have to do more of it and to more people. The peas aren’t going to taste any better sitting there on our plate getting cold.Report

            • Avatar DarrenG in reply to Burt Likko
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              I suspect this is an artifact of the bad threading presentation of comments here, but I was responding to Michael Drew, not you, and Michael most certainly did claim that “true poverty was something of a near-myth.”

              I agree with you that Heritage’s numbers (and motives) are suspect and that they’re acting largely as a propaganda organ for the Republicans here, but I disagree that drastic cuts to the social safety net are inevitable, given the number of other potential cost savings and revenue increases that are potentially available.Report

              • Avatar Will Truman in reply to DarrenG
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                Michael, too, was reciting the Heritage position.Report

              • Avatar Michael Drew in reply to Will Truman
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                Actually, it was meant to be a tongue-in-cheek caricature of their position, not a fair restatement. They don’t claim that, and I don’t claim they do. Just a catchy thumbnail way to refer to the basic thrust of their point, which frankly I can’t with confidence state as briefly as that context required Hence the resort to what I hoped would be understood to be a knowing misstatement of, though clear reference to, their point. If that makes any sense.Report

            • Avatar Will Truman in reply to Burt Likko
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              To tie a couple sub-threads together, peas never taste good.Report

              • Avatar Art Deco in reply to Will Truman
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                Yes they do. In soup. And they are always better than lima beans or brussels sprouts.Report

              • Avatar Burt Likko in reply to Art Deco
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                I disagree. Peas are good raw, right out of the pod. Their high sugar content makes them sweet. Brussels sprouts are delicious when sliced in half, steamed in olive oil and garlic. Sadly, most markets sell sprouts when they have grown too large and tough. Lima beans I can’t endorse. Fire-roasted in the pod they are not bad, but too much work for what you get.

                To be clear, I am talking about actual vegetables here, not Federal budget cuts.Report

  4. Avatar greginak
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    I assume it would be crass to point out that in all those countries that have high quality medical care with universal access competition and pricing mechanisms are not the most prominent components of the plans.

    It might also be interesting to note that all those high tech advances that gave us our ipods , kindles, refrigerators with Internet connections and HDTV’s , besides being run by profit orientated companies, are also the product of technocratic, empiricist and pragmatic principles.Report

  5. Avatar Jesse Ewiak
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    says:

    Yes, poor people have it better off than they did in 1927. Obviously this means we can repeal the New Deal, drop the minimum wage by half, and remove all taxes on the top one percent.Report

    • Avatar Murali in reply to Jesse Ewiak
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      says:

      No, that means that in order to make it even better, we eliminate repeal the new Deal, eliminate the minimum wage and eliminate all corporate taxes and reduce the top rate of personal income taxes to 20%.

      Of course while we are at that cut the defence budget to 20% of its current size, get rid of farm subsidies and unilaterally liberalise all trade with all nations.Report

  6. Avatar greginak
    Ignored
    says:

    The answer obviously is higher taxes on nose sized ribbons.Report

  7. Avatar DarrenG
    Ignored
    says:

    Health care is indeed an outlier and I think you’ve got the cause and solution largely right, but that’s still only one component of the issue.

    Focusing on health care almost exclusively is as non-productive as Heritage’s silly focus on consumer electronics.

    Yglesias quite rightly points out several other key areas where people living below the poverty line struggle in today’s economy. Education, public safety, employment opportunity, transportation, food security (particularly if you factor in nutrition) are all troublesome for many in the lower income quintile.

    This would be where a witty reference to, or quote from, The Wire goes if I weren’t still on the wrong side of my first cup of coffee.Report

  8. Avatar DensityDuck
    Ignored
    says:

    “The bill came back a couple weeks later for $250. In what sane world does this cost $250?”

    I dunno; how much of that goes to malpractice insurance? How much is being charged to cover the cost of people who walk into the ED, get treated, and walk out without paying a dime? How much is simply part of the negotiating game that providers play with insurers (where it’s assumed that the insurer will only pay 66% of whatever the provider charges, no matter how much that is?)

    You’re right that the price of healthcare services seems strangely high, but there are actual reasons for that, and those reasons aren’t “doctors are a bunch of greedy fuckers”.Report

    • Avatar Jesse Ewiak in reply to DensityDuck
      Ignored
      says:

      Doctors aren’t greedy fuckers, but insurance companies sure are.

      Multiple studies have shown malpractice insurance doesn’t increase the cost of health care that much and even in cases where it does, it’s due to price gouging by malpractice insurance companies, not massive lawsuits.

      As for the cost of covering ER, the problem with that is that other countries have UHC where literally anyone can do the equivalent of what poor people can do here in the US and they pay less.Report

      • Avatar DensityDuck in reply to Jesse Ewiak
        Ignored
        says:

        Well, yes, when the entire tax base is paying for the no-payers at the ED, the cost per individual person is relatively low.

        Before we continue, I think I need to point out that my belief is that the only meaningful “health care reform” concept is to let everyone buy into Medicare if they want, and the premiums are based on age, and once you hit 65 the premiums go to zero.

        My point is that “$250 for pulling ribbon out of the nose” is pure hyperbole. If you thought it was so simple then why were you at the doctor? You aren’t paying $250 for the mechanical act of tweezers pulling ribbon; you’re paying $250 to have a trained professional determine that the ribbon was the only problem, that pulling it with tweezers wouldn’t cause a worse problem, and to have all the equipment necessary if it did cause worse problems after all. You’re paying $250 so that the doctor can buy malpractice insurance and stay in business to pull ribbons out of noses. You’re paying $250 to cover all the other people who get ribbons pulled out of noses and then don’t pay anything to anyone.

        And let’s maintain a sense of proportion here. Our fridge went out a few weeks ago, and it turned out that a circuit board had failed and a duct had frozen up. That cost $175 to fix. In what sane world does a board swap and “hold a hairdryer on this tube for about 20 minutes” cost $175?Report

        • Avatar Will Truman in reply to DensityDuck
          Ignored
          says:

          Along these lines, when you go in with a pre-determined problem and a nurse-ready solution, you often can and do go to the clinic without ever seeing a doctor. Shots are an example of this. My ears tend to get clogged up with wax. I go to the clinic, the nurse gets out her Super-Soaker 5000, I get an inner ear massage/cleaning, and I leave.

          I’m not sure why this didn’t happen with the ribbon. I’m not sure it is the law, though.Report

        • Avatar Murali in reply to DensityDuck
          Ignored
          says:

          You’re paying $250 to cover all the other people who get ribbons pulled out of noses and then don’t pay anything to anyone.

          Only in Singapore, it would have cost $25 – $50 at a private clinic.Report

    • Avatar DarrenG in reply to DensityDuck
      Ignored
      says:

      “I dunno; how much of that goes to malpractice insurance?”

      Almost nothing.

      “How much is being charged to cover the cost of people who walk into the ED [sic], get treated, and walk out without paying a dime?”

      Potentially a significant portion, depending on where she was treated, which is why having large numbers of uninsured is really, really bad for the health care economy.

      “How much is simply part of the negotiating game that providers play with insurers (where it’s assumed that the insurer will only pay 66% of whatever the provider charges, no matter how much that is?)”

      Quite a lot of it, most likely, which is kinda Erik’s point about the utterly broken pricing mechanism in U.S. health care.

      ” those reasons aren’t “doctors are a bunch of greedy fuckers”.”

      Yes and no. Doctors do make significantly more in this country than most of the rest of the advanced economies, but more importantly far too much clinical practice in the U.S. involves doctors, largely due to regulatory capture.

      There’s a lot of medical practice in this country that could easily be done by a combination of PAs, RNs, or LVNs quicker, easier and cheaper that currently requires an MD to “supervise.”Report

    • Avatar RTod in reply to DensityDuck
      Ignored
      says:

      “how much of that goes to malpractice insurance?” Assuming the practice was full time, very little. This is partially because in order to manage both risk and revenue, providers now advice or require a great deal of “just in case” procedures to rule out diagnoses which are not likely or even relevant. This is a fairly large cost offset – if you’re going to ding the $250 for malpractice, you also have to credit costs for additional procedures.

      “How much is being charged to cover the cost of people who walk into the ED, get treated, and walk out without paying a dime?” I am assuming you meant ER, if not disregard this: If Erik took his child to his pediatrician, it would (I assume) be a private practice and the costs associated with whatever CTP codes are a reflection of a negotiation between the provider (or provider network) and the insurer. The losses you are describing are treated as write offs and are not generally factored in to CTP negotiations.

      “How much is simply part of the negotiating game that providers play with insurers (where it’s assumed that the insurer will only pay 66% of whatever the provider charges, no matter how much that is?)” Probably a lot. Most physicians charge a certain percentage over CTP costs (whatever their state’s allow) as a write off.

      “You’re right that the price of healthcare services seems strangely high, but there are actual reasons for that, and those reasons aren’t “doctors are a bunch of greedy fuckers” True enough, but a system that does not check cost and procedural increases from providers *is* one of those reasons.Report

    • Avatar Burt Likko in reply to DensityDuck
      Ignored
      says:

      …how much of that goes to malpractice insurance?

      Less than one percent.

      How much is being charged to cover the cost of people who walk into the ED, get treated, and walk out without paying a dime?

      About one percent.

      How much is simply part of the negotiating game that providers play with insurers

      Quite a lot.

      “doctors are a bunch of greedy fuckers”

      1) What’s wrong with a doctor liking money? What’s wrong with a doctor charging money for her services and even withholding services for non-emergent care if payment is not apparently forthcoming? 2) Lawyers and insurance company executives are greedy fcukers too. So, it seems, are writers with children that have medical problems; despite wanting and needing his kid to receive rhinoribbonectomy, Erik nevertheless didn’t want to pay more than he really had to and is not unreasonable for questioning the price for this service. Conclusion: We’re all greedy fcukers and that’s what makes the world go ’round. 3) In the situation described, The doctor’s instructions were to charge the minimum, which doesn’t sound all that greedy to me. The doctor appears to have had no particular idea what was going to be charged and the price was determined by a combination of the billing clerk and the pre-set billing codes.Report

      • Avatar E.D. Kain in reply to Burt Likko
        Ignored
        says:

        Yes. This.Report

      • Avatar Will Truman in reply to Burt Likko
        Ignored
        says:

        Worth adding to this is the doctor’s persepctive. They get out of medical school, approaching 30 (or often well into their thirties), with no savings, six figures worth of debt, and exhausted by residency and medical school. From there, it’s really tempting to go into profit-maximizing mode.

        My wife was asked to interview for a position making almost 2.5x times what she’s making now. That was suspicious on the face of it and she never followed up. Places that offer that kind of money are profit-obsessed and that’s not the kind of medicine she wants to practice. But looking at our financial situation and our debt (which is low by MD standards, because she had a free ride for undergrad), those kinds of things are tempting.

        Meanwhile, we’re also looking at working for the federal government on a reservation. One of the biggest obstacles is money. In most other contexts, $110k a year would be a lot of money. But we’ve got a late start, a lot of debt, and hope to be starting a family soon (something we had to put off because of residency+fellowships). And my ability to work is hindered by a sketchy job history by following her around (and I don’t know how good my prospects would be in the parts of the country where reservations are).

        Meanwhile, my brother the engineer has paid off all his debts, makes in the low six figures, and would be well on his way to saving for his kids’ college tuition, if he had any. The general sense of doctors is “We have a lot of catching up to do!” And I think, once that pace is set, they don’t slow down and take the pay cut when the needs are less urgent or pressing.Report

        • Avatar Jon Rowe in reply to Will Truman
          Ignored
          says:

          “Worth adding to this is the doctor’s persepctive. They get out of medical school, approaching 30 (or often well into their thirties), with no savings, six figures worth of debt, and exhausted by residency and medical school. From there, it’s really tempting to go into profit-maximizing mode.”

          I’m not sure if I’m ideologically pure enough of a libertarian to endorse this: But laissez faire invisible hand libertarian utopia completely solves this problem by eliminating licensure requirements for the professions.Report

          • Avatar Will Truman in reply to Jon Rowe
            Ignored
            says:

            I could write posts and posts on licensure and credentialing, but my main point was a response to the “greedy doctors” notion. There are a number of things that could be done, but doctors are coming up in the system as it exists. That doesn’t excuse rank profiteering, but it is a real dynamic in terms of doctor wages and the like.

            The long and short of licensure and credentialing is that I believe EDK is oversimplifying. A mid-level provider could have moved the ribbon (I’m not sure a nurse couldn’t). The deck is not so stacked against midwifery that you can’t find out outside of rural areas (and even rural areas). And there really are situations that these types of practitioners are not equipped to handle. I support strengthening these institutions, for sure, but you still have folks who can see a doctor or an MLP for the price of a copay*, or they can have a midwife or obstetrician for out-of-pocket costs that do not come close to reflecting the overall costs.

            * – I mention my brother elsewhere in this thread, but when I called the local hospital for medication, they wanted to send me to an MLP because the doctors couldn’t see me, until I told them to check with Dr. So-and-So who agreed to be my doc. I was also shuffled to an MLP for my care back in the Pacific Northwest, which was fine, though that particular MLP did not impress.Report

      • Avatar Jon Rowe in reply to Burt Likko
        Ignored
        says:

        I’m not sure if a 6 figure paid medical doctor with hundreds of thousands of dollars of student loans to pay off is needed for the procedure that Mr. Kain needed for his daughter. Seems to me like a nurse with a good hands could have handled the problem and charged $20 for it. Again, back to licensure/regulating the profession as the problem.Report

        • Avatar RTod in reply to Jon Rowe
          Ignored
          says:

          Prices are not determined by regulation. They are determined by regular negotiations between insurers and providers.Report

          • Avatar DarrenG in reply to RTod
            Ignored
            says:

            If by “negotiations” you mean “take whatever the insurers decide to give you or stop accepting their patients,” which is the status quo for any small to mid-size health care provider.

            And licensure is *a* problem, but not *the* problem, for the reasons Jon describes — there’s a ton of care that can, and should, be provided by people other than MDs that currently requires an MD to be involved. Removing all licensing requirements from medical practice is most certainly not the right way to solve this problem, though.Report

      • Avatar DensityDuck in reply to Burt Likko
        Ignored
        says:

        I think I should point out that “doctors are greedy fuckers” was my (exaggerated) description of the top post’s perceived attitude. It is not my position.

