Medicare vs. Universal Health Care: An Honest Question for the Right


Tod Kelly

Tod is a writer from the Pacific Northwest. He is also serves as Executive Producer and host of both the 7 Deadly Sins Show at Portland's historic Mission Theatre and 7DS: Pants On Fire! at the White Eagle Hotel & Saloon. He is  a regular inactive for Marie Claire International and the Daily Beast, and is currently writing a book on the sudden rise of exorcisms in the United States. Follow him on Twitter.

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372 Responses

  1. Avatar Glyph says:

    Hi Tod,

    Could it be just as simple an assumption of ‘-abledness’? That is, the elderly are presumed to not be as able-bodied (-minded), to go out and work to take care of themselves, whereas the poor (assuming reasonable physical and mental health) can?Report

    • Avatar Glyph says:

      actually, you kind of hit this with ‘senior citizen had either been born into different circumstances or made different economic decisions during their younger decades they would not need a safety net’ so maybe not.Report

      • Avatar Glyph says:

        On the gripping hand (I just like talking to myself) I really do think people in general are just more empathetic to the elderly, due to the -abledness question and the idea that they have paid their dues, so give them a break.

        Put another way – if I lose all my money to a Nigerian e-mail scam, y’all point at me and laugh. If grandma does, that’s sad, and we will try to bring the law to bear on the perps more vigorously.

        But if I lose the money now to the Nigerian scam and people laugh at me now, but decades from now need a safety net because I never recovered, people will still be inclined to give me help then. My dumb mistakes get ‘forgiven’ to an extent over time. While I am young, not so much. In part this may be an attempt at ‘shaming’, so I will hopefully learn not to do something so dumb again. With the elderly, it’s too late to learn any more lessons.Report

        • Avatar Tod Kelly says:

          So a variation of we like old people, but we don’t like poor people?

          (The Nigerian scam analogy was awesome.)Report

          • Avatar Stillwater says:

            I think it’s more like this: as you age you lose your bootstraps.Report

          • Avatar Glyph says:

            Well, it’s not that the Right (which to be clear, I don’t consider myself part of) ‘don’t like’ poor people. I think that’s uncharitable. The Ants may have ‘liked’ the Grasshopper just fine, he puts out good tunes.

            But how else will the Grasshopper learn? The School of Hard Hnocks is always accepting new students.

            But Grandpa Grasshopper? That dude is AWESOME.Report

        • Avatar Will Truman says:

          Glyph, I think this is exactly right. There’s something in the American spirit about the ability to start and restart from scratch no matter what happens. With the elderly… the opportunities for such are limited. It’s a different situation. Not so different that I don’t think, the question is worth asking (the degree of dissonance between Death Panels and Socialized Medicine is pretty extreme – I lost a lot of respect for the GOP at that juncture – but I do see how distinctions can be made.Report

          • Avatar Tod Kelly says:

            I’m not sure I agree entirely. My feeling about the response from the right hasn’t been one that celebrated the spirit of renewal (or anything) so much as railed against mooches.

            I didn’t see inspiration; I saw contempt.

            This might have just been my perception, of course.Report

            • Avatar Glyph says:

              Tod, I do think it is a question of perception – if you see me smack my kid on the butt, you might think ‘contempt’/abuse, whereas I might see it as needed and loving correction; unpleasant for both, but necessary.

              Now, is it better if I can instead ‘inspire’ better behavior? Of course. But sometimes the only way to learn something is the hard way. People who espouse this view are not just meanies who want everyone to die.Report

            • Avatar Will Truman says:

              Oh, I don’t think they sell it on the inspiration. But I think it’s lurking there. The contempt for the moochers is that, by and large, they could be working, but they aren’t (or aren’t working hard enough or whatever). Since the expectations for the elderly are so different, I think that does change the calculations at least somewhat.Report

              • Avatar Glyph says:

                Hi Will, maybe this belongs as another thread, but something else that occurs to me is that another reason most don’t kick too hard about supporting the elderly is because we *can*. We can afford to do so because we are on average richer than they were, and are.

                If this was not the case, we might be telling grandma to get on that ice floe, there just ain’t enough blubber to go around this winter.

                This ties sideways into a thread that Kyle Cupp had going, about possible tradeoffs between innovation and access. I believe pretty strongly that innovation is a primary driver of access in a feedback loop. So if artificially increasing access causes decreased innovation, then that decreased innovation will likely also eventually cause *decreased* access (access will either eventually get narrower or ‘shallower’).Report

          • Avatar Kimmi says:

            It’s a different situation. except if you’re a fucking immigrant. Start a business at 50+? That’s just what you’re expected to do. And it’s what people did, including my greatgrandparents,who came to this country virtually penniless.Report

  2. Avatar Koz says:

    Why can’t we start by considering the problem contextually. UHC might be good and might be bad, but the context in which the libs have tried to implement it is bad and therefore should be opposed and reversed?Report

    • Avatar Tod Kelly says:

      So Koz, are you saying that it’s just this version you find unpalatable, but otherwise you would support a government-supported UHC program that provided no-cost insurance for the poor or underemployed?

      I would have bet a pint that you would not.Report

      • Avatar Koz says:

        Tod, think in terms of process if that helps. The substance of PPACA is really bad, if there were another hypothetical version of UHC on offer, there’s a decent chance I would oppose that as well. But what’s really killing us is the way the libs have attempted to implement PPACA, things that implies about America and the consequences for it going forward.Report

        • Avatar Tod Kelly says:

          With all due respect, Koz, you’re substituting the questions asked for one you feel more comfortable answering. I get that you don’t support Obamacare.

          But assume it doesn’t exist, or that it gets repealed. The Right still opposes any UHC, yes? And they still support Medicare, yes?

          My question is, why is that?Report

          • Avatar Koz says:

            Ok, I can answer all those questions but the first thing to understand is that the answers aren’t abstract, they are contextual.

            Especially in the context of lib thinking surrounding the various iterations of PPACA, libs have gotten into the mental habit of trying to simplify the health care debate into abstract policy issues. Those things are important. But my point is either accidentally or deliberately that train of thought ignores what’s even more important in the whole situation.

            As just one case in point that ought to be obvious. The GOP supports the continuation of Medicare. They probably wouldn’t support the creation of Medicare as it exists today, if in fact it didn’t already exist. Therefore the question of whether the GOP supports Medicare is a contextual question. To ask it abstractly is missing the point (same goes for UHC in general obviously).Report

            • Avatar Tod Kelly says:

              So, it has less to do with the principals behind either Medicare or UHC, and more to do with the ability to win political battles?

              I don’t say this flippantly; this actually rings true to me.Report

              • Avatar Brandon Berg says:

                Right. Opposing Medicare is political suicide. There’s no point in blowing a bunch of political capital on a fight you can’t win.Report

              • Avatar Tod Kelly says:

                I think there is some truth to this in some quarters – I certainly would have anticipated your being against medicare, for example, BB, as well as other libertarians.

                But I am still convinced that a lot – a LOT – of the GOP rank and file love Medicare, and would fight tooth and nail against any form of UHC.Report

              • Avatar Jesse Ewiak says:

                There was a poll a year or so out that even 70% or so of Tea Party members don’t want cuts to Medicare or Social Security. I fully expect the GOP plan among “smart” conservatives who don’t want to blow up the world (aka Boehner/McConnell/etc.) was to get Obama to agree to a Grand Bargain w/ Medicare & SS cuts, run against those cuts, then never do anything about those cuts once you win.Report

              • Avatar Stillwater says:

                There is wisdom in those words. The “bait-and-switch” is a tried and true political winner for the GOP, even tho it’s based on deception. But ironically (or incoherently) the conservative base eats that shit up. Conservatism cannot fail, even if realizing the Dream requires being outright deceitful.Report

              • Avatar Koz says:

                Getting warmer, though I’d venture that that’s a pretty reductionist way of putting things, and that too misses the point.

                What’s more important is the changing perception of the resources we have available (specifically about Medicare though it applies to health care in general as well). There’s an important point here that’s worth stating explicitly: a resource is something that we have credible operational control of. Just because some valuable thing exists, doesn’t mean that you or I or Nancy Pelosi can deploy it at will. As a result of many things, of which the prevalence of Demo unemployment is very very important, we have less resources than we used to.

                This is underlying the political food fights.Report

              • Avatar t-height says:

                This point is very true. Its always been about winning to the GOP rather than fixing this country for the better. For the last four years the GOP has worked twice as hard trying to get rid of the elected members on the right than trying to emprove this country. If you really love your country political parties shouldn’t matter. Don’t wait 4 year to try and better this country, try now because there is no guarantee you will win. Why would you want your president to fail!! If your President fail we all fail!Report

              • Avatar Murali says:

                and more to do with the ability to win political battles?

                Or more charitably, as conservatives, the longer and more established an institution, the more they support it (everything else being equal).

                To the extent that this is more a cast of mind than anything else. For any given set of reforms, presenting it as a minor modification of previously existing programs is more likely to garner conservative support. And possibly, putting all the reforms together into one bill satisfies something among the left (i.e. the sense that something useful has been done to solve the problem rather than merely tweak the system along the edges.)Report

              • Avatar zic says:

                Koz’s argument sounds like shockdoctrine, to me. Koz seems like he’s sayint, “There have been several severe shocks, constraints on the system.” Notice he left out the natural disasters, as in Japan. “Because of these shocks, we must continue doing what we’ve already been doing — giving Medicare to the old folk, cutting taxes on the wealthiest, living with paying high prices for being the worlds’ pharmaceutical guinea pig and denying the sick health insurance because we cannot figure out how to control costs. Better not to try.”

                A mild version of shock doctrine.Report

            • Avatar Stillwater says:

              The GOP supports the continuation of Medicare.

              That’s not true. The GOP supports the continuation of a policy in which federal funds subsidize health care for the elderly. They do not, however, support Medicare (unless what you mean by “supporting Medicare” is dismantling it).Report

              • Avatar Snarky McSnarkSnark says:

                I think that most Republicans support MediCare, but the conservative movement base (i.e. the most “conservative” third of the GOP) is opposed to it on principle.Report

              • Avatar Stillwater says:

                (pedantry) This may be a semantic point, but I think it’s an important one: Republicans (in the House, surely, if acceptance of the Ryan plan counts as evidence of their beliefs) do not support Medicare as we know it, as the term is conventionally understood. What they support is ‘Medicare’: providing federally funded subsidies to the elderly to purchase private insurance. (/pedantry)Report

              • Avatar Koz says:

                “The GOP supports the continuation of a policy in which federal funds subsidize health care for the elderly.”

                Again, this is stripping the important context. It certainly is reasonable to say that the default GOP position is the Ryan plan. But even there, at least in the short term, say less than three years at least, I’d expect the continuation of typical fee-for-service Medicare will be the fallback GOP position, certainly above abolishing the whole thing.

                And that was the GOP position for about 25 years or so. The reason why it isn’t now, and why the GOP hasn’t been punished politically for advocating the Ryan plan, is lack of resources, just what I said before. Specifically, I’d venture that the perception of the social good that Medicare provides is pretty much the same as it was at the time that President Johnson created it, but the perception of the resources that it takes to provide it has changed wildly. (In fact, a substantial part of lib advocacy at the moment is engineer to avoid the acknowledgement of that very fact.)

                Therefore, for substantive and political reasons both, it’s important to ask, at the creation of any policy, what resources are required to implement this policy and what resources do we have?Report

            • Avatar Jeff says:

              The GOP supports the continuation of Medicare.

              No, they don’t. They would love to privatize it (and Social Security) into extinction, but realize that the Tea Party Idiots they have supporting the GOP won’t go for that. UHC is Socialism for “them”, Medicare is a right from God for us.

              -10 history fail.Report

              • Avatar Patrick Cahalan says:

                Jeff, don’t confuse “privatize it” with “privatize it to extinction”.

                A goodly number of elderly conservatives who don’t want Medicare to go away would probably support privatizing Medicare, believing it would make it better.

                Whether or not that is the outcome is different from the intention.Report

              • Avatar James Hanley says:

                The worst possible outcome is always my political opponent’s intention.Report

              • Avatar Chris says:

                That’s why my political opponents are so dead set on killing puppies and breaking up rainbows.Report

  3. Avatar trizzlor says:

    We have Medicare for the old, SCHIP for kids, and Medicaid for the poor, everyone else either doesn’t want insurance or isn’t trying hard enough. All of these programs would benifit from aggressive cuts and privatization.Report

  4. Avatar Angela says:

    One distinction between UHC and Medicare (and SCHIPs-type programs) is the expected need for health care.

    Both as a younger child (0-15 years old would be my personal range if forced to pick) and as an older adult (50+ ditto) the need for regular health care is important to catch and treat medical conditions. For healthy people 16-50 years old, you don’t really need to see a doctor until something happens (broken bone, cancer, migraines, pregnancy, etc). It’s still important to have health insurance in case something unexpected happens, but the point of the insurance is to handle the risk of something that can’t be planned. The need for health care is actually pretty low.

    Using myself and extended family as assumed typical cases: we go years without seeing doctors. I expect this to change as we move from the 40s-50s into the 60s-70s. My parents and in-laws see doctors much more frequently. Even though I have really good (employer-provided) insurance, I still don’t go until my spouse nags me about how long it’s been between mammograms.

    OTOH, a nephew with mild CP will always need health care his whole life. Loosing affordable health care when he’s no longer covered by his parent’s insurance will be devastating. His health challenges have been identified while a child, and aren’t going away just because he’s becoming an adult. He doesn’t need insurance (managing risk) he needs health care.

    We go to the dentist (really dental hygienist, but that’s another argument…) regularly for cleaning and checkups. I have dental insurance which pays for some of the care. Looking at the terms of the insurance, it’s clear it’s more pre-paid care (preventative cleanings covered at 100%, reconstructive stuff at 50%) rather than risk management for some unexpected care.

    So: Your request for the difference between UHC and Medicare: Assumed need for health care, based on the aging body.

    Note: I am definitely not a spokesperson for “the Right” but this was always a distinction that made sense to me.Report

    • Avatar MaxL says:

      “For healthy people 16-50 years old, you don’t really need to see a doctor until something happens (broken bone, cancer, migraines, pregnancy, etc).”

      This is precisely the reason that private health insurers and their lobbies have had zero problem with both the very young and the very old participating in a UHC style public insurance plan rather than seeing them as lost customers. They are a bad risk and are not profitable to insure. Add to that pre-existing condition exclusions, and this is also why the status quo is unworkable.Report

      • Avatar Brandon Berg says:

        They are a bad risk and are not profitable to insure.

        That’s not how insurance works. Anyone can be insured profitably; it’s just a matter of setting the premium correctly.Report

        • Avatar Kimmi says:

          bullshit. gulf coast. flood insurance.
          Or maybe we ought to just say it’s real fucking easy to have premiums get too high to be affordable.Report

        • Avatar MaxL says:

          OK, check that. They are a bad risk to insure at a rate that both the market would bear without subsidies and be profitable for insurance companies.

          It is not difficult to see the path that we took getting to our current, awful system as one where:

          1) Taxpayers subsidize insurance for working age people via the health insurance tax deduction for businesses. This masks the real cost of both the plans and cost of services, allowing for greater profit at each point in both the business of health care delivery and insurance.

          2) Those that are not as profitable to insure (those more likely to be health service consumers: the old, the too-sick to-work, the very young) are shunted toward taxpayer financed UHC style programs. This is rent seeking by the insurance industry. Steering the structure of those programs towards fee for service payment plans is rent seeking by health care providers.

          3) And finally, patent laws siphon off trillions of dollars for protected drugs and equipment. There is no better example of rent seeking: taxpayer and consumer capital is extracted at an exorbitant rate by virtue of government granted monopolies. There is some benefit to research and development given by these patents because of the longer potential monopoly, but I venture that the return on taxpayer/consumer investment is terrible compared to direct research funding. We are talking trillions of dollars/year here.

          So, yeah, those without taxpayer subsides who fall into a more risky profile for health coverage because of age or past illness are not insurable at a rate that is both profitable to incumbent providers/insurers and affordable.Report

    • Avatar Tod Kelly says:

      First of all, excellent and well explained reply. This is certainly better than what I came up with.

      And saying that, I will counter with this:

      If the difference is what you say, then we agree it exists for people that need it, but any people are in anagram range where they almost vnever need it. Why not do everyone then, if the need is so small for the midrange ages, and have it cover the unexpected costs?

      I’m not sure I agree that it’s a convincing argument for me, but I can see the logic. I’ll be curious to see if more people from the Right agree with you.Report

  5. Avatar Brandon Berg says:

    I’m just a crazy libertarian, but yes, definitely, Medicare is clearly federal overreach under any good-faith reading of the Constitution. It’s also highly redistributive, since the tax is proportional to income but everyone gets the same benefits, and this is problematic for all the usual reasons redistribution is problematic.

    I suspect that there are two reasons Medicare is more popular among conservatives:
    1. Poverty in old age is more common than poverty in adulthood, and thus less blameworthy.
    2. People feel that beneficiaries have paid for it. This is nonsense, of course—it’s clearly redistributive. But people tend to be very bad at thinking clearly about income taxes, and often get confused about the difference between amounts and rates, leading to absurd rhetoric about the rich paying less in taxes than the middle class. I think most people honestly do believe that all or most Medicare beneficiaries have paid their fair share.

