Is the New Republican Sales Tax Plan ‘Fair?’

David Thornton

David Thornton is a freelance writer and professional pilot who has also lived in Georgia, Florida, Kentucky, South Carolina, Tennessee, and Texas. He is a graduate of the University of Georgia and Emmanuel College. He is Christian conservative/libertarian who was fortunate enough to have seen Ronald Reagan in person during his formative years. A former contributor to The Resurgent, David now writes for the Racket News with fellow Resurgent alum, Steve Berman, and his personal blog, CaptainKudzu. He currently lives with his wife and daughter near Columbus, Georgia. His son is serving in the US Air Force. You can find him on Twitter @CaptainKudzu and Facebook.

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289 Responses

  1. Chip Daniels
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    says:

    As I mentioned to in the other thread conservatism has lost any semblance of a coherent ideology, and this is the latest example.

    Before even getting into whether it is fair or not, what is the purpose here? How is this meant to improve our system of governance? Why is the current system un-“Fair”?

    Notice how even in this essay, almost no mention of a larger purpose or motivating idea behind it. Why is an income tax bad, but consumption tax good?

    And the reason why a larger ideology is so critical, is that it establishes a brand identity for what the movement stands for.
    Right now, the brand identity for conservatives is opposition to cultural changes, and preference for the rich. Takers and makers, 47% vs 53% and all that.

    In the absence of a coherent and compelling purpose, it isn’t possible to consider this proposal without this brand identity filling in the missing component.Report

    • Jaybird in reply to Chip Daniels
      Ignored
      says:

      Personally, I hate it when people write essays for people familiar with the debate instead of writing them for people who have never even heard of the debate before.

      What about me? WHY WASN’T THIS ESSAY WRITTEN FOR *ME*?????Report

    • Dark Matter in reply to Chip Daniels
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      says:

      Why is an income tax bad, but consumption tax good?

      Economics.

      1) This would MASSIVELY reduce the various distortions in the tax code and make it something humans could understand.

      2) This brings us into line with the VATs that Europe uses. That makes exports/imports harder to game from a tax point of view and encourage both of them (especially with Europe).

      3) The various money’s that are parked off in other countries could come home and be investments here.

      4) It’s easier to administer.

      5) It strongly discourages tax evasion.

      6) It’s way more aligned on how modern economies actually work. The Income tax doesn’t work well with multiple tax jurisdictions and multi-nationals.Report

  2. Jaybird
    Ignored
    says:

    I very much do not like the shell game of whether it’s 23% or 30% and I know that they’re playing that game because of all of the psychological reasons of the difference between “almost a third” and “less than a quarter” and that’s on top of all of the people out there who actually pay attention to stuff like “tax rates” are firmly in the “30% would be a tax hike and 23% might not be?” camp.

    But the thing I like about it is that it ends the game of “hide the ball” that deductions, exemptions, and other gameables have.

    But, as you said, it’ll never get off the ground.Report

  3. Michael Siegel
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    says:

    I’ve been writing about the Fair Tax for a long time and I suggest reading Bruce Bartlett’s critique. Some major problems:

    1) No country using a sales tax this high because compliance become a very serious problem. Most countries that have a national sales tax use a VAT instead, which is self-enforcing.
    2) Because wages are inelastic, the result of implementing the Fair Tax would be a one-time 30% inflation. People are not going to let their paycheck be cut to what their takehome pay is now so business will have to raise prices. The Fair Tax advocates lie about this A LOT.
    3) The 23/30% line is a very back-of-the-envelope calculation. It assumes governments pay the Fair Tax; that the Feds pay it to themselves, etc. Because of this, the uncertainty in how much revenue you’d actually pull in is VERY large. Like hundreds of billions of dollars.

    That’s just to start. It’s a terrible idea.Report

    • InMD in reply to Michael Siegel
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      says:

      The inflation component is what immediately stands out to me. Seems like the wrong time for something that would act as an immediate massive stimulus plus immediately raising the prices on everything by a third.Report

    • Dark Matter in reply to Michael Siegel
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      says:

      I’m assuming this becomes a VAT somewhere very soon during the process because you’d pretty much have too. My response to Chip was written with that in mind.Report

      • Philip H in reply to Dark Matter
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        says:

        The “Fair Tax” true believers don’t support VAT’s. Never have.Report

        • Dark Matter in reply to Philip H
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          says:

          They’re both consumption taxes and would look the same to the consumer.

          The VAT would just be a lot easier to enforce and require less overhead.

          I.e. the VAT could collect the same revenue at a lower rate. That’s such a strong political argument that my expectation is “Fair Tax” gets the credit, the labeling, and we keep the prebate, but the actual nuts and bolts is VAT.Report

  4. Jaybird
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    says:

    The other thing I’m worried about is that this opens the door for not a Fair Tax but a National Sales Tax. A small one. Just 2% or so. Why would you be opposed to a 2% tax? This will help fund things that are good. You like things that are good, right? What does “fungible” mean? If you don’t support this tiny, miniscule tax, you’re a bad person.

    And then this 2% tax is on top of everything else rather than replacing something else and, next thing you know, the camel is in the tent.Report

  5. Saul Degraw
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    says:

    This is a rather easy promise for McCartthy to make because the chances of it passing the Senate or even coming to a full floor vote in the Senate are close to zero. Hell, I would not be surprised if this fails a floor vote in the House.

    A 30 percent sales tax is regressive and unfair. It is also amazingly bad politics from an optical standpoint. How is it going to look when families discover that their every day expenses go up by 30 percent? What happens if this drives spending to a halt?Report

    • InMD in reply to Saul Degraw
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      says:

      That’s also a good point. Lower income people pay effectively no income taxes as it is so it’s not like there’d be anything close to a commensurate trade off in take home if it was eliminated. This would kill them.Report

      • Pinky in reply to InMD
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        says:

        “Back in 2007, the analysis showed that Americans who earned less than $15,000 would see their share of the federal tax burden decline from -0.7 percent to -6.3 percent.” If we’re talking about negative percentages, this bracket is going to be seeing their revenue from the government increase.Report

        • InMD in reply to Pinky
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          says:

          Yea but this is one of the situations where I’m not sure the percentages really do justice to the question. Giving everyone another thousand bucks a year isn’t going to make up for everything becoming 30 percent more expensive, including stuff that was never taxed before.Report

      • Jaybird in reply to InMD
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        says:

        One of the upsides for the “monkey throwing a cucumber” crowd is that the “rich” who pay effectively no income taxes will start paying this.Report

        • InMD in reply to Jaybird
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          says:

          I suspect if this was going to be a net loss for them it would not even be on the agenda.Report

          • Jaybird in reply to InMD
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            says:

            I have no idea what will happen in practice. Remember when they put a “luxury tax” on stuff like jewelry or yachts that cost more than $100,000?

            Well, there were unintended consequences.

            In 1990, the Joint Committee on Taxation projected that the 1991 revenue yield from the luxury taxes would be $31 million. The actual yield was $16.6 million. Why? Because — surprise! — the taxation changed behavior: fewer people bought the taxed products. Demand went down when prices went up. Washington was amazed. People bought yachts overseas. Who would have thought it?

            According to a study done for the Joint Economic Committee, the tax destroyed 330 jobs in jewelry manufacturing, 1,470 in the aircraft industry and 7,600 in the boating industry. The job losses cost the government a total of $24.2 million in unemployment benefits and lost income tax revenues. So the net effect of the taxes was a loss of $7.6 million in fiscal 1991, which means the government projection was off by $38.6 million.

            Report

    • DensityDuck in reply to Saul Degraw
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      says:

      “This is a rather easy promise for McCartthy to make because the chances of it passing the Senate or even coming to a full floor vote in the Senate are close to zero.”

      oh you mean like the Green New DealReport

      • Chip Daniels in reply to DensityDuck
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        says:

        Exactly.

        It seems more like an announcement of their brand identity than anything.

        So I hope to see a lot more discussion about this.

        A whole lot more, every day and every day until November 2024.Report

  6. North
    Ignored
    says:

    One could, perhaps, argue that it’d not be a net increase of taxes on the poor specifically but it’s inarguable it’d be a net transfer of taxation off the wealthy and on to everyone else. With our modern Republican party one wouldn’t expect anything else. That leg of zombie Reaganism never stops a-twitchin.Report

    • Chip Daniels in reply to North
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      says:

      What else they got?
      A national phonics mandate?Report

      • North in reply to Chip Daniels
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        says:

        As much as it pains me to say so there is a suite of moral and practical objections and alternatives to liberal/Democratic/Left wing policies. The modern GOP doesn’t really consistently espouse many or any of them. The only thing their plutocratic wing agrees on is cutting taxes for itself and its marionets in Congress dance accordingly. That is an incredibly big problem for the country- we could really use two operational sane parties- not just the Dems.Report

  7. Philip H
    Ignored
    says:

    This is yet another act of GOP cowardice – both in being unwilling to talk about which part of the economy this really benefits, and their continued unwillingness to propose the necessary service cuts that would have to go with it.Report

    • Chip Daniels in reply to Philip H
      Ignored
      says:

      What makes you say that?
      Making America’s tax system more like the rest of the developed world would logically allow us to have the same things the rest of the developed world has- universal income support, nationalized health care and high speed mass transit, for example.