        Also, “fcukers”? You ain’t foolin’ nobody, son. Either say it or don’t.Report

  9. Avatar tom van dyke
    Ignored
    says:

    Cable/satellite TV – 63.5%. This jumps out at me.Report

    • Avatar Will Truman in reply to tom van dyke
      Ignored
      says:

      Not me. A lot of people who live in poverty live in rural areas. It’s cable/sat or nothing.Report

      • Avatar Jesse Ewiak in reply to Will Truman
        Ignored
        says:

        Also, I’d put money that number is lower today. Also, “cable” can be the basic 20 buck a package that gives you local channels that actually come in easily without an antenna configuration that looks like a Rube Goldberg machine.Report

        • Avatar tom van dyke in reply to Jesse Ewiak
          Ignored
          says:

          I don’t think cableTV spending by the poor can be waved away by what may be the exceptions. There is surely a significant chunk being financed by the taxpayer that is luxury.Report

          • Avatar Will Truman in reply to tom van dyke
            Ignored
            says:

            Having once taken calls for one of the two major satellite companies, I can tell you with some certainty that there are folks buying cable that clearly are not in a financial position to doing so. You get a lot of calls from people who haven’t paid their bill in months, or who have never paid their bill regularly, who are irate that their cable got turned off.

            But if you combine those folks with folks who live in rural areas on meager income with folks who live in apartment complexes where access to the antenna is $8 and the basic cable package is $30, the 63.5% figure doesn’t surprise me at all. If anything, I would have guessed higher.Report

            • Avatar tom van dyke in reply to Will Truman
              Ignored
              says:

              TV is a luxury, and Heritage has a point. Surely the taxpayer is financing luxuries such as this. I don’t make a BFD out of a TV or a DVD player that costs a few hundred dollars, but cable/satellite is a monthly drain on household income.

              So too, the Kevin Drum chart recently posted had a high “sin tax” component of the poor “paying their fair share.” This is BS.

              There is no categorical imperative or moral duty to provide the poor with booze, smokes and TV. A closer look at the stats and facts elicits less legitimate handwringing, not more.Report

              • Avatar DarrenG in reply to tom van dyke
                Ignored
                says:

                What is the point that you, and presumably, Heritage have, exactly?

                That the government should audit your media (and/or booze and cigarette) consumption before providing any sort of assistance with food, medicine, or education?

                If not, what’s the solution to people having these allegedly-subsidized luxuries?Report

              • Avatar tom van dyke in reply to DarrenG
                Ignored
                says:

                The point is that many of “the poor” aren’t exactly poor. The term has become so elastic that it has little utility except as a rhetorical bludgeon.Report

              • Avatar Jesse Ewiak in reply to tom van dyke
                Ignored
                says:

                Was I not poor because my mother occasionally bought name brand macaroni and cheese and ice cream with her food stamps?

                Was I not poor because my mother managed to buy a Super Nintendo second hand?

                Was I not poor because my mother managed to buy us a couple brand new outfits for school every September?

                I’m well aware how most people think you shouldn’t be considered “poor” unless you live in a hovel with no electricity and no entertainment of any kind aside from some broken sticks. After all, that’s government money being spent on tax cuts to rich people or corporate welfare for ConAgra.Report

              • Avatar tom van dyke in reply to Jesse Ewiak
                Ignored
                says:

                An unfair restatement of my argument. In fact the luxury items that cost a few hundred dollars were explicitly excluded from my argument.

                Bad show, mate. 🙁Report

              • Avatar DarrenG in reply to tom van dyke
                Ignored
                says:

                I disagree. “Poor” is still a very useful proxy for people who lack access to economic opportunity, a decent education, food security, and a safe living environment, as those things track very well with income level.

                And I’m still not sure what policy response you’re advocating.Report

              • Avatar tom van dyke in reply to DarrenG
                Ignored
                says:

                “Poor” is a useful catchall for you, clearly, Darren, and your laundry list of newspeak.

                Transfer payments are not “economic opportunity”; “food security” is the new concern troll fallback from “hunger”; a “safe living environment” is generic enough to include most ever facet of human life.

                “Decent education” is of course the subject of post after post and comment after comment, and of course, this thread is back to health care, which the Heritage excerpt didn’t even touch on.

                So what is the point? That “the poor” as you define them includes a lot of folks who fall short of being genuinely needy.

                “Needy” is often used synonymously with “poor” in the grand political catchall for the state of the nation, but it needs some clarification, which Heritage has just done.

                We should indeed concentrate on the needy; there is no disagreement from any quarter about that.Report

              • Avatar DarrenG in reply to DarrenG
                Ignored
                says:

                Please don’t put words in my mouth. I have not equated “economic opportunity” with transfer payments here, or anywhere else, for one.

                If you’ve got a better way of identifying “the needy” than income level, great, I’d love to hear it.

                And I recommend you read up some more on the issues surrounding food security in both urban and remote rural environments before blithely dismissing them as concern trollery. (Hint: these issues also play heavily into the health care problem.)

                I don’t share your optimistic assessment of Heritage’s motives, though, given their track record. I rather suspect they’re stumping for further cuts to programs like Medicaid and food stamps as offsets for more tax breaks for the wealthy rather than expressing their deep concern for providing help to the truly needy.

                Making “the poor” disappear is very useful to that cause.Report

              • Avatar Jaybird in reply to DarrenG
                Ignored
                says:

                If you’ve got a better way of identifying “the needy” than income level, great, I’d love to hear it.

                Culture.Report

              • Avatar Will Truman in reply to tom van dyke
                Ignored
                says:

                Hour for hour, cable is actually a pretty cheap source of entertainment, and when you’re poor and/or lack transportation, there’s not a whole lot to do with your time. It’s easier for people with money to go without cable, in that respect.

                While I might prefer that they spend their money on a computer and an Internet connection, I just can’t begrudge them their TV or cable too much. And I’m not going to say “Because these people spend money on cable, I’m going to take away the government support you may have intended to buy a computer. Those people with the cable and without the computers demonstrate that we’re giving you too much money.”Report

              • Avatar tom van dyke in reply to Will Truman
                Ignored
                says:

                That’s an argument for making being poor more enjoyable, true. But “cable TV” and “food insecurity” don’t belong in the same paragraph except to point out that they don’t belong in the same paragraph.

                Nobody skips meals to pay the cable bill, or if they do, society is not to blame.Report

    • Avatar Burt Likko in reply to tom van dyke
      Ignored
      says:

      I’m reminded of an observation I made in January about affluence and sources of income, which I referred to as the Tennessee Taxonomy. Just because you are deriving your income from public entitlements does not mean that you are living a comfortable lifestyle — nor does it mean you are living an uncomfortable lifestyle. Similarly, if you work for a living or if you live off of accumulated capital, this also is not necessarily indicative of the quality of your lifestyle.

      Here, the question is whether someone who meets the definition of “poverty” is nevertheless able to live an affluent life. My observation was that yes, this is possible, but very uncommon. As to TVD’s point that cable and indeed TV are, in fact, luxuries, we should take into account that if there is enough money to get at least one TV and some kind of non-broadcast programming into it, we’re seeing someone who is not at the extreme end of the “lack of affluence” spectrum, regardless of where the money comes from.Report

  10. Avatar Steve S.
    Ignored
    says:

    Granting for the sake of argument the assumption that the poor have more baubles than ever before, so what? Our society generates X amount of wealth. Various interests seek to maximize their slice of the pie. The poor and middle classes, to the limited extent they can, seek social policies they perceive will be to their benefit, just as the richer classes do. Sorry this makes the Heritage Foundation so sad.Report

    • Avatar tom van dyke in reply to Steve S.
      Ignored
      says:

      Steve S unwittingly gives away the lefty game here: it’s not about providing for the poor, it’s about power.Report

      • Avatar Steve S. in reply to tom van dyke
        Ignored
        says:

        “unwittingly”

        No, wittingly, and it’s not the “lefty” game, it’s Heritage’s implicit game.Report

        • Avatar tom van dyke in reply to Steve S.
          Ignored
          says:

          I think it’s Marx’s game, no?Report

          • Avatar Steve S. in reply to tom van dyke
            Ignored
            says:

            From the Heritage paper:

            “To the average American, the word “poverty” implies significant material deprivation…The actual living conditions of America’s poor are far different from these images…wise public policy cannot be based on misinformation or misunderstanding. Anti-poverty policy must be based on an accurate assessment of actual living conditions…”

            In other words, when we elites decide how to distribute society’s wealth it behooves our own interest to define “poverty” in as restricted a manner as possible. That’s as naked an assertion of power it gets; we’ll decide who gets what.

            “Poverty” is of course an entirely relative concept and Heritage, as you say, give their game away when they try to give it a self-serving definition.Report

            • Avatar tom van dyke in reply to Steve S.
              Ignored
              says:

              Absent your definition or anybody else’s here, I’ll have to prefer Heritage’s.

              “Needy” is probably a more definable term, “poverty” a line drawn in the sand by your very own elites, and “poor” is merely a term of art, as Heritage illustrates here.

              Clarity first; policy later.Report

              • Avatar Steve S. in reply to tom van dyke
                Ignored
                says:

                My definition is the dictionary one. What’s relevant to public policy is a different kind of understanding. If your understanding is televisions then it’s settled, the Department of Electronics needs to issue very few vouchers for televisions. If your understanding includes health care in the country where health care costs the most, by a mile, on Earth then it’s not quite so simple-minded.Report

              • Avatar tom van dyke in reply to Steve S.
                Ignored
                says:

                Humor me with your definition anyway, Steve S. Dictionaries differ.

                And no, my argument was never “televisions.” That’s an unfair reduction of an argument I explicitly did not make.

                I don’t make a BFD out of a TV or a DVD player that costs a few hundred dollars, but cable/satellite is a monthly drain on household income.—TVD here, todayReport

  11. Avatar NoPublic
    Ignored
    says:

    Really? In a rational world you’d call 5 different people to get pricing on a medical procedure for your child? You may be the only parent in the universe who has that much presence of mind when their child’s healthcare is in the mix. Granted, it’s not like she needed stitches but still. Most parents I know go for

    1) Competent
    2) Fast/Close
    .
    .
    .
    .
    26) CheapReport

    • Avatar E.D. Kain in reply to NoPublic
      Ignored
      says:

      You’re so literal. Who actually calls around like this for much of anything? The point is once prices are transparent they begin to balance out. Once competition exists, that tends to hold prices down.Report

      • Avatar DarrenG in reply to E.D. Kain
        Ignored
        says:

        Possibly (but not certainly) true for routine care like you described, but the problem is that routine care isn’t what’s driving health care cost inflation.

        Chronic disease, trauma, and end-of-life care are the big problems and I’ve yet to see a realistic market-driven solution to those with the possible exception of chronic diseases that can be managed exclusively through drug therapy.Report

        • Avatar Jaybird in reply to DarrenG
          Ignored
          says:

          A public willingness to treat end-of-life care with aggressive drug therapy would be a step up.Report

        • Avatar Will Truman in reply to DarrenG
          Ignored
          says:

          It’s worth noting that on the McKinsey report, American health care costs for inpatient care is not nearly so exaggerated as outpatient care. I don’t know if I would call it routine care, but in-and-out care does appear to be a major factor in our costs. This is not mutually exclusive with what you’re talking about (a lot of in-and-out is chronic disease, for instance), but I thought it worth mentioning anyway.Report

          • Avatar DarrenG in reply to Will Truman
            Ignored
            says:

            Very true, and I over-simplified above. In-and-out care also encompasses a lot of trauma care and medical care for the uninsured, so I think there’s quite a bit of overlap between your point and mine in addition to chronic disease.

            Anyone who claims to have a simple explanation, let alone a simple solution, for U.S. health care cost inflation is off their rocker.

            Erik seemed to be getting dangerously close to a “the Invisible Hand will fix it” non-solution in his responses, and I wanted to point out some obvious areas where transparency and competition are unlikely to drive down costs in any meaningful way.Report

            • Avatar DensityDuck in reply to DarrenG
              Ignored
              says:

              It’s important to not look at per-capita costs and assume that everyone everywhere in America spends that much.

              If you “average” an inner-city street kid with an octogenarian, you get a person with a life expectancy of 32 who spends $14,000 a year on health care.Report

            • Avatar E.D. Kain in reply to DarrenG
              Ignored
              says:

              Nonsense. I said we need to expose the supply side of medicine to competition and transparent pricing. This is neither the work of the “invisible hand” (it’s the work of policy makers) or simple (it’s the work of policy makers).

              The point is that we’ve got a badly mangled system right now, with lots of rent-seeking, lots of stupid barriers to entry, a completely vapid “insurance” set-up whereby you have insurance while employed but not while unemployed, and a broader system of entitlements whereby we transfer wealth from the young to the old rather than from the rich to the poor. It’s bonkers. It’s not easy to fix at all.Report

              • Avatar DarrenG in reply to E.D. Kain
                Ignored
                says:

                It’s the assumption that exposing the supply side of medicine to competition and transparent pricing would have a large effect on controlling cost that I find unconvincing.

                Completely agree with your second paragraph, though.Report

              • Avatar E.D. Kain in reply to DarrenG
                Ignored
                says:

                Why? Why shouldn’t competition and transparent pricing help with healthcare costs? Oh, it might not help with costs associated with major surgeries all that much, but even there…

                …I mean, you have pricing screwed up the whole way down the line. Hospital beds cost too much. Insurance companies collect all sorts of expensive middle-man rents. Medical school is too expensive. We see too many doctors when we should be seeing nurses and/or nurse practitioners. The pricing is just mad, mad, mad, mad, mad and finding ways to untangle it would be huge for cost-saving. There is a huge demand for healthcare, but a very bottlenecked supply. On top of this we have lots of expensive (but positive) advances in medical technology. The trick is to keep innovating while increasing supply and access to meet demand.Report

              • Avatar DarrenG in reply to E.D. Kain
                Ignored
                says:

                Because the major drivers of cost inflation aren’t very price-sensitive. You can’t meaningfully comparison shop for the types of care that account for the bulk of costs in the current system (i.e. it’s the things I list above, not rhinoribbonectomies or similar non-emergent acute care, that are producing unsustainable inflation).