    And, of course, Medicare is more popular enough among the masses that it’s impolitic to speak against it, regardless of your true feelings.Report

    • Avatar DBrown says:

      You feel it is wrong to redistribute wealth when it comes to health care but it is fine for the poor and middle class to have their wealth redistributed to the wealthy thru the system of taxes that support of the DoD? The wealthy benefit vastly more thru their investments in the military supply companies than even the middle class, much less the poor. Where is your issue with this system that takes the poor/middle class tax money and transfers the majority of this wealth to the upper class via investment income generated by military industrial support companies?Report

    • Avatar Kolohe says:

      3. Old people vote, and vote Republican unless they have a good reason not too.Report

  6. Avatar Roger says:


    I have no issues with a transfer program from the young to the old or from those well off to those temporarily down on their luck. These are proper uses of insurance. We can increase our utility by building smart safety nets.

    That said, Medicare is not very well designed, though I could probably rationally (not politically) solve that with a pencil, a napkin and a few minutes of thought.

    Obama care is an even larger and more poorly designed travesty of economics and politics. It is almost guaranteed to further separate the benefits from the costs, to misallocate decision making, and to eliminate competition and proper incentives. It leads to more waste, more rent seeking, less innovation, higher costs, less effectiveness and longer term lower quality of life especially for the poor than if we did nothing. It is “nucking futs.”

    Does this answer your question though?Report

    • Avatar Tod Kelly says:

      Um, no. And it might just be that the question isn’t necessarily aimed at someone like you, Roger.

      I’m not talking about Obamacare at all. I’m more curious why about half the people in the country (and about half the well known political pundits out there) speak of Medicare as a Good and Necessary Thing, whether it be in its current form or a redesigned model – and yet are still against any kind of universal health care, regardless of the model.

      The only reasons I can think of are some form of selfishness (I will be old but I won’t be poor; I don’t want to have to pay for my parents’ care; etc.) or a desire to give out largesse for purely emotional reasons (I like poor people but poor people make me uncomfortable, etc.). I am assuming that this is because I am not seeing a Very Large Point that most of the GOP rank and file sees, and I want to know what that point is.

      Otherwise I have to create my own cynical and not very flattering excuses for why they support one so strongly and rail against the other so mercilessly, and I’d rather not do that.

      In other words, I’m not looking for someone like you or Berg to come up with a good argument about the way the system should work; I’m more curious about why so many people have such strongly held opinions that seem so contradictory to me.Report

      • Avatar Snarky McSnarkSnark says:

        I’d venture a guess that it boils down to two primary factors:

        1. It’s new. There’s a reason that conservatives are called conservatives. And that’s that they are resistant to new social and economic arrangements. And that is, in part, a healthy instinct: grand programs often have harmful or unintended consequences. Medicare has been around for the lifetimes of most of us, and it’s now a well-tread part of the social contract. HUC is new, and potentially very costly.

        2. The karmic model of society. Another part of the conservative soul (from my perspective) is an assumption that social arrangements are the exterior manifestation of a universal moral model (hence the acceptance of social heirarchies, relationships, and customs that favor one class of people over another). In this karmic understanding of society, there’s a reason that people are poor: they are unworthy. They haven’t shown the discipline, or character, or unity of purpose to transcend their condition. And for that reason, they are less deserving of social and economic benefits.Report

        • Avatar Tom Van Dyke says:

          Pretty fair, McS. It is the conservatives trying to save the Great Society, those parts that have proven to work and are indeed now in our societal fabric.

          As for the poor, there is a dimension of enabling, you know, the alcoholic family thing, being “enablers” of bad choices and bad conduct. When the safety net becomes a hammock, such careless charity is downright immoral.Report

      • Avatar Roger says:

        I think the arguments about politics are correct. It is a political idea, and is being attacked on political grounds.Report

  7. Avatar Michael E says:

    I’m all in favor of some kind of medical coverage* for people below a certain income level, but I don’t understand why it has to be so complicated. Food stamps are the best model I can think of for how medical care* should be paid for by the government, state and federal: You get a card loaded with money. You can spend the money as you see fit on the kinds of medical care you think you need and the government recharges the card based on whatever formula the pols have worked out with the lobbyists and the voters.

    The argument the Right likes to believe is that poor people have already proven they make bad decisions about money, so the recipients of “medical stamps” will waste the money on bad care. The argument from the Left is basically the same, that poor people are too stupid to know what’s best for them, so they need to be protected from the evildoers in the medical care system who will take the money and not give good service.

    Since I believe that people have the right to make bad decisions as well as good, then I don’t find the arguments from the Right or Left convincing.

    I think there are two steps that will make this entire problem much easier to deal with:

    1. Everyone under a certain income level, say $30,000 per person?, gets free medical care, via prepaid medical care card.

    2. Employers are no longer required to offer medical coverage for employees.

    I’m not saying these two steps will solve the problem, but I think they will get us closer the solution that will: Medical care is an economic good, just like all others, and giving people in the market the freedom to choose how much and what kind of medical care they get at the price they want to pay will lower the cost of the good.

    *Sorry, this rhetorical trick of calling it “health care” in order to use the word that has more moral oomph is total BS. “Health care” is when you take care of your health, you know, eat right and exercise and don’t smoke. We feel like good health is a natural right, so those who deny it are trampling on our personhood. “Medical care” is what we are talking about when we mean the commodity of drugs, devices, doctors, nurses and hospitals.

    Try it. Read these two sentences aloud:

    I want free health care.

    I want free medical care.

    Which one makes you feel more justified in claiming it?Report

    • Avatar Don Zeko says:

      I don’t think Dems think that poor people are incapable of responsibly managing their medical finances – we think that the notion of responsibly managing your medical finances is a total fantasy for almost everyone. Disease and injury create costs that are far too large, varied and unpredictable to be budgeted in a reasonable way.

      Also, what’s not justified about asserting a moral right to free medical care if you, a law-abiding citizen of an affluent democracy, get in a car accident or are diagnosed with MS? If somebody is unlucky enough to be born with Diabetes type I, do they really have no moral claim upon the rest of us not to suffer easily preventable disability or death if they can’t pay for their own (extremely expensive and predictable) treatment?Report

      • Avatar Michael E says:

        Don Zeko,

        Well, nobody has a moral claim on the rest of us.

        What the rest of us can do, and I agree we should, is figure out a way to provide ongoing medical assistance to others who don’t have enough money to buy it themselves. Bu this is because the price of medical care is artificially high, due to the intertwining of government and business in the medical care industry.

        I’ve offered my proposals for moving to a more free-market version of providing medical care, which will lower prices, as free markets do for all other economic goods.

        Do I believe people in America would be better off economically and in terms of their health if medical care were directly subsidized through taxation? Of course.

        Do I think the current members of our legislative and executive branches can develop such a plan? No. Nor do I see anyone in the opposition who could do so, either. Well, that’s wrong. “Could” they? Yes. “Will” they? No.Report

        • Avatar Jeff says:

          nobody has a moral claim on the rest of us.

          “You live in Colorado? Sucks to be you. Not my problem!” (This is the very person who will scream for help the loudest if disaster will strike him or his.Report

          • Avatar Michael E says:


            If you are one who believes that one person has a moral claim on others, do you I have a moral claim for you to not twist my words?Report

    • Avatar Angela says:

      I agree that “health care” vs “medical care” is a useful distinction.

      I also have a big issue between treating care and insurance as the same thing.
      Ideally insurance should be for managing risk across the population.

      Figuring out how to pay for and deliver normal, routine, expected medical care should be a totally separate discussion of how to handle expensive and rare care.

      (My own preference if I was dictator for the year: Universal coverage for all residents (citizenship status not an issue) with an approved list of covered services based on age. Services list generated by active practitioners in the fields, with ongoing review to prove the value (cost/benefit) of the treatment. Private moneys to pay for services not on the list, which are available for (private) insurance coverage.)Report

      • Avatar Snarky McSnarkSnark says:

        Oregon actually tried that model in their MedicAid program in the 80’s–it worked fairly well at improving outcomes, but the approach was ultimately forbidden by the Feds.Report

    • Avatar Will H. says:

      This is already supported, to some extent, in the tax code.
      You have to itemize to get the credit (meaning that if you don’t itemize, you’re better off by not claiming it), and it’s everything in excess of 7.5% of AGI.
      The amount of the benefit of doing this is dependent on the marginal tax rate.Report

      • Avatar Will H. says:

        …and I should have been more clear the first time around that persons with $30k or less in income would typically be better off with the standard deduction, or they don’t have enough in medical expenses to justify claiming the credit without other factors making it worthwhile to itemize.Report

        • Avatar Brandon Berg says:

          It has very to little to do with income. I was making six figures and still taking the standard deduction. Whether it’s worthwhile to take the standard deduction is almost entirely a function of how much mortgage debt you have, because mortgage interest is pretty much the only significant deductible expense middle-class people have.Report

          • Avatar Patrick Cahalan says:


            Which also is one of my problems with the mortgage interest deduction, as it makes other deductions live.

            Renters don’t get those deductions.Report

            • Avatar James Hanley says:

              Of course they don’t. Part of the purpose of the mortgage interest deduction is to encourage home ownership. Offering renters the same deduction would defeat the noble middle class purpose of that policy.Report

              • Avatar Kimmi says:

                except it doesn’t encourage home ownership. Except if your house is worth more than a set minimum. Say… $200 grand.
                Which is not the case for most middle class people, I’d venture to say, outside of the Boswash.Report

              • Avatar Brandon Berg says:

                Sarcasm not missed, but ideally they would eliminate the mortgage interest deduction rather than allowing the deduction of rent. Allowing deductions for personal expenses narrows the base and necessitates higher marginal rates.Report

              • Avatar Patrick Cahalan says:

                I would have no problem with a phased-out elimination of the mortgage interest deduction.

                Cutting it tomorrow would put yet another stab wound in the real estate market, on the other hand.Report

    • Avatar Jesse Ewiak says:

      Both feel fine to me. I’m a dirty liberal. 🙂Report

    • Avatar zic says:

      Are you familiar with the Oregon Medicaid study?

      Basically Oregon had a small amount of money available to enroll additional people in Medicaid; more then were on the wait list. So they held a lottery, basically creating a test and control group of its impacts.

      One of the biggest discoveries was that people who won the Medicaid Lottery had fewer ‘financial mistakes,’ fewer bills in collection, fewer foreclosures, etc. then those who didn’t win.Report

  8. Avatar Tom Van Dyke says:

    “…it’s too late for the oldsters to make any more choices, Tod. But they live off the fat of the land—”gleaning” they called it in the Bible.

    But everybody can’t live off the gleanings. That defeats the whole purpose of farming in the first place. Medicare is a free rider, paying steep discounts. Everybody can’t be on a steep discount.

    I’m all for financing our county health systems as the provider of last resort for the poor. And we ignore charity and clinics in this discussions as well, as if they don’t exist, despite them contributing on the order of $40-50 billion.

    That is what we as a society owe them, some minimum but not full health insurance—that defeats the whole purpose of working a farm. Why bother to farm when you can live off the gleanings of the next guy’s place? And indeed, free health insurance makes people consume health care at a much higher rate, a trip to the doctor’s for the sniffles.

    There must be some sense to all this.”Report

    • Avatar Jesse Ewiak says:

      Which if of course why the US places last among major industrialized in use of tests, antibiotics, pharmaceutical drugs, and other uses of medical care. Because 70% of have to pay premiums unlike those free loaders in the Canada and the UK.

      Again, free medical care isn’t free food. Almost nobody likes going to the doctor. Yes, if we passed Medicare for All tomorrow would health care expenditure probably experience a big jump for a year or two? Of course, because sick people w/ no insurance or crappy insurance would actually take the needed steps to take care of themselves and we’d be better off in the long run.Report

    • Avatar Kimmi says:

      without someone living off the gleanings, you don’t get tomatoes. or onions. or broccoli. just corn.Report

    • Avatar Rod says:

      And indeed, free health insurance makes people consume health care at a much higher rate, a trip to the doctor’s for the sniffles.

      I have to push back a bit on this, Tom. Health care isn’t the kind of consumer good that you consume for pleasure (hypochondriacs aside). Even with insurance health care isn’t costless. You have to take off time from work–which for most of the targeted population for UHC means forgoing income, drive to the office or clinic, sit in line, etc. And then you generally have deductibles and co-pays to cover. In my case going to the doc is a real PITA since my work is basically the lower 48 (truck driver) and scheduled home time is more of a wish and a prayer than any kind of sure thing.

      Have you ever actually experienced free health care? I did, for the nine years I was in the Navy. Medical, dental, vision, all of it. About the only thing I had to buy out-of-pocket were eyeglasses other than the “birth-control” version they gave you for free. I observed actual behavior in that situation–not the economist’s hypothetical–and I can attest that demand isn’t unlimited and very few sailors would go the infirmary for the “sniffles” unless they were trying to get out of work. “Malingering” was the term for that. That doesn’t work so well when there exist incidental costs like I laid out above.

      On the other hand, when you have a genuine medical need, demand is extremely inelastic wrt price. If you get a diagnosis of cancer, for example, your priority isn’t finding the most cost-effective treatment. It’s finding the most effective treatment, full stop.Report

      • Avatar Tom Van Dyke says:

        But Rod, it’s right in the stats and studies that people use health care more often when they have insurance.

        Public health—clinics—kind of suck, so yeah, people use them more sparingly. But this is a built-in feature of self-rationing.

        I’ve been to County-USC when a friend came down with AIDS symptoms, spent a week there off and on. It wasn’t the greatest but neither was he permitted to die on the street. And he could have bought health insurance, he just decided not to. Enough of his income was off the books that the IRS wouldn’t have fined him anyway under the Obamacare mandate.

        So frankly, I’m proud that America didn’t let Dan die, but neither am I real happy that he didn’t hold up his end of citizenship. So if County-USC is a little on the crappy side, I don’t think that was unfair—and being a Republican himself, he himself was more grateful than resentful.Report

        • Avatar Rod says:

          Sure, I’ll concede that they use it more. That’s my bad for not being clearer–or having my thoughts more focused before I commented. So let me try again because I truly appreciate respectful conversation with you.

          The relevant questions are these: You claim “much higher rate, a trip to the doctor’s for the sniffles,” implying… what? That people with insurance trot off to the doctor for any and every little twinge and sniffle? Do you have insurance? Do you do that? If the answers to those last two questions are “yes” and “no” respectively, why do you assume others would behave differently? Men in particular are notorious for neglecting their health, with or without insurance.

          What I was pushing back against is the libertarianish assertion–which I stipulate is not specifically what you were saying, but pretty closely related–that health care is just another consumer good, like TV’s or cars. Zero cost to the consumer does not imply infinite demand. You economically demand the care that you need, but if you don’t need it, you’re not particularly interested. I currently have no need for a cast on my leg or high blood pressure medicine and I wouldn’t want those things just because they’re free.

          So, for me at least, my support for UHC is predicated on the same moral impulse that you laud, the impulse that resulted in the charity care being available for your friend, combined with my belief–which I feel is strongly justified theoretically and empirically– that a free market in health care is unworkably defective. The incentives just don’t work right.Report

          • Avatar Trumwill says:

            Warning: Anecdotal evidence! I shall proceed…

            If my wife’s experiences are any indication, it’s not just a matter of people going to the doctor for the sniffles. The bigger issue is, as my wife phrases it, people “trying to get non-medical needs met through medicine.” Pregnant women seeking reassurance, lonely people seeking interaction, hypochondriacs, and so on. For the reasons you outline, and because I am (ironically) inclined against medical care, I would not have thought it an issue. But it really does seem to be. I’ve heard more than one doctor (including some liberal ones) talk about how nice it would be if some of these patients had to pay just a mere $5 (sometimes $20) per-visit, because they think it would cut down on it (they might be wrong, though I don’t personally feel in a position to say so). It’s arguably the case that the kinds of patients they are talking about are very likely to be on government medicine under the current system anyway (Medicare and Medicaid patients having more time to do such things).Report

          • Avatar James Hanley says:


            Let’s distinguish between “some people” and “everybody.” No, not everybody will overuse low cost (to them) medical care, but some people will. That’s straightforward demand theory–lower cost increases demand in the aggregate, even if everyone doesn’t increase their demand. (Make sauerkraut cheaper and I still won’t buy it, but my wife will buy a lot more, etc.)

            People afraid of being called malingerers, as in your Navy example, have a countervailing incentive that offsets the incentive of lower cost. A guy with a job like yours (and kudos–I could never do that job) is not in a position to use much more. And some folks are just too proud and/or stubborn to go to the doctor until a bone’s sticking out.

            But not everyone is like that. I personally worked with a guy who said, “I know the doctor can’t do anything for a cold, but I go anyway when I have one because it doesn’t cost me anything and it makes me feel (psychologically) better.” There’re also the people who will insist on needless tests, just to rule out the remotest possibilities and put their minds at ease.

            It’s a difficult issue. We don’t want to discourage people from going to the doctor when they need to go, but we don’t want to encourage them to go when they don’t need to, or to demand care they don’t actually need. But the law of demand is present in health care as much as in any other good or service.Report

  9. Avatar DensityDuck says:

    Do we need to have another conversation about discussing things people said without actually presenting us with sourced quotes, and then claiming that you don’t need to provide sourced quotes because All Of Those People Always Act Like That?Report

    • Avatar Rtod says:

      Awesome point. I TOTALLY made up that part about the Right being against UHC.