      I’m a Democrat, and even I could get behind that. The Republicans may be on to something here.Report

      • InMD in reply to Chip Daniels
        Ignored
        says:

        I don’t think other countries are supporting their welfare states with a VAT. Even if they do they are also taxing income at high levels compared to the US, so pretty different than what this would be.Report

      • North in reply to Chip Daniels
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        says:

        In the rest of the developed world a VAT is a supplement to progressive income taxation- not a replacement.Report

      • Philip H in reply to Chip Daniels
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        says:

        The problem with a mixed VAT and income tax system is that it would only work if we invalidated the state and local taxation authorities. I’d be happy to be wrong, but I don’t believe that every burb or borough or whatever the European equivalent is gets to tax below the national taxation authority.Report

      • Dark Matter in reply to Chip Daniels
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        says:

        universal income support, nationalized health care and high speed mass transit, for example.

        Our HC system is sick but the solution is probably more market and less management from the gov.

        High Speed Mass Transit depends on population densities that we lack.

        IDK what universal income support would look like or how it works in reality.Report

        • Chip Daniels in reply to Dark Matter
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          says:

          As with all things, the ability to point to a working model is worth a thousand arguments.Report

          • Dark Matter in reply to Chip Daniels
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            says:

            If Sweden is making something work, then the first thing to examine is whether their solution requires a monocultural ethnic group the size of a city.

            Even then, what works for the Amish may not work for Inner City Chicago.Report

            • Jaybird in reply to Dark Matter
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              says:

              You don’t need a monoculture. You just need a high-trust society.

              “Can you give examples of high-trust societies?”
              “Japan, South Korea, Denmark…”Report

              • Philip H in reply to Jaybird
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                says:

                I’ve reached the conclusion that we don’t have a low trust society. We have societal segments with low trust. but its not universal.Report

              • Jaybird in reply to Philip H
                Ignored
                says:

                It’s one heck of a continuum.

                Instead of seeing it as “low trust” vs. “high trust”, see it as “somewhat high but going lower” versus “somewhat high-middle and going lower”.

                Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                Likewise, the idea that other nations like South Korea just “have” a high-trust society is also a fallacy.

                Korea has historically been just like many other nations around the world, with a strict hierarchical class system and slavery for the peasant class, i.e., much like the American model, and had a number of wars and struggles to sort itself out.

                Trust didn’t just happen, the Koreans worked very hard and made sacrifices to make it happen.

                Again, both this idea and the “monoculture” idea are rooted in the idea of cultural essentialism- Koreans are just nacherly docile and trusting which is why they have such low crime rates and the Swiss are just all alike with no differences between them nosiree and that’s why thing work there.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                If seeing it as “high” vs. “low” is a mental blocker for you, see it as like a scale of 1-100.

                In order to have, say, Socialized Medicine, you need to have at least an 80. If you only have a 75, you won’t be able to set up Socialized Medicine.

                Maybe you can set up Socialized Medicine if you have an 80 and maintain it if you start dipping down into the 70s, but if you don’t have an 80, you won’t be able to kick it off in the first place.

                So running around and defining “high trust” as something around 95 and pointing out that there isn’t a single country with a score of 95 *ANYWHERE* isn’t as useful as saying “well, which countries do I wish to emulate?” and then seeing what overlap they have with each other.

                “BUT NONE OF THOSE COUNTRIES I WANT TO EMULATE ARE A 95! WHICH I HAVE DEFINED AS HIGH TRUST!”

                Okay. So let’s just look at the ones you want to emulate.

                “I can’t tell a thing about them. I see no differences between them and us. CHECK AND MATE!”Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                You’re the one who introduced the term, so its your baby to deal with.

                How about we drop the use of it since it doesn’t seem like it is doing any work?Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                Oh, I continue to be 100% fine with using terms like “high trust”, “medium trust”, and “low trust”. Heck, even introducing caveats that it’s possible for two medium trust societies to be different from each other (even to the point where one is higher trust than the other without being high trust).

                How about we drop the use of it since it doesn’t seem like it is doing any work?

                To whom?Report

              • Pinky in reply to Jaybird
                Ignored
                says:

                Could you spell out why societal trust is a necessary precondition for large social programs? Also, what would be a bigger challenge, broadly diminishing societal trust or pockets of much lower societal trust?Report

              • Jaybird in reply to Pinky
                Ignored
                says:

                Trust goes hand in hand with co-operation. Well, it’s more of a pre-requisite, really.

                If you want high co-operation (such as “large social programs”), you’re going to need high trust first. You can attempt to impose high co-operation programs but if they don’t have high trust, they’ll break down and the planners won’t understand why.

                Diminishing social trust is fairly easy. All you have to do is defect. That can mean “rip somebody off” and it can mean “break stuff for no reason” or “stab somebody in the back”.

                This is all pretty much based on models of the iterated prisoner’s dilemma and on the importance of collaboration rather than defecting.

                “High trust”, in this particular case, means “we can trust each other to collaborate”. This can keep the collaboration going indefinitely. If you want to diminish societal trust? Just defect. Defend defecting. Explain why defecting is good, actually.

                Oh, and if you want a real-life example of this, you can look at stuff like “the police”.

                Police were mostly trusted at one point. Well, maybe not by some elements of society but, for the most part, they enjoyed the benefits of being trusted.

                Trust in the police has gone down in recent decades. This is because of failures, massive failures, on the part of police. Look at how the police have responded to it to see examples of how *NOT* to deal with breaking the trust of the public.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                American history contradicts this theory.

                The 1920’s was a period of violence and cultural chaos in backlash to the recent waves of immigration followed by the Great Depression, and trust was at such a low level as to spark credible fears of an actual shooting revolution.

                And yet, a large social program was created that was supported even by groups of people who hated each other. A black guy, and the white guy who wanted to lynch him, were both supporters of the New Deal. The ethnic ghettos of Italians and Jews who fought bitterly with each other, were all supporters of the large social programs.Report

              • LeeEsq in reply to Chip Daniels
                Ignored
                says:

                Italy is another example of creating social programs in a low trust society.Report

              • Jaybird in reply to Chip Daniels
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                says:

                Have you ever compared the demographics of the countries you’re hoping to emulate with the demographics of the US in the 1920’s?Report

              • Chip Daniels in reply to Jaybird
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                says:

                Aaaand we’re back to this.
                Every time.

                The amazing gall of this is that the “countries I’m hoping to emulate” are the dozens of developed nations in every part of the world, with wildly differing cultures and demographic mixes and internal fractures.

                They all have similar complex historical and cultural issues, just like America, they all have history of bitter cultural grudges and feuds and oppressions, they all struggle with the issues of assimilation and cultural preservation, they all balance individual freedom versus group obligations.

                There is nothing unique about our issues or struggles. There is no special magic curse upon America making it impossible for us to have nice things.

                “Monoculture”, “Trust”, “Demographics”…these are just spurious objections without any support.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                It’s weird. I ask for a list and you keep saying “a whole bunch of them!”

                Yep, wildly different cultures. That’s for sure.

                Can you list them? It might make it easier to list them. I keep expecting stuff like The Nordic Countries to show up and, if we narrow stuff down to merely stuff like “socialized medicine”, we’ll be able to include England, Canada, maybe France.

                And then we can talk about “monoculture” and stuff like “official languages” and you won’t understand why we’re talking about “official languages” in a discussion of monocultures.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                You need to do some work here.

                Your theory is that there is some way for dozens of different nations to do something, but there is some weird factor that you can’t explain blocking America from doing a similar thing.

                We’ve shown that it isn’t “Monoculture”, it isn’t “Demographics”, it isn’t “Trust”, so what is it?

                You can’t seem to explain to us what it is.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                No, you haven’t.

                Like if I argued “we’ve *GOT* socialized medicine! It’s called Medicaid!”, would that be sufficient for you?

                Then I could just hammer on Medicaid being exactly what you’re asking for and be impervious to any information otherwise.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                Ok so which of these things explains why we can’t have, say, socialized medicine here?
                Monoculture
                Trust
                Demographics

                Pick one and defend your theory.Report

              • Jaybird in reply to Chip Daniels
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                says:

                We do! It’s called “Medicaid”!Report

              • Chip Daniels in reply to Jaybird
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                says:

                Sure, so what stops us from expanding it to cover everybody?Report

              • Jaybird in reply to Chip Daniels
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                says:

                The middle class prefers their work insurance and the elderly class prefers medicare and the military class prefers tricare (if only barely).