                You’re absolutely right about the insanity and inanity of the current pricing and insurance system, along with ridiculous licensing restrictions and a myriad of other inefficiencies. No arguments there. Transparency and competition just aren’t viable solutions for some major components of the problem, though.Report

              • Avatar RTod in reply to E.D. Kain
                Ignored
                says:

                “Insurance companies collect all sorts of expensive middle-man rents.”

                Explain please?Report

              • Avatar DarrenG in reply to RTod
                Ignored
                says:

                Profit, for one. The billions extracted from the system in the form of insurance company profit do little or nothing to provide health care.

                But the far bigger one is the beyond-ridiculous bureaucratic inefficiencies that are a fundamental feature of the system.

                A few years back I worked for a small compounding pharmacy company. At any given time we employed 4-5 pharmacists, 8-12 pharm techs, and 30-35 people to handle billing, collections and A/R.

                Having to hire and maintain 2 people to shuffle insurance paperwork for every 1 person providing actual products and services is not unusual, and a serious impairment to innovation and competition on the provider side.Report

              • Avatar E.D. Kain in reply to RTod
                Ignored
                says:

                Darren – profit is not the problem at all. Rent-seeking is the problem. Insurers are all basically regional monopolies. They are never exposed to any sort of competitive practices. They don’t really serve consumers either, but rather employers who then give insurance to workers as a part of their wages. It’s just insane. Other countries, such as Denmark, have private insurers that earn profits but are forced to heavily compete with one another.

                A really good piece to read on all of this artificial scarcity is this one by Kevin Carson.

                In any case, insurance companies don’t really provide insurance. That’s the real problem. Most of what they do is subsidize normal transactions that shouldn’t be covered by insurance at all. And when you need insurance the most – when you’re sick or old or out of a job – you can’t get it anyways. They suck a lot of money out of the system and provide no value. If they provided value, profits would be okay. As it stands, the profits are all just economic sinkholes.Report

              • Avatar DarrenG in reply to RTod
                Ignored
                says:

                If profits are economic sinkholes, and I agree they are, I do think they are a problem (again, not *the* problem, but *a* problem).

                Nor are they all regional monopolies. Larger states often still have some level of competition. The areas of the country where monopolies exist are indeed a problem, though.

                And yeah — I’d take the Danish system (or the Dutch, Swiss, or Japanese) over ours any day.Report

              • Avatar Jaybird in reply to RTod
                Ignored
                says:

                Plane tickets are $700ish.

                Watch out, they have language laws.Report

              • Avatar KenB in reply to RTod
                Ignored
                says:

                Much cheaper than flights to Somalia!Report

  12. Avatar Jon Rowe
    Ignored
    says:

    “The trick is getting healthcare and education costs to follow a similar pattern.” A few years ago I remember reading an article from TechCentralStation (are they still around?) that made a similar point. How do we get Moore’s Law to apply to medicine and education? With online edu., it’s probably starting there.Report

  13. Avatar E.D. Kain
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    says:

    Poverty and wealth are always and always will be relative. Anyone dancing around in this thread claiming that having a television – which is apparently a luxury good now, which stretches the definition of “luxury” in this day and age – is just dancing. Rich men used to only have ox carts before there were cars. It’s all relative and we could dance about claiming this or that qualifies or disqualifies someone as poor and I would still fail to see the point.

    People with TV’s can still be poor. They can still struggle to pay the bills, see a doctor, get healthy food or even find a place to get fresh produce at all (food deserts, etc.)

    Too often, I suspect, people who play semantics with these terms have never suffered from very much need themselves and have a flimsy-at-best sense of what constitutes poverty in this country.

    No – you don’t have to be a starving Somalian to be poor. Thank god for that.Report

    • Avatar Jaybird in reply to E.D. Kain
      Ignored
      says:

      But this very much changes the dynamic.

      If an indoor water closet is a luxury during that decade but a basic human right during this one, if a fifth outfit is a luxury during that decade but something not worth mentioning in this one, if a car is a luxury during that decade but an essential item in this one… how can we speed that dynamic up? How can we get to the next decade where we are discussing whether poor households shouldn’t have a second replicator? Whether we should try to make it so that more poor homes have new autodocs rather than being “forced” to use second-hand autodocs?

      What is the fastest way to get to that debate?Report

      • Avatar tom van dyke in reply to Jaybird
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        says:

        The progressives will always be with us, even if the poor are not.Report

      • Avatar DarrenG in reply to Jaybird
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        says:

        I agree with EDK that debating over whether the possession of certain consumer goods or services disqualifies one from being poor is the wrong debate entirely.

        More salient questions than “do you own a TV, have cable service, and/or smoke cigarettes?” are things further down the Maslow hierarchy:

        – Do you have access to reasonably nutritious food and viable shelter from the elements?
        – Are you and your property reasonably secure from violence?
        – Do you have access to a viable non-criminal employment market?

        …and similar. In our current state, the answer to many of these sort of questions is still “sadly, no” for many lower income folks, regardless of how many ‘luxury’ goods they possess.Report

        • Avatar Jaybird in reply to DarrenG
          Ignored
          says:

          These are *AWESOME* questions that really address the underlying issues fairly well.

          The wacky thing is that it seems to me that the answers to those questions are best addressed through programs almost *ENTIRELY* unrelated to the government ones that have been set up to address poverty.Report

          • Avatar DarrenG in reply to Jaybird
            Ignored
            says:

            I’m not sure about *entirely* unrelated. Food stamps, especially in their current EBT form, have done a lot of people a lot of good, for example (no, they’re not a complete solution, but they’re worlds better than the status quo ante).

            Conversely, some government programs/activities like the war on (some people who do some types of) drugs have actively exacerbated the problems of poverty, obviously, so it’s at best a mixed bag.

            Which programs would you advocate instead of, or in addition to, what’s in place now?Report

            • Avatar Rufus F. in reply to DarrenG
              Ignored
              says:

              “Food stamps, especially in their current EBT form, have done a lot of people a lot of good, for example”

              Emphasis on a lot of people…
              http://www.nytimes.com/interactive/2009/11/28/us/20091128-foodstamps.htmlReport

              • Avatar tom van dyke in reply to Rufus F.
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                says:

                And that’s Nov 2009. Food Stamp Nation—and it’s Bush’s fault.

                Actually, it partly is:

                But the Obama administration doesn’t deserve all the blame. Food-stamp enrollment surged before Mr. Obama took office. The number of food-stamp recipients on George W. Bush’s watch rose by more than 50%, even before the recession hit in 2007. As Slate reporter Annie Lowrey wrote for the online magazine last December, President Bush and his food-stamp chief Eric Bost “went on a quiet crusade to expand eligibility, increase enrollment, and reduce stigma around nutrition aid.”

                http://online.wsj.com/article/SB10001424052702304657804576401412033504294.htmlReport

              • Avatar Rufus F. in reply to tom van dyke
                Ignored
                says:

                I couldn’t care less about Bush- I intended to link to the Economist article that said the same thing just this week, but it’s behind the paywall. Anyway, I’m guessing the 9 or 10 or 15 or whatever-the-hell-it-is percent unemployment rate isn’t helping any. If you can’t create jobs, put em on the dole. The other trick I’ve seen a lot of recently is to get people enrolled for SSI instead of straight up welfare.

                And it’s not like I really begrduge the people using food stamps. Unemployment is through the friggin roof where my family lives. It’s probably past 30% where my father’s living. Not all of them are getting food stamps- there are some local charities that work overtime getting people food as well. My dad works part time at a local grocery store that runs in the winter on IOUs, if you can believe it. gI’ve known plenty of people on food stamps in my life and most of them were just going through a really bad time.

                And if this isn’t a bad time, I don’t know what is! Do you know how many people I know back home who have gone from being middle class to the edge of nothing? Lost jobs, lost mortgages, lost savings, and on and on and on. I couldn’t care less for Bush v Obama on this count, although nothing’s gotten better that I can see and a hell of a lot’s gotten worse.

                Shoot, I know a couple in their early 60s who went from being the major business owners in their community to moving in with their daughter and her husband in a trailer because the business tanked in the recession and took their home, their savings, and everything else with it- all in a few years. This stupid chart makes it sound like the salient fact would be that they have a refrigerator in that trailer they’re sharing with their daughter and her husband.Report

              • Avatar Rufus F. in reply to Rufus F.
                Ignored
                says:

                And I realize there’s a BIG part of that response that’s purely subjective. Namely, if you know a lot of people who are struggling right now at the low end of the economic pool or are living in one of those places, or have lived for a long time in one of those places, your take on that chart is likely to be a lot different from what it would be if you live in a place where the economy’s fairly strong. So, that’s probably biasing my take on it fairly strongly.Report

              • Avatar Will Truman in reply to Rufus F.
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                says:

                To an extent, though it cuts both ways. Living in a couple of slumholes gave me a different view of the poor. Some more compassionate, some more contemptuous (for lack of a better word). When I was living in my $300/mo apartment-slash-halfway-house, I saw an unfortunate number of bright and capable people coasting by because they could. And I saw an unfortunate number of people that would be out on the street but for the aid of the government.

                Ditto for my wife and her work at charity hospitals. Some just needed help. Others were circling the drain and no amount of money would help them – and their kids were moving on the same trajectory. It’s a complicated issue.Report

              • Avatar Anderson in reply to Rufus F.
                Ignored
                says:

                I don’t really understand some of the outrage over food stamp usage rising as much as it has during the recession (i’m looking at you Newt Gingrich), key word being *recession.* This is what the safety net is designed to do during times of severe economic distress. The threshold is 130% of the poverty line ($28,600 for a family of four), a majority of the recipients are children, and the average monthly benefit is about $130 per person ($1-$2 per meal)…which seems like a fair use of government money to help folks eat. And waste, fraud, and overhead costs are pretty low since the new debit-card system (http://www.slate.com/id/2277405/pagenum/all/#p2). Does this reduce poverty in a way we can measure? I have not a clue, but it does reduce hunger and makes some poor people’s, particularly parents, lives an iota less shitty. I think a better place to look for ineffective government welfare programs is in disability insurance through social security or other state-run programs. I know in Illinois worker’s compensation is something that’s been talked about a lot as a program that is prone to fraud and abuse..Report

            • Avatar Jaybird in reply to DarrenG
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              says:

              I think that getting rid of, oh, half of the drug war would be a good start when it came to violence in some parts of some parts of the country. I think that zoning and cartelization creates barriers to entry to create a small business that most folks in those parts of those parts have it more difficult to overcome. There are a lot of rules and regulations ostensibly created in order to protect employees (which is awesome!) but also have the side effect of making businesses not happen in the first place, which means that they don’t hire employees.

              I’ve said before, again and again, the barriers to entry to create something as simple as a bar that serves beer and salted nuts are downright prohibitive. To pour beer and hire a person to serve it to tables in the corner should require how many permits, do you think? How much paperwork to become an LLC? Should you be required to serve prepared food? Should you be required to purchase one of a limited liquor licenses from a bar that is closing or should the government be able to grow another one out of thin air?

              Because, I guarantee you, there is a lot more paperwork to go through than most folks believe. There are much higher barriers to entry than most folks can handle.

              It’s easier for most folks to just shrug and become an employee of someone else’s business… but the more difficult it becomes to open a place of one’s own, there will be fewer places hiring.

              So the drug war and zoning/licensure.Report

    • Avatar DensityDuck in reply to E.D. Kain
      Ignored
      says:

      “Poverty and wealth are always and always will be relative.”

      So you’re saying that it’s impossible to ‘help’ the poor, because even if you just straight-up throw money at them they’ll still be poor?

      That’s a surprisingly Republican argument.

      The basic assumption of people who rail against poverty is that poverty is inherently harmful, that a person in poverty is not only restricted in their lifestyle choices but is actively damaged due to being poor. Their life is shorter, less healthy, less enjoyable (and less enjoyed), and overall less fulfilling; and this is entirely due to their lack of money relative to the rest of their society.

      What the Heritage Foundation is asking, indirectly, is whether this is really true in America. Whether a family that has televisions, telephones, refrigerators, indoor plumbing, assuredly-clean water and a steady power supply, automobiles, access to healthcare services and knowledge, access to broadcast media and the internet, assured communications, a society that’s reasonably secure…whether that family can truly be said to be in a condition where it’s being harmed by its circumstances.

      And, y’know, maybe it is. Maybe there’s something we’re missing in all this (and, as we see in this thread, you can quibble about anything and everything on that list.) But isn’t it worth trying to identify the actual harm caused by poverty, and alleviating that, rather than just saying “he’s got more, means I’m poor”?Report

      • Avatar Will Truman in reply to DensityDuck
        Ignored
        says:

        Their life is shorter, less healthy, less enjoyable (and less enjoyed), and overall less fulfilling; and this is entirely due to their lack of money relative to the rest of their society.

        Errr, causality on this isn’t concrete. A lack of money is sometimes or often (though by no means always) a result of the above, and not the cause of it. Living in a slumhole actually stripped me of a lot of my “if they only had money” thoughts. Ditto for my wife and the charity hospital where she has worked.Report

        • Avatar DensityDuck in reply to Will Truman
          Ignored
          says:

          But that’s my point! Is it a lack of goods or money that causes harm to people? Is material poverty the reason that some people have miserable lives?

          The Heritage Foundation chart is one argument that this isn’t the case. Your experience is another.Report

      • Avatar DarrenG in reply to DensityDuck
        Ignored
        says:

        As above, I’m not sure Heritage is really asking anythingin good faith so much as they’re providing ammo to their supply-sider allies in government and the media.

        To your question, though, I think a quick trip through any inner city, Appalachia, or the rural South would dismiss any lingering doubts as to whether there is still real and substantial harm due to poverty in this country.Report

        • Avatar Will Truman in reply to DarrenG
          Ignored
          says:

          The Heritage foundation may be operating entirely out of bad faith, but for a lot of us, they seem to bring up a valid question that is being dismissed too quickly by som: How do you define poor? How do you define poverty? Unless they’re using a definition of poor that liberals would find too broad, it seems that one of three things is the case:

          1) We’re defining it so that people can comfortably afford cable television. While I don’t consider cable to be an extravagence, it’s not what I mentally associate with being poor (save for #2). And certainly, as Tom Van Dyke points out, should not be associated with going hungry (save again for #2). So when we talk about helping the poor, are we talking about helping people with their food bills so that they can then use the money for cable? I don’t have a problem with this, actually, but a lot of people (and not just right-wingers) do.