      Great, great argument.Report

      • Avatar DensityDuck says:

        So, no, you’re not going to provide sources, you’re just going to invent a Theoretical Republican and tell us all how he’s wrong. There’s a name for that method of argument.Report

        • Avatar Snarky McSnarkSnark says:

          Seriously? You think you’re scoring a cogent point here?

          Come to think of it, the Republican Party seems about evenly split between advocates of Universal Health Care, and those who propose mandatory HBO subscriptions…Report

          • Avatar DensityDuck says:

            *sigh* All I want is some links to these quotes. Instead of doing the usual “I don’t have to dig up sources for any of this because everyone knows that niggers are thieves–um I mean that Republicans hate healthcare!”Report

            • Avatar Snarky McSnarksnark says:

              Perhaps you could save us both some time by naming a single national Republican politician that advocates for Universal Health Care (which is the assertion that you took exception to).

              Just one will do.Report

              • Avatar ktward says:

                I’ve just recently asked Mr. D the very same question. He never answered it for me either.

                It seems to me he’s being disingenuous for sport. He can’t possibly be that dense … ohhh.Report

              • Avatar M.A. says:

                This is why it’s pointless to discuss with DensityDuck, Tom Van Dyke, or James Hanley.Report

              • Avatar James Hanley says:


                How ironic that you would make that comment without linking to any examples to support your claim.Report

              • Avatar M.A. says:

                I named three. You’re one of them.Report

              • Avatar James Hanley says:

                No, you made an assertion. You didn’t provide evidence. That’s what Duck is objecting to, an objection you glommed onto while doing exactly the thing being objected to. That’s why it was ironic.Report

              • Avatar Koz says:

                I’m with Duck on this one. Not even so much because you might be wrong, but for clarity’s sake it’s worth agreeing or disagreeing with an actual prominent Republican as opposed to an impressionistic imputation of one.

                It wasn’t that long ago, while PPACA was working through Congress, that libs were working the exact opposite angle. “This can’t be that bad, the Republicans assured us they really want wider access to healthcare.” Really? Which Republicans were those?Report

              • Avatar Tod Kelly says:

                Is this in fact the case? If so, then it would certainly explain the contradiction (I think) I see. If so, I would be surprised.

                I would also be curious as to why they weren’t more vocal about it. It seems a politically expedient thing to trumpet, especially in a recession.Report

              • Avatar Koz says:

                It was. “Everybody agrees” we need to expand coverage, ban preexisting conditions, ensure affordable access, etc., etc. So that way they could delude themselves that PPACA was just arguing over details.


              • Avatar trizzlor says:

                Just one will do.

                Ten Democratic Senators and ten Republican Senators co-sponsored the Healthy Americans Act at one time or another, so when the rubber meets the road there are as many D’s formally for UHC as there are R’s. Historically, both S-CHIP and Medicaid were co-authored by Republicans. Be sure not to let this information get in the way of the general conclusion from this thread that Republicans are Randian sociopaths who like to fire people so they can watch them get poor, sick, and die young (presumably leave a good-looking corpse).Report

              • Avatar Kris says:

                Mitt Romney V. 1.0?Report

  10. Avatar Morat20 says:

    I think the answer is relatively simple, and goes back to some core cultural beliefs of Americans. (Even if, by and large, those cultural roots have been forgotten).

    Whether we remember the roots of these are not, there are a handful of things that Americans seem to believe deep down. (Or at least many believe.)

    First and foremost, if you are poor it is your fault. In specific, people will allow for context. In general, however, the poor are to blame for their poverty. Generally in conjuction with a core sin — sloth or hedonism. They are LAZY or they are on DRUGS.

    Reagan’s welfare queens dog whistle was so effective not because it appealed to racists ( though it did) but because it was equally effective with a large group of Americans who firmly believe the poor are poor through sloth and drug use, moochers off society.

    Many Americans believe this of the poor — and act accordingly. We despise them, hold them in contempt, and begrudge any attempt to help them. Whether conciously or unconciously, the belief is there that ALL that seperates the poor from success is hard work. (And, of course, stop indulging in alcohol or crack or pot).

    Whether you want to blame it on our ingrained rags-to-richs fables, all the result of hard work, or our Calvisnist roots –where the poor are poor because they deserve to be for their sins, and should never be anything but — is up to you.

    But the old? We ALL grow old. No choice you can make, no planning you can do, nothing can prevent it. You eventually grow too old to work. That’s a forgiveable weakness, one society is willing to plan for — although even now that’s under assault.Report

    • Avatar M.A. says:


      I’ve lost track of how often on radio the repetitive meme was that if the poor would just “get a job” (nevermind high unemployment conditions and the realities of the workplace), “stop having kids”, or avoid whatever the pet “vice of choice” right winger of the day was railing against, they’d all suddenly be millionaires.Report

    • Avatar Kimmi says:

      Too old to work? *ptsui* that’s like saying there’s an age that’s too young to work (3yr olds can work).Report

      • Avatar Morat20 says:

        I suspect the real reason Medicare and Social Security are under assault is because those making the calls come from a purely white-collar world.

        It’s one thing to work into your seventies (assuming you survive that long) if your job is behind a desk, in an air-conditioned office. That’s quite doable.

        It’s another if your job is blue-collar, and involves actual physical labor.

        It’s really easy for Ron Paul to talk Social Security and changing the retirement age (or outright ending it). He doesn’t need it, and his job means as long as he’s not actually required to wheel an IV around he can do it.

        But if his job had been construction, or carpentry, or any form of manual labor — he’d be well past the age of productivity there. The human body isn’t a machine.Report

        • Avatar Tod Kelly says:

          I don’t see either Medicare or SS as being under assault. I see a lot of people believing that the are in need of reform, usually for budgetary reasons. And even if you’re not inclined to agree with that viewpoint, it certainly doesn’t seem so outrageous a concern.

          But if there’s any kind of mainstream conservative movement to eliminate either, I’ve never seen it.Report

          • Avatar Kimmi says:

            Have you heard the mutterings on getting rid of the ADA?Report

          • Avatar Morat20 says:

            You don’t look hard enough then. Privatizing Social Security was on the list, and Paul Ryan’s Medicare “plan” was effectively the elimination of Medicare.

            Sure, he didn’t call it that and Polifact said it was true (apparently if you get rid of Medicare and replace it with an identically named plan, it does not count as getting rid of Medicare. Not their best moment), but that’s the effect.

            Replace Medicare with a voucher system that doesn’t even keep up with medical inflation? Anyone with the vaguest sort of attention span can see how that would utterly collapse — first and foremost, there is no individual market for health insurance policies for 60 year olds. Especially not those with health problems. So, yah voucher. It won’t pay for the insurance, but that’s okay, because no one’s selling it.

            The fact that it doesn’t even keep up with the rate of medical inflation is sort of meaningless. After all, it’s not enough money for your average 60 year old to purchase health care, it’s not even enough for them to purchase health insurance — which no one is selling anyways.

            Thing about Medicare is — it insures the most expensive segment of the health marketplace already — the elderly. Medicare SHOULD be the single most costly health-care system in the US, so costly that in essence an individual needs to start paying for it as soon as he or she begins working, because only by paying up-front is it even possible to break-even on the large scale. (Which is, by and large, how Medicare works. You pay now, when you’re young, to recieve when you are old. The fact that it runs as a pay-as-you-go system is immaterial. There’s lots of good reasons for the US government not to sit on giant piles of cash.)

            The King of the GOP budget plan wants to axe it and replace it with something that, flatly, cannot possibly work. The GOP has rallied around his budget as the future of the GOP program.

            I can’t imagine that not being “under assault”.Report

  11. Avatar Walter says:

    The thing is, everyone would benefit from UHC. We would all be better off. We would pay less, and get better services. Expect that conservatives would be deprived of seeing “the other” suffer. I think is a perverse addiction to the suffering of “the other” that drives some to oppose UHC. Here is a choice between two systems:
    A. I benefit the most, unfortunately the people I do not like also benefit.
    B. I do not benefit at all, but neither do the people I don’t like.
    What do I chose? Well, it depends of what I value the most, my own benefit, or the joy from seeing my enemies suffer. I may sound callous, but think about it. There is a tendency among conservative of “my way or total destruction.”Report

  12. Avatar Will H. says:

    I don’t see anything wrong with expanding Medicare to include basic coverage for all people. Or the VA system, for that matter.
    But I believe the coverage should be basic, and should be limited to annual caps.

    I remember reading an article by a psychologist that was talking about the decline of the conventional talking therapy. A big part of this is that insurance typically covers medication, but not therapy. As a result, we have the highest per capita rate in the world of persons on long-term medications.
    I say pull the plug on the medicine cabinet and get people into treatment.

    We need to have something basic that prevents treatable conditions from becoming severe long-term conditions.
    And I think a network of catastrophic injury protection and end-of-life care policies should make up the difference.

    I have life insurance, as well as a death benefit from my union, and some other stuff I’m not even sure what it is. I don’t expect UHC to alleviate the need for that.Report

    • Avatar Snarky McSnarkSnark says:

      Two questions:

      1. How do you define “basic?”

      2. Why caps? Catastropic care is the area of largest concern.

      I completely agree that we need to establish limits on coverage that will allow for cost control. And that’s more likely in a VA type of system than a Medicare type (different incentives).

      But how you define “basic” will have an awful lot to do with how manageable your future medical costs are going to be. Will it include:

      Conditions that are annoying but not life threatening? (e.g. Moles? Cataracts? Flus? Acne?)
      Expensive treatments? (Patented-protected chronic conditions? Liver transplants? AIDS? Heart bypasses? Mood disorders? AIDS?)
      Extensive end-of-life care? (Maintenance of brain-dead patients?)
      High cost-to-benefit treatments? (UV therapy for psoraisis? Lower back surgery? Prostate management?)

      Medicare has a pretty much “pay for it, regardless” policy, and as a result it is threatening to overwhelm our economy in the long term. And yet, if there is any talk of “rationing” there is screaming about “death panels.” We cannot have reasonable universal health insurance without establishing some limiting principles. What would you propose?Report

      • Avatar Will H. says:

        Personally, I would propose $2k/yr limits.
        What “basic” means is really the big sticking point.
        But with catastrophic injury & end-of-life care off the table (to be covered by supplemental policies), expenses could be managed somewhat; surely not perfectly, but better than they are now.

        Now, I’ve seen people on disability from the state for being too fat to work and for being an alcoholic– both of which conditions are exacerbated by maintaining the illusion of self-sufficiency. I would support group homes for most of those types of individuals, as well as making them available for seniors.
        Section 8 was a good idea for seniors, but it was another program where eligibility expanded exponentially until it made it unpalatable for everyone.Report

        • Avatar Snarky McSnarkSnark says:

          8 years ago, I had a kidney stone that ended up costing about $7k after insurance. Are you saying that I–had I had UHC–I should have been left to suffer or die?

          Did you know that median health care expenses are about $8k per person-year?Report

          • Avatar Jaybird says:

            Is there a dollar amount above which we should be willing to say “okay, we, as a society, think this money would be better spent on the Rock and Roll Hall of Fame”?

            Is there any limit to the dollar amount of medical care that any individual should expect society to provide?Report

            • Avatar Kimmi says:

              Two things here:
              1) Limits of practicality: Let’s say that everyone decided that large amounts of plastic surgery were necessary. $100,000 a year, every year. Obviously we couldn’t afford that.

              2) …? “doesn’t help” care.Report

              • Avatar Jaybird says:

                One can of worms that I’d enjoy seeing someone else open and/or engage with is the whole “should bullshit be covered?” part of insurance.

                Multivitamins? Chiropractors? How about those ring bells and smell essential oils people? (I have loved ones who tell me to use “Thieves”.) What about homeopaths?Report

              • Avatar Kimmi says:

                multivitamins prevent headless babies. I vote we keep those.
                The rest can go to hell.

                I’ll give some amount of credence to “placebo-based medicine” if they’re willing to make it ethical. Patients gotta agree beforehand, and there needs to be good guidelines for when “you’ve gone too far”Report

          • Avatar Snarky McSnarkSnark says:

            Don’t know: a limit would be entirely appropriate. I wouldn’t be willing, as a taxpayer, to contribute my portion of the $200M that it might cost to pay for a body transplant.

            But the $2K/yr that Will was proposing seemed kind of unreal…Report

            • Avatar Will Truman says:

              I’m not making a point here, I just thought I would link to this story because it’s really interesting.Report

            • Avatar Will H. says:

              I was thinking of $2k/yr max prescription coverage.
              My bad.
              But I’m sure there’ s a way to come up with some real figures that covers basic services for everybody, but still would leave enough out to incline people to purchase supplemental policies.
              The more that goes into the “basics” pile, the less needs to be covered by supplemental insurance, and the cheaper it becomes.Report

              • Avatar Kimmi says:

                so, basically, Zyrtec, prescription grade. Or birth control pills, your body is weird-grade. And nothing else.

                Not to poke holes for no reason, but without insurance, things cost an awful lot more than most people are used to.Report

              • Avatar Will H. says:

                There’s only so sick you can get, and then you die.

                Regardless of the level of technological advancement, if there is no means to pay for it, the technology is unavailable.Report

          • Avatar Brandon Berg says:

            Did you know that median health care expenses are about $8k per person-year?

            That has to be mean, not median. $8,000 times 300M is $2.4T, which soudns about right for total health care expenditures. Since health care expenditures are distributed very unequally, the median has to be much smaller than the mean.Report

            • Avatar Snarky McSnarkSnark says:

              You’re right.

              I spent some time Googling for some more real numbers, but they seem hard to come by.Report

            • Avatar Will H. says:

              I think medications are actually a greater expense than a diagnostic visit, unless you’re getting a cat scan or something.Report

          • Avatar wardsmith says:

            Snark, interesting that you had a kidney stone. Are you familiar with extracorporeal shock wave lithotripsy? Are you familiar with its (non)coverage history with Medicare?Report

            • Avatar Snarky McSnarkSnark says:

              I know about the therapy, but my stone was waaaay too tiny to merit it. The main thing I know is that it can bruise the daylights out of you.

              Why is it non-covered?Report

              • Avatar Will H. says:

                Whatever the basis for the criterion of coverage in your own particular case, were we funding the matter as a public, it would likely be to the extent that occupation is affected which would be of primary concern.
                Have to get people well so we can tax the fish out of them.Report

              • Avatar wardsmith says:

                Correct, Medicare covers it NOW, but didn’t for decades and still won’t cover ESWL for some other similar problems. It always seems silly to me when big monolithic government agency determines that it is somehow better to do an invasive surgery (for example) with all the complications that entails while not being interested in cheaper and more effective options. Blaise, you already are well aware of my distrust of big everything, gov’t, business, banking, it is all the same, once it gets too big, it is too big period. At least when corporations get too big they [can] get chopped up. Not so easy with governments.Report

              • Avatar James Hanley says:

                At least when corporations get too big they [can] get chopped up. Not so easy with governments.

                “War! What is it good for? Absolutely….something?”Report

              • Avatar Snarky McSnarksnark says:

                Sing it again!Report

              • Avatar BlaiseP says:

                There’s a straightforward way of dealing with Big. Assigned designated handlers. When a problem develops inside IBM, they’ll assign one person to deal with that customer. He’s the single point of contact. You’re not dealing with IBM, you’re now dealing with Joe McCormick. Joe’s your guy. He’s your Customer Engineer.

                Thus, a huge bureaucracy can be reduced to a single thread of conversation. Joe can work the bureaucracy. It’s just like in the military: only two people you never, ever piss off: your supply sergeant and your first sergeant. I wish more people understood how to work a bureaucracy. When those support people at the other end of the wire pick up the phone and say their names: write them down. When they give you a case number, write it down.

                We fear and distrust what we don’t know. A good bureaucracy doesn’t have to be monolithic: given a chance and a decent attitude from both the CE and the client, you’d be amazed how flexible a big bureaucracy can be.Report

              • Avatar DensityDuck says:

                So it’s possible to get what you want from an interaction with an objective impartial unemotional system that’s focused on absolute equality…just so long as you create a good personal relationship with the right people.Report

              • Avatar BlaiseP says:

                To a large degree, yes, absolutely. A bureaucracy is composed of individuals, each of whom must balance two objectives: their own and that of the bureaucracy.

                Dwight Eisenhower was a middling cadet at West Point but rose to lead the Allied forces in Europe. When one of his more punctilious classmates was promoted to the rank of General, Eisenhower scornfully observed that man had never bent a rule in his life.

                Bureaucracies aren’t about equality. You’re just being obtuse, but then you always are. Hardly worth replying to you at all. Bureaucrats give life to laws. Cops are bureaucrats, they’re tasked with enforcing the law. Firemen, social workers and the like, all given mandate by legislatures. You just want to make up some straw man.

                The genuinely awful bureaucrats are in the civilian world: they make up the rules as they go along but never shall we hear a word on that subject from you, nossir. A government bureaucrat is accountable to some public figure.

                The only reason a bureaucracy seems unemotional is because it lacks a face from which we might infer emotion. My scheme puts a face on the bureaucracy and doesn’t angrily fart and carry on about the evils of creating a good personal relationship with the right people.Report

              • Avatar DensityDuck says:

                Aren’t things like Title VII supposed to make objective and truly-neutral bureaucracy a legal requirement?