                50%+1 of the country prefers what they have right now.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                Wait, so we actually DO have large social programs,, and we CAN make them work, we just prefer somethings else?

                it isn’t Monoculture? Not Trust? Not Demographics?Report

              • Jaybird in reply to Chip Daniels
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                says:

                Yeah, I don’t know why you want to change things when we already have the things that you claim to want! We are Europe already.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                So, we’ve shown that it isn’t “Monoculture”, it isn’t “Demographics”, it isn’t “Trust”, it’s just “We Don’t Wanna”.Report

              • Jaybird in reply to Chip Daniels
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                says:

                What do you mean we don’t wanna? We already have them! Why do you deny that they exist at all?Report

              • Philip H in reply to Chip Daniels
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                says:

                Its not even we don’t wanna for large swaths of the public. Take Jaybird’s reference to the middle class liking their work associated health insurance. There’s lots of polling and lots of reporting on how that’s not true. What’s missing however is the political will of the middle class to vote out the politicians who are perpetuating that system (which was created in the 1950’s in part to stem the rise in unions post-war). Politicians may like it like that but the middle class is way more open to the idea then you might think.Report

              • Jaybird in reply to Philip H
                Ignored
                says:

                “Do you like what you have?”
                “No, it sucks.”
                “Do you want to change it?”
                “HELL NO!!!”

                There’s kind of a revealed preference thing going on.

                I’d compare to stuff like, say, paying for college. They want exactly what they have right now (or exactly what they had a few years ago) except they want it to be cheaper. No trade-offs.Report

              • Chip Daniels in reply to Philip H
                Ignored
                says:

                This is the same dance we have every time.

                “We can’t because Monoculture!”
                “There are plenty of multicultural nations that have it.”

                “Oh, uh we can’t because Trust!”
                “Here are some examples of low trust nation that have it.”

                “Oh well, we just don’t wanna.”

                Which is true I just wish they’d stop with bullsh!t and get to the point.Report

              • Jaybird in reply to Chip Daniels
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                says:

                “There are plenty of multicultural nations that have it.”

                “List them!”
                “Switzerland, Denmark, Canada…”Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                Yes and…?Report

              • Jaybird in reply to Chip Daniels
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                says:

                “All of those countries have an official National language.”

                “I don’t see what an official National language has to do with multiculturalism.”Report

              • Chip Daniels in reply to Jaybird
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                says:

                Oh, now it’s language.
                Yeah that’s it.

                Like, Switzerland which is officially not just multicultural but multilingual.

                Next excuse?Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                No, it’s not language. It’s about shared culture.

                Now you may say that there’s no way for us to measure whether a culture is “multicultural” or “monocultural” and point out that there’s no such thing as a monoculture in an attempt to argue that it’s not possible to distinguish between things but the great thing about Official Languages is that they set a measurable floor.

                Is the expectation that you be on the floor?

                And having an official National language is not sufficient to argue for a monoculture (indeed, is there anything monocultural once you get into relationships larger than the individual to him or herself?) but it is the floor for whether there is an official expectation of shared language.

                The United States, for example, does not have one.

                “We should be more like these other countries?”
                “You mean like having an official language?”
                “Oh, now it’s language!”

                Do you want to be like other countries or not?Report

              • Chip Daniels in reply to Jaybird
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                says:

                Ok so it’s not about Monoculture, or Trust, or Demographics, or even Language, but a shared culture that allows other nations to have socialized healthcare.

                Is this it, where the goalposts are fixed?

                I just want to make sure this at last is where you are going to make your stand.Report

              • North in reply to Jaybird
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                says:

                Dude did you just list fishing Canada as a monocultural country?!?!Report

              • Jaybird in reply to North
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                says:

                If the EU counts as one, I don’t see how Canada escapes the charge.

                More seriously, I think that being officially two cultures (and *NOT* three) gives it a status of being it’s own thing in a way that is not a “melting pot” (or tossed salad).Report

              • North in reply to Jaybird
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                says:

                The EU doesn’t count as one, obviously, they have enormously different systems unique to each of their respective member states.

                And you’re somewhat out of date on Canadian cultures. Certainly the French and English ones are the major ones but Canadians recognize and embrace multiple cultures as public policy- the salad rather than the melting pot so to speak.Report

              • Chip Daniels in reply to North
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                says:

                The majority of developed nations that have some form of socialized medicine all have their own versions of the struggles America has- indigenous people vs colonizers, underclass vs aristocracy, assimilation of religious vs secular…none of this stuff is unique to us much less an excuse for not solving our healthcare delivery system.Report

              • Dark Matter in reply to Chip Daniels
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                says:

                Depends on the program and how long you want to take to roll it out.

                The big issues with UHC are less cultural and more political/economic. We can’t pay for UHC without serious HC reform. Serious HC reform would mean firing very large numbers of people. Markets have a history of doing that but politicians do not.

                After that I’m not sure what programs you want to talk about.

                Housing? The root problem is locals preventing the creation of housing, the solution is to not let them have that ability.

                Income Support? Increasing the min wage to X means very different things in different parts of the country because of cost of living. We also have pretty specific groups of people who are poorly educated and thus have low productivity and thus low pay.

                This implies solutions that seem reasonable in one part of the country would seem unreasonable in others.

                Note we’re already spending very large amounts of money on various social programs. In terms of raw per person funding I think we’re the equal of Europe. That’s why these program’s supporters typically use GDP adjusted stats.Report

              • Chip Daniels in reply to Dark Matter
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                says:

                “No Way To Do This, Says Only Developed Nation Yet To Do This”Report

              • Dark Matter in reply to Chip Daniels
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                says:

                “No Way To Do This, Says Only Developed Nation Yet To Do This”

                We can do this if we’re willing to get rid of the system we currently have.

                That will involve firing millions of people.

                That’s the big problem, although convincing everyone to give up what they currently have will also be a lift.Report

              • Philip H in reply to Dark Matter
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                says:

                We can’t pay for UHC without serious HC reform. Serious HC reform would mean firing very large numbers of people.

                This isn’t correct – the healthcare system (as in the systems and institutions that deliver healthcare) works just fine, and will work just fine after we make changes.

                What doesn’t work and needs replacing is the payment system for those services. That’s where the firings would have to occur, but rankly its pain we need to endure, and pain that would be minimized because a lot of the worker bees in the health payments/insurance would be able to find similar jobs in single payer.Report

              • Dark Matter in reply to Philip H
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                says:

                What doesn’t work and needs replacing is the payment system for those services. That’s where the firings would have to occur…

                That’s fine. You’re just restating what I said.

                , but rankly its pain we need to endure, and pain that would be minimized because a lot of the worker bees in the health payments/insurance would be able to find similar jobs in single payer.

                We have multiple GDP percentage points being spent on our health payments systems. That overhead is why our HC spending is so much higher than other countries.

                Saying “the pain will be minimized” ignores the scale of the problem. If we admit our HC is inefficient, then we need to realize that inefficiency represents lots and lots of jobs. They’re not value added jobs. We’re paying large groups of people to fight with each other.

                If we’re going to end that then we can redirect multiple points of GDP from paper pushing to actual health care. If we’re not going to do so then we can’t.

                Firing multiple GDP percentage points worth of people will generate a crazy level of political pushback and political pain. If that pain is on a politician, then he’ll fold. If that pain is on a market, then it won’t care.Report

              • Philip H in reply to Dark Matter
                Ignored
                says:

                There is no market based solution to this. Pre ACA we had as close to full market driven systems as we can get. Insurance companies grew, delivery of care diminished, and states, counties and cities had to pick up the pieces for the uninsured. The ACA leveled that field off somewhat, but still accepted as a precondition that the multi-payer system with its inherent conflicts was the starting point and would remain so. Health insurance companies have zero incentive to rationalize the market. And forcing them to disclose prices so over tired, over stressed low information consumers can allegedly make decisions based on price sheets isn’t the answer.

                When markets fail – and health insurance is one of my current favorite poster kids for market failures – government of necessity ha to step in.

                Also, lets be clear – moving to single payer means most of those people working in private insurance will be able to be employed by the single payer doing exactly the things they are doing now. Its going to be a requirement of making that approach work. Some lawyers and CEOs may well loose their jobs, but they usually have much more economic means to fall back on the file clearks.Report

              • Dark Matter in reply to Philip H
                Ignored
                says:

                Pre ACA we had as close to full market driven systems as we can get.

                We had a market driven system with pricing unknown and every transaction requiring “networks”?

                This is nonsense.

                There is no market based solution to this.