          2) People are going hungry and paying for cable. I’m not sure this is the case (I suspect those going hungry are mostly among the 1/3 without cable), but the 63% doesn’t actually bother me as much as the 38% without a computer and 27% without broadband. I’m not comfortable going into too much what they should be spending their money on, but neither am I comfortable with those statistics when it comes to people who it is said need our help.

          3) The criteria that THS is using is overly broad, and if it’s what advocates for the underclass are using, we need to differentiate between those that are making the choice between computer and those you refer to in Appalachia.

          These statistics are not the game-winning field goal that THS-types think it is. But neither are they worthy of the abject dismissal and contempt that Elias Isquith and others are giving them. Even if the Society itself is worthy of contempt, they appear to make a point that resonates.Report

          • Avatar Will Truman in reply to Will Truman
            Ignored
            says:

            THS=The Heritage Foundation. For some reason my mind drifted into thinking it was Society.Report

            • Avatar tom van dyke in reply to Will Truman
              Ignored
              says:

              Heritage worthy of contempt? I hope you meant this hypothetically and not as a possibility in play, WT. That would appeal to an epistemological solipsism on the part of the left that is in itself worthy of contempt.

              BTW, Cheeks is still on dial-up. Is this a failure of American society?Report

          • Avatar DarrenG in reply to Will Truman
            Ignored
            says:

            “Even if the Society[sic] itself is worthy of contempt, they appear to make a point that resonates.”

            Which is exactly their goal, and why you see a chart like this every time the GOP start stumping for large cuts to welfare programs. The goal here is precisely to lead people to one or both of the following conclusions:

            “There are virtually no *real* poor people in America any more, so welfare spending is entirely wasteful.”

            and/or:

            “Poor people are only poor because they waste their money on extravagances rather than necessities.”

            This is a sort of crypto-Calvinist world view that allows them to entirely dismiss the effects of poverty in the U.S. in the service of dismantling public sector efforts to eliminate or mitigate these effects.

            Otherwise, what’s a better answer to the questions you raise about people on food stamps having cable TV or a computer than “eliminate food stamps?”Report

            • Avatar tom van dyke in reply to DarrenG
              Ignored
              says:

              Gov’t largess is charity. Our society uses the gov’t to dispense it.

              Somewhere we got the idea that accountability, how the charity is dispensed, how it’s used by the recipients, is an inhuman and mean question to ask. Only indiscriminate and undiscriminating doling out of society’s charity is considered moral.

              Once we have made receiving charity a “right,” we have undergone a moral inversion [and practical catastrophe, human nature being what it is] that makes responsibility on the part of the giver or recipient impossible.

              Oy:

              http://www.scientificamerican.com/article.cfm?id=food-stamps-obesityReport

              • Avatar DarrenG in reply to tom van dyke
                Ignored
                says:

                “Somewhere we got the idea that accountability, how the charity is dispensed, how it’s used by the recipients, is an inhuman and mean question to ask. Only indiscriminate and undiscriminating doling out of society’s charity is considered moral.”

                I don’t think this is the case at all, and given the significant number of reforms to various welfare programs over time, I think history backs me up here. We as a polity have been generally very good about asking ourselves whether our welfare programs are working and how best to alleviate the effects of poverty and deprivation.

                The only people I don’t see much participating in that discussion are those who just want to burn the whole system down without regard to the consequences.

                As for obesity and food stamps, that’s part of the whole “food security” issue you nonchalantly dismissed above, as the article makes clear. We’ve done a pretty good job at eliminating severe hunger due to poverty, but now have the problem that people have the resources to buy food, but little if any good food to buy in increasingly-large food deserts.Report

              • Avatar tom van dyke in reply to DarrenG
                Ignored
                says:

                The “food desert” theory is not holding up, Darren.

                No surprise, then, that neither USDA nor the Institute of Medicine of the National Academies has been able to establish a causal link between food deserts and dietary health.

                Yes, there’s more scrambling that healthy food is too expensive, but absent accepting some burden of proof, it’s just more blahblah from the epistemological bubble that rejects anything it doesn’t like.

                http://www.economist.com/node/18929190Report

              • Avatar Will Truman in reply to tom van dyke
                Ignored
                says:

                Historically speaking, my food expenses go down when I have tried to eat healthy, and were at their highest when I was heaviest*. Canned foods are dirt cheap and can be okay for you (other than the sodium). Fast food’s cheaper items are better, calorie-wise, than their more expensive ones (because there’s less of it!). It’s eating out that kills you, and fast food has the remedy for that in the small-portions dollar menus, that other restaurants lack.

                The notion that you have to be healthy or in a good part of town to be able to eat not-atrociously is flawed.

                * – We’re talking 70lbs of weight variation here, so when I say “at my heaviest” I don’t mean “OH NO! I GAINED TEN POUNDS!” I mean going from normal-weight to obese (and back again).Report

              • Avatar Jesse Ewiak in reply to tom van dyke
                Ignored
                says:

                But you’re also one person. Once you throw in a couple of kids, the price of feeding four people on the McDonalds value meal + a 2-Liter of Coke versus good food gets a lot closer than it is for just you or me. Plus, throw in the fact that what ‘costs less’ when it comes to time. A relatively quick in and out run to fast food store x _or_ going to the grocery store, waiting in line to pay, getting back home, and then spending time making the food.

                I’m also assuming you have a vehicle with the above. I’m not saying canned foods aren’t cheap (god knows I learned to love canned corn and such when I was a kid), but I think people sometimes do forget to throw in the time factor when they talk about the ‘cost’ of eating healthy, especially when that time cooking is time away from their kids and another hour on their feet when they just spent eight hours on their feet.Report

              • Avatar DensityDuck in reply to Jesse Ewiak
                Ignored
                says:

                “Plus, throw in the fact that what ‘costs less’ when it comes to time.”

                This is where most of fast food’s attraction comes from, I think. I just made dinner for myself and my wife, ravioli with jar sauce and steamed broccoli, and I dirtied three pots and two plates to do it, and it took 15 minutes. If I’m buying Burger King then I pick it up on the way home from work, and the packaging is also the plate (and your fingers are the utensils.)Report

              • Avatar Will Truman in reply to Jesse Ewiak
                Ignored
                says:

                Jesse,

                And buying groceries and cooking dinner saves time? If anything, this is an argument that not much will be helped by watering the food desert.

                Plus, as I said, dollar menus. Fast food allows you order everything a la carte and get things in manageable portions. Getting a 99c burger is cheaper than any combo meal. Get two!Report

              • Avatar DarrenG in reply to Jesse Ewiak
                Ignored
                says:

                Will,

                I suspect my response to this part of the thread got lost in the rather limiting comments software here, but I find your suggestion that fast food value menus are a viable, healthy diet option to be completely unconvincing.

                If you order 2k calories worth of food off a typical fast food value menu per day you will end up malnourished due to the overwhelming bias of those calories toward sugar and fats. If you get the vitamins and minerals necessary for a healthy diet, you will have to consume far more calories than are healthy.

                I do agree fast food and packaged food is far more convenient than cooking from fresh, though, which is an associated and frustrating problem with our food supply in many urban and rural areas.Report

              • Avatar Will Truman in reply to Jesse Ewiak
                Ignored
                says:

                I saw and responded to your post below. But in short, my comment above didn’t say anything about a “healthy diet.” I merely said that eating thin has been cheaper than eating heavy was.

                Eating healthy helps one stay thin, but isn’t necessarily required for it. Fiber goes a long way. Fiber (or inulin at least) is nicely available in both canned and cereal box form.Report

              • Avatar Will Truman in reply to Jesse Ewiak
                Ignored
                says:

                Moving reply to DarrenG’s to here.

                Then I think your original response completely dodged the most relevant issue of food deserts, which is that it is insanely difficult (albeit not impossible) to eat a balanced diet when your main food sources consist of packaged and fast foods.

                Yeah, I can be annoying that way. I didn’t have a whole lot to add about food deserts specifically. Tom linked to the article I was going to link to. But tangentially, there is the notion that obesity is caused by the inability to access/afford nutritious food. I think that’s questionable from a number of standpoints. Less so if your point is “eating healthy,” though as Tom’s link points out, it’s uncertain that access to the foods does a whole lot of good when worse alternatives are also accessible.

                Nor is it solely an issue of fresh produce; that’s another straw man.

                An unintentional one. When I think of “food deserts” I think of produce. While we’re on the subject, what other than produce are we referring to?

                However, my point in response to Tom was that food security and access to a healthy, balanced diet among the poor is a valid concern both separately and additionally from hunger.

                As I said, Tom gave the response I was going to. I am of the mind that the deserts are the result of an existing lack of interest, much of the time, rather than the cause of people not eating real food. Much like the fast food places learned that when people said they wanted “healthier options,” they didn’t really mean it. I’m rather cynical that way, I fear.Report

              • Avatar DarrenG in reply to Jesse Ewiak
                Ignored
                says:

                As I mentioned I find a key distinction in Tom’s link between ‘unproven” and “disproven,” and still see food deserts as an important contributor to food insecurity issues.

                Beyond produce, the issue in many food deserts is with anything that is properly considered more an ingredient than a prepared food — fresh meat, seafood, grains, and yes, produce.

                Your point about preference is a good, although I think incomplete, one, and raises some valid issues regarding both education and agricultural/food supply policy that take us a very different direction from the very good ongoing discussion about entitlements and the welfare state.Report

              • Avatar Will Truman in reply to Jesse Ewiak
                Ignored
                says:

                My apologies, I didn’t see your comment to Tom. I am probably more inclined to apply greater weight the Economist’s findings because they confirm my biases.

                My views on obesity (and, to an extent, nutritional health) are somewhat extensive, as it is something that I have struggled with off and on over the years. The long and short (you’ll note I do not do “short” very well) of it is that folks on one side of the debate seem to think that fat people are fat just to be an eyesore on the respectable, physically fit citizenry, and that they could lose the weight if only they gave a damn. Then on the other side of the debate I see people say “they would be healthy and choose the right foods, if only…” finished with something to the effect of “they knew how dreadful obesity was” or “they had access to better foods” or “we encouraged them to eat better foods” or something else along those lines.

                I find the former view far too condemnatory (and sometimes mean-spirited). I find the latter view well-intentioned, but ultimately off-target (and a little condescending). I think what it comes down to is, we eat junk food because it tastes good in its prime state (ie nothing has to be done to it after you receive it). Some people are better at saying “that tastes good, but now I should eat something healthier” than others. And I think the longer you eat junk food, the more natural it tastes to your system (and the more bland “real” food tastes). I further believe that there are mammoth psychological issues involved with our relationship with food. So in sum, I believe that it is insanely more complicated than mere willpower (as the first group would have it) or nudging and providing the food on the belief that since it’s good for their bodies, they really do want it on some level.

                I mentioned that I’m really bad at “short”, right?Report

              • Avatar DarrenG in reply to Jesse Ewiak
                Ignored
                says:

                Much appreciated, Will, and rest assured I also don’t fall into either of the stereotypes you describe, although I’m very familiar with them both.

                I agree that the politics, sociology, and science of nutrition, diet, food supply, etc. are all much more complex and nuanced than can be adequately covered in a blog comments section, and that anyone who purports to have *the* solution is likely full of it.

                That said, I’d certainly like to see a better, and more healthy, variety of food selections available in inner city and rural markets. I have no illusion that this would be a panacea for obesity, diabetes, or other nutrition-related disorders, but I believe it would be a step in the right direction.Report

              • Avatar Will Truman in reply to Jesse Ewiak
                Ignored
                says:

                I’d like to see it, too. Even if it doesn’t help all that much in the aggregate, it would at least help those that do want healthier foods. I’m less sure what I’m willing to do to make it happen. Or how much I’m willing to spend from public funds, if that’s what it were to come down to (I’m less sanguine on our financial position than you are).

                But I’m in favor of all sorts of things that, by themselves, may not do much. Just recently I was defending calorie counts on fast food boards. Some recent study suggests they don’t do anything, but dang if they don’t help me. And if they help me, presumably they help others. And they seem to have encouraged Jack-in-the-Box to shed some calories from their selections (or maybe it’s a coincidence).

                Anyhow, I’d better stop now, because like I said this is something I can really go on about.Report

              • Avatar DarrenG in reply to Jesse Ewiak
                Ignored
                says:

                In case it wasn’t clear, I can also go on at great length about food politics, although it’s close to bedtime here, too.

                I’m convinced that improving the food supply in many areas doesn’t, in fact, require additional government expense or coercion.

                Merely reducing the support and protection we give to corn syrup, cheap beef, and processed foods in general should encourage groceries and restaurants to serve a larger variety of more healthy choices.