                See, I don’t mind the idea that you get things done by creating personal relationships with people. I think that leads to far better outcomes than wilfully foregoing independent thought in favor of a procedures written by committee and employed in a Procrustean manner.

                But we’re told that doing things via personal relationships leads to cronyism, industry-government collusion, paying off regulators to look the other way. We’re told that it lets people govern by personal preference rather than law, which lets racism and other rights violations flourish (Joe at City Hall hates black people and doesn’t want any in his town, so suddenly no black person can get a permit for a sewer hookup outside of the Harvestone neighborhood. Jane at the police department thinks deer are cute and nobody should be allowed to shoot them, which is why there aren’t any gun dealers within city limits).

                The industry I work in has been a twenty-year demonstration of what happens when you throw out partnerships in favor of bureaucracy. You don’t need to get all Poppa Gon Tell You TROOF at me about it. But neither you nor I are in the driver’s seat on this one.Report

              • Avatar BlaiseP says:

                What’s your beef with Title VII? This I gotta hear. Do you have a problem with the idea of prohibiting discrimination? A quick look at the legislation mentions “injunctive relief”. That means someone can go to court and expect some definition of discrimination to be applied to his problem.

                Do you think judges are robots? They call it a “hearing” for a reason. Someone has to talk and someone else has to listen. All this talk of Cronyism and Wicked Government — hey, if we want to evict the crooked pols and their pimp cronies, I want their behaviour to be dragged into a courtroom where some dispassionate judge will dispense some industrial-strength justice.

                It’s all about People. As you point out, with commendable wrath and insight, the perversion of justice can only arise when someone with power can push the rest of us around. Happens inside government, happens outside government. Thus I contend we must have a free press and an independent judiciary to fulfil the OWHolmes’ predictive description of law, where Bad Men refrain from badness according to the odds of the law’s predictions about punishment coming true.Report

              • Avatar James Hanley says:

                Bureaucracies are about equality–that is, in the Angl0-American civil service tradition they are. Outside that tradition, not necessarily. As every public administration text emphasizes, one of the values of a professionalized bureaucracy is that it eliminates (eh,… diminishes) arbitrary and capricious treatment by making “you’re the wrong ethnicity” or “you’re my wife’s brother-in-law’s cousin” illegitimate grounds for distributing benefits.

                That said, personal relationships remain personal relationships. A bureaucrat generally has no responsibility to make extra effort to help anyone. It’s easier and safer to say no than to figure out how to say yes. But by establishing a personal relationship with the bureaucrat you give him/her a reason–a non-bureaucratic reason–to put in the extra effort on your behalf.

                That’s why anyone with any sense treats the low-level administrative staff at their place of business very well. They’re not obligated to go out of their way to help you, but if they like you they will.

                That’s one of the two secrets to successfully working a bureaucracy to your own ends. The other is to figure out how to classify your goal in a way that allows it to fit into the regulations they have to follow.Report

      • Avatar BlaiseP says:

        Any good solution has certain desirable attributes:

        1. This solution applies to conditions affecting a maximal number of patients.
        2. It is cost-effective: a minimum amount of money spent on it improves quality of life for a maximal period of time.

        Just start picking off the most statistically-prevalent conditions first. It’s sorta like draining the lake. Inoculations have drained the lake far enough to where we don’t have thousands of children dying of pertussis or measles.

        But other conditions have appeared. Arthritis is the Number One complaint, I see more ICD-9 code 710.0 in the system than anything else. People are living much longer lives, arthritis is what they get. Old people die of all sorts of things, circulatory disorders, ischemic heart disease, influenza and such. We all sorta know better than to get all panicky because more people are dying of ischemic heart disease on a percentage basis: in the long run, we are all dead.

        Apply my two rules above, you have your limiting principles. There’s no draining the lake completely, people just will go on dying, the bastards. Question is, how can we do the most good for the most people at the best price point.Report

        • Avatar Snarky McSnarkSnark says:

          That’s kinda where I was headed, except that there’s currently a lot of mis-coding in order to get insurance companies to pay. Arthritis almost always points at some underlying inflammatory condition.

          Here’s a summary of the Oregon Medicaid program that I mentioned earlier (some rigor was used in trying to establish the cost-to-benefit ratio for different treatments).

          The conclusion that the Oregon experiment “failed” is somewhat debatable. Here’s an analysis that concludes that political and bureaucratic factors led to the program never having been fully implemented as designed in the first place.Report

          • Avatar BlaiseP says:

            Fixed your second link.

            Not many people outside of healthcare statistics know about this study. Kudos for being up on this. I haven’t seen these documents before, but a quick scan of them is congruent with my own analysis: the problem with OHP was the paperwork.

            Want to solve the paperwork problem in health care? Oboyoboy… have I got an essay to write about that. First thing, get everyone out of the healthcare paperwork business who doesn’t at least have an RN. There are some excellent RNs I know, superb human beings, who I’ve worked with on just this problem. There are some speciality RN programs which focus on health care information.

            Put it this way, there’s a reason MUMPS never went out of style in good hospitals.Report

      • Avatar Kimmi says:

        Medicare has a pay for it regardless for less than the next two years. Read a little?Report

      • Avatar Kris says:

        Canada has Medicare for all and controls costs well.

        Access is supposed to be a problem, but it really isn’t, and it’s a problem that could be easily solved with more spending (though nothing as crazy as U.S. levels of spending.)Report

        • Avatar Will H. says:

          My friends from Alberta tell me that they also have supplemental health insurance; and also that their insurance does not cover visual or dental.

          So we need to get back to the idea of “basic coverage.”
          What is “basic?”Report

  13. Avatar Tim Kowal says:

    With respect to conservatism-qua-theory, there is no principled different between UHC and Medicare. Medicaid, sure. Social safety nets are fine, even for us meanies. Older folks can get in line with all the other people who can’t afford medical attention.

    With respect to conservatism-qua-politics, taking away Medicare is a third rail. Conservatives like trying to be consistent with our principles, but we’d like to continue to exist as a relevant movement, thanks very much. You can talk about conservative principles till your head pops, won’t make any difference with John Q. Public who wants what’s comin’ to him. Entitlements are a one-way ratchet. That’s one of the reasons, by the way, we conservatives generally are agin’ ’em.Report

    • Avatar MikeSchilling says:

      Entitlements are a one-way ratchet. That’s one of the reasons, by the way, we conservatives generally are agin’ ‘em.

      Likewise the defense budget, which conservative pundits, at least, are telling us is still too low, placing our nation in grave peril.Report

      • Avatar Stillwater says:

        Even the thought of cutting spending jeopardizes our security. It emboldens the enemy.Report

      • Avatar Brandon Berg says:

        This is incorrect. Entitlements are a one-way ratchet, and defense spending is not, at least not in %GDP terms. In fact, defense spending as a percentage of GDP declined dramatically over the latter half of the 20th century, falling to an all-time low of just under 3% in 2000, down from 9% as recently as 1968. It’s up to about 4.7% now.

        In real per capita terms, military spending has been pretty much flat over the long run, with no discernible long-term trend in either direction.

        Entitlement spending, however, has been growing inexorably for more than fifty years, and is now up to 12% of GDP from under 4% as recently as 1966.Report

        • Avatar Brandon Berg says:

          If we look at spending adjusted only for inflation, ignoring population growth, then it is true that military spending has increased over the long term, but it’s been far outpaced by the growth in entitlement spending.Report

        • Avatar Snarky McSnarkSnark says:


          It was very low in the previous half-century (up until WWII), but grew to over 10% of GDP as the Cold War took hold. It’s been shrinking in relative terms relative to that, but the US still spends a larger portion of its GNP than any other developed country except Israel and Saudia Arabia (by a pretty long shot).


          • Avatar Brandon Berg says:

            I don’t have data on military spending prior to WWII, so you may be right about that. My point is that Mike said it’s a one-way ratchet upwards, and it very clearly is not.Report

    • Avatar BlaiseP says:

      Agin’ as in against? Or Agin’ as in Aging? Let Medicare Part D prove these so-called Conservatives are all about getting their bennies at everyone else’s expense. These pedo viejo Conservatives are all so many outraged dudes in Bermuda shorts trying to get everyone else off their Entitlement Lawn.Report

      • Avatar Stillwater says:

        Lessee. I for it before I was agin’ it. Then I was for it agin’. Now I’m agin’ so damn much I don’t know even know what the hell.Report

  14. Avatar MFarmer says:

    An honest question — do conservatives lovey-kiss-cuddle their Medicare, thus showing their hypocritical nature by opposing UHC, or do they want to destroy Medicare. I just don’t know. Which is it? Maybe it’s either depending on how you want to frame an argument.

    • Avatar Patrick Cahalan says:

      I expect, like their liberal brethren, conservative politicians care first about getting elected. I don’t find this particularly either interesting or damning.

      So, if the true desire is to “destroy” medicare, likely it will require some obfuscation – or more charitably an attempt to replace with something else – as the GOP-leaning demographic skews towards the older.

      I can’t tell you what the average GOP politician thinks about Medicare. The ones that I’ve heard quoted on the topic have wildly different rhetoric over the years.Report

      • Avatar MFarmer says:

        Yes, Patrick, they sure do have wildly different rhetoric, for sure. Destroy, love, and other stuff. I just don’t know. Then I hear democrats/liberals/progressives say they want to reform Medicare, some say never touch Medicare, and some want to expand it to everyone. These are honest questions, and I don’t know the answers.Report

      • Avatar Patrick Cahalan says:

        I will say this: regardless of rhetoric, I don’t think the GOP wants to “destroy Medicare”. Medicare Part D is inexplicable under those terms.

        Frankly, I don’t see the GOP as being particularly interested in health care, as an issue. I see the Democrats being interested in health care, as an issue. I see the GOP being reactive in this dynamic: what they support, or don’t support, is largely a function of politics. There are individual exceptions, but the movement itself is not actively engaged in health care as an issue.

        I see the GOP as being particularly interested in taxes, on the other hand.

        I don’t see the Democrats as being particularly interested in redistribution for the sake of redistribution. Again, individual exceptions. I see the Democrats as being interested in other social welfare goals (which require some redistribution), though, and I see “higher taxes on the rich” as a political means to the end of funding those other social welfare goals.Report

        • Avatar Tod Kelly says:

          “Frankly, I don’t see the GOP as being particularly interested in health care, as an issue. I see the Democrats being interested in health care, as an issue. I see the GOP being reactive in this dynamic: what they support, or don’t support, is largely a function of politics. There are individual exceptions, but the movement itself is not actively engaged in health care as an issue.

          I see the GOP as being particularly interested in taxes, on the other hand.”

          I have to say in a post full of great possible answers to my question, Pat, this is perhaps the best. Or at least it’s the one that rings the truest to me.Report

          • Avatar Patrick Cahalan says:

            It’s odd; our political system more or less requires everything to turn into a Pick These Guys or Those Guys dynamic.

            But people forget that These Guys and Those Guys are only practically opposites. They’re actually driven by more core motivations; they act as opposites in many ways, but usually as a function of who is in power.Report

          • Avatar Koz says:

            That’s true, but it’s also not the whole thing either. In particular, the political perceptions are not monolithic either. Specifically, there has been a tremendous confluence of events, 2008 meltdown, greater appreciation of aging demographics, the Euro crises, etc., that have changed the perception inside and outside the political class of the feasibility and desirabilty of the welfare state.

            One big problem is, that the libs never internalized that any of these things represent a legitimate constraint on them.Report

            • Avatar Patrick Cahalan says:

              I’m curious as to how the 2008 meltdown represents a legitimate constraint on libs, in your head.

              It certainly hasn’t been internalized as a legitimate constraint on free marketeers.Report

              • Avatar Koz says:

                We have less government resources to fund welfare state programs with.

                For the most part libs do a much better job of understanding the ebb and flow of political developments as opposed to the ethical obligations of modern statecraft, but this is an exception in that for as much as libs have liked to complain about the political viability of funding cuts to this or that, as near as I can see they have never made any attempt to see why that’s the case.

                You don’t see it quite so much any more but 18 months or so ago, the libs were doing their best to third rail the GOP over Ryan plan but they have never come to grips with any understanding of why third rails aren’t third rails any more.Report

              • Avatar Mike Schilling says:

                Things are bad now, so we have to cut back on social spending. When they improve, we’ll be able to afford more tax cuts and military adventures.


              • Avatar Koz says:

                Yawn, if you must but you should understand that a significant part of the energy in current political culture is geared toward creating situations where you can’t yawn.

                Specifically, this is why things like the debt ceiling crisis exist. In an environment where one party refuses to understand or accept the motivations of another, either you can capitulate to us, you can force us to capitulate to you, or we can collaborate on a huge swath of collateral damage. Whatever it is you do, you can’t yawn.Report

              • Avatar James Hanley says:

                In an environment where one each party refuses to understand or accept the motivations of another,


              • Avatar Mike Schilling says:

                this is why things like the debt ceiling crisis exist.

                Because one party consists of stupid, irresponsible assholes that would rather wreck everything than be out of power.Report

              • Avatar Snarky McSnarksnark says:


              • Avatar James Hanley says:

                FTFY = Fixed that for you.

                AKA, snark.Report

              • Avatar Koz says:

                “Because one party consists of stupid, irresponsible assholes that would rather wreck everything than be out of power.”

                I dunno Mike, it seems more socially optimal for all parties if Team Red and Team Blue could get together find places to cut or attrit government expenditures to cause minimum loss of service, social upheaval and/or political disruption. But IIRC we were never given that option.Report

              • Avatar Mike Schilling says:

                Obama never offered a deal that cut spending. Uh-huh. Right. Yeah. Sure.Report

              • Avatar Koz says:

                “Obama never offered a deal that cut spending. Uh-huh. Right. Yeah. Sure.”

                He didn’t.

                Our Constitutional design contains nuts and bolts that work perfectly well to implement the practice of limited government. But over time, those mechanisms are bulldozed by other seeming more expedient concerns, and as such political dramas get fought in different places than they were before.

                We believe in engagement. You believe in entanglement. You won.

                As a consequence I expect to see more debt limit crises and the like.Report

              • Avatar Mike Schilling says:

                He didn’t.

                In my timeline, Neil Armstrong was the first man to walk on the moon. What about yours?Report

              • Avatar James Hanley says:

                I know Obama offered a plan to reduce the expected 10 year deficit. But did he offer a plan that actually cut current levels of spending, or just cut expected levels of spending (reducing the rate of growth of spending?

                Frequently reductions in expected spending are called spending cuts, but that’s a bit misleading. (it’s also a bipartisan practice.)Report

              • Avatar Koz says:

                In my timeline, neither President Obama nor any other significant Democrat offered to cut any amount of expenditures from the President’s FY12 budget request from that February until Sen Majority Leader proposed a deal along those lines approximately one week before it was feared that the US would not have enough borrowing authorization to fund its previously appropriated commitments.

                Surely you know this, it’s why we went through the whole debt limit drama in the first place.Report

              • Avatar Mike Schilling says:

                That is, they didn’t until they did. Shocking.Report

              • Avatar Koz says:

                “But did he offer a plan that actually cut current levels of spending, or just cut expected levels of spending (reducing the rate of growth of spending?”

                No, he never offered any significant cuts only modifications to the FY12 budget request until shortly before the resolution of the debt limit crisis. That was what the upshot of the drama surrounding the continuing resolutions that spring.Report

              • Avatar Koz says:

                I have a slightly different perspective to the Cato blurb. It’s politically and substantively easier to cut expenditures in the out years. And, cuts in the out years are definitely not worth as much dollar for dollar as cuts in the current year. But, they are worth more than nothing.

                The President’s unwillingness to find out year cuts during the whole debt limit deal was very disappointing, and one reason why the issue became as contentious as it did.Report

              • Avatar Tom Van Dyke says:

                Cato’s Tanner: “Neither President Obama nor Paul Ryan actually cuts government spending. Rather, both are playing the time-honored game of calling a reduction in the rate of increase a “cut.” Thus, the president would increase federal spending from $3.8 trillion in 2013 to $5.82 trillion in 2022. That might not be as big an increase there might otherwise be, but in no way can it be called a cut. Meanwhile, Ryan, who is being accused of “thinly veiled Social Darwinism,” would actually increase spending from $3.53 trillion in 2013 to $4.88 trillion in 2022.

                The president warns that Ryan’s spending “cuts” would “gut” the social safety net. And, it is true that Ryan’s budget knife falls more heavily on domestic discretionary spending than does the president’s — but only relatively. Over the next 10 years, Ryan would spend $352 billion less on those programs than would Obama, an average of just $35.2 billion per year in additional cuts. Given that domestic discretionary spending under the president’s budget will total more than $4 trillion over the next decade, Ryan’s cuts look less than draconian.”


              • Avatar Koz says:

                Cato’s is making an argument that conservatives lost about 15 years ago. Government budget conventions use the idea of a current services baseline. That’s to say, because of increasing population served, increasing costs, or other reasons, it costs more to provide the same level of services. Most people would intuitively describe this as increases in funding, but according to the current services baseline it is no change in funding.

                Conservatives fought this war with the lib intelligentsia and the Cllinton Administration and lost. We believe in engagement, they believe in entanglement. They won. Shtt is entangled.Report

              • Avatar Kimmi says:

                funny how conservatives never apply the economies of scale to government. ain’t it?Report

              • Avatar Tod Kelly says:

                Well, not “not funny” so much as “not true.”Report

              • Avatar Koz says:

                Ok Tod, what say you?