                Force all HC providers to advertise their prices (and outcome+quality outcomes) and outlaw “networks” so they’re forced to honor those prices.

                You have then fixed the market failures and transformed the entire industry into Lasik/etc HC.

                HC providers compete on price and/or outcome. They can’t complete by making sneaky deals with other parties (i.e. insurance).

                moving to single payer means most of those people working in private insurance will be able to be employed by the single payer doing exactly the things they are doing now.

                We will have one big network and the vast numbers of people managing networks will still have their jobs? Good grief I hope not.Report

              • Philip H in reply to Dark Matter
                Ignored
                says:

                Force all HC providers to advertise their prices (and outcome+quality outcomes) and outlaw “networks” so they’re forced to honor those prices.

                You have then fixed the market failures and transformed the entire industry into Lasik/etc HC.

                So you do want government to step in and fix market failures by legal mandate just not in the same way I do. Good to know.Report

              • Dark Matter in reply to Philip H
                Ignored
                says:

                So you do want government to step in and fix market failures by legal mandate

                Yes.

                The market failure here is we don’t have a market. Fix that and we should expect market economics to vastly reduce prices. Just reducing prices goes a long way to expanding coverage.

                I have zero faith in the gov’s political will to destroy hundreds of thousands (or more) of jobs. Markets do that as a matter of course, the gov not so much.Report

              • Philip H in reply to Dark Matter
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                says:

                Fix that and we should expect market economics to vastly reduce prices. Just reducing prices goes a long way to expanding coverage.

                You’ve been following the recent inflation trends correct? When -in say the last 5 or 6 decades – have fully open markets actually reduced prices?

                And again – why do you assume jobs will be eliminated, not transferred to other sectors or other employers? The Fed is currently stuffing interest rates to try and slow the labor market and we are STILL below pre-pandemic employment levels, with net jobs added every month.Report

              • InMD in reply to Philip H
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                says:

                There are also just core supply and demand issues that transparency isn’t going to magically fix. Our system absolutely has some capture and rent seeking components to it but the larger set of rules and administrative issues exist because the supply has constraints, as opposed to the supply being constrained because of the rules and administration.Report

              • Dark Matter in reply to Philip H
                Ignored
                says:

                When -in say the last 5 or 6 decades – have fully open markets actually reduced prices?

                We have an industry which has had no price competition. It’s viewed as very wasteful, with very high prices. We’d be subjecting it to price competition.

                Why should we believe the current prices, viewed as grossly excessive, are efficient?

                …why do you assume jobs will be eliminated, not transferred to other sectors or other employers?

                Our current system has armies of bureaucrats fighting with other armies of bureaucrats. Why do you think that’s even slightly value added?

                How many people does Walmart have whose jobs are to inflate specific bills to customers? How many people does Walmart have to fight over and appeal bills from customers?

                If you have the price agreed upon before the service is provided, then why should we think we’d need armies of people to debate the price after the service is provided?Report

              • Philip H in reply to Dark Matter
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                says:

                Those armies of bureaucrats are accountants, policy specialists, communications specialists, payment managers, bankers and all sort of other white collar finance and accounting professionals. They may currently use their skills to fight each other, but moving to single payer means we will still need their skills to implement and run single payer. Its the same skills just redirected. The need for the number of lawyers will be reduced, but again I suspect as a class they will be fine.

                I’m also glad you brought up efficiency of pricing – because again we see few examples of self regulated industries making pricing efficient. Frankly it blows my mind that you think price competition in medicine would make things better, since declining prices means declining revenue which in markets usually results in businesses exiting the market, which constrains supply which then drive prices back up.

                Frankly single payer results in net efficiencies because it take away that supply side constraint and rationalizes long term investment and planning. And given that we always hear about business wanting certainty form government, it calls that bluff.Report

              • Dark Matter in reply to Philip H
                Ignored
                says:

                we see few examples of self regulated industries making pricing efficient.

                Explain that to Walmart. Or Lasik. Or Pet care.

                They may currently use their skills to fight each other, but moving to single payer means we will still need their skills to implement and run single payer. Its the same skills just redirected.

                So there will be no efficiency gains and no cost reductions from single payer. That’s seriously ugly from a budget standpoint if you’re trying to expand access.

                declining prices means declining revenue which in markets usually results in businesses exiting the market, which constrains supply which then drive prices back up.

                The number of doctor’s affected would be zero because they add value. That “declining revenue” will be made up by firing people whose jobs shouldn’t exist. What we’re looking at is vast numbers of people employed doing things that shouldn’t be done at all.

                If we compare our HC efficacy to other countries, we have multiple GDP points more spending, often with worse outcomes by whatever metric you’d like to use. The massive overhead we’ve inflicted on ourselves doesn’t add value.

                That’s not even comparing ourselves to Pet Care and Lasik which is where we should go if we’re going to use a lot more market.Report

              • Philip H in reply to Dark Matter
                Ignored
                says:

                If we compare our HC efficacy to other countries, we have multiple GDP points more spending, often with worse outcomes by whatever metric you’d like to use. The massive overhead we’ve inflicted on ourselves doesn’t add value.

                Agreed. Which is why I favor single payer. Some of that over head will be eliminated. Much in fact.

                So there will be no efficiency gains and no cost reductions from single payer. That’s seriously ugly from a budget standpoint if you’re trying to expand access.

                ALso not likely true. You keep referring to vast armies of the unemployed generated by the switch – and I am trying to make the point that some of that vast army will be needed for single payer; the rest is made up of people with skills that are economically viable.

                That’s not even comparing ourselves to Pet Care and Lasik which is where we should go if we’re going to use a lot more market.

                Lasik is not a necessary health procedure. Its economic and outcomes don’t map tp preventative care, or broken arms or heart attacks. You can plan for lasik, you can’t plan to get COVID. more market isn’t going to work because when you need the ER you aren’t going to shop around for the best one that handles heart issues, no matter how much outcome metrics a hospital is required to throw out. Single payer takes away the biggest guess work – which is will my insurance pay for this.Report

              • Dark Matter in reply to Philip H
                Ignored
                says:

                the rest is made up of people with skills that are economically viable.

                Absolutely agreed. They’re very smart but writing computer programs to increase/decrease billing doesn’t need to be a thing.

                some of that vast army will be needed for single payer

                One hopes a tiny percentage. If we’re planning on eliminating multiple GDP percentage points worth of jobs, then “armies” is the correct term.

                And “one hopes” is doing a lot of heavy lifting there. It’s possible to implement single payer to we’re NOT getting rid of them, and firing millions of people will be so politically painful that I have to think that’s what happens. We get another layer of paper pushers on top of the others to fight with everyone, so the system becomes even more inefficient.

                You can plan for lasik,

                All of my quite expensive surgeries have been planned. Even the various “fix a broken bone” events over the years in my family have taken days to see a doctor. Seeing specialists is normally done by booking them weeks or months in advance.

                “Emergency” HC is extremely rare and has nothing to do with why the market isn’t working here. The bulk of HC can be planned and subjected to lasik style market forces. If I run out of toilet paper, I don’t get jacked over the price.

                Single payer takes away the biggest guess work – which is will my insurance pay for this.

                Insurance is expensive because HC is expensive, and HC is expensive because we don’t have a market. If you don’t have defined costs then nothing has changed… unless we’re planning on going command/control which is the likely outcome.

                Single payer sounds like insurance reform (again). We need HC reform. If you can convince me that our politicians have the backbone to destroy millions of well paying jobs then I’m all for it. Talking about how these people will still have jobs in Single Payer isn’t the way to do that.Report

              • Philip H in reply to Dark Matter
                Ignored
                says:

                So I don’t think we have to eliminate multiple percentage points of jobs to make this happen. The health insurance industry employs around a half a million people (563,366 to be precise; https://www.ibisworld.com/industry-statistics/employment/health-medical-insurance-united-states/#:~:text=There%20are%20563%2C366%20people%20employed,the%20US%20as%20of%202023.). Figure a concomitant amount of people in doctor’s offices and others to process. add in some extra folks at Walmart corporate and I’ll give you may 1.5-2 million people who would be impacted by the shift to single payer. As of the January Labor Department summary, there are 10.5 million open jobs in the US. Unemployment remains 3.5% – which is still slightly below pre-Covid, the interference of the Fed not withstanding. while some of those open positions are likely to be for the same work, some aren’t.

                so even if 2 million people were to be unemployed by the shift to single payer the economy at present could absorb them.Report

              • Dark Matter in reply to Philip H
                Ignored
                says:

                even if 2 million people were to be unemployed by the shift…

                We have 200 million people working in the US. So (massive handwave) every point of GDP is about 2 million jobs. HC is 18.3% of GDP.