                This is an area where I fall firmly into the traditional libertarian camp and believe that the state is the main thing standing between the status quo and a good outcome.Report

            • Avatar Will Truman in reply to DarrenG
              Ignored
              says:

              No doubt it is their goal. But so what? If their point is dismissed or mocked, it’s actually left standing to anyone who doesn’t already agree that The Heritage Foundation is a bad apple barrel. The answer is to address the points. Going after the messenger simply allows the message to stand among people who don’t view the messenger in quite such a negative light. I’m not even a liberal, and I can come up with a number of more substantive critiques off the top of my head:

              For instance:
              1) Of course a large number of them are going to invest in cable. Hour-for-hour, it’s one of the cheapest forms of entertainment there is. They can’t afford to go to theater or the opera. They can’t even afford food that isn’t fast. They can’t meet their friends for a $5 latte. They meet their friends and watch TV. If that’s what they can afford to do, $50 isn’t a bad investment. And $50 a month does not a wealthy person make.
              2) What’s missing from this list. Transportation! Another reason to have cable, if you can’t go anywhere. And while you can get cable for $50, you can’t insure and maintain a car for that much. So you spend the money you have on what you can use.
              3) By arguing that cable is a luxury, you’re demanding that they make sacrifices that you haven’t make. Okay, maybe you don’t have cable. It’s less necessary when you have broadband and access to transportation. But are you prepared to say that sitting around and reading books from the library (if you have transportation) or reading used books is a reasonable request? If your grown kid was living like this, how likely would you be to shrug it off instead of help, if you could afford to?
              4) Three-fifths don’t even have a computer. Thankfully some of the rest are going to have cable to connect them to the world outside their town or neighborhood. But then some lack both. Think about that.
              5) Yeah, 98% of them have a fridge, which apartments generally come with, and thank heavens for that, because what would they eat otherwise? Going out to eat can be expensive. Does not living on canned beans mean that you aren’t poor? 20% of them don’t even have a microwave with which to heat up canned beans, anyway (since fewer apartments come with microwaves).
              6) More broadly, our society is built around things that you might consider luxuries. Air conditioning? People *die* without it. And again, transportation, which is conspicuously missing. Since we don’t have thorough public transportation, this is a real problem. And we should cut their benefits?
              7) More broadly still, we’ve created a society that simply doesn’t account for the poor. Transportation being an example, but only one. It’s also the case that if you’re the poor person that would spend your money wisely, chances are you live in an undesirable neighborhood with undesirable schools and often undesirable neighbors. Even if you completely lack sympathy for some of the poor, shouldn’t we be doing what we can to help those people out? Unfortunately, we can’t always differentiate between those and the folks that are poor by their own poor choices (instead of simply failing to choose their parents wisely). You can’t afford the things to get out of poverty on minimum wage. Helping out the irresponsible is simply the price we pay not to give those that are capable of a better life a greater chance of achieving it. Even in the big, bad days before Welfare Reform, most people were on AFDC for a pretty limited amount of time.
              8) So are we going to cut off the parents that are using food stamps in order to save up and buy a computer for their kid simply because others are using that money for television sets? Or are we going to dictate what they can and cannot buy? Keep in mind, it wouldn’t be a matter of helping them out solely to purchase certain items (like food), because they could use the money freed up by that in order to pay for air conditioning and other “luxuries.” We would have to literally dictate what they spend every dime they have on, or else cut off support to anyone that makes some money on their own (which is not a fantastic incentive to go and find work).

              These arguments aren’t bulletproof, just as the chart is not the QED that THF probably thinks it is. But they’re a lot more effective than simply saying “The Heritage Foundation is being disingenuous with these numbers” or outright mocking concern that our money is going to people that don’t need it.Report

              • Avatar DarrenG in reply to Will Truman
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                says:

                Completely fair points about attacking the messenger.

                What I was, and am, getting at is “what comes next?” If people look at this chart (or its many predecessors) and see a serious problem, how do they propose fixing it?Report

              • Avatar Will Truman in reply to DarrenG
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                says:

                Oh, I think that part is pretty obvious. What you stated. Which, if you oppose cutting the welfare net, makes it all the more important that the chart is taken seriously.Report

              • Avatar Art Deco in reply to Will Truman
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                says:

                Even in the big, bad days before Welfare Reform, most people were on AFDC for a pretty limited amount of time.

                Mean of about 6.6 years. IIRC, bimodally distributed, with one set that tended to be on and off for a few years and one set for which it was a way of life.Report

              • Avatar Will Truman in reply to Art Deco
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                says:

                Oooh, I’d love to see that chart, if you can find it. According to these data:

                http://www.huppi.com/kangaroo/L-welfareblack.htm

                19% are off within 7 months, 34% off within a year, 53% within two, and 80% within five. I’m open to alternative data. And in any event, I really have no problem with Welfare reform. I mostly point out that it was a minority of people racking up the time on it. And I’m glad that it wasn’t used to get rid of it entirely.Report

              • Avatar Art Deco in reply to Will Truman
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                says:

                The figure came from David Ellwood, and was current to about a generation ago.Report

              • Avatar Art Deco in reply to Will Truman
                Ignored
                says:

                Implicit in your comment is a complaint about the quality of public goods and of certain services commonly the subject of common provision (schools, &c.). Would tend to agree with you, but providing open-ended doles to people and subsidizing their mundane expenditures does not address those problems (aside from the administrative costs and rent-seeking entwined with doing that).Report

              • Avatar Will Truman in reply to Art Deco
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                says:

                I agree that’s a general weakness in the argument, but:

                1) It does help those that have the capacity to escape, do so.

                2) They may have cable TV, but it still sucks to be poor. Implicit in THF’s argument is that things are okay with the lower classes because they have nice stuff. It could just as easily be said that it makes an unpleasant life a little less unpleasant.

                3) There is an overlap between the people skeptical of welfare reform and the people skeptical of investing more heavily in common provisions. They both typically require higher taxes.Report

              • Avatar Jesse Ewiak in reply to Will Truman
                Ignored
                says:

                To answer point two, the problem is, basically, there’s a subset of conservatives (and some ‘moderates’ and ‘liberals’ who oddly only have this feeling toward poor minorities) who in their heart of hearts believe that every time a person in poverty smiles or laughs, they should at least a portion of their food stamps or other forms of assistance.Report

              • Avatar tom van dyke in reply to Jesse Ewiak
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                says:

                Straw man, Jesse. That’s just not right.Report

              • Avatar Jesse Ewiak in reply to Jesse Ewiak
                Ignored
                says:

                I guess those dirty looks my family when my mom handed over her EBT card at the Publix were all in my imagination. If you don’t think there’s a strain of puritan feeling “poor people should be as miserable as possible if we’re giving them money” within American politics, you’re just not paying attention.Report

              • Avatar Jaybird in reply to Jesse Ewiak
                Ignored
                says:

                I do think that there is an attitude that “we” all have responsibilities to “each other”.

                The attitude almost explicitly says: If “you” are one of the people who is receiving assistance from “us”, you had best use that assistance on healthy foods and milk rather than on RC Colas and Moon Pies.

                I’d be interested in hearing your arguments for why people ought not have this attitude, actually.Report

              • Avatar Jesse Ewiak in reply to Jesse Ewiak
                Ignored
                says:

                First, my snarky point. I’ll worry about what those people think the moment they start worrying about the amount of waste in the Defense Department. 🙂

                Second, more serious point. I’ve got no theoretical issue with more limits on EBT cards. However, you’ll also have to accept that will make things less efficient, lead to a bigger government, and quite frankly, make those would vote for such a thing (the GOP) even bigger hypocrites when it comes to their calls for smaller government.

                The mission of food stamps is to allow parents to feed their children, not feed them according to the wishes of 218 Representatives and 51 Senators.Report

              • Avatar tom van dyke in reply to Jesse Ewiak
                Ignored
                says:

                Well, that’s a fairer way to put your point, Elias.

                Someone mentioned “quasi-Calvinism” in a typically unthinking and pejorative manner. But quasi-Calvinism made this country great, not the progressive mindset that has mutated charity into the recipient’s own “rights” and “entitlement.”

                This has weakened the American spirit and often made the recipient hostile and defiant [if not still envious of those who have more], rather than grateful to the American society and his fellow citizens.

                And so, the backlash: Mr. Kain, citing bleeding-heart libertarians or whatever, has spoken dismissively of “pity-charity.”

                But it is charity, Mr. Isquith, despite the modern and secular recasting of it as rights, entitlement, and “social justice.” In the “Puritan” days [Puritans are Calvinists], this was known as “Christian” charity.

                Now we use “puritan” and Calvinist” pejoratively. Sneeringly!

                I realize I’m getting pedantic here, but there is a point: the funny looks your mother received were either genuinely uncharitable in a way unacceptable to Christian charity or a backlash against the new rights/entitlement social regime, to which no respect is due. I ran across a comment from a reasonable-sounding man today about an absurd tomato protest at Trader Joe’s [yes, via Instapundit!]

                http://pajamasmedia.com/tatler/2011/07/19/tomato-protest-at-trader-joes-prototypical-example-of-alinsky-tactics-and-smug-self-immortalization/

                and one commenter wrote:

                And every time I go to the local supermarket, I’m in the minority of people using my own money to buy groceries, and my car is one of the oldest and smallest in the parking lot.

                Now, the proper Christian [Puritan/Calvinist!] response to your mother using her Food Stamp card would be pity, and to look away to spare her embarrassment. That’s what it was like in the olden days, when Food Stamps were American society’s charity, and not a political right.

                The point being, we can give the Food Stampee a more discreet card to make them feel less conspicuous, and we can try to use political means to change society’s view of accepting charity. But politics has its limits, and indeed the view of the next person in line is not one of pity or grace, but of resentment that they’re being taken for a fool by someone who’s about to drive off in a car nicer than theirs.

                These are my observations, Elias, not pontifications. To return to my recent theme on Moynihan, culture and politics [and JB hit “culture” today too], I think politics is not nearly as powerful as culture, and what you describe here is culture, the interaction of people at the checkout line.

                If for every action there’s an opposite and equal reaction, the “empowerment” of the recipient of charity has resulted in an arrogance of entitlement, and the diminishment of pity, which to the ordered soul says, there but for the grace of God go I, and I’m happy to help.

                Under the current regime of rights and entitlement, it just makes you feel like a chump for playing by the rules, and there’s nobody who doesn’t resent feeling like a chump.

                Respectfully submitted, and by the way of de rigeur autobiographical disclaimer, I am no Calvinist. I just study them in the context of the American Founding. For me personally, they are a foreign country as well, although i’m starting to get it.

                In an empirical sense, I cannot disagree with their general attitude that poverty is self-inflicted: when you peel back the onion on these newspaper hard-luck stories, there is often a core of self-destruction. I pity the fools, but it goes no deeper than that.

                As for your mother, as a taxpayer and fellow citizen, I’m happy to help.Report

              • Avatar Elias Isquith in reply to Jesse Ewiak
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                says:

                Why is this addressed to me?Report

              • Avatar Jaybird in reply to Jesse Ewiak
                Ignored
                says:

                The mission of food stamps is to allow parents to feed their children, not feed them according to the wishes of 218 Representatives and 51 Senators.

                Really? Tell Stillwater. He didn’t believe me when I told him that society had a stigma against food stamps being used for cigarettes.

                I’ve got no theoretical issue with more limits on EBT cards. However, you’ll also have to accept that will make things less efficient, lead to a bigger government, and quite frankly, make those would vote for such a thing (the GOP) even bigger hypocrites when it comes to their calls for smaller government.

                This doesn’t really answer my question.

                If people internalize this idea that we, as a society, have interconnected responsibilities (fairly uncontroversial statement, no?), should you be surprised when they start thinking that “the poor” have responsibilities back?

                Personally, I think that this is where the War on Drugs comes from.Report

              • Avatar tom van dyke in reply to Jesse Ewiak
                Ignored
                says:

                Appy-ologies, Elias. Many distractions here. Mr. Ewiak was the intended victim.

                I hope this means you agree with my argument. 😉Report

              • Avatar Jesse Ewiak in reply to Jesse Ewiak
                Ignored
                says:

                Sorry TVD, I’m not gonna’ feel pity or be embarrassed for my mother taking the options available her to feed her children.Report

              • Avatar Jesse Ewiak in reply to Jesse Ewiak
                Ignored
                says:

                Jaybird, as for you, I say we start at the top when it comes to ‘wasteful’ spending. People can be upset about mothers buying their kids some ice cream once we take care of the massive fraud and waste at the Pentagon, etc. Until then, I don’t really care they’re upset if they’re not even more upset at where more money is being ‘wasted.’Report

              • Avatar Jesse Ewiak in reply to Jesse Ewiak
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                says:

                Oh, and even the biggest socialist in the world would be against food stamps being used to buy cigarettes. Hell, even me, the social democrat, is against an EBT card being able to be used to buy prepared food from a deli or a fast food place.Report

              • Avatar tom van dyke in reply to Jesse Ewiak
                Ignored
                says:

                Not my point, Jesse. You didn’t engage it. 🙁Report

              • Avatar Jesse Ewiak in reply to Jesse Ewiak
                Ignored
                says:

                You’re point is the poor should feel shame for being poor and be happy society gives them help at all, since after all, poverty is self-inflicted.

                I disagree with all of that. Food stamps are available to all, as long as you don’t mind only earning 130% of poverty level.Report

              • Avatar Jaybird in reply to Jesse Ewiak
                Ignored
                says:

                Dude, don’t tell me! Tell Stillwater!!!

                Jaybird, as for you, I say we start at the top when it comes to ‘wasteful’ spending. People can be upset about mothers buying their kids some ice cream once we take care of the massive fraud and waste at the Pentagon, etc. Until then, I don’t really care they’re upset if they’re not even more upset at where more money is being ‘wasted.’

                I think that this misunderstands the dynamic that I see taking place.

                It’s not that EBT is being “wasted”. It’s that the trust relationship is being abused.

                We all have responsibilities to each other, right? Our responsibility is to provide nutrition and “your” responsibility is to eat healthy rather than RC Cola and Moon Pies.

                The fact that this attitude exists does not surprise me for one moment… it also doesn’t have a 1:1 overlap with attitudes toward the military or Social Security or Medicare. There is a different dynamic there.Report

              • Avatar tom van dyke in reply to Jesse Ewiak
                Ignored
                says:

                No, that’s not my point, Jesse, it’s your caricature of it. I gave my actual point a lot of time and thought, offered in good faith and respectfully submitted. If you don’t choose to reread it and reconsider it, I hope the gentle reader will.Report

              • Avatar Jesse Ewiak in reply to Jesse Ewiak
                Ignored
                says:

                I can’t find it in this thread, but I’m thinking you and stillwater talked past each other when it came to cigarettes.

                As for the ‘trust relationship’, even if EBT cards banned ‘junk food’, people would complain mothers were ‘wasting government money’ by buying name brand macaroni and cheese, etc.

                Most people aren’t complaining because they truly care about government money being wasted on food stamps being spent on thing x. They’re upset that government money is being spent on food stamps at all, so they’re going to qualify it with, “oh, I’d just be fine with it if they didn’t waste it all on ice cream and soda pop.”