                Do you accept that the various things since September 2008 have changed the perception of what’s plausible in terms public funding for this or that?

                As a followup, do you see a particular difference of what your perception of those things and what others’ perception might be (in such a way that it alters the current political landscape)?Report

              • Avatar Tod Kelly says:

                “Do you accept that the various things since September 2008 have changed the perception of what’s plausible in terms public funding for this or that?”

                Yes, but probably for different reasons than you would argue. My belief is that one of the paradoxes of a democracy is that we’re far more likely to want to expand the role of government in times when the economy is going gangbusters, and more panicked about any spending (even on things that might directly positively impact us, like safety nets) when the economy is bad. This leads to all kinds of circular problems, but suffice it to say for the purposes of answering your question that I think we are being more guarded against spending due to the recession.

                In terms of what that means for the political landscape, I will say now – as I’ve said often here – that were the Republicans not in a rebuilding phase, trying to figure out amongst themselves what they were going to become, they would just about have the White House locked up already. As it stands, however, I think that they are going to miss a big opportunity.

                I still believe Obama won not because of who he was or what he had done, but because he was able to craft a compelling vision and narrative of how he saw the country changing for the better. (That he did not become that president, for whatever reasons we might argue about, is partly why he really *should* be more vulnerable now.)

                I do not see the right taking advantage of the situation in the way Obama did four years ago. I don’t see a compelling vision, I mainly see criticisms of liberals and the President in particular. But those are the things that drive ratings; they are not the things that win national elections.

                So my short answer is that there should be a political shift happening right now, but its not going to happen… yet.Report

              • Avatar Koz says:

                That’s a great answer Tod, but let’s narrow the focus a bit to the objective or subjective perception of resources specifically, ie, thinking about the political motivations as opposed to the political consequences.

                I gather that, when put directly, you agree with or have no particular beef against the proposition that there are less resources available to us for government funding for this or that?Report

              • Avatar Tod Kelly says:

                Not necessarily. One of the things I discovered in the Inequality Symposium, for example, is that after taxes the aggregated corporate profits are at record highs this year:


                So is there less? I’m not so sure.

                However, I think the question of whether or not we should be looking to curb expenses is an unqualified “yes” regardless of that answer.Report

              • Avatar Koz says:

                It is very true that corporate profits are high, which has relevance for many things but not necessarily this. And actually that relates to a huge comment I might write but for the moment lack the motivation for.

                So for now let me repeat a narrower point that has some salience. We need to be able to think clearly and creatively about our resources. A resource is something that we have operational control of. If we don’t have operational control of something it’s not a resource. We don’t have operational control of corporate profits therefore they are not a resource for us.

                Therefore, supposing that we (you and I, acting with fiat authority over the polity) raise corporate taxes rates and generate increased revenues, the new revenue is not a resource for us but the consequence of exercising a more fundamental resource, in this case the real or imagined fiat we have over the American polity.

                Of course, there are limits to how much fiat authority we can pretend to exercise over the American polity or the American political class. And more importantly, there are limits to what either one of them controls outside the political process.

                Given this, let me restate my question slightly. If, hypothetically, you believe that it’s feasible to continue the path of expenditures implied by American welfare state for the last twenty years + PPACA, what resources do we have that would be sufficient for this and how would they be deployed?Report

              • Avatar Tod Kelly says:

                Oh, I don’t think there’s any question that we need to cut expenditures. I don’t think of money as being endless, and I think our habit these past 10 years of borrowing so we could pretend that wars and social programs were free was a terrible idea.

                I believe HCR is needed, and not just for the poor – for our entire economy. I don’t trust the Republicans to do it, however, because of the current Grover Nordquist style of governing that’s in vogue with them these days. I’m not thrilled with Obamacare, and as I’ve said it’s going to have a lot of hiccups (and that’s a best case scenario) but it’s at least a first step, which is more than we’ve had for the past 50 years we’ve been saying it needs to be addressed.

                Our other big spending items need big reform as well: military, SS, Medicare. I see no reason for someone like me, for example, to get SS benefits. I see no good reason for us to continue wars everywhere; they’re expensive and they’re counter productive. To quote Sorkin, we spend more on the military than that the next 26 countries combined, and 25 of those are allies.

                So you have no need to convince me that we need to radically adjust the budget. WHere you and I part was, I think, is on these fronts:

                1. You have a confidence that the GOP, if given the reigns, will work to cut government power, executive power, spending and the deficit. I have no confidence in this in that since I have been of voting age, every federal GOP campaign has run on these things but done the opposite when in power.

                2. You think that government necessarily makes things worse. I do not. I am for safety nets, and while I like privatizing in certain areas I do not see them as being the low-cost high-efficiency panacea that I suspect that you do.

                3. I’d like to move to a mindset where we cut government spending in boom times, and increase it in lean times. When unemployment is low and wages are up, we don’t need to ramp up safety nets. When budgets are so tight, we do. Sorry rich guys and corps, sometimes you just have to suck it up if you want to be part of the team. It may not be fair, but that’s life in the big city.

                But I have no desire to continue spending the way we have over the past 10 years.Report

              • Avatar Rod says:

                3. I’d like to move to a mindset where we cut government spending in boom times, and increase it in lean times. When unemployment is low and wages are up, we don’t need to ramp up safety nets. When budgets are so tight, we do. Sorry rich guys and corps, sometimes you just have to suck it up if you want to be part of the team. It may not be fair, but that’s life in the big city.

                FWIW, that’s the precise Keynesian prescription. We almost did it once, too. Except we elected GWB who declared that a surplus meant the government was taking too much of your money. I expect the surplus would have evaporated in any case with the dot-com implosion and then 9-11, but not as much or as fast.Report

              • Avatar Koz says:

                I think you’re taking my comment in a slightly different spirit than what was intended. You responded with an expression of several preferences. And even if I don’t agree with them, your preferences are eminently reasonable given what you take to be the premises.

                But for now at least, I’m not asking you to agree with me, I’m asking something different (and to be fair, considerably more difficult imo). That is, I’m asking you to explain why you think your preferences are plausible in the real world, or at least to describe the extent of your belief that they are. Or to put it another way, if you prefer A to B, I’m not asking you to switch to B if I happen to prefer B, I’m asking you to explain why it’s in your individual or collective power to choose either A or B.

                So, given this context and allowing for a reasonable amount of fiat control over the American polity, do you think that it’s plausible that the path of the American welfare state for the last 25 years or so + PPACA can be funded indefinitely?

                If the answer is yes, what resources would be sufficient for this and how would they be deployed?

                If the answer to the first question is yes, can you imagine that other reasonable people might look at our situation and think the answer is no?Report

              • Avatar Tod Kelly says:

                “do you think that it’s plausible that the path of the American welfare state for the last 25 years or so + PPACA can be funded indefinitely?”

                I think that it is possible, but not plausible.Report

              • Avatar Koz says:

                That’s a great answer. In fact it’s one that I might even agree with.

                So, given the premise that indefinite continued funding for the previous welfare state + PPACA is barely in the realm of possibility it certainly shouldn’t be any surprise that I and substantial number of other Americans don’t believe that it’s plausible either.

                So given this, I think we should eliminate PPACA and attrit the welfare state until such point as we view the path of expenditures to be at least plausible. Now, let’s say you disagree with this which is probably reasonable since it is substantially at odds with your prior comment.

                Assuming that’s right, what resources would you deploy to fund prior welfare state + PPACA and how would you use them?Report

              • Avatar Tod Kelly says:

                Well, see, this is where we part ways and talk past one another. I don’t see HRC as something that increases costs; I see it as a necessary thing to stop exponential cost growth. For me it’s not a question of, how would we afford whatever version of universal health care we might end up with, but rather how are we going to afford not having it?

                Almost every idea that I have seen that is not universally expansive makes things worse for us, as a nation, financially. (e.g.: Get more carriers, because the more carriers we have the more competition will drive down prices.)

                So I don’t see it the way you do.Report

              • Avatar Will Truman says:

                RTod, you have a much more abstract perception of Hillary Rodham Clinton than I do… 🙂

                More seriously, universal health care can be cheaper or it can be more expensive. The same is true of a patchwork system. As great of systems as I can devise, I have trouble imagining that a non-universal system that we implement will actually result in cost savings.

                I hope that PPACA, or whatever comes after it, proves me wrong.Report

              • Avatar Tod Kelly says:

                But will, in other countries that have a universal model, there is no exponential growth. A lot of this has to do with mandatory cost controls, to be sure, and those are not always popular. But cost growth is steady.

                I am not understanding how you can look at the health insurance now as a way to curb costs?Report

              • Avatar Koz says:

                Ok well over the 10-year CBO time horizon, PPACA is estimated to cost a huge amount of money, ie, over $1 Trillion for that period alone. Do you disagree with that finding or should we be looking at a different context instead?Report

              • Avatar Will Truman says:


                One of the big reasons that our current system has such large growth is because we have refused to implement cost-containment mechanisms. Our government side lends no more reason for optimism than our private side. Payouts are lower (generally speaking) but spending is nonetheless enormous. Maybe we could better contain that if we didn’t have the private sector to compete with, but I’m not optimistic on that score.

                There are ways to contain costs on each side of the equation, but the biggest obstacle we have is culture. There are places with a productive culture where costs aren’t so severe (I believe El Paso is one of these places) and there are other places that are driving it through the roof. The big difference? Culture. Kaiser Permamente has a model that works, but we refuse to accept their model because (among other things) we want to pick our own doctor. We complain about medical costs, but we will pay more to pick our own doctor. Culture.

                I see no obvious reason to believe that if we were under a universal-system umbrella that these things would change. We often cite fee-for-service as one of the great causes of our spending woes. Yet what do they have in Canada? Fee-for-service. It works in their culture, I don’t see it working in ours. The goal might be Canada, but the result McAllen.

                (For the same reasons that Canada has a system that wouldn’t work as well here, I think they could actually make a patchwork system work.)Report

              • Avatar Koz says:

                Ok, let me briefly summarize a couple points here that are worth mentioning, because for the most part they are not dwelled on but are in important part of the context of why the Right and the Left don’t understand each other or talk past each other.

                First, the “preference” for preferences is secondary. We can’t make cut a deal or make intelligent choices about what we want to do until we figure out what we can do. This is imo a substantial cause of miscommunication between the Right and the Left.

                It’s fair to say, I think, that Tod believes his policy path is plausible but has probably heretofore given relatively little thought to the subject. And he has not explained what resources are required to implement this policy path and how they will be used.

                And, in PPACA his first major policy move will spend well over $1 Trillion over the next ten years according to the CBO.

                Therefore at the very least there is strong prima facie case that the libs’ preferred policy path is not sustainable.Report

              • Avatar Tod Kelly says:

                “It’s fair to say, I think, that Tod believes his policy path is plausible but has probably heretofore given relatively little thought to the subject. “

                Actually, I think about it quite a bit – often for money. Creating large group health plans is one of the thing my firm does; in fact, it makes up almost 20% of our (and my) revenue. Any move toward universal care will negatively impact our financial position, to one degree or another depending upon what path we as a nation take. So I strongly suspect that I think about it more often than most people, and that I approach it from far less of an R v. D basis than most.

                I’m not sure which part of the program you are talking about, nor am I sure where you are getting you facts. But I believe that the $1 trillion over 10 years is the cost of administering the program. If so, this number is most likely overly optimistic. Most independent figures that I have seen believe it will be up to 50% greater. But this cost does not occur in a vacuum; it is a cost you are already occurring. So lets take those numbers and say that a more likely number is $1.5 trillion. Plus, let’s assume that 60% of the country are going through independent carriers that add their own admin costs, which (lets round up to be conservative) adds another half a trillion over 10 years. The cost of admin and regulatory over site are now $2 trillion over a 10 year period.

                Because of Incurred but Not Reported claims dollars the last year we have reliable drill-down statistics for national HC is 2010, where the cost of HC nationally was more than $2.6 trillion. If the trend over the past 50+ years continues, that amount will be $5.2 trillion in 2022.

                Insurance admin costs are about 3% of healthcare expenditures in our country, state regulatory costs and taxes are also about 3%, and federal are about $2.5%. That’s about 8.5% of expenditures that that $1 trillion will look to replace. Let’s assume that we repeal PPACA tomorrow; further, let’s assume that over the next ten years costs remain stable – they do’t grow at all. (Why this might occur without government intervention I cannot begin to guess, but let’s pretend anyway.) That’s $221 billion a year on admin and regulatory costs, or $2.2 trillion over a ten year period. And that’s if costs don’t grow the way we’re expected to, in the way they have for 2 generations.

                So when you say $1 trillion over a ten year period it doesn’t really shock me so much, because I don’t have the illusion we would be saving that money if we were to scrap any kind of universal coverage plan.Report

              • Avatar Tod Kelly says:

                Will –

                I agree with you that there are ways to control costs, and that the Kaiser model is a good example of this. What I am not quite understanding is why you think people will independently choose this route.Report

              • Avatar Koz says:

       and following, referring to the basic structure of PPACA: subsidies, exchanges, mandates, community rating, etc.

                Clearly, in the absence of PPACA this cost would be not be borne by the federal government. I gather Tod thinks it would be paid in private sector somewhere, either from individuals, insurance policyholders, or employers. I think it’s a plausible but dubious argument.

                But in any event it’s not relevant because it’s a dodge around the question of resources. Why do we think the government has the resources to fund this policy path? There’s a very good prima facie case to think we can’t. The private sector will fund it’s health care expeditures out of it’s resources, which is a different issue. And on that note, let’s note that while there are still problems there, private sector finance has gotten much stronger since the advent of the recession.

                So, from the point of view of describing a path of public sector finance, specifically the US federal government, let’s avoid sloppy uses of “we” and “you” and describe with as much clarity as we can what it can plausibly fund going forward.Report

              • Avatar Tod Kelly says:

                But I reject this framework; it’s uninformed. Neither the government or the private sector have “resources” they are dipping into.

                Individuals or employers are paying premiums to one or the other. (Or, perhaps, people are paying taxes in lieu of premium.) Whether there is a single payer or multiple payers does not change this. Neither the government nor an unregulated insurance company is set up to dip into resources – each are pass-through systems.Report

              • Avatar Will Truman says:

                Tod, I don’t think they will choose it independently. I don’t think they will choose it collectively, either (ie via our elected representatives). What’s required is an attitude shift (informed by unfortunate realities of unsustainability) that is far more important than “national plan” versus “patchwork.”Report

              • Avatar Koz says:

                “Neither the government or the private sector have “resources” they are dipping into.
                Neither the government nor an unregulated insurance company is set up to dip into resources – each are pass-through systems.”

                How? It seems to me there’s a very concrete way that can’t possibly be true. CBO has estimated that PPACA will cost the federal government over $1 Trillion dollars over the next ten years. That’s after the premiums and taxes.

                We know this is more complicated and worse than a pass-through system because if that’s all it was nobody would care.Report

              • Avatar Koz says:

                Also, I meant to mention that the cost of PPACA is partially offset by taxes, but a fair number of them have nothing to do with health care and even the ones that do have a tangential relationship at best to the services they are supposed to fund.Report

              • Avatar Kimmi says:

                Third rails will continue to be third rails until we shove them up the Boomers’ collective ass.Report

  15. Avatar DensityDuck says:

    Arguing that conservative opposition to UHC is hypocritical because they don’t hate Medicare as much is like arguing that environmentalist opposition to petroleum-burning vehicles is hypocritical because they don’t hate trains as much.Report

    • Avatar MFarmer says:

      I just don’t know. I’m asking because there is a contradiction, and my answers just aren’t sufficient, I guess, but who knows?Report

    • Avatar wardsmith says:

      Gee Duck, I’ve seen it both ways right here on this site. On the one hand, ALL conservatives hate UHC and on (apparently) the same hand Conservative Republicans (the sneaky bastards) are the VERY PEOPLE who wrote Obamacare and foisted it on the simpleton Democrats! Too Machiavellian for me…Report

      • Avatar Snarky McSnarkSnark says:

        I don’t think that anyone has averred that ObamaCare was written by conservative Republicans.Report

        • Avatar MFarmer says:

          They took it straight from Heritage and Romney– no shit, bro.Report

          • Avatar Snarky McSnarksnark says:

            Romney was in no way a “conservative Republican” when he was governor of Massachusetts, and the Heritage proposal was simply an attempt to distract from HillaryCare.Report

            • Avatar MFarmer says:

              So, it’s all on Democrats and when they says that conservative Republicans once called for the mandate and that the mandate came from their playbook, they are lying?


              • Avatar Snarky McSnarkSnark says:

                One of the habits of the conservatives on this site is to treat liberals as monolithic. So these “some guy on a liberal blog said” arguments are tired and kind of stupid.

                In point of fact, the outlines of the Obamacare bill were first outlined by the Heritage Foundation, mostly as a way of subverting Hillarycare in 1993. But stupid “lumping” arguments like the ones above (“Conservative Republicans… wrote Obamacare and foisted it on the simpleton Democrats!”) are purely rhetorical, and completely unhelpful.Report

              • Avatar Will Truman says:

                I get what you’re saying about liberals and monolith. It’s difficult to remember at times, that you’re talking to individuals and not spokespeople of an ideology.