                We could cut HC by three points and still be worse than most of the other countries. Just bringing use to average efficiency would be cutting our GDP percentage in half. Moving down to Germany or France (2nd and 3rd highest after us) would be a loss of 6 GDP points. Those countries themselves shouldn’t be very efficient since they’re not doing much market.

                Serious HC reform should be expected to destroy 10-20 million jobs.

                A lot of these jobs are well paid. Smart people writing bill inflating software can do something else.

                This is a MASSIVE disruption in the economy. This is a massive amount of political pain.

                If we’re not going to use markets, politicians won’t fire 10 million people and create a recession. It would be much easier politically to keep them all employed where they are and just sign checks.Report

              • Philip H in reply to Dark Matter
                Ignored
                says:

                We have 200 million people working in the US. So (massive handwave) every point of GDP is about 2 million jobs. HC is 18.3% of GDP.

                So we have the insurance industry folks, the physicians and clinic staff, pharmacies, drug an device manufacturers, ambulance companies. I’m probably missing a few niche things, but I think this list covers the broad categories of people in your 18.3%.

                If we can agree to hat, your contention is that over half the people employed across those sectors will loose their jobs by switching who pays for the healthcare services. You’re saying doctors, nurses, paramedics, pharmacists, prothesis developers, pharmaceutical plant workers and the like will be have to be fired in huge numbers just because we switch who pays for health care?

                That’s a stunning – and probably wildly inaccurate – conclusion.Report

              • Dark Matter in reply to Philip H
                Ignored
                says:

                You’re saying doctors, nurses, paramedics, pharmacists, prothesis developers, pharmaceutical plant workers and the like will be have to be fired in huge numbers just because we switch who pays for health care?

                Just the opposite. I’m saying none of those people will be.

                What I am saying is we have vastly more back office stuff going on than we think we do, and the administrative bloat is crazy high.

                We think that we have 5+ GDP percentage points of inefficiency in there. We also have vast armies of paper pushers at war with each other. So we probably have about 10 million people doing that sort of thing. They’ll have multiple names, they’ll be buried in other fields and even other industries, but they’re there.

                For example my childhood friend writing software works for a software company and wouldn’t show up in your numbers at all.

                However people like that are going to understand darn well that their jobs are on the line and they’ll resist them being destroyed.Report

              • Philip H in reply to Dark Matter
                Ignored
                says:

                For example my childhood friend writing software works for a software company and wouldn’t show up in your numbers at all.

                Is he in your 18% of GDP figure? And what’s your source for that? And why would a person who codes – in the 21st century – worry about his job just because one avenue of coding might be endangered?Report

              • Dark Matter in reply to Philip H
                Ignored
                says:

                Is he in your 18% of GDP figure?

                His full time job is making code for the billing war. If we look at the money hospitals pay then he’s in there somewhere.

                His company would be an expense item in their cost to do business.

                And why would a person who codes – in the 21st century – worry about his job just because one avenue of coding might be endangered?

                This sort of disruption is how I ended up moving to Florida a year plus ago.

                It was a massive disruption and has played a big part in my divorce.

                Losing a job is a big deal for most people and often has other side effects. Most people let themselves get spun up over it way more than I do, and I found it very stressful.Report

              • Philip H in reply to Dark Matter
                Ignored
                says:

                It seems my swag at 2 million lost is about right based on published studies. And it doesn’t account for the offsets from gains elsewhere.

                See here for one example – https://www.epi.org/publication/medicare-for-all-would-help-the-labor-market/Report

              • Dark Matter in reply to Philip H
                Ignored
                says:

                I have a hard time believing we’re going to eliminate 5% of the GDP and we’re going to only affect 2 million people.Report

              • Philip H in reply to Dark Matter
                Ignored
                says:

                THat’s one of half dozen studies from a variety of perspectives that I found on Google that were in the 2 Million gross loss range. Some go on to look at net losses from people moving elsewhere, some don’t. I can’t find any analysis that supports your assertion of tens of millions. So if you care to share a citation, I care to look at it.Report

              • Dark Matter in reply to Philip H
                Ignored
                says:

                Those studies seem to be limited to “direct billing”.

                If we’re going to be eliminating worthless administration jobs, then that’s an obvious place to start but from what I’ve seen inside of colleges I doubt it’s limited to just that.

                Or maybe this is just a reflection on the difference between single payer and subjecting hc systems to market. We’d save 1 point of gdp from single payer. That doesn’t change that we seem to have 5+ out there.

                I see zero pushback on the idea that we’re wasting about 5 percent of gdp inside the HC system. We’re running at 18% and the countries coming in 2nd and 3rd are at 13%.

                IMHO if your big plan for reducing the cost of the system is going to save 1%, then that’s not enough. Not even close.Report

              • Pinky in reply to Jaybird
                Ignored
                says:

                It doesn’t seem obvious to me why a society with low-medium trust couldn’t still have universal health care. I’m not getting the relationship between trust toward individuals and trust toward society.Report

              • Jaybird in reply to Pinky
                Ignored
                says:

                It doesn’t seem obvious to me why a society with low-medium trust couldn’t still have universal health care.

                They *COULD*. It just would have a bunch of people who defect and we’d find ourselves in a system with a grey (or black) market and with people upset that there are multiple tiers of health care in practice.Report

              • Philip H in reply to Jaybird
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                says:

                if we have single payer where would they defect to?Report

              • Jaybird in reply to Philip H
                Ignored
                says:

                A grey (or black) market.Report

              • Philip H in reply to Jaybird
                Ignored
                says:

                Why? And in what numbers? The whole point of single payer is to restructure the payment side of the equation so everyone can get access to a certain level of care anywhere. While a few of the ultra wealthy might be able to go elsewhere – or to boutique doctors – the vast vast majority would be within the single payer system. And the defectors would have no one to complain to because the alternative of working in the system is something have already rejected.Report

              • Chip Daniels in reply to Philip H
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                says:

                As I mentioned to Dark in my very first comment, the ability to point to a working model is better than a thousand arguments.

                And there are plenty of working models of single payer to point to.Report

              • Jaybird in reply to Philip H
                Ignored
                says:

                Why?

                To get the small batch artisanal health care.

                And in what numbers?

                Very small numbers. It’d only be available to the people who could afford it for one… though there might be a second, larger, market for people of more middle class means who are smuggling in stuff that is legal in the EU or Canada or wherever but hasn’t been approved by the FDA.

                And the defectors would have no one to complain to because the alternative of working in the system is something have already rejected.

                It’s not about having someone to complain to but about having someone to purchase from.

                Medical Marijuana existed for decades prior to Colorado’s Amendment 20. Similar things will exist after we have an official Single Payer system.Report

              • Philip H in reply to Jaybird
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                says:

                And none of these are reasons to keep from moving to single payer. As I noted they are things we can easily anticipate, and probably to some extent compensate for.Report

              • Jaybird in reply to Philip H
                Ignored
                says:

                I rather expect us to move to single payer and I’m kind of surprised that we haven’t yet.

                That said, it will come with a double buttload of tradeoffs that aren’t being acknowledged before the fact and will become painfully apparent after the fact.

                And then the goalposts will move again.Report

              • DensityDuck in reply to Jaybird
                Ignored
                says:

                “I rather expect us to move to single payer and I’m kind of surprised that we haven’t yet.”

                The reason we haven’t seen it yet is that they looked at how much we would spend and saw that it was the same, and they looked at the amount of coverage and saw that it was the same, and realized that if they made single-payer the law it would just make everybody mad, so they made a big noise about a side issue that everyone already had a script for (abortion) and passed a Medicaid funding expansion with some weird complexities tacked-on that were slowly pared away by legislation over the next decade.Report

              • Jaybird in reply to DensityDuck
                Ignored
                says:

                I think it will be redistributed somewhat.

                The problem is that it will be redistributed away from the people who tend to vote and redistributed to the people who tend to not.

                And that’ll be rectified tout de suite.Report

              • DensityDuck in reply to Philip H
                Ignored
                says:

                “The whole point of single payer is to restructure the payment side of the equation so everyone can get access to a certain level of care anywhere. ”

                oooooh we finally got it, we finally got the admission that there are people in a single-player system who can just eat ass and die because they don’t deserve to be kept alive, because The Amount Of Resources They Would Require Exceeds Their Expected Value To Society

                which is…what we have now?

                so why should we switch to single-player, then?

                “And the defectors would have no one to complain to because the alternative of working in the system is something have already rejected.”

                you’re doing that thing again where you forget that you’re arguing for something instead of against itReport

              • Philip H in reply to DensityDuck
                Ignored
                says:

                How in the world do you get

                oooooh we finally got it, we finally got the admission that there are people in a single-player system who can just eat ass and die because they don’t deserve to be kept alive, because The Amount Of Resources They Would Require Exceeds Their Expected Value To Society

                From this

                The whole point of single payer is to restructure the payment side of the equation so everyone can get access to a certain level of care anywhere.