                I’m sure there are people who are truly worried about what mothers are feeding their kids with food stamps. But, I’m going to take a guess most of those people voted for Obama and shop at Whole Foods anyway. 😛Report

              • Avatar DarrenG in reply to Jesse Ewiak
                Ignored
                says:

                Tom, my comment was “crypto-Calvinist” not “pseudo-Calvinist,” a small, but not irrelevant, distinction.

                At the risk of derailing an otherwise-interesting discussion about the welfare state, I couldn’t disagree more with your characterization of Calvinism as both “what made this country great” and “proper Christianity.”

                I’m with Jefferson, Adams, Franklin, et al in their *very* anti-Calvinist post-Enlightenment ideals.

                Specifically, I find the Calvinist notion that material wealth, regardless of how it is acquired or maintained, is a sign of divine favor and accordance with the will of God, along with the converse notion that poverty is always a result of sin and punishment, to be both empirically false and theologically abhorrent.

                Also above, regarding food deserts, you seem to have confused “unproven” with “disproven” as while the causal link isn’t completely established, it’s still the explanation that best fits the data.

                And Will, I lost your thread while fixing dinner myself, but I found your anecdotal story of eating a balanced diet off fast food value menus to be completely unconvincing.

                If your main sources of food are fast food and packaged foods it is virtually impossible to get the required nutrients without far exceeding a healthy daily amount of calories, carbs, and fat.Report

              • Avatar BSK in reply to Jesse Ewiak
                Ignored
                says:

                TVD-

                Stop playing that game. State your own damn point. If the person you are conversing with has misstated it or misunderstood it, correct him. Stop hiding behind innuendo and vagueness.Report

              • Avatar Jaybird in reply to Jesse Ewiak
                Ignored
                says:

                The thread I’m talking about can be found here.

                Most people aren’t complaining because they truly care about government money being wasted on food stamps being spent on thing x. They’re upset that government money is being spent on food stamps at all, so they’re going to qualify it with, “oh, I’d just be fine with it if they didn’t waste it all on ice cream and soda pop.”

                I don’t agree.

                I think that more of it has to do with the idea that the poor are taking advantage of the good nature of society by acting the schnorrer. It’s the attitude that the social agreement that resulted in EBT isn’t being followed.Report

              • Avatar DarrenG in reply to Jesse Ewiak
                Ignored
                says:

                Jaybird,

                Then it’s incumbent on those who believe as you do to both prove their case (the plural of ‘anecdote’ isn’t ‘data’ after all), and propose a solution that isn’t itself worse than the problem (e.g. a vast new government intrusion into the daily lives of millions of people).Report

              • Avatar Jaybird in reply to Jesse Ewiak
                Ignored
                says:

                DarrenG, what argument do you think that I am making?

                Because I’m pretty sure that I am *NOT* making the argument that you think that I am making.Report

              • Avatar tom van dyke in reply to Jesse Ewiak
                Ignored
                says:

                BSK, hockey has a third-man-in-rule, game misconduct, ejected. It’s a good rule.

                If you’re to inject yrself, pls engage the comment I spent much time, effort and good faith on. That would be OK. Otherwise kindly get off my back. I get enough noise.Report

              • Avatar BSK in reply to Jesse Ewiak
                Ignored
                says:

                Jaybird-

                But many (not all) of those same people are often conspicuously silent on far bigger breaches of the social agreement. They don’t mind exploiting tax loopholes when it is them or their friends doing it, but when the poor guy down the block gets himself a soda and a Snickers, suddenly the public trust has been violated. They often have a very skewed perception of the social agreement. I read an interesting study recently profiling the Tea Party that discussed how their is a pervasive sense of those who are justified to take from the government and those who are not without a consistent, objective standard for who fits where. Those who were justified were generally those with whom the individual identified with; those who were not were those perceived as “other”. Now, I’m not saying that everyone who would be upset to see a chart like this is a Tea Partier; rather, I think this is a fairly common aspect of human nature (the ol’ “It’s different when I do it” line of reasoning). I bring up the Tea Party because the paper did a really interesting job of demonstrating how this type of thinking can allow an individual to hold two seemingly contradictory viewpoints. I’ll see if I can dig it up.

                But, yea, basically, these people have selective outrage about violations of the social agreement.Report

              • Avatar DarrenG in reply to Jesse Ewiak
                Ignored
                says:

                Jaybird,

                Perhaps. My reading of your argument is that you believe (or are arguing on behalf of those who believe — I concede that isn’t clear) that there is a significant problem with food stamp recipients breaking an implied social covenant when they use their EBT cards to buy and consume unhealthy foods.

                That is the argument I was responding to, since I haven’t yet seen any hard data on the prevalence of EBT purchases of junk food, or a proposed solution that I don’t find far worse than the alleged problem.Report

              • Avatar BSK in reply to Jesse Ewiak
                Ignored
                says:

                Sorry, TVD, this isn’t hockey. And I call bullshit when I see bullshit. I think Jesse deserves to know about this little “tactic” of yours. Say what you mean and mean what you say or shut up.Report

              • Avatar Will Truman in reply to Jesse Ewiak
                Ignored
                says:

                And Will, I lost your thread while fixing dinner myself, but I found your anecdotal story of eating a balanced diet off fast food value menus to be completely unconvincing.

                I didn’t say anything about a balanced diet. I merely said that it was costing me more in food to be fat than it has cost me since being being fat anymore.

                Access to produce may help you avoid being obese, but it’s not required. And, of course, even if you have access to it, doesn’t mean you’re going to eat it.Report

              • Avatar Jaybird in reply to Jesse Ewiak
                Ignored
                says:

                But, yea, basically, these people have selective outrage about violations of the social agreement.

                Oh, certainly.

                I’m not particularly surprised by this, however. It seems to me to be a perfectly reasonable outcome of the system.Report

              • Avatar DarrenG in reply to Jesse Ewiak
                Ignored
                says:

                Will,

                Then I think your original response completely dodged the most relevant issue of food deserts, which is that it is insanely difficult (albeit not impossible) to eat a balanced diet when your main food sources consist of packaged and fast foods.

                Nor is it solely an issue of fresh produce; that’s another straw man.

                I agree that some people will choose to eat less-than-healthy diets even when it’s easily within their means to to do so. Hell, I’m one of those people myself.

                However, my point in response to Tom was that food security and access to a healthy, balanced diet among the poor is a valid concern both separately and additionally from hunger.Report

              • Avatar Jaybird in reply to Jesse Ewiak
                Ignored
                says:

                My reading of your argument is that you believe (or are arguing on behalf of those who believe — I concede that isn’t clear) that there is a significant problem with food stamp recipients breaking an implied social covenant when they use their EBT cards to buy and consume unhealthy foods.

                Not exactly.

                My argument is that this attitude on their part is completely predictable and understandable and goes part and parcel with the attitude that we all have responsibilities toward each other.Report

              • Avatar DarrenG in reply to Jesse Ewiak
                Ignored
                says:

                Jaybird,

                I stand partially corrected, then. Thanks.

                Only partially, though, since I think you’re making a philosophical argument I’ve never seen practically instantiated.

                Yes, I think many of us who are in favor of a relatively strong social safety net would prefer that the beneficiaries of the safety net not use it for destructive purposes.

                However, I also think most of us are realistic enough to concede that in a nation of 300+ million people you will inevitably find cases where people abuse the social compact in a myriad of ways, and that empowering the state to intercede to prevent each and every one of those cases is both impractical and undesirable.Report

              • Avatar tom van dyke in reply to Jesse Ewiak
                Ignored
                says:

                Darren, I used “quasi-Calvinist” rather than the more pejorative “crypto-Calvinist” or “pseudo-Calvinist.” Admittedly out of memory, indeed a more charitable reading and memory than the original.

                As for your cites of the same 2 Founders whom everyone cherry-picks, Jefferson and Franklin [and somewhat John Adams], I assure you I’m aware of every quote and slag you may offer chapter and verse. They were pretty much all there was. My study of the Founding is an honest one: again, I am no Calvinist. Were we to litigate this, well, better you take your objections to my home blog, and I’ll clean your clock there instead of here, since it’s irrelevant to the current discussion.

                I quite stand by my argument on Calvinism per Max Weber and reading the Calvinists from Jean Calvin, Theodore Beza, Jonathan Edwards and the whole megillah. It’s a cultural argument, not a religious one: I do not argue religion in fora such as this, Darren. God forbid!

                My argument is on the socio-political transmutation of “Christian charity” to “rights and entitlement. Why would I argue religion in a forum that sneers at the very mention of Puritans and Calvinists? I am many things, but an idiot is not one of them.

                I’ve pretty much had my say, this discussion degenerating into the usual unpleasantness. Should anyone have a substantive rebuttal, I’ll reply, but at this point, I’d be pleased if you let me go.

                Thx for yr time, and the gentle reader’s.Report

              • Avatar Jaybird in reply to Jesse Ewiak
                Ignored
                says:

                Yes, I think many of us who are in favor of a relatively strong social safety net would prefer that the beneficiaries of the safety net not use it for destructive purposes.

                However, I also think most of us are realistic enough to concede that in a nation of 300+ million people you will inevitably find cases where people abuse the social compact in a myriad of ways, and that empowering the state to intercede to prevent each and every one of those cases is both impractical and undesirable.

                Sure.

                But I do think that there are more than enough people out there who are more than willing to engage in altruistic punishment when it comes to these things that they can fill in the cracks left by the state… and perhaps even they see it as better that it be done by the busybodies than by the state.

                And this is both predictable and understandable.Report

              • Avatar DarrenG in reply to Jesse Ewiak
                Ignored
                says:

                Fair enough, although you’re now risking a dovetail with the narrowly-averted Puritan/Calvinist pro/con flame war.Report

              • Avatar Jaybird in reply to Jesse Ewiak
                Ignored
                says:

                I understand a lot of things that I don’t agree with.Report

              • Avatar tom van dyke in reply to Jesse Ewiak
                Ignored
                says:

                And fair enough back atcha, Darren. JB writes, “I understand a lot of things that I don’t agree with.” I am no Calvinist.

                And I have resisted being third-man-in on yr colloquy with JB, altho we’re arguing on parallel tracks. Word up, BSK, my old friend and newly-minted enemy. That is not how gentlemen go about things.Report

              • Avatar Art Deco in reply to Will Truman
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                says:

                I suspect that if you are talking about replacing assigned counsel plans with salaried public defenders (an issue down South) or rendering mass transit more extensive, a greater quantum of expenditure would be necessary. These are, however, quite small components of the tapestry of common provision. By way of example, financing the deficits of the Regional Transit Service in my home town amounts to an expenditure equal to 0.1% of the personal income of those living in the service catchment. The public defender’s office is a consumer of similar magnitude.

                Then you got the big ticket items: law enforcement, schooling, long-term care, and medical care. I tend to the view that with schooling and medical care, you need a restructuring of benefits, not an increase in the quantum of public resources devoted. With regard to long-term care, the issue is less the quantum expended than how to integrate provision for it into people’s long-range planning and distribute burdens in an equitable manner; public policy has been groping for solutions for a generation. With regard to law enforcement, cops cost money, but you might be able to make some economies by replacing highly discretionary systems of sentencing (which can incorporate quite distended sentences) with a system of short and determinate sentencing. New York has been as successful as any place in the last 20 years in suppressing crime. However, the per capita prison population here increased 2.5 fold rather than 5 fold. There might be some lessons in that (then again their might not).Report

              • Avatar Jesse Ewiak in reply to Will Truman
                Ignored
                says:

                OK, I found the thread. I think stillwater was making a larger point and didn’t answer your specific question about cigarettes, so I truly don’t know what he’d say. Some liberals are more in favor of just direct cash grants to the poor instead of things like EBT. So he may have that opinion. Which I have mixed feelings about.

                I guess my issue with the ‘social agreement’ is that it’s a muddled social agreement. Is name brand food instead of generic food breaking the social agreement? Is getting a little exotic fruit instead of cheap bananas breaking the social agreement? Hell, is the occasional box of Oreo’s every other week breaking the agreement? I think the vast majority of people would say no, but a ‘loud’ minority would say yes, but if you really drilled down, they’re truly upset they’re paying for any of the poor person’s food in the first place.Report

              • Avatar Jaybird in reply to Jesse Ewiak
                Ignored
                says:

                Some liberals are more in favor of just direct cash grants to the poor instead of things like EBT.

                Some Libertarians are too.

                I guess my issue with the ‘social agreement’ is that it’s a muddled social agreement.

                Oh, absolutely. It’s very muddled.

                But it makes a kind of sense to me to see “Society” respond to the argument that “We, as a society, all have responsibilities to each other” with the argument that “hey, that means that they have responsibilities to us!”

                Especially if the argument behind EBT is that we are all in this together.

                Hell, on Burt’s site, we were discussing the whole “Government Taking Obese Children Away” issue.

                Personally, I find the concept appalling… much more appalling than I find the concept of obese children.

                But I can certainly see how folks, after hearing that we all have responsibilities to each other year after year after year might jump to the conclusion that we need to take a firmer hand with those folks out there that need one.

                We are all in this together, after all.Report

              • Avatar Stillwater in reply to Jesse Ewiak
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                says:

                Jaybird, That was a damn fine thread! The conversation continued for like, 7 days. Amazing.

                But, to get back to the topic, instead of focusing obliquely on the role of interconnected obligations plays in creating and perpetuating the drug war, why not just say it. How, in fact, do positive obligations create and perpetuate the drug war?

                Jesse: I answered his questions regarding cigarettes the only way I honestly could – that is, I have no idea what ‘society’ thinks with regards to using food stamps for cigarettes. My best guess view would be that most people have never even thought about and don’t care. But I’m happy to be wrong.Report

              • Avatar Jaybird in reply to Jesse Ewiak
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                says:

                How, in fact, do positive obligations create and perpetuate the drug war?

                That’s what I was trying to do. I was trying to get from here to there.

                I couldn’t even get people to agree that society had certain expectations which, it seems to me, stymied my argument from the very beginning.

                I mean, if we can’t even agree that society thinks that food stamps ought to be used for food, we won’t be able to establish something as complex as societal resentment as a driving force of policy with regards to the drug war.

                I see you still hold that you have no idea what society thinks about stuff.