                That being said, people around here have been making that argument (MA falsely implicated Cato, I have more than once had to say “No, there wasn’t nith-universal support for the Mandate among the right before the black president proposed it…”).Report

              • Avatar Snarky McSnarkSnark says:

                I understand what you are saying, Will, and you’re completely right. What I love about this blog is the cubaya–we have liberals, and libertarians, and conservatives talking (mostly) civilly and respectfully with one another, resulting in some really interesting conversations. I have had my mind changed many times, and I have an opportunity to have my own presumptions and world view challenged (and to challenge those of others).

                But these types of arguments are completely unhelpful. They are just snarking–they alienate more than illuminate. And, on the whole, there’s not a whole lot of that here (and when there is, it’s usually so “meta” that it’s hard to take offense).

                Granted it’s not just the conservatives (and I know, very well, that Mike doesn’t consider himself a conservative). M.A. has destroyed more civil conversations in the last month than just about anyone. But it seems–to me at least–that this ideological “lumping”–of being called to defend the stupidest comment on the stupidest liberal blog–is particularly pernicious on our right flank.Report

              • Avatar Will Truman says:

                No disagreement, Snark. Ideological lumping should be resisted.Report

              • Avatar MFarmer says:

                The only reason I do it is because it’s done to me and my ideas. But quoting the NYT is a little more than an idiot blogger on the left. I mean giving a reference is okay to prove a point, right? People do it all the time, I hear. I think you just don’t like to be countered with evidence.Report

              • Avatar Snarky McSnarkSnark says:

                Thanks, Mike.

                I couldn’t have asked for a more perfect example.Report

              • Avatar MFarmer says:

                “Thanks, Mike.

                I couldn’t have asked for a more perfect example.”

                In other words, you have no rational reply left to offer. That’s okay, you started on shaky ground, so it’s only expected you’d wind up with nothing to justify your claims except snark.Report

              • Avatar MFarmer says:

                ” But it seems–to me at least–that this ideological “lumping”–of being called to defend the stupidest comment on the stupidest liberal blog–is particularly pernicious on our right flank.”

                Can you at least provide an example of someone in this conversation relying on the stupidest comment on the stupidest liberal blog? You can’t. You made it up because you have no intelligent response — you worked your way into a corner, and when you couldn’t think your way out, you made something up and accused me of doing it. This is the tactic used by those who don’t like to admit when they are wrong.Report

              • Avatar MFarmer says:

                You can’t have the Left constantly laying Obamacare on Romney and Heritage and Gingrich and others on the Right, then claim that the Right had nothing substantial to do with Obamacare, unless you are calling those on the Left making these claims, like Obama, liars.Report

              • Avatar Trumwill says:

                Is he calling them liars? Seems to me he’s just saying they’re wrong.Report

              • Avatar Stillwater says:

                You can’t have the Left constantly laying Obamacare on Romney and Heritage and Gingrich and others on the Right

                No one on the left is doing that. The left owns Obamacare. The left is just wondering what happened to all the from Romney and Heritage and Gingrich once the Dems and the Black Guy signed the bill.

                then claim that the Right had nothing substantial to do with Obamacare, unless you are calling those on the Left making these claims, like Obama, liars.

                Everyone concedes that the right had something to do with the structure of the bill (well thinking people anyway). What they claim – justifiably so – is that the right had no interactive role in determining the shape of the legislation that was signed into law (unless you think Ben Nelson and Joe Lieberman are on the right, acourse).Report

              • Avatar MFarmer says:

                “The left is just wondering what happened to all the from Romney and Heritage and Gingrich once the Dems and the Black Guy signed the bill.”

                Damn it took longer to get to the racist charge than I thought it would. Yes, Snarky is just saying they are wrong, and the Republicans are racists. On the Left, it’s a legitimate disagreement — on the right it’s racism. I’ll leave again now that we cleared that up. Geez, what a place this has become. Liberalism is truly dead.Report

              • Avatar Tod Kelly says:

                Where do you see Snarky accusing people of racism? I don’t think I’ve ever seen him do that.Report

              • Avatar Tom Van Dyke says:

                Tod, Mr. Farmer clearly misidentified the miscreant, but got the offending quote right.Report

              • Avatar wardsmith says:

                One of the habits of the conservativesliberals on this site is to treat liberalsconservatives as monolithicReport

              • Avatar Snarky McSnarkSnark says:


              • Avatar James Hanley says:

                One of the habits of people…Report

              • Avatar North says:

                Well both versions are correct. It’s a bipartisan foible.Report

              • Avatar Will Truman says:

                I’ll stop doing it when they stop doing it all the friggin’ time.Report

              • Avatar Mike Schilling says:

                I’ll stop harping on their faults when they stop making stuff up about me.Report

              • Avatar North says:

                Don’t make me turn this polity around!Report

              • Avatar MFarmer says:

                “I’ll stop harping on their faults when they stop making stuff up about me.”

                Tee hee. You guys are a riot.Report

              • Avatar Mike Schilling says:

                Glad you enjoyed that one. Sometimes people miss sarcasm.Report

        • Avatar Rod says:

          I would say the process was largely controlled by the conservative Democrats. Sort of on board, but only at a price, and only willing to go so far–as in not single payer or even public option.

          The main “contribution” of the Repubs was to create a poisonous atmosphere. Anyone remember those lovely town hall meetings?Report

  16. Avatar Kazzy says:

    ““I can easily see myself being old, but I can’t see myself being poor. So I’m going to lobby for the one I think will pay off for me personally, and lobby against the one I think will pay off for someone else.””

    I think this isn’t getting enough play (at least from the comments I read… about half).

    People’s ability to identify with others and/or their situation is HUGE. No, I’m going Mike Francesa … it’s HA-YUGE! As Stewart pointed out in that Rubio interview… Rubio’s proximity to immigration gave him a more nuanced understanding and perspective on it, just as Cheney’s proximity to LGBTQ folks gave him a more nuanced understanding and perspective on it. The ability to “otherize” a group of people is incredibly powerful. It’s the same reason, for some people, an American’s dog being shot by the cops generates more outrage than civilians being killed half a world away with a drone strike. It’s why 3000+ dead American soldiers is a bigger tragedy than tens of thousands of dead foreign civilians. It’s why my wife having a really shitty day at work resonates with me more deeply than a news report of a stranger being raped.

    Is it logical if we simply evaluate the varying responses? No, not really. But is it understandable given what we know about how folks intellectual responses are often dictated by their emotional responses, which in turn are highly predicated on their proximity and familiarity with an individual or an issue?

    This doesn’t explain all of it, as I think there are some far more insidious things going on for at least some of the folks you are wondering about. But I think there is a very real aspect of human nature that you acknowledged but seemed to “pooh pooh” and wrongly so.Report

  17. Avatar ktward says:

    Kazzy wrote:

    People’s ability to identify with others and/or their situation is HUGE. No, I’m going Mike Francesa … it’s HA-YUGE! As Stewart pointed out in that Rubio interview… Rubio’s proximity to immigration gave him a more nuanced understanding and perspective on it, just as Cheney’s proximity to LGBTQ folks gave him a more nuanced understanding and perspective on it.

    Spot on.

    To my mind, this outlines what is perhaps the fundamental difference between Conservatives (including Libertarians?) and Liberals.

    Cons find it difficult to imagine the need for–or they even rail against–public policy that reaches beyond their own limited realm of experience. (Cue all manner of “you lazy assholes/you ignorant poor/you sinners/find-your-f**king-bootstraps-already” rationalizations.)

    Libs, otoh, take a more egalitarian view regardless of their own experiential purview. (There is psycho-neurological research to support this, but no surprise to anyone that it’s all still a mite controversial. Such is always the fate of cutting-edge science.)

    An easy example of this political paradigm is the issue of SSM, but an equally easy example is, perhaps, UHC/MFA.

    I don’t see any reason to make the UHC/Medicare contradiction that exists within the greater GOP any more complicated than necessary, and I’d say that Kazzy has absolutely hit the nail on the proverbial head.

    To my mind, the more important question is this: why are there Dems who are so afraid of UHC/MFA? (C’mon. If we were all mostly on board with this policy concept, we would have had a much stronger, perhaps very different-looking, PPACA.)

    I think the answer to that lies within the way murkier waters of Dems than it does within the GOP.

    The fact is, the vast majority of Dems, like most Americans, possess relatively comprehensive health insurance. (PPACA has already kicked in some critical benies and so private insurance, for the bulk of us, has gotten better not worse.) As a collective, these already-insured Dems may indeed feel a conviction that all Americans should have a similar ease of access to health care regardless of income or employment status, but fear of the unknown keeps some number of them–enough of them to make a difference on The Hill–from getting on board with UHC.

    NIMBY, basically.Report

    • Avatar ktward says:

      I like the site’s newer look. I do. (Yowsa. That was quick, E.D.)

      Still wish there was an edit function. I’ll edit my last sentence ..

      “… but fear of the unknown keeps some number of them–enough of them to make a difference at the polls and therefore on The Hill …”Report

    • Avatar Kazzy says:

      I should add that I don’t think this phenomenon is unique to cnservatives. It is part of the human condition.Report

    • Avatar Tom Van Dyke says:

      The left want the next fellow to get benefits; the right wants him to have a job. That’s the real difference in worldviews, whether to gear for the tragic or the ideal.

      As for the Democrats who aren’t leftists, well, glory be.Report

      • Avatar Kazzy says:


        Where were you when I argued this point vis-a-vis soup kitchens with… Crap… What was that guy’s name? Super liberal who wanted to fight everyone? Big presence during the inequality summit…Report

        • Avatar Kazzy says:

          To clarify, I argued that many service organizations might be more successful at addressing long-term poverty on a macro level if they employed the folks they sought to help (in addition to helping them) instead of staffing volunteers and only offering assistance.Report

          • Avatar DensityDuck says:

            In some cases that’s impossible, because it’s legally required that money donated To Help The Poor be given to the poor, and not used for operations. Money for operations must be donated or collected specifically for that purpose. My father is involved with a food-bank charity that has a warehouse full of food that they can’t give away, because they only have enough money to hire staff to be open once per week.

            And there’s that damn government screwing things up again. But, we’re told, libertarian ideology offers nothing but all-against-all anarchy.Report

            • Avatar James Hanley says:

              In a libertarian world, nobody would ever volunteer at a soup kitchen.Report

              • Avatar Will H. says:

                They would do so, because it would be to their own benefit.Report

              • Avatar James Hanley says:

                Don’t undermine my snark, Will! 😉Report

              • Avatar Mike Schilling says:

                But they would invest in soup kitchens that developed a profitable business model, say, selling (fully legal) crack on the side.

                I write this snippet of libertarian SF a while ago:

                “Who is he anyhow, an actor?”


                “A dentist?”

                “…No, he’s a gambler.” Gatsby hesitated, then added cooly: “He’s the man who fixed the Galactic Series back in 2219.”

                “You mean he determnined that the player’s econmonic self-interest was better served by being paid to lose games than by playing to win, and gave them that opportunity? I admire him greatly.”

                “We all do. “Report

        • Avatar Tom Van Dyke says:

          Kazzy, wherever he is, I’m not. ;-/Report

        • Avatar James Hanley says:


          Shh, naming calls.Report

          • Avatar Kazzy says:

            Hahaha… What is he, Beetlejuice?Report

            • Avatar James Hanley says:

              It’s an ancient superstition. Beetlejuice was a contemporary riff on it.Report

              • Avatar Murali says:

                Just think of it this way: His nom-de-plume was basically my initials reversedReport

              • Avatar Kazzy says:

                Heh… Ya, I just saw him referenced elsewhere. Did he go out with a bang or just fade away?Report

              • Avatar James Hanley says:

                Showed up on this very thread yesterday, but not to much effect.

                This is the way the world ends
                This is the way the world ends
                This is the way the world ends
                Not with a bang but a whimper.

              • Avatar Jesse Ewiak says:

                Of course, the fact the said evil horrible person made good points in all but one of his posts on this thread is going to be ignored, because he’s not nice to everybody.Report

              • Avatar Mike Schilling says:

                Libertarians occasionally lose patience with people who refuse to understand them.

                Conservatives sometimes make their points over-emphatically.

                Liberals are strident.Report

              • Avatar BlaiseP says:

                I lose patience with anyone who can’t explain himself adequately. I’ve read the Libertarians and remain baffled by their notions about Freedom and Voluntary Association. Their version of Liberty cannot be distinguished from anarchy, indeed, every time I’ve tried to point out how much they resemble the Marxists in this regard, I’m told I Don’t Understand.

                Oh, but I do understand, all too well. I’ve heard this argument before, from the Theologians. Every time they’re confronted with internal contradictions in their theology, they smugly sum it up by calling it a Mystery and I should just accept it. Well I won’t. Those who would be Understood must first Understand the nature of the questions they’re asked and quit treating their skeptics as heretics.Report

              • Avatar Roger says:


                If you agree to really, really try to understand me, and agree not to call me names I would be glad to try to explain it. After all, it is a good practice to assume that a group of rational adults has reasonably good reasons to believe something.

                Are you interested?Report

              • Avatar BlaiseP says:

                You can try. I’ll ask the questions, you supply the answers.

                Would you abolish the state? If not, why not?Report

              • Avatar Roger says:

                No. Because the state is a great, time proven way to establish and enforce the rules and protocols of a thriving society. It can also provide public goods (one of which is that of rule enforcer).

                Some think that we could do away with the state. I say they better try it and prove it on a small scale before they mess with my society.Report

              • Avatar ktward says:


                The Reply function doesn’t allow me to Reply where I actually want to Reply. Maybe it’s a glitch that simply exhibits, for whatever reason, on my end.


                Lord knows I’d never speak for Blaise.
                (He and I agree more often than not on policy and philosophy but his dripping arrogance is, well, admittedly sometimes off-putting.)

                That said, I’ve never seen a demonstrably realistic vision from any Libertarian.

                And so, how exactly would Libertarian philosophy strive to resolve modern day health care challenges without resulting in a whole bunch of our citizens either living seriously debilitated lives or, y’know, just dying.

                I am, genuinely, all ears.Report

              • Avatar BlaiseP says:

                Dripping? I secrete Arrogance by the bucketful when confronted by Theological Mysteries. I am awfully hard on Dime Store Doctrinaires: generally I send them away howling, clutching their heads and other parts of their anatomies. I kick bad thinking to pieces. Nobody has ever confused me for a Nice Person and I don’t encourage it in others. I learn nothing from those I agree with, anyway.

                But I did fix your html. You’re welcome.

                Back to Roger: so far, so good. As a Liberal who trends more toward Libertarianism than any other quarter, I am for the Minimal State.

                Next question: please lay out the basis for this Voluntary Association rhetoric I hear about from the Libertarian camp. Sounds too much like Denominations for me to sign up for such a plan.Report

              • Avatar Roger says:


                Could you clarify the question please? Are you asking why I recommend interactions between rational adults be consensual or voluntary?Report

              • Avatar Roger says:


                Please follow me down below to a new thread at the bottom so we can have more room. I will give it my best try.Report

              • Avatar BlaiseP says:

                Roger: see, I’m equally baffled by this phrase, which is why I’m asking. Rothbard’s always using it. A quick google on “voluntarist Libertarian” turns up this wiki entry, which explains precisely nothing to me.Report

              • Avatar Roger says:

                LOL, I will not even try to defend deontological libertarianism, Rothbard, Or Rand. I do not get them either.
                I support noncoercion for consequentialism reasons.

                Next question?Report

              • Avatar James Hanley says:

                Of course, the fact the said evil horrible person made good points in all but one of his posts on this thread is going to be ignored, because he’s not nice to everybody.

                You might want to go back and actually count the number of posts he has on this thread.Report

              • Avatar Brandon Berg says:

                Of course, the fact the said evil horrible person made good points in all but one of his posts on this thread is going to be ignored, because he’s not nice to everybody.

                Honestly, I have more of a problem with his inane analysis and habit of brazenly trying to pass off utter rubbish as the truth than I have with his personality.Report

              • Avatar Brandon Berg says:

                s/the truth/fact/Report

  18. Avatar Chris says:

    I just had to say this, Tod: I dunno exactly what it is, but man do your posts elicit a lot of comments.

    If I were guessing, I’d say it’s the fact that you tend to leave things a little more open ended than most of the FPers. Doing that basically says to everyone, “Talk about this shit, yo.”Report

  19. Avatar Maribou says:

    Here is a conversation I used to have a lot when I first moved to the US:

    Me: The best part of my immigration application was when I had to answer yes to the question about ever having been part of any socialist, communist, or other radical political groups.*
    Them: GASP
    Me: What? I was in the Young NDP in high school. I grew up in a socialist country, and if you had to slap a label on me you’d probably be right to call me a socialist. I’m comfortable with that.
    Me: . o O (Are we even having the same conversation??)
    Me: You know, I think the US is a pretty darn socialist country, frankly. Look at Medicare, Social Security, the GI bill, unemployment insurance, welfare… I mean, for some of these programs, Canada’s eligibility requirements are stricter than -**

    So, I guess my equally unsatisfying answer to your question is that “Medicare” was adopted with the covering fire of huge amounts of Cold-War era THAT’S TOTALLY DIFFERENT propaganda, which UHC has not received since it’s obviously available in multiple socialist countries.
    * The application seems to have been simplified since 1998, or else I wasn’t able to find the Super Duper Inform on All The Potheads You Know version I had to fill out.
    ** I have not looked at the current Canadian or American (or Coloradan) requirements, couldn’t tell you if this is still the case.Report

    • Avatar James Hanley says:

      Similar to the conversation euth my dear mum last weekend. She was all worked up about Obamacare being a big giveaway to people who just expected gov’t to take care of them. And then she said, “And how is this going to affect my Medicare when they start taking money from it to cover Obamacare?”