                Because my support of single payer has always been for a system that gives everyone good solid basic healthcare. Too many Americans STILL don’t have that. That means everyone. Because I see healthcare as a human right, not a privilege. Our current system sees it as a privilege not a right.Report

              • Jaybird in reply to Philip H
                Ignored
                says:

                Part of the problem is that there are only X units of health care to go around.

                There are Y units of health care that are needed.

                Y is larger than X.

                By making sure that everyone is covered, you will not give everyone good solid basic healthcare. You will, at best, redistribute some of health care from the people taking a little bit more than they need to the people not getting enough.

                But if you want to give good solid basic healthcare to everyone, you either need to create more good solid basic healthcare *OR* redefine “good”, “solid”, and/or “basic” down a bit.

                “Exercise more, eat less fast food, drink less, quit smoking, and exercise more. Seriously. Just go for a walk after dinner!”

                There you go. Good solid basic healthcare for everybody. That was easy. Oh, you need something more complicated than “basic”? Well, here are some forms to fill out.Report

              • Philip H in reply to Jaybird
                Ignored
                says:

                Part of the problem is that there are only X units of health care to go around.

                There are Y units of health care that are needed.

                Y is larger than X.

                By making sure that everyone is covered, you will not give everyone good solid basic healthcare.

                That’s an interesting assessment. And to a certain extent its correct for the present condition.

                But take a look at Medicaid and Medicare expansion under the ACA – which as you may have noted elsewhere is still being resisted in Mississippi and other GOP controlled states. Expanding those programs will, of necessity create more units of healthcare – X+Delta if you will. because getting more people coverage means more people will access care. which drives demand for more. Single payer can and will have the same effect. It will also relieve counties, cities and parishes from having to write off the delta in ER visits. Meaning both quantity and quality of care – which are not fixed commodities – will adjust.Report

              • Jaybird in reply to Philip H
                Ignored
                says:

                Eh, I remember writing a while back about how our very own Doc Saunders wrote that switching to Medicare-For-All means that he’d have to shut down his practice.

                The big counter-argument against this?

                “Maybe he’s wrong and hasn’t taken into account how much money he’d save by not having to provide insurance to his staff.”

                Personally, I take the Doc at his word and am willing to assume that he knows his costs better than I.

                If we want more health care, we’d do a better job of shifting to creating more health care than doing everything we can to make sure that more people are covered.

                (See also: Housing.)

                Meaning both quantity and quality of care – which are not fixed commodities – will adjust.

                Yeah, this is one of the trade-offs that I see happening too.

                And I see a *LOT* of voting-type people saying something to the effect of “I wanted my quantity and quality of care to change in the *OTHER* direction.”Report

              • Philip H in reply to Jaybird
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                says:

                More people covered – all people covered – means more funds going into creating health care. ITs the demand side solution. There isn’t a supply side solution because we would have to accept ever more healthcare spread over a fixed population. Which means lower returns to providers. That’s not gonna fly economically.Report

              • Dark Matter in reply to Philip H
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                says:

                More people covered – all people covered – means more funds going into creating health care.

                Our current HC system is breathtakingly inefficient.

                Reform the various market failures in HC. Eliminating the non-value-added parts of the process would give us a lot more money to give more people HC.

                My back of the envelope suggests there is an insane amount of money we could save and redirect. Pet HC costs are something like 10x as efficient as our own. Lasik costs suggest that might be ball park.Report

              • Philip H in reply to Dark Matter
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                says:

                I look forward to reading your post containing this analysis in detail.Report

              • Chip Daniels in reply to Philip H
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                says:

                Which is where this all started.

                “Free Market Health Care” is like Socialism- There is and never has been any working model that anyone wants to point to.

                So it exists entirely as a thought experiment of hypotheses and conjecture.

                Meanwhile, socialized healthcare has dozens of working models all around the world.Report

              • Jaybird in reply to Philip H
                Ignored
                says:

                I could see the argument that since more money was going into the system, therefore the system would create more units to address the demand, I could also see the argument that, no, it’ll just soak up the extra money the way that housing or college did.Report

              • DensityDuck in reply to Philip H
                Ignored
                says:

                “[T]ake a look at Medicaid and Medicare expansion under the ACA…[e]xpanding those programs will, of necessity create more units of healthcare…”

                really? why? how will the new lower reimbursement rates cause there be more doctors, new hospitals, additional labs built?Report

              • Philip H in reply to DensityDuck
                Ignored
                says:

                The expansion of Medicare and Medicaid doesn’t mean reimbursement rates go down – it means the state gets more federal dollars to provide more services to more people. The Mississippi state economist has published a study that says accepting the ACA Medicaid expansion here would add 11,000 jobs in the state, many in medical care delivery. Other studies also showed that increased reimbursement dollars would stem the tide of the closing of rural hospitals in Mississippi – where we loose -2 hospitals a year and have for over a decade.

                https://mississippitoday.org/2022/11/10/medicaid-expansion-mississippi-studies/Report

              • Jaybird in reply to Philip H
                Ignored
                says:

                Doc Saunders went so far as to write an article for The New Republic. He explains what would happen for *HIS* practice.

                Maybe his practice is unique, of course.Report

              • LeeEsq in reply to Chip Daniels
                Ignored
                says:

                Post-WWII South Korea was also filled with political conflicts against the authoritarian military dictatorship and corrupt crony capitalism that wasn’t too dismiliar to what existed elsewhere.Report

            • Chip Daniels in reply to Dark Matter
              Ignored
              says:

              ” monocultural ethnic group ”

              Please stop with this.

              Seriously, the idea that some other society has something called a “monoculture” is just flat out idiotic.

              In America, skin color is the great sorting mechanism, but this isn’t true around the world.

              Look at the Great Britain, look at the Balkans, look at Switzerland, look at Italy, look at Ukraine, look at anywhere in Asia, South America, or Africa and you will see that ‘monocultures” don’t exist.

              Other societies sort themselves by accents, language groups, or ethnic deviations so subtle Americans don’t notice but they are every bit as riven and divided as we are. There is practically no nation on earth that thinks of itself as one big cohesive group.

              “B-But they have a monoculture” is just a flimsy excuse for failure.Report

              • Jaybird in reply to Chip Daniels
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                says:

                Yeah, it’s hard to figure out “necessary” versus “sufficient”.Report

              • Dark Matter in reply to Chip Daniels
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                says:

                “B-But they have a monoculture” is just a flimsy excuse for failure.

                What Europe calls countries we’d call states. Their “solution” for many of these issues is to not pretend that Italy, Sweden, and Germany can all have the same solutions and do not expect the same outcomes from different cultures.

                Inner City Chicago is not an Amish village nor a Rich Suburb.

                Are you willing to give up your various cultural demands for the sake of doing “the hard work” to create a high trust society? Are you willing to be pro-life, back down on Affirmative Action, admit open carry is a right, and so on and so on?

                Or does that one solution you want us to have for every issue be your solution? And if you’re not willing to sacrifice for the sake of a high trust society, why should everyone else?Report

              • Chip Daniels in reply to Dark Matter
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                says:

                Any given European nation is like California, divided into many regions and cultural segments with sharply differing values.

                So how do they make it work?

                “Are you willing to be pro-life, back down on Affirmative Action, admit open carry is a right, and so on and so on?”

                How about we let the nation state of California take a vote and let the majority decide?Report

              • Dark Matter in reply to Chip Daniels
                Ignored
                says:

                How about we let the nation state of California take a vote and let the majority decide?

                If your plan is to use majority rule to issue cultural cramdowns, then you shouldn’t be surprised if you don’t enjoy high trust.Report

              • Chip Daniels in reply to Dark Matter
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                says:

                But…that’s exactly what other high trust nations did, and do.

                So what makes America different?Report

              • Dark Matter in reply to Chip Daniels
                Ignored
                says:

                Dark Matter: If your plan is to use majority rule to issue cultural cramdowns, then you shouldn’t be surprised if you don’t enjoy high trust.

                Chip: But…that’s exactly what other high trust nations did, and do. So what makes America different?

                Scale. Putting a cram down on a tiny minority in your own culture is easy, thus the UK could outlaw Fox Hunting.

                Doing that cross culture on a large brick of voters who have captured a major political party (or even a country) is much harder. Doing that on something they view as part of their cultural identity is harder still.

                Poland mostly doesn’t allow immigration and highly restricts abortion. When Germany and the rest of the EU have put pressure on Poland on these issues, it hasn’t worked.

                If we picture the EU able to pass laws and force cram downs on Poland, we’re also picturing Poland leaving the EU.

                If the question is, “how can the EU be very high trust and also issue cultural cram downs on Poland”, then the obvious answer is it can’t.