                Mmm hmm.Report

              • Avatar Stillwater in reply to Jesse Ewiak
                Ignored
                says:

                Here’s a tip: don’t be so concerned with getting my agreement along the way. Just state the argument, I’ll read it in good faith and then we can go over quibbles about premises.

                And look, my disinclination to form a view of what ‘society’ thinks about things isn’t trickery: really, I don’t know. Since I don’t know, I will take your word for it that yes, society in general, the majority of people, holds that food stamps ought not be used for cigarettes.

                Now, can we move to the next premise?Report

              • Avatar Stillwater in reply to Jesse Ewiak
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                says:

                Jaybird, what I think about society really shouldn’t be a factor in this argument. Should it?Report

              • Avatar Jaybird in reply to Jesse Ewiak
                Ignored
                says:

                There are many things that I am trying to do with the argument, Stillwater.

                I’m trying to establish premises, relationships between the premises, the truth of these premises, and, from there, a conclusion.

                If the person with whom I am speaking cannot agree on one of the most foundational of my premises, there’s noplace to go from there.

                You claim a hard agnosticism when it comes to attitudes about food stamps being used for cigarettes. You don’t know that society disapproves. You don’t know that society has even thought about it.

                The idea that society disapproves of such things as food stamps being used for smokes provides a pretty foundational premise for my argument about society’s attitudes about welfare and the drug war.

                If you can’t agree with this foundational premise because you just don’t know how people would feel about food stamps being used for cigarettes, then we’ll never get anywhere within this argument.

                Our experience of the world and society are too different for us to be able to have a conversation beyond “hey, how ya doin'”.Report

              • Avatar Stillwater in reply to Jesse Ewiak
                Ignored
                says:

                Jaybird, How about this: I agree that if you canvassed every single American and asked them ‘Do you think food stamps should be used for food?’, a large majority of them would say yes. Does that commit me to the claim that ‘society’ thinks that people ought to use food stamps for food? Then so be it. That’s what society thinks.Report

              • Avatar Jaybird in reply to Jesse Ewiak
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                says:

                Didn’t see this. I’ll try to put together a post.Report

              • Avatar Michael Drew in reply to Will Truman
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                says:

                This is an awesome list, Will. Especially point #7, namely that if you live in a crappy, dangerous neighborhood with horrible schools (even with vouchers!) because you are poor, but you have three HDTVs, three DVD players, two refrigerators, a state-of-the art blender, and a jacuzzi (and possibly the credit card debt to go along with it, YOU STILL LIVE IN A CRAPPY, DANGEROUS NEIGHBORHOOD WITH HORRIBLE SCHOOLS EVEN WITH VOUCHERS BECAUSE YOU ARE POOR (as defined by, uhh, how much income you have in a year)!!!

                The only thing I would say is that “liberals” (the thing you say you aren’t) don’t necessarily claim that redistribution only goes to those who *need* it. They just claim, when they defend some given instance of redistribution, that the results are better if it happens than if it doesn’t, and that your liberty, whatever you might think about it, isn’t actually infringed to an unjustifiable degree as a result.Report

              • Avatar Art Deco in reply to Michael Drew
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                says:

                It is a reasonable wager that the Democratic caucus in the local legislative bodies will as a rule be at best ambivalent about a project of improving public safety or improving the quality of the schools. Both require formulating fixed standards (behavioral and academic) and actually enforcing them on the public and providers alike. A great many patron-client relationships would be upset in the process, among other things.Report

              • Avatar Michael Drew in reply to Art Deco
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                says:

                Yes, well, that doesn’t change the fact that poverty is what forces the people who live there to live there. With exceptions, of course.Report

              • Avatar Art Deco in reply to Michael Drew
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                says:

                A great many impecunious people do live in slums. That aside, income redistribution, whether advisable or not for whatever reason, does not improve the quality of the schools or the safety of the streets.Report

              • Avatar Michael Drew in reply to Michael Drew
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                says:

                While i do debate the politics of redistribution in America elsewhere in this comments section, here, in this sub-section, the question Mr. Truman was addressing that I thought worth commending was just how to judge the brute fact of poverty in the midst of the (perhaps seemingly?) increasing levels of material acquisition that the presumably poor seem to be exhibiting. What does this mean for assessing levels of poverty that exist in the country? That’s what we’re discussing here. The question of consequences for redistributive policy is another a large sequential step that I simply wasn’t implicating in my main response to Will. (The quick note on liberal justification for redistribution was entirely independent of the consideration of the meaning of Heritage’s observation of the material acquisitiveness of those with low incomes for the question of real poverty.)Report

  14. Avatar tom van dyke
    Ignored
    says:

    I did make a case on cable/satellite TV, a running expense, but not TVs themselves. I don’t see anyone on this thread complaining about luxury items costing a few hundred dollars, although I might have missed one. Perhaps I’m misreading your comment here, EDK, but it seems directed at a misrepresentation of my view, or at someone who doesn’t exist atall.

    As for

    Too often, I suspect, people who play semantics with these terms have never suffered from very much need themselves and have a flimsy-at-best sense of what constitutes poverty in this country.

    I certainly hope this doesn’t apply to me either. I don’t trot out my autobiography much, but I grew up poor, albeit not needy, and can tell the difference.Report

  15. Avatar tom van dyke
    Ignored
    says:

    The answer is to address the points. Going after the messenger simply allows the message to stand among people who don’t view the messenger in quite such a negative light.

    Thx for that, WT. If there are any such people hereabouts. But the points can’t be “addressed,” only discounted, and that has been the tactic.

    And $50 a month does not a wealthy person make.

    Oh, I reckon the avg is higher than that. Some on lifeline @ $30, most at $50-$150. This stuff adds up, and it buys a lot of beans and rice. However, I don’t expect the professional social science establishment to study it; all we have is Heritage and a handful of others with very limited resources who mostly make do with re-analyzing the data gathered by the establishment.

    The microwave figure [only 81.4%] gives me pause: Since new they’re only 100 bucks and mebbe $20 at the Goodwill, this says to me that some people aren’t cooking @ home atall, meaning they eat out instead. [Re-analyzing data. 😉 This one gets a flag on it.]

    More broadly still, we’ve created a society that simply doesn’t account for the poor.

    Can’t hang here. We’ve accounted for them enough to drive us into bankruptcy. [Halving the defense budget nets ~$400B a year; Clinton tax rates net <100B. The deficit is ~1.4B. Numerical literacy remediation moment brought to you by the vast RWC.]

    Shirley at least half of the national discussion is what to do about the poor. One party is out of business without them!

    But a fair and judicious outing, WT. Tip o'brim.Report

    • Avatar Will Truman in reply to tom van dyke
      Ignored
      says:

      Oh, I reckon the avg is higher than that.

      I doubt it, actually. You have some getting the extras, but you also have a lot getting cheap $30/mo cable from their apartment complex. A lot of the frills aren’t even available in low-rent apartment complexes.

      And outside of apartment cable, if you miss enough payments, they won’t even offer the higher-end packages. Instead, they will talk about the unadvertised just-the-basics. And seriously, a lot of poor people will go month to month, cut off one and back on the next. That was the case at my satellite company. I’d imagine it’s true for cable, as well.

      We’ve accounted for them enough to drive us into bankruptcy.

      I was referring to structure, actually, not distribution. I go back to the transportation example (a car culture is great… if you own a car). Or health care being coupled with employment. We bundle school funding and the like with neighborhoods that intentionally price people out by refusing to allow apartment complexes or smaller houses. That sort of thing.

      I’ll let someone else tackle why we have a deficit.Report

  16. Avatar Sam MacDonald
    Ignored
    says:

    ” In a sane world we would have been able to go down to a nurse’s office where we would have been told upfront the cost of the procedure. We could have called around to five different offices, or checked on their websites to comparison shop.”

    But nobody wants to do this. They want “patient choice.” And the directon people lean in is to have this kind of procedure done by a world-reknowned ENT specialist, just in case it nicks an artery on the way out. Any move that’s seen as “pushing” people to a nurse rather than a specialist is seen as rationing care. Why should only the richest of the rich have ribbons removed from noses by the guy who runs the mayo Clinic?Report

  17. Avatar Greg
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    says:

    You would call several doctors looking for cheapest price while your daughter had foreign object in her nose? Wow, this is incredible. I think a parent who buys video game for their child has more parenting skills than you. Sorry.Report

    • Avatar E.D. Kain in reply to Greg
      Ignored
      says:

      Greg – I’ve addressed this same question earlier in the thread. Obviously few people would actually call around. The point is, if several clinics were competing with one another around town with transparent prices, they would inevitably have to compete for customers/patients and that would drive prices down. Likely many other factors would figure into a parent’s decision, such as word of mouth, etc.

      One other thing: don’t presume to come to my blog and criticize my parenting skills. That’s just a dick thing to do. A piece of ribbon stuck up a girl’s nose is hardly the end of the world. If it were possible, yeah, I might call around to check prices. Hell, I’d already be calling around to see who could take us in and when. So get off your fucking high horse. This may be the internet but we try not to act like it.Report

    • Avatar Greg in reply to Greg
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      says:

      The only reason I am being rude is because I am tired of the argument that if only we could call a few doctors while some emergency happens our healthcare system would be great. And somehow this argument is used by you while we discuss how many TV poor people have. This is not an argument. Anyone can say no to a TV. No one can say No to diabetes treatment. And if you break your leg you do not have a luxury to shop around. This is a fantasy. Sorry if I was harsh but anything in the nose of my daughter would drive me crazy and would force me to go to the nearest ER. I would never even think about calling several places for better price. It makes no sense. And simple evidence shows that this is not the case ever. yet the same argument is being made again and again. markets do not work in healthcare because consumer cannot refuse service. Period. So high horse or not, but you try to go without insurance for years because paying 300 out of 1200 salary makes no sense at all.Report

      • Avatar E.D. Kain in reply to Greg
        Ignored
        says:

        You seriously fail to grasp the entire point of my piece.Report

        • Avatar Scott in reply to E.D. Kain
          Ignored
          says:

          E.D.:

          I think he grasps this piece. I think it is silly on your part to think that prices for medical treatment can be made to follow prices for TVs. Of course a ribbon up the nose is not life threatenig so why not call around first. Frankly, it sounds like you are now angry that you didn’t ask in the first place and so you blame the system. But I’m also curious where you insurance was, which I assume you have.Report

    • Avatar Greg in reply to Greg
      Ignored
      says:

      How? In what way? You argue that healthcare competition would drive prices down. You write: “The trick is getting healthcare and education costs to follow a similar pattern.”. My response is that it is simply impossible. Why? TV’s are cheaper today because we have access to time to shop around. And if we do not like a price we simply do not buy it. This is the foundation of market: refusal of service. In healthcare it is impossible. If you take your child to a doctor and that doctor tells you your child needs urgent surgery for $1mm, you will find that million to get it done. Maybe 1 in a million will actually go home with sick child, Google her sickness, talk to specialists, find cheaper prices and so on. But guess what – by the time the cheaper price is found the child might be dead. So this is fantasy. Healthcare will never follow the same pattern as electronics. Education is a totally different thing. However, education does work like market today and yet prices keep going up. How uis education different from TVs? You have so many choices today it is amazing. From community to internet based to Ivy league colleges. Yet price inflation is huge.Report

      • Avatar E.D. Kain in reply to Greg
        Ignored
        says:

        There are many ways that healthcare spending is out of control, and it is not merely driven by emergencies. Obviously emergencies and major procedures are exactly what health insurance ought to be used for. In this country, that is hardly the case. However, even with emergencies and other major procedures, adding competition to the back-end of the supply side would help. One reason these are so expensive is the cost of supplies such as hospital beds and other medical equipment. There is no reason this equipment is as expensive as it is, except that they can get away with it thanks to our seriously screwed up healthcare system. Prescription medication is similarly wildly inflated. I could go on and on. It’s not just about the patient competing, it’s about all that competition that leads up to the point of sale.Report

        • Avatar Greg in reply to E.D. Kain
          Ignored
          says:

          I agree. However, based on stats I have seen most costs are incurred when patients are in emnergency situation. Long-term sickness is actually taken care of – insurance compnaies require all kinds of approvals and so on. Yes, medical costs are crazy, but they do not drive how expensive healthcare is. With long-term illness I have all the time in the world to shop around for better doctor and my insurance has all the time in the world to compare prices. And the medical costs are so high because doctors and hospitals can basically charge whatever they want for ER like stuff. No one will ever say no. And not because we are stupid.Report

  18. Avatar Greg
    Ignored
    says:

    What is the point of this useless statistic? TV can cost as little as 100 dollars. Is Heritage claiming that poor should live in small houses with no electricity? How about we run stats on how many cars rich have today versus 20 years ago and base taxes on that? Or how many houses? What is it supposed to mean?Report

    • Avatar Jaybird in reply to Greg
      Ignored
      says:

      That things that were within living memory considered luxuries are now ubiquitious and, as such, the term “poverty” is relative… which changes the dynamic in any conversation about poverty that makes moral claims.Report

      • Avatar Mike Schilling in reply to Jaybird
        Ignored
        says:

        And some become necessities. I recall an uproar locally about giving homeless people cell phones, but their purpose was to allow them to call and receive calls from prospective employers. I don’t think I could do a reasonable job search without using the internet, nor could I keep in touch with my kids’ schools without e-mail.Report

  19. Avatar Buckeye Surgeon
    Ignored
    says:

    I love how ED Kain just assumes that a “minor procedure” like extracting a foreign body from a child’s nasopharynx shouldn’t cost anything more than 20 bucks. It cracks me up, the entitlement some people have vis a vis their perception of what physicians owe their patients and how much patients are willing to pay for such care.

    Where is the similar outrage for the plumbers who charge 80 bucks just to come to your house and won’t repair the leak unless you write them a check for $250 bucks on the spot. When your muffler goes out, you have to pay. When your kid needs braces, you pay. When your AC goes down in July, you grumblingly pay the outrageous repair costs. No one blogs about those annoyances. Like taxes and death, we just “deal with it”. But health care is a different story. Those nefarious doctors should be ashamed of themselves for even contemplating asking for an appropriate remuneration for time/expertise. There should be a value menu hanging in the window of their offices. Any procedure more than 19.99 is outrageous! Extortion!Report

    • Avatar E.D. Kain in reply to Buckeye Surgeon
      Ignored
      says:

      1) The ‘procedure’ took all of a few seconds. It required no special tools, only a little special knowledge that I’m sure any nurse would have also had. This isn’t entitlement, but that’s a nice way to dismiss someone’s argument in any case.