      No sense of irony, my dear old mom.Report

    • Avatar Stillwater says:

      There’s a bunch of really good point made in this really good comment. The one that jumps out at me the most is that the conservatives and libertarians all seem to agree that the existence of programs and policies that constitute the central platform of liberalism in the US – social safety nets – are perfectly acceptable and justified. They actually agree with the central liberal argument here. The interesting part is that even tho liberalism and liberal thought is defined by programs they in effect support, they somehow also view liberalism as some alien-like view of government and society, one that must be destroyed before all that’s good an holy is obliterated from the world. Just like what happened with social safety nets, I guess.


      • Avatar Roger says:


        Before you start patting yourself on the back for the great wisdom of liberal ideals,I think I need to counter that conservatives and libertarians want social safety nets too. We think it is a super duper idea to plan for retirement and have insurance to cover medical expenses, auto accidents and unemployment.

        Where we totally part ways is how to do so. Liberals lean toward centralized, top down, coercive programs. Libertarians lean toward voluntary, private and noncoercive. See my recent response to North on details.Report

        • Avatar Stillwater says:

          Roger, I’ve read your views on that. Here’s where I’m at on it: I like the idea of our whole social life being based on voluntary, non-coercive interactions. I also think it’s practically, politically (and even logically!) impossible to ever get there.

          But it is a nice ideal.Report

          • Avatar Roger says:

            To get where? I am not suggesting utopia. Society is formed from countless decisions. All I am suggesting is that we consider path B a little more strongly at each decision point.Report

          • Avatar ktward says:


            “Voluntary” has demonstrably never worked.

            For quick example, what has been the Military’s means of servicing its manpower needs during The Iraq/Afghanistan Wars without benefit of The Draft?

            Stop-Loss. A life-crushing policy if there ever was one.Report

            • Avatar Roger says:

              I am not following you ktward. I do not support invading countries or drafting soldiers. When it comes to defending our nation, we should pay for this specialization just like any other job.Report

              • Avatar BlaiseP says:

                Would that we could return to the days of Single Combat. Imagine, if you will, two doughy politicians in their boxer shorts, duking it out on television.

                Listen all! This is the truth of it. Fighting leads to killing, and killing gets to warring. And that was damn near the death of us all. Look at us now! Busted up, and everyone talking about hard rain! But we’ve learned, by the dust of them all… Bartertown learned. Now, when men get to fighting, it happens here! And it finishes here! Two men enter; one man leaves. Report

              • Avatar James Hanley says:

                Nothing personal, but I’d rather see Tina Turner’s face when I hear those lines. 😉Report

              • Avatar BlaiseP says:

                I know you won’t break the rules, because there aren’t any.Report

            • Avatar James Hanley says:

              “Voluntary” has demonstrably never worked.

              Have you ever lived in a place that’s suffered a natural disaster? I lived in Fort Wayne, Indiana, during the 1984 flood, and like countless other citizens voluntarily participated in sandbagging to prevent the flood from taking more neighborhoods, even though many of us didn’t live in threatened areas.

              I also lived in San Francisco during the ’89 earthquake, and saw many people voluntarily directing traffic in the absence of traffic lights, and nearly all cars voluntarily obeying these mere citizens. Others dragged their grills out and began cooking, feeding neighbors who couldn’t risk turning on their stoves.

              Voluntary works frequently, for many things. Not for everything. But by denigrating it as useless we downplay it in cases where it can work, and are too quick to assume coercion is necessary.Report

  20. Avatar Brandon Berg says:

    You had a “euth” conversation with your mom? I knew there were going to be death panels, but I didn’t expect them so soon.Report

  21. Avatar Roger says:


    “That said, I’ve never seen a demonstrably realistic vision from any Libertarian. And so, how exactly would Libertarian philosophy strive to resolve modern day health care challenges without resulting in a whole bunch of our citizens either living seriously debilitated lives or, y’know, just dying.”

    I believe that strong and effective social safety nets are a necessary part of any good society.

    1) I would recommend exploring ways to establish catastrophic care for extremely serious and expensive medical conditions. I would allow people to opt out of this with some very onerous requirements. This would be paid for via payroll taxes unless the fool opted out.
    2) I would recommend people buy their own insurance that meets their needs for routine, non catastrophic care. I would choose a high deductible and low premiums and few frills. Others can get low deductibles, high premiums and all the frills they would like. I would allow any company to sell any policy that people will buy as long as the company is honest and has proper reserves.
    3). I would encourage experimentation with guaranteed insurability and portability, so that people would not be harmed on their routine care premiums if their health status changed.
    4). I would subsidize the poor and elderly and possibly the sickly so that they could purchase the underlying coverage policy and pay their deductibles. Catastrophe coverage would be free or cheap as they do not work much or at all.

    I would add choice, competition, experimentation and all that wherever possible, and if this doesn’t work, I would just follow Singapore’s model.Report

    • Avatar BlaiseP says:

      Thou soundest altogether too much like a Liberal. Thy vision of Choice in this context doth involve much of this Onerous Coercion, O word of fear / unpleasing to a free man’s ear.Report

      • Avatar Roger says:

        I have an opt out to throw a bone to the hard core anarchists. If they want to sign a notarized form annually rejecting all rights to subsidized health care in the US, then they should be able to. My guess is it will shut them up and they will keep paying the tax/premium. The rest of this is all voluntary.Report

        • Avatar BlaiseP says:

          Here’s my summary of Libertarianism. It’s the logical inverse of Marxism and comes in just as many flavours. Them what wants good government must pay for it, as with any other good and necessary thing in life. And them what wants less government ought to understand the laws are written in the blood of the victims, often bearing their names.

          Health care is fundamentally a numbers problem, just like baseball. And like baseball, health care is run by a cabal of monopolist non-baseball-playing shitbirds intent upon ruining the game for the rest of us.Report

          • Avatar Roger says:

            I’m having a similar issue discussing the issue of employer abuses of employees with the various Marxists at The Crooked Timber site. They assume I am some Rothbardian fanatic, and it takes a while before I can get them to talk to me rather than their disdain for anarchism.

            My mantra is positive sum. I think society is a “cooperative venture for mutual advantage.” I use freedom and voluntary associations as ways to learn to cooperatively thrive. To the extent that freedom or liberty cause net harm they are bad things.Report

            • Avatar BlaiseP says:

              Thank you for taking my questions. I wish all my opponents were as willing to answer them.

              I read Crooked Timber. Refuse to write there. I’m not as intelligent as they are. My hatred of Marxism is deathless: were it to arise again in the United States, I would gladly shoulder arms and shoot every goddamn one of them. They are the curse of the world.Report

            • Avatar Stillwater says:

              One thing about Roger’s view is that he presents a case in favor of non-coercion, one which everyone accepts. From that he argues, it seems to me, via a ceteris paribus framework: all other things being equal, isn’t the non-coercive solution to social problems to be preferred?

              And the answer is, obviously, YES! But determining in what way all other things are equal or not requires looking at the evidence, not just guessing or rejecting or proclaiming.

              It’s a good argumentative strategy, and presents a good challenge to liberals. It puts the burden back on us to re-justify the policies and specific mechanisms that are already in place. (Hanley does more or less the same thing, acourse.)Report

    • Avatar James Hanley says:

      Blaise, from above.

      Would you abolish the state?

      Libertarians, in general, do not want to eliminate government. There may be a few, but they are quite rare. The normal “extreme” libertarian view is to favor a “night watchman” state, one where–as Wiki puts it–“the state’s only legitimate function is the protection of individuals from aggression, theft, breach of contract, and fraud, and the only legitimate governmental institutions are the military, police, and courts.”

      Libertarians want a state to protect private property, to enforce adherence to contracts voluntarily entered into, to punish fraud (although that’s leavened with a heavy does of caveat emptor, to be sure), and to protect the community from invasion. Let me reiterate, they don’t just accept the government doing that, they see that as the legitimate and desirable purpose of government.

      Relax that extreme version just a bit and you have libertarians who believe government can legitimately act to offset other market failures. How frequent market failures are, whether they are severe enough to warrant government action, and whether government action will actually improve upon the situation, make it even worse, or result in a roughly equal degree of imperfection, are areas where there is limitless room for disagreement, so some libertarians will accept more government action than others.Report

      • Avatar BlaiseP says:

        Would you be as willing to answer my questions as Roger? Nobody in his right mind wants more government than necessary. The question arise: from whence arises government’s mandate?

        I am inclined to agree with Roger: Murray Rothbard and the Dimestore Doctrinaires are simplistic and their arguments larded with altogether too many begged questions, wrapped about with strips of greasy Marxist bacon wherein the need for the state shall wither away. This is dangerous nonsense and I shall always oppose it.Report

        • Avatar James Hanley says:

          Blaise, I am perfectly willing to answer your questions. I have never refused to answer anyone’s questions. But I would put the same stipulation as Roger, that you try sincerely to understand, and not use answers just as an excuse for calling names.

          However the question, “from whence arises government’s mandate” is one I have been pondering since my first political philosophy class two decades ago, and I still don’t know my own answer. I wish I had a decent answer.

          Nobody in his right mind wants more government than necessary.

          Agreed. But of course different people, all in their right mind, have very different views of how much government is necessary. That determination is a function of their values and their belief about how the world works. That is ultimately why political disagreements are so sharp and so frequently irresolvable–Adam can’t simply expect Bob to abandon his values and accept Adams’, and it’s precious hard to persuade someone they’re wrong about how the world works (as you and I have demonstrated in spades).

          I am inclined to agree with Roger: Murray Rothbard and the Dimestore Doctrinaires are simplistic and their arguments larded with altogether too many begged questions….

          They’re not my fancy, either. I don’t have a utopian vision; I just want to make marginal moves in a different direction than most liberals want to go.Report

          • Avatar BlaiseP says:

            We Liberals know from whence the mandate of government arises, if you do not. Government arises of the necessity of protecting us from each other. We are distinguished from Conservatives by our belief in the limits of government jurisdiction, a sentiment we share with the Libertarians. We believe good government ought to advance the rights of man: we grant government power over us that we might be free men and a better society.

            Today’s Conservatives have so thoroughly disgraced themselves they have nothing further to contribute to the discussion. Given the opportunity by the panic of 9/11, the Conservatives created a police state in its wake and engaged this nation in fruitless and costly wars on the basis of lies and fearmongering. They have not given us peace nor have they given us victory, always the final measure of war and government.

            Their every movement betrays them for who they truly are: a pack of fascists in all but name, intent upon the incestuous union of government and industrial power, concentrating power in the hands of the few. Fuelled by outrage, they are become outrageous, the enemies of the very Liberty they so proudly proclaim allegiance. Auferre trucidare rapere falsis nominibus imperium, atque ubi solitudinem faciunt, pacem appellant., Ravaging, murdering, seizing power under false titles, they call this Empire; and where they make a desert, this they call peace. They have obstructed justice and defied the will of the people. This country needs a genuine Conservative movement and does not have one.

            A Liberal observes government is not supreme because it is composed of mortals, no wiser than ourselves. The law is supreme because it is abstract, amendable and enforceable. Government is not always the best solution to a problem, a charge often levelled at Liberals by stupid persons. Nor is government any better than the other organisations in our lives. We Liberals believe in the distribution of power to the lowest possible levels, contending problems ought to be solved by the people who have them and not always by Washington. State, county and municipal powers have withered while those of Washington have increased. See previous paragraph for why this is so.

            Where Liberals differ from Libertarians, or more properly, where the Libertarians refuse to concede the obvious, is the necessity of government itself beyond the Watchman State. Every honest Libertarian around here seems to be a Liberal in all but name, wisely confessing to the necessity of government, many even going as far as understanding the need for a safety net and other entirely reasonable roles for government beyond this simplistic Force and Fraud argument. Force and Fraud encompass many sorts of crime, including the ruthless abolition of good laws which once protected us.

            The Libertarians ought to quit bashing government so stupidly. If government is a necessary evil, I will grant the Libertarians their points about its evils if they will grant mine about its necessity. And not all government is evil. C. S. Lewis once said of Evil, that it was a perverted good, perverted because it was selfish and short-sighted. For all the scoffing about the Nanny State, even the Libertarian would approve of the night watchman government searching for a lost child or rescuing an abused child from her abusers.

            We Liberals are not Statists. We are not amoral bystanders. As suffers one, so suffer we all. We believe in the perfectibility of government and the need to revise its mandate in light of the facts and the will of the people. If we are to have Free Markets, we must first have Honest Markets, illuminated by the light of day and not by the slanting light seeping between the closed blinds of the corporate boardroom.Report

            • Avatar Roger says:

              The shared assumptions of liberals and libertarians is actually pretty overwhelming as revealed by our common heritage. We are like feuding denominations within a church. We just try to keep you liberals grounded.Report

              • Avatar Tom Van Dyke says:

                Depends on what you mean by “liberal,” Roger. I’m just sittin’ here watchin’ the wheels go round & round. I do agree you libertarians have common ground on libertinism, but it ends there.Report

            • Avatar James Hanley says:

              We Liberals know from whence the mandate of government arises, if you do not.

              I’d say you have a theory about it, which is not the same as “knowing.”

              Government arises of the necessity of protecting us from each other.

              That’s a tempting theoretical approach. Contract theory is certainly attractive to me, and in fact I have espoused this Hobbesian/Lockean view myself. So I certainly take it seriously. But I have two problems with it.

              1) There’s no indication that it has any relation to how governments actually arose.

              2) The amount of killing done by government weakens its claim to be justified by its protective role.

              Those two criticisms aren’t necessarily fatal, so I’m not categorically claiming you’re wrong. But they are strong enough to keep me in doubt about the argument.

              Where Liberals differ from Libertarians, or more properly, where the Libertarians refuse to concede the obvious, is the necessity of government itself beyond the Watchman State.

              You claim it is obvious. But you do no more than claim it. Saying something is so neither makes it so nor proves that it is so.

              The Libertarians ought to quit bashing government so stupidly.

              Can we keep this on a non-pejorative level? Otherwise I’m not going to engage. My stipulation is the same as Roger’s, avoid insults.

              As suffers one, so suffer we all.

              No, the reality of the world is that most suffering touches us not at all.

              We believe in the perfectibility of government

              I would argue that the non-perfectibility of government is much more obvious than it’s necessity beyond the night watchman state. Government is devised by, selected by, and operated by, humans. Humans are not perfectible; hence neither is government. (Non-perfectible does not mean non-improvable, of course.)Report

              • Avatar BlaiseP says:

                The Libertarians have excellent arguments for government bashing at their disposal. They do not play to their strengths, hence the “stupidly”, as in stupor. Who’s demanding smaller government? That would be the Liberals and the Libertarians. If that’s one thing I could get out of this debate, it’s the Libertarians carrying on as if the Liberals were the advocates of big government. I’ve heard it from you, too. It’s a myth. We don’t believe it.

                So why not make the case for testing the necessity of these rules written in blood, especially where they overreach? Law can be amended, distortions corrected. That’s where the Libertarian argument is most useful and it’s proven a useful rhetorical club in my own bag, may I add. I stole it from you guys. Read Hayek, it’s all laid out in Law, Legislation and Liberty. You guys already have a better line of rhetoric with Nomos and Taxis than this belligerent nonsense about Force and Fraud. Give it up. Read your own prophets.Report

              • Avatar Snarky McSnarkSnark says:

                Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance, where, in short, we deal with genuinely insurable risks, the case for the state’s helping to organize a comprehensive system of social insurance is very strong…. there is no incompatibility in principle between the state providing greater security in this way and the preservation of individual freedom.

                Friedrich von Hayek, The Road to Serfdom


              • Avatar Roger says:

                Kind of matches up with what I wrote above about three hours ago . I need to read more of this Hayek character.Report

              • Avatar BlaiseP says:

                Hayek is an eye-opener. When Ayn Rand was all the rage whilst I was in college and I was rattling on about the evils of Communism, one of my professors took me aside and told me to read Hayek on political theory. Hayek’s views on economic theory were not as good, he said, but his stuff on political theory was first-rate.

                Hayek must be seen in the context of his times. Much of what he said was correct, though a good deal it has been largely superseded. Hayek should have steered clear of Mises entirely. Mises is to capitalism what Marx was to communism, a teller of half-truths, a beggar of questions, an excuse maker and a great deceiver.

                But it’s easy to prune out Mises’ influence from Hayek. If Hayek preached a spontaneous order, he was all too aware of the dangers facing that new order from the still-powerful old order, ready to smother it in its cradle.Report

              • Avatar Stillwater says:

                Well, I guess that’s why MFarmer said Hayek is pretty much a modern liberal. What he’s presenting in the quotation Snarky cites. In particular this:

                where, in short, we deal with genuinely insurable risks, the case for the state’s helping to organize a comprehensive system of social insurance is very strong

                That’s the contemporary liberal argument in a nutshell.Report

              • Avatar James Hanley says:

                I don’t see how New York’s soda ban fits in to that model. Or anti-free trade policies.