                The US, by it’s nature, has both lots of cultural identities and also has the ability for one group to issue cramdowns on other groups if they get enough power. Thus we do things like have bitter fights over the Supreme Court.Report

              • Philip H in reply to Dark Matter
                Ignored
                says:

                If your plan is to use majority rule to issue cultural cramdowns, then you shouldn’t be surprised if you don’t enjoy high trust.

                Funny how the right side of the aisle doesn’t care about this when the do the minority cultural cramdowns like abolishing the right to choose.

                If a majority wants to do a thing then one assumes the majority – by your description – has high trust in the thing and the doers.Report

              • Dark Matter in reply to Philip H
                Ignored
                says:

                Funny how the right side of the aisle doesn’t care about this when the do the minority cultural cramdowns like abolishing the right to choose.

                You’re coming very close to announcing you don’t trust them. That their views are so divergent from yours that they can’t be trusted.

                What the Right did was exactly what the EU does on this issue. France, Germany, Italy, and Poland are allowed to have different policies on the subject of abortion in the EU.

                If you’re insisting that we need to have all states implement your policies on all ethical issues, then pretty much by definition a country this large and this diverse will be low trust.Report

              • Philip H in reply to Dark Matter
                Ignored
                says:

                The majority of Americans – including a goodly number of conservatives and independents – trust women to make decisions with their bodies, including abortion. Even in states where so called trigger laws have now all but outlawed abortion, polling indicates that majorities of people trust women to make decisions about their bodies.

                And yet the GOP’s politicians at the state and federal level champion and enact laws taking away that control, over the objections of those majorities. Mississippi now has all but outlawed abortion but has consistent polling saying that over 60% of residents want it to be safe and legal to 15 weeks. That’s a minority cultural cramdown if ever there was one.Report

              • Dark Matter in reply to Philip H
                Ignored
                says:

                …polling indicates that majorities of people trust women to make decisions about their bodies.

                Democracies decide things via voting, not poling.

                The people who oppose abortion are willing to vote on the issue. The people who support choice largely are not.

                That has lots of political implications.Report

              • Philip H in reply to Dark Matter
                Ignored
                says:

                The people who oppose abortion are willing to vote on the issue. The people who support choice largely are not.

                That’s not true though. Yes, there are more ardent single issue anti-abortion voters then pro-choice voters. Especially in primaries. But as you know, political party affiliation has culture, class and race influences that can outstrip that single issue.

                The only reason that the GOP in Mississippi exercises such frim control is that here, GOP = White and Democrats = Black for the vast majority of people.Report

              • Pinky in reply to Philip H
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                says:

                Well at least you’re adding “for the vast majority of people” after I showed the statistics. But you still use the equals sign. Oh well.Report

              • LeeEsq in reply to Chip Daniels
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                says:

                Japan, North Korea, South Korea, and maybe the Nordic countries are pretty much the only examples that come close to what Jay calls a monoculture. The rest of the European countries were riven with ethnic, geographic, and cultural conflicts.Report

              • Jaybird in reply to LeeEsq
                Ignored
                says:

                Give a list of the countries that you want to emulate.

                “Why can’t we be more like X?”

                Rattle off the countries that fit into X.Report

              • North in reply to Jaybird
                Ignored
                says:

                Canada?Report

              • Jaybird in reply to North
                Ignored
                says:

                Sure. Let’s include Canada as well.Report

              • InMD in reply to Jaybird
                Ignored
                says:

                I don’t think the social trust issue is all that important as long as we take it for granted that universal in the US will never look like the NHS in the UK (which would be a total debacle here). But there’s no reason we couldn’t have something like a government backed insurance plan covering a bare minimum level of care for everyone with the freedom to supplement on a well regulated private market. If you squint hard that’s kind of what we have now, just with holes in it that people can still fall through and a really incoherent system of federal and state administration plus age, income, and employment variables thrown into the mix for no real reason.Report

              • Philip H in reply to InMD
                Ignored
                says:

                Bernie Sanders had just such a proposal called Medicare for All.Report

              • InMD in reply to Philip H
                Ignored
                says:

                I know. I think the more plausible reality though would be more like Medicaid for all plus the exchanges. And we all know what selling that would be like politically.

                That said we’ve already implemented the same basic premise the rest of the rich world has, which is the state acting as insurer of last resort. We’ve just done it in an inefficient hodgepodge of a way which is then exacerbated by one of the major political parties teetering between rejecting the legitimacy of that decision and the political impossibility of reversing it.Report

              • Dark Matter in reply to InMD
                Ignored
                says:

                Given how medicine works for Lasik, plastic, and pets; imho it’s really clear we need market based medical reform (as opposed to insurance reform).Report

              • Philip H in reply to Dark Matter
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                says:

                As long as insurance is the payment mechanism, reforming – or abolishing it – is the market based reform we need.Report

              • InMD in reply to Dark Matter
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                says:

                Optional and cosmetic surgeries are not comparable to dealing with acute medical emergencies, serious chronic illnesses, or the the kinds of diseases like cancers that we have gotten good at treating but at very high cost, to say nothing of the conditions many if not all of us will navigate in the last few years of our lives. You need some kind of risk sharing, same way you do with something like a home, or with life insurance.

                Now, that doesn’t mean there’s no room to consider supply side reform, especially if you can find ways to increase supply while maintaining high quality. And besides, having more insured people itself creates more of a market. One of the unheralded achievements of Obamacare if the proliferation of urgent care centers. Those barely existed before, but having more people with insurance has created a great retail-ization of basic care.

                But it’s unrealistic to think people with critical injuries that need to be treated immediately or who need to get on chemo are going to go bargain hunting the way they would for a smart phone.Report

              • Dark Matter in reply to InMD
                Ignored
                says:

                How much of the market is dealing with critical injuries? Ten percent? Less? And that’s by cost which is inflated.

                Given that “urgent care” is both retail and able to deal with minor “urgent” expected injuries, that should showcase that the problem you’re touching on is less of a thing than we’d think.

                If I need an emergency oil change and don’t have time to do market research, I still benefit from the garage being subjected to market forces most of the time.

                The big problem is much of the HC system isn’t subjected to market forces at all, ever. Every transaction generates a negotiation between multiple sets of paper pushers on what the cost should be.

                We have cartels dealing with other cartels.

                I see no reason why “chemo” needs to be mysterious and why we’re supposed to benefit from it’s costs being obfuscated.

                Lasik shows surgery can be subjected to market forces and what happens when it is. If Lasik were covered by insurance it’d be far more expensive and the quality would be lower.Report

              • Greg In Ak in reply to Dark Matter
                Ignored
                says:

                Elective and/or cosmetic surgery is a terrible analogy to cancer, diabetes and all the other chronic disorders.Report

              • DensityDuck in reply to Greg In Ak
                Ignored
                says:

                “Elective and/or cosmetic surgery is a terrible analogy to cancer, diabetes and all the other chronic disorders.”

                True, very true.

                Is an insulin pump elective? After all, we have needles. How about continuous blood-glucose monitors, those Freestyle things, are those elective because we have finger-stick monitors that work okay?

                “these are just bad-faith trolling questions” I dunno, it seems kind of important to have a good answer for them, because someday you’ll get asked “why should we spend money on this crazy experimental garbage” by someone whose go-to answer is “as a government employee with a duty to spend the taxpayers’ money wisely, we shouldn’t“.Report

              • CJColucci in reply to InMD
                Ignored
                says:

                I don’t think the social trust issue is all that important as long as we take it for granted that universal in the US will never look like the NHS in the UK (which would be a total debacle here).

                But talking about social trust is so much easier than talking about what needs to, or can, be done.Report

              • InMD in reply to CJColucci
                Ignored
                says:

                I don’t think he’s totally wrong about that, in the sense that there are certain limitations we have to operate within that others don’t. And I also think a lot of people in the US that talk about ‘universal healthcare’ are advocating for more of an abstraction than a policy, without appreciating just how this works in the countries we like to compare ourselves to, no two of which are exactly alike.

                But of course as I said to Philip, the main problem here is less that than that one of the big political parties refuses to live anywhere remotely close to reality on the issue.Report

              • Jaybird in reply to InMD
                Ignored
                says:

                For 20 minutes there, Bloomberg managed to ban extra large Big Gulps.

                As part of the argument for why this wasn’t necessarily a bad move on his part, it was pointed out that we, as a society, have an obesity crisis. Do people really *NEED* to drink 64 ounces of sugar? And so on.

                In that argument, I saw that not only was Socialized Medicine meeting an obligation, it was also incurring obligations.

                All that to say: We’re going to incur new obligations with any new program.