      2) There is plenty of outrage over plumbers. But we aren’t facing a massive public spending crisis over plumbing fees, or debating the plumbing entitlement packages the federal government is trying to reform.

      Anyways, beyond a few false comparisons that utterly miss the point – do you actually, you know, have a point yourself? Or do you simply show up on blogs to bitch?Report

      • Avatar BlaiseP in reply to E.D. Kain
        Ignored
        says:

        Plumbers make on average about 40 to 70K a year, a lot closer to 40. In a large market, where you have to be licensed to work in high rises and other specialized environments, you might clear 120K after five years or so of work. Some plumbers do really well if you look at their gross numbers, but really, not all that well once you look at their insurance and union dues and other factors.

        As for children and what you might find in their nasopharynxes, well gosh, it’s the general rule of thumb that kids will stick curious thing in holes above their neck and adults stick ’em in the holes below.

        I’m getting to the point where I won’t work with MDs or health care practices anymore. The money isn’t worth it. What is it with anyone who sports FACS after his name? Do they have a secret initiation ceremony where they do an ego augmentation on the newbies?Report

    • Avatar Stillwater in reply to Buckeye Surgeon
      Ignored
      says:

      Your comment reminded me of art work and art prices. A piece of art that takes to artist three hours to make can be sold for (lets say) $1000. I’ve heard complaints that the hourly rate here is excessive. The artist’s response is that making the piece actually took three hours and a lifetime of practice.Report

  20. Avatar Buckeye Surgeon
    Ignored
    says:

    It takes me a few seconds to do a breast biopsy using ultrasound as guidance. I’ll take out your appendix in fifteen minutes. The relative expediency of a procedure is a poor rather poor indicator of the expertise/training/knowledge involved, wouldn’t you agree?

    The point is that no one hesitates to write a check for their air conditioning or a leaky faucet or their monthly bundled cable/internet/telephone service. Health care is certainly a train wreck in terms of costs and pricing. But to attack the individual doctors for charging fees that are, in many cases, less than what your tree pruning guy charges is beyond belief.

    You want to get at the root of the cost conundrum? Find out why Stryker knee replacement parts cost tens of thousands of dollars. Figure out why an MRI is 3 grand a pop. Explain to me the cozy White House/Big Pharm relationship that leads to experimental cancer drugs for advanced stage disease that cost hundreds of thousands of dollars for a 3 month course of therapy in the hope that the patient will live an extra 13 days.

    Is this “bitching”or simply dissent? I am not in a think tank. I am unsaware of the specific differences.Report

    • Avatar E.D. Kain in reply to Buckeye Surgeon
      Ignored
      says:

      Dude. If you can’t take time to read the piece, don’t bother commenting. Nobody is “attacking the individual doctors”. What a ludicrous thing to say.Report

      • Avatar Scott in reply to E.D. Kain
        Ignored
        says:

        E.D.:

        No, you aren’t attacking individual docs but you are attacking them in general. At least be honest about what you are doing.Report

        • Avatar Will Truman in reply to Scott
          Ignored
          says:

          I can be sensitive on the subject since my wife is a doc, but I don’t take it that way at all. I don’t fully agree with him, but it’s entirely possible to dislike the way that things are set up, without blaming doctors as a group. A lot of doctors dislike the way things are set up.

          Per my sensitivity, I almost came to doctors’ defense… but realized that I didn’t need to. The things he’s poking at is what non-doctors are and are not allowed to do. These are pretty legitimate questions to be asking, even if I think he (as with many, many other commentators on the subject) are a bit off-base when it comes to “the medical cartel”, what it is, what motivates it, and why exactly we have the system that we do.Report

    • Avatar Jaybird in reply to Buckeye Surgeon
      Ignored
      says:

      Is this “bitching”or simply dissent?

      It depends on if you decide to stick around.

      (Personally, I’d hope that you’ll talk to us as if you were the new guy at the poker table rather than as if we were all bitter ideological enemies.)Report

  21. Avatar Buckeye Surgeon
    Ignored
    says:

    Alright, I’ll try to stop being a dick. In the middle of office. But I get upset when people make a false equivalence between the “cost of healthcare” in general and what your personal doctor charges you for a visit or procedure. We general surgeons are paid 45% less today for a hernia repair than what we got 15 years ago. There is a primary care shortage crisis because many of those docs in low income areas can barely keep their heads above water. Increasingly, there is a disconnect between the spiralling health care costs and the remuneration paid to the very professionals who directly provide that care. It’s the ancillary aspects of health care (i.e new technologies, new drugs, new equipment, etc) that is killing us—-not the fact that you pediatrician billed your insurance company for $250 bucks. (As an aside, that same pediatrician probably did 8 well-child visits, 30 minutes each for 50 bucks a pop, i.e. less per hour than what they charge at your Toyota service station).

    Found this link via Sullivan.Report

    • Avatar E.D. Kain in reply to Buckeye Surgeon
      Ignored
      says:

      And this challenges my assertion that the pricing mechanism in our healthcare system is totally screwed up…how?

      Really, what you’re saying enforces my point that the whole thing is a tangled mess that makes no sense at all. Yes, new equipment, drugs, etc. etc. etc. drive costs. Largely this is because none of those things are exposed to any sort of real competition at all. Because of the way the insurance system works, people are pushed toward expensive specialists and away from general practitioners. The list goes on and on. The fact is, none of it makes sense and I don’t think it makes sense for doctors either, really.Report

  22. Avatar David Cheatham
    Ignored
    says:

    I find this list baffling. First of all, a refrigerator is not an ‘amenity’. Neither is a store/oven or a microwave. Those are _necessities_. It’s like citing how many poor people appear to own beds and light bulbs!

    Likewise, I suspect the percentage of poor people who own air conditioners is mostly the same as all people who own them, nationwide…and an air conditioner is also a necessary in many parts of the country, or are we going to pretend that 200+ poor people don’t _die_ in the 2006 heat wave because they don’t have one?

    Those crazy poor people, buying things so they don’t die.

    A clothes washer and dryer, of course, is also a neccessity, or you have to spend a lot of money at laundromats. I guess in Heritage’s universe, people shouldn’t wash clothes.

    Secondly, a lot of stuff on that list is _cheap_. Has anyone priced a VCR lately? Anyone wh0 paid more than $10 for a VCR got ripped off. Oh no, some people have more than one! And DVD players are almost twice the price! Of course, some of those poor people might have gotten them for free or whatever, but we’ll pretend they went out and spent our tax dollars on them.

    Ooo, and fancy cordless phones. Another ten dollars! And answering machines…people out of work don’t need those, potential employers can just telepathically call them whenever they’re at home.

    And I laugh at ‘ceiling fans’. Yes, the poor have, inexplicably, refrained from ripping the ceiling fans out of the home they’ve lived in for a decade to sell for $2 or whatever a used ceiling fan would sell for. The same thing with dishwashers. Those are part of the damn house! It’s at that point I realize the list is pretty blatantly dishonest…what’s next, how many of the poor own them fancy ‘doorbells’?

    Once we’ve removed the things you actually _need_ from the list, and things built into the home, and purchases that literally cost two days worth of food., you run into some interesting facts. For example, less than a third of them have internet, which I guess is the first necessity that gets cut back, instead of cable, which would seem to make more sense. (But, then again, you need a computer for internet.)Report

    • Avatar Member548 in reply to David Cheatham
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      says:

      heh… Air Conditioning a necessity… I was nearly 30 before I lived in a house with A/C and my Grandmother lived to be 96 and never lived in a house with A/C, and it was over 100 degrees here today, and that isn’t an unusual heat wave here either.

      Yeah, who knows, maybe a few people would be saved if everyone had A/C, and maybe a few more people would be saved if we all drove S class Mercedes, heck, we might save even more people if we all rode bicycles instead.

      It’s called law of diminishing returns. Worrying about if someone has A/C or not is ridiculous when there are much better, and important things that money could do.Report

      • Avatar Will Truman in reply to Member548
        Ignored
        says:

        People die from heat. This is not some theoretical thing. There’s no “maybe a few.” No “maybe.” No “a few.” Over 10,000 died in France due to a heat wave in 2003. One of the ways you avoid heat stroke is… air conditioning. There’s a reason that these deaths tend to most occur in places where AC is as common as it is in the south.

        You’re comparing this to a Mercedes?

        Beyond all of this, the underlying criticism here is not that we don’t buy everyone air conditioning, but rather that they are buying air conditioning for themselves. Except that they’re not, much of the time. They’re renting apartments that already have air conditioning in them. In my home state – a very red one – you can’t rent one without air conditioning.Report

        • Avatar Member548 in reply to Will Truman
          Ignored
          says:

          It doesn’t matter if the A/C is part of the house/apartment or not, if you bought the unit or not, if you have access to it, you have it, and A/C is a luxury both in it’s initial cost and continued cost, and there’s a few billion people out there that’d heartily agree.

          The easy data I pulled up shows 3,442 heat deaths in the US from 1999-2004, and a large percentage of that are people over 65, and the reality is that dying is what people over 65 tend to do, and I bet the vast majority of younger deaths were from exerting themselves out doors, not dying from heat stroke sitting in a chair indoors. I really don’t consider this some kind of out of control health trend as you have about the same deaths from falling from furniture in some way, 650 in 2000 for instance.Report

          • Avatar Jesse Ewiak in reply to Member548
            Ignored
            says:

            Hundreds of millions, if not billions of people don’t have easy access to clean drinking water. Are we going to classify that as a luxury as well?Report

          • Avatar David Cheatham in reply to Member548
            Ignored
            says:

            It doesn’t matter if the A/C is part of the house/apartment or not, if you bought the unit or not, if you have access to it, you have it, and A/C is a luxury both in it’s initial cost and continued cost, and there’s a few billion people out there that’d heartily agree.

            First off, things that keep you from dying are by definition not ‘luxuries’, and second, you have absolutely no evidence that the AC continues to be ‘continued cost’. That’s if they have it, not if they use it.

            In a good portion of the county, air conditioning units are built into every new building. As are dishwashers, and fricking ceiling fans.

            In your universe, the poor magically can go ‘Oh, no, the installation cost of the air conditioning, when avergaed over my rent payments, add an average $2. I better rent the identical apartment without the air conditioning installed that someone, for some insane reason, built next door, and also happens to be for rent.’

            Do you really not see how stupid this is? People cannot actually choose what’s built into the houses they are able to find and rent.

            And it’s even _stupider_ when you realize ‘the poor’ aren’t some magical group of people who have always been poor. Perhaps they used to do okay, and built a house with AC, and now they aren’t doing okay. As I pointed out, you can’t pull parts of your house out and sell them! (Well, you can, but it’s idiotic.)

            And, actually, it’s the same with pretty much everything on the list. It’s not like you can go and resell old TV. Oh, look, this poor person has a 27″ CRT, and a 17″ inch CRT in the bedroom, bought back when he used to have a job. I guess he should…sell them? No, no one will buy them. Give them to charity? But then other poor people will end up with TVs!

            I guess he should just smash them up, to demonstrate he’s really poor.

            About the only thing you could do that with where it would be worth, to sell something on that list you own, it is the Jacuzi…and I suspect the 0.6% of the poor are just renting somewhere with one. (Yes, it’s sounds crazy, but that’s not who _own_ one, that’s if their ‘household has one’. Way more than 0.6% of the poor are living with richer relatives, and a certain amount of those richer relatives are going to be wealthy enough to own a Jacuci.)

            Oh, and BTW, a significant portion of rental properties, especially the apartments that the poor are likely to get, come with cable TV for free. And a smaller portion come with internet.Report

            • Avatar David Cheatham in reply to David Cheatham
              Ignored
              says:

              And it’s even _stupider_ when you realize ‘the poor’ aren’t some magical group of people who have always been poor.

              Rereading my post, I realized something:

              Everyone here who thinks this study makes any sense seems to implicitly think the ‘the poor’ are some separate group of people who have always been poor, and have been receiving government checks this entire time so they can ‘rise out of poverty’, and shouldn’t have been wasting that money on luxuries. If they have just saved every incoming penny, now they’d have enough to…I dunno, buy their way out of it.

              Or perhaps they were operating on the cusp of poverty, and decided to go out and spend wildly, buying another TV and DVD player and a fancy ceiling fan, so fell over the edge.

              That is not how poverty works at all.

              Poverty has almost nothing to do with small one time purchases, small being defined as anything under $200. There are purchases that can be the difference between poverty or not, but they’re very large things, like cars and houses.

              Small purchases don’t get you into poverty, they don’t keep you there, and not doing them won’t get you out. People aren’t ‘poor by a few dollars’. Poor people are usually short by thousands of dollars, with a shortfall of $500 a month or whatever. Buying a fricking cordless telephone has nothing to do with it.

              There are things on the list that are expensive enough that the poor should not buy, like Jacuzis and big screen TVs, where the cost would make an actual difference to their budget…and we have no evidence people are buying those while poor. We just know they’re living in a household with them while poor. (Which doesn’t even mean they own them, much less purchased them after becoming poor.)

              Everyone who thinks ‘the poor’ purchasing a $20 coffee maker is a problem is a complete and total idiot who has no idea how poverty works…and I include the Heritage Foundation in that.Report

          • Avatar Will Truman in reply to Member548
            Ignored
            says:

            The chart says nothing about how often they actually keep their AC on (or at what temperature). Only that it’s there. And I never said it was an out of control health trend. What I said was that people die from it (which they do) and what I meant was that comparing a real quality of life appliance like air conditioning to a Mercedes is utterly absurd. Buildings and settlement patterns weren’t built around Mercedes. They were built around the existence of air conditioning (being in a house/building that is supposed to have working AC and doesn’t is a different experience than one that was built with air circulation and movement in mind).Report

  23. Avatar BSK
    Ignored
    says:

    I know the conversation here has probably died, but this seems a fascinatingly relevant part of the discussion…

    http://www.boingboing.net/2011/07/08/half-of-us-social-pr.htmlReport

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