                I agree that liberals want do do what you say they do, but it does seem as though they don’t only want to do that.Report

              • Avatar Stillwater says:

                I don’t see how New York’s soda ban fits in to that model. Or anti-free trade policies.

                I actually don’t know much about the Soda Ban – in part because I don’t really given a dink about it – so I don’t know what the argument is justifying it. But! if the argument is that soda is a contributory factor in adverse health condition which other people end up paying the bills for (as well as being bad for people as individuals), then I can see that being subsumed by Hayek’s general principle that if the state has a role to play in providing insurance against legitimate risks, then the state has a role to play in mitigating harms.

                Acourse, maybe I’m not understanding what he’s saying here.

                I agree that liberals want do do what you say they do, but it does seem as though they don’t only want to do that.

                That, I will concede.Report

              • Avatar James Hanley says:

                if the argument is that soda is a contributory factor in adverse health condition which other people end up paying the bills for (as well as being bad for people as individuals), then I can see that being subsumed by Hayek’s general principle that if the state has a role to play in providing insurance against legitimate risks, then the state has a role to play in mitigating harms.

                No. My god, a thousand times no. Hayek was talking about “those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision.” He’s talking about being hit by tornadoes, or having a stroke. He’s not talking about getting diabetes brought on by drinking too much soda.

                The absolute critical key in his statement is “uncertainty [against which] few individuals can make adequate provision.” He is not talking about nanny-state policies.

                Hayek can’t possibly be stretched, without greatly perverting him, to cover those types of policies.

                “I agree that liberals want do do what you say they do, but it does seem as though they don’t only want to do that.”
                That, I will concede.

                And that is a critical difference between liberals and libertarians. For all the areas of overlap and commonality, it tends to break down, sharply, right there. (That’s not a statement about which side is right; just about where the two sides break.)Report

              • Avatar Stillwater says:

                I better read some Hayek, eh?Report

              • Avatar James Hanley says:

                Start by reading about him. Seriously, it helps to have context when you dive into him.

                BTW, MFarmer is very much wrong about Hayek being a modern liberal, although he would be closer to them than Mises.Report

              • Avatar Brandon Berg says:

                It’s often difficult to tell exactly what people mean when they speak in such abstract terms. There are hints here, as when he talks about moral hazard, that what he is endorsing may not closely resemble the system which we actually have, which does indeed engender moral hazard.

                We could speculate all day long about this. Fortunately, there’s no need for speculation. Hayek wrote a book, The Constitution of Liberty, in which he apparently expressed a strongly unfavorable opinion of social welfare as actually practiced in Europe. The book’s still under copyright, and I don’t have a copy on hand, so I’ll have to see if I can track it down.Report

              • Avatar Brandon Berg says:

                If you use Amazon’s Search Inside feature to search for “social security”, it’ll let you read most of that chapter. There are gaping 1-3 page holes scattered throughout, but it’s enough that you can tell that, no, he wasn’t really a big fan. It’s possible that he might have supported an Obamacare-type policy, with a stronger mandate, but he was very explicitly against single-payer health care and middle-class welfare programs like Social Security.Report

              • Avatar Stillwater says:

                Thanks BB. I’ll check it out.Report

              • Avatar James Hanley says:

                If that’s one thing I could get out of this debate, it’s the Libertarians carrying on as if the Liberals were the advocates of big government. I’ve heard it from you, too. It’s a myth. We don’t believe it.

                So New York’s soda ban is a myth?

                Robert Reich’s hard-on for industrial policy is a myth?

                No, I don’t think liberals say, “We want big government for big government’s sake.” I think they want government to do lots of things I don’t want it to do. I don’t even like the term big government, since it’s too vague and ill-defined, but there’s little doubt that liberals are frequently urging government to do more while I’m urging it to do less, so I do think liberals want policies that would necessitate a bigger government than the policies I want.

                So why not make the case for testing the necessity of these rules written in blood, especially where they overreach?

                Speaking only for myself, I do that all the time. Your response is usually to assume I’m saying a lot more than I am.Report

              • Avatar BlaiseP says:

                Is Bloomberg a Liberal? Or is he a Republican? Of course he’s a Republican. That’s what they do, they’re all about ramming their morality down your neck.

                Robert Reich makes a lot of sense. Of course, some folks don’t mind if America turns into a Banana Republic. Here’s what Reich actually said:

                Industrial policy ought to fill in where the market fails — providing basic research to help spur new technologies and industries, reducing the negative side-effects of the market (such as carbon pollution), and easing the adjustment of workers and communities out of older industries that are shrinking toward new ones. Ideally, these three parts of industrial policy would be synchronized so the new technologies and industries address negative side-effects while also creating opportunities for communities and workers to gain new employment.

                Sounds reasonable enough to me.Report

              • Avatar Jesse Ewiak says:

                Pretty much every Western nation aside from us has no problem saying, “yeah, we have an industrial policy focusing on this and this and that.” It’s not some weird lefty thing.

                Also, Bloomberg isn’t a liberal. Bloomberg’s an asshole CEO who managed to get elected Mayor and is now trying his best to govern as a CEO.Report

              • Avatar James Hanley says:

                1. OK, let’s see the evidence of all the liberals protesting against Bloomberg’s soda law. If you don’t like that example, make it smoking laws.

                2. Blaise, the issue isn’t whether Reich’s call for industrial policy makes sense to you. The question is whether it requires more government activity and involvement than a libertarian is likely to call for.

                2. Jesse, your point is not on point. I’m comparing liberals to libertarians. Liberals in the U.S. advocate industrial policy, libertarians don’t. I’m sure you’re one of those folks who see the U.S. Democratic party as center-right in the context of most Western industrialized nations, so it’s a bit much to suggest their economic policies aren’t generally somewhat liberal. But if you want to suggest they’re actually conservative, that’s fine, because I think conservatives want a lot more government than libertarians do, too.

                Look, the issue here isn’t whether industrial policy, or soda bans, or smoking bans, are good or bad. The issue is whether the set of policies favored by liberals requires more government activity than the set of policies required by libertarians. I really don’t like the term “big government,” as I noted, because it’s so vague. But I just don’t see how anyone, liberal or libertarian, could seriously argue that liberals don’t want more government than libertarians do.Report

              • Avatar Stillwater says:

                But I just don’t see how anyone, liberal or libertarian, could seriously argue that liberals don’t want more government than libertarians do.

                Agreed. This really shouldn’t be a point of dispute. In fact, it seems to me it’s the cause of the dispute.Report

              • Avatar Mike Schilling says:

                But I just don’t see how anyone, liberal or libertarian, could seriously argue that liberals don’t want more government than libertarians do.

                So do conservatives. And so does pretty much any officeholder, other than ineffective gadflies like Ron Paul.Report

              • Avatar James Hanley says:

                Stillwater, But unless I’m misreading him, Blaise does seem to be disputing that.

                Mike, Agreed; I even said so explicitly. And as I’ve said numerous times over the years, if–as seems inevitable–I’m going to have to live under more government than I want, I’d prefer to live under the liberals’ more government than the conservatives’ more government. It’s a pain-in-the-ass, but it’s not half as scary.Report

              • Avatar Stillwater says:

                James, I think he was saying liberals advocate smaller government than conservatives, not smaller than libertarians. Could be wrong about that.Report

              • Avatar Stillwater says:

                I mean, I hope that’s what he was saying.Report

              • Avatar James Hanley says:

                Stillwater, I honestly wouldn’t know how to measure the difference in size between what liberals want and what conservatives want. The two sides would ramp up and pare down such different sides of government, I just don’t know an easy way to determine which would be “bigger.” I wouldn’t measure purely on either tax revenues or total expenditures. I suspect the conservative government would “feel” bigger to me.Report

              • Avatar Brandon Berg says:

                Pretty much every Western nation aside from us has no problem saying, “yeah, we have an industrial policy focusing on this and this and that.” It’s not some weird lefty thing.

                We should probably stop and clarify here, for the new folks, that it’s libertarians, not leftists, who are the corporate shills. You can see how a comment like this might confuse someone who’s new to this stuff.Report

              • Avatar James Hanley says:


              • Avatar trizzlor says:

                Smoking bans in public spaces seem like a typical solution to the commons problem. You walking around with a cigarette in a public park is destroying my health, just the same as if you were walking around brandishing a weapon, and I don’t see anything wrong with such a ban based on purely libertarian grounds.

                Smoking bans in private businesses get at a very interesting distinction between liberals and libertarians where the latter assume that a voluntary contract cannot, by definition, be coercive. So if an employee volunteers to work in a smoke-filled environment and destroy their health, that’s their voluntary choice and the state has no business moderating it. See also the whole “fuck me or you’re fired” debate going on at Crooked Timber where even left-libertarians are wringing their hands over weather a sexually exploitative employment contract is coercive. This is one area where liberals do not quibble. Still, I believe Mr. Hanley has expressed libertarian support for minimum safety mandates on employers, in which case a smoking ban seems like an issue of degree rather than of ideology and too can fall comfortably within the libertarian framework.

                These “libertarian” justifications are usually what I’ve seen liberals rely on, and I haven’t heard of major liberal campaigns for banning smoking in general private spaces.Report

              • Avatar Tom Van Dyke says:

                Um, no. I hope you were satirizing: “You walking around with a cigarette in a public park is destroying my health…”Report

              • Avatar BlaiseP says:

                One thing about problems: someone’s going to get involved. War may be politics by other means but a nation which issues money must not expect a bright future without either an economic policy or pegging that currency to a country which does.

                All this hooey about how less government is always better in every case, rattling on about Robert Reich and Bloomberg in the same sentence: you’ve already doomed your case by not sticking to your anarchist guns. I’ve tried to put up Hayek as common ground. That only went so far, it seems. Hayek, better than anyone of his age, laid out the case for Thesis, a synthesis of what government can and ought to do for society on the basis of the quality of ends and the ethics of the means required.

                Robert Reich hasn’t advocated a command economy. Had you read what he said, he laid out the problems with any such proposal in it.

                All you’ve presented is 1) a Republican with some Judaeo/Calvinistic impulses and 2) Robert Reich, whose entire thesis has been the corruption of good government by economic forces. You are mightily upset with those who would simplify the arguments of the Libertarians: be not so quick to simplify the Liberals.

                Robert has been good enough to lay out the case for government. Take your problems with the size of government up with him, you sound like a damned old Marxist, I swear you do, substitute Mises for Mao and it all works the same.

                There is a diminishing law of returns on reducing the size of government, two points in any regulatory spectrum beyond which harm is done via deregulation or regulation. There is a happy medium, where, in the real world, government serves the many and not the ends of the powerful few.Report

              • Avatar Mike Schilling says:

                So New York’s soda ban is a myth?

                How can libertarians claim to be against big government after they passed the Patriot Act?Report

              • Avatar James Hanley says:

                ?? Libertarians are mostly against the Patriot Act. Roger Pilon supports it, or at least certain parts of it having to do with intelligence sharing. But he’s a bit of an outlier on that one.Report

              • Avatar Brandon Berg says:

                I believe that the point he’s making is that leftists weren’t the ones behind the big soda ban. I haven’t really been following it, so I don’t know whether that’s true.Report

              • Avatar Mike Schilling says:

                Yes, that Bloomberg is no more a liberal than Bush or Cheney is a libertarian.Report

              • Avatar Brandon Berg says:

                Well, he’s a New York Republican, which is roughly equivalent to a Texas Communist. What that means on a normal scale is anyone’s guess.Report

              • Avatar Will H. says:

                I’m not so sure that the Patriot Act really increased the size of government so much as decreased the limitations on federal actors.Report

              • Avatar James Hanley says:

                Bloomberg may not be a liberal, but I’m hard pressed to believe those types of laws aren’t generally supported rather more by liberals than by conservatives.Report

              • Avatar Brandon Berg says:

                More by Democrats than by Republicans, anyway. Also, apparently Bloomberg is an independent, not a Republican, so I stand corrected there.

                Regardless of whether leftists support this particular law, they ultimately bear some responsibility for it. If your health care is the government’s responsibility, then the proposition that your lifestyle choices are the government’s business becomes much more tenable.Report

              • Avatar BlaiseP says:

                Consider yourself hard-pressed, Hanley. It’s not the Liberals shutting down abortion clinics or advocating a War on Drugs. Thank our Conservative compadres for that sort of Legislating Morality.

                You’re constantly whining about how everyone misunderstands Libertarians. I’m growing increasingly tired of you demonising Liberals. It’s obvious you don’t know anything about what we believe.Report

              • Avatar James Hanley says:


                For god’s sake, I never said liberals were doing those things. If you’re going to accuse me of misunderstanding liberals, don’t pretend I’ve said something I haven’t, and don’t pretend I didn’t critique conservatives for their supportbfor oncasive gov’t programs when the explicit evidence that I did is right above in the very same thread.

                Is this really your idea of sincere and honest discussion?Report

              • Avatar BlaiseP says:

                Then please explain this, James.

                1. OK, let’s see the evidence of all the liberals protesting against Bloomberg’s soda law. If you don’t like that example, make it smoking laws.

                2. Blaise, the issue isn’t whether Reich’s call for industrial policy makes sense to you. The question is whether it requires more government activity and involvement than a libertarian is likely to call for.

                This sort of question begging is exactly why I can’t be nice to you, James. And now, once again, when I confront you on the floor of the Straw Man factory, with your statement about how you’re hard pressed to believe those types of laws aren’t generally supported rather more by liberals than by conservatives, you raise your clammy hands to heaven and swear you’re also producing a Conservative model of your straw man.Report

              • Avatar Will Truman says:

                Brandon, could you try again on that last link of yours (wrt the soda ban)?Report

              • Avatar James Hanley says:


                There’s not one bit of question begging in any of that. The issue was whether liberal’s want more gov’t than libertarians. I sails explicitly that I didn’t like the term “big gov’t” because it’s too vague, but that liberals clearly want more gov’t than libertarians, and gave a couple of examples. Regardless of whether industrial policy is a good idea or not–which is a separate issue–it does require more from government, and liberals are more likely to favor it than libertarians. As to the soda ban, a Quinnipiac poll shows more Dems than Repubs support it (about 50% – 31%), so it’s clearly more favored by liberals than conservatives.

                If your argument is that conservatives are mor big gov’t than liberals, I already addressed that and I’d appreciate you having the decency to not pretend I didn’t.

                Anyway, you asked if we’d answer questions. If you actually have honest questions, I’ll be happy to answer. If you’re just looking for a point of atack, then you engaged under false pretenses, and I’ll pass.Report

              • Avatar James Hanley says:

                Damn, I messed up the soda tax (not ban, my bad), too. Must be gremlins.

                Let’s try again, and if this doesn’t work, just google “new York soda ban poll” (even though it’s not a ban).


              • Avatar Brandon Berg says:

                This was my link on the big soda ban.Report

  22. Avatar Timbo says:

    Newbie post. Tried to read through all responses, but to your original question, I would hazard that most elderly (and possibly the GOP) find Medicare “acceptable” for the same reason they find Social Security somewhat acceptable: The assumption is you have skin in the game. If you assume a basic $40K annual salary and 45 years, you’ve paid in roughly $27K towards premiums. Comparing that to someone with no skin in the game (the poor), where do you think the contempt will be directed?Report

    • Avatar Jaybird says:

      Yeah, when I was a little kid, I made a reference to “medicaid” in front of my grandfather’s second wife and, my goodness, she explained to me the difference between medicaid and medicare.

      Medicare was earned, she told me.Report

      • Avatar Brandon Berg says:

        The thing is, for most people this isn’t true. Medicare is funded by a flat 2.9% tax on wages. If you make $30k per year, you pay $870 per year towards Medicare. If you make $300k per year, you pay $8700 towards Medicare. Some people are paying much more than others, but they all get the same benefits. Ergo, some people are subsidizing, and others are getting subsidized.Report

        • Avatar Jaybird says:

          I’m pretty sure that explaining that to Nana would not have helped the situation.Report

          • Avatar Mike Schilling says:

            “No, Nana, to compare it to a private insurance policy we’d need to calculate the present value of the contributions you made before you turned 65 and then reverse the process to generate an annuity based on your life expectancy. No, I don’t think I hear the ice cream truck. Why?”Report

        • Avatar Timbo says:

          Brandon, this is true. It is even true to say that the amount paid it isn’t enough to cover the premiums. And, as Mike says, this doesn’t take into account the potential growth/loss of your contribution had it been privately invested. But all this obfuscates my original answer to the macro question queried by Tod: As a society, we are much more “forgiving” when it comes to those who contribute or, at least, participate in which ever activity we are talking about than those we perceive as “getting something for nothing”.

          If you look at unemployment compensation, society (as a rule) is more accepting of an individual who has worked and indirectly contributed via their employer to UI than to a person who hasn’t worked and receives TANF or SNAP. We, as a society (as a rule) applaud home owners who deduct mortgage interest during tax time and thusly reducing their tax liability, but we look down upon those who receive tax credits because of the EIC or pay no income taxes because they don’t earn enough. We applaud the soup kitchen worker who gets a tax break for charitable contribution, but ignore the soup kitchen beneficiary because they a “moocher”.Report

  23. Avatar Tod Kelly says:

    Wow! You read through all the comments on this post? Yeoman’s work.

    Also, this is a great response.Report