                Hey. We’re all in this together.Report

              • InMD in reply to Jaybird
                Ignored
                says:

                And there’s certainly a conversation to be had about things like that. Even if we had a reasonable conservative party in this country I’d still expect them to be more circumspect about how far we go and less eager to cover more than the bare bones. But they’d at least in principle accept that the state has a role in creating a coherent system. Right now I’d say they’re at best agnostic about that, and even then only because they know that if they get too loud about how they really feel they’ll get crushed for it.

                But I also think to have this conversation we need to talk about what ‘socialized medicine’ even is. I think most people in the Anglosphere immediately think of the NHS in Britain but that’s not what they have in the big continental European countries like France and Germany, where care is still very much private and it’s the insurance that is public or (heavily) publicly supported through different mechanisms. So it’s a few shades more ‘socialized’ than ours is, but it’s a difference of degree rather than kind. They just have found a way that works for them to run it a lot better than we do.Report

              • CJColucci in reply to InMD
                Ignored
                says:

                There are plenty of reasonable ways to skin the health care/finance cat, and many of us, whatever our abstract preferences, would accept anything that would get the votes.
                So what’s the offer? And who will make it?Report

              • InMD in reply to CJColucci
                Ignored
                says:

                Well not Republicans, hence the problem in a system that requires at least some degree of support from that side of the aisle.Report

              • LeeEsq in reply to InMD
                Ignored
                says:

                Why do you think the Republicans will they get crushed if they voice how they really feel? The evidence doesn’t back this up. Liberal measures poll constantly popular among Republican voters but the Republicans keep saying no and openly defying their own voters and they still get elected.Report

              • Pinky in reply to LeeEsq
                Ignored
                says:

                “Liberal measures poll constantly popular…”

                I know a lot of Democrats believe this, but considering that the elections don’t back it up on any level, shouldn’t you reconsider it? The framing of questions influences the results. This can be deliberate or accidental, such as asking about benefits without tying them to costs. People aren’t always honest with pollsters. Polls that support liberal causes land on the front page of liberal media, and confirmation bias keeps them fresh in the liberal mind. All in all, there are a lot of possible explanations for this seeming disparity.Report

              • Jaybird in reply to Pinky
                Ignored
                says:

                Part of the problem is that some stuff does poll well (hey, they have numbers; they’re measurable…) but they’re spun into something completely different.

                Like a poll that asks:
                How much immigration do you think would be appropriate?
                A: None.
                B: 1-100,000
                C: 100,001-500,000
                D:500,001-1,000,000
                E:1,000,001-5,000,000

                This poll will *CONSISTENTLY* get a majority (not plurality) of people to vote B. Across demographics.

                And this is used as an argument for defunding the DHS. “PEOPLE SUPPORT IMMIGRATION!”, they say. They can point to this poll. They do.Report

              • InMD in reply to Jaybird
                Ignored
                says:

                You can get a poll with strong majorities expressing grave concern about climate change and another poll showing that people are unwilling to accept even very small increases in taxation to fight it.Report

              • InMD in reply to Pinky
                Ignored
                says:

                Yea I’ve never believed that either. I think polls that suggest it to be the case are misleading and tend to overlook important nuances not to mention just general incoherence across the electorate. So you’ll get polls that say majorities support one thing but not the taxes or the more specific laws that would be the most obvious way to effectuate it.

                However to answer Lee’s questions the existing programs poll well and humans have a very strong aversion to giving away something they understand as already theirs especially in exchange for a highly uncertain return.Report

              • Philip H in reply to InMD
                Ignored
                says:

                Polls also suffer from being single issue focused and not discussing trade offs. You won’t see a poll asking if a person’s support for a politicians abortion stance carries over to the same politicians opposition to single payer – even when the economic benefits of single payer are explained.Report

              • Pinky in reply to InMD
                Ignored
                says:

                There’s a poll of voters that takes place every year, and since 1994 it has reliably been 47-53% Dem, 47-53% Rep. The results reflect some bias and ignorance, but they’re so consistent that we should start to admit they also reflect a good chunk of informed public opinion.Report

              • InMD in reply to Pinky
                Ignored
                says:

                I’m never totally sure how informed I think public opinion actually is, though I’ll grant it could be moreso than I give it credit for.

                My hypothesis is that the electorate is functionally liberal, in the sense that it takes for granted that we operate in a liberal system and is deeply invested in fairness (note, not ‘equity’) in a way that really is a product of a liberal and not a conservative tradition. However it’s disposition is conservative, in that it is (at times, very) skeptical of radical change, or the idea that there is a better deal to be had by overturning existing orders and arrangements.

                Not a hill I’d die on or anything but I think it explains the seemingly muddled results one gets from polling the public.Report

              • CJColucci in reply to InMD
                Ignored
                says:

                This has been the conventional wisdom for close to half a century, when I first heard it. Make of that what you will.Report

              • Greg In Ak in reply to Jaybird
                Ignored
                says:

                Good reminder about the insane panic over the death of Grande Gulp’s that was a nothing burger.Report

              • Jaybird in reply to Greg In Ak
                Ignored
                says:

                My point wasn’t about whether Bloomberg instituted it, nor whether a judge struck it down prior to it going into effect, but over whether people defended it because we had an obesity crisis.

                Which happened.Report

              • North in reply to Jaybird
                Ignored
                says:

                My point is that Canada is as multi-ethnic, multi-cultural as we are (if not more so) and they have all these things you’re ascribing to monocultural, mono-ethnic states. It falsifies your core thesis.Report

              • Michael Cain in reply to North
                Ignored
                says:

                I agree that they have it wrong. What Canada has — and all the other countries they’re holding up have — is a parliamentary government rather than the US model. The US model was originally designed to (a) leave things in the hands of white male land/business owners, (b) allow horrible mistreatment of minorities and the poor, and (c) impede formation of national policies.

                All of (a), (b), and (c) remain surprisingly possible even after 235 years.Report

              • Jaybird in reply to North
                Ignored
                says:

                Canada’s multiculturalism was similar to, say, Northern Ireland’s. It was a very peculiar duopoly that puts it in a similar category to Belgium (Flemish vs. Walloons).

                I wouldn’t compare its historical diversity to the US’s, though.

                Would you?Report

              • North in reply to Jaybird
                Ignored
                says:

                Yes, and frankly I’d call it more so even than the US’s. According to the 2021 Canadian census, immigrants in Canada number 8.3 million persons and make up approximately 23 percent of Canada’s total population. This represents the eighth-largest immigrant population in the world, while the proportion represents one of the highest ratios for industrialized Western countries.

                https://en.wikipedia.org/wiki/Immigration_to_Canada#:~:text=According%20to%20the%202021%20Canadian,ratios%20for%20industrialized%20Western%20countries.Report

              • North in reply to North
                Ignored
                says:

                Though, I would add, that this thread is somewhat of a non-sequitor since, regardless of what social safety net level the US had, the current iteration of the GOP would still be running up deficits through tax cuts and spending when in power and then yelping about the deficit when out of power to try and force cuts of the Democratic administration.Report

              • Jaybird in reply to North
                Ignored
                says:

                I’d be more interested in the numbers from 1957 and/or 1966 if we were discussing instituting a particular program similar to the one that Canada instituted.Report

              • North in reply to Jaybird
                Ignored
                says:

                Well if you want to shift the goal posts that way then I think you’d be on stronger ground to say that in the 50’s and 60’s medicine was cheap and ineffective so instituting universal medical care was pretty easy. Now that medicine is expensive and effective it’d be a harder lift. But that’d involve ditching the whole trust society nonsense.Report

              • Jaybird in reply to North
                Ignored
                says:

                I don’t see asking to compare the apple to another apple instead of to an orange as a shifting of the goalposts.Report

              • Brent F in reply to Jaybird
                Ignored
                says:

                1960s when Canada had a succession of massive waves of immigration from Central and Eastern Europe while English Canada was voluntarily giving up on any notion that British was the dominant culture? That’s the homogenized society you want to use as a basis point?

                I really think your actually talking about Black Americans but don’t have the courage of your convictions to just say it.Report

              • Jaybird in reply to Brent F
                Ignored
                says:

                Is the argument that Canada was less or equally homogenized in 1960 than the US is today?

                Or are you just asking incredulously how someone might possibly think otherwise?Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                I think we’re all incredulous that anyone could think that Cultural Homogeneity/Shared Culture/Language/Demographics/Monoculture/Euphemism A thru n has f*ckall to do with the success or failure of socialized medicine given that it has been successfully implemented in countries with none of these things.

                Seriously, this is absurd.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                Chip, the argument is that it’s a necessary (but not sufficient) condition.

                And arguing against it by saying “BUT IT’S SO OBVIOUSLY NOT A SUFFICIENT CONDITION!” is to misunderstand the argument.Report

              • Philip H in reply to Jaybird
                Ignored
                says:

                No its not. You keep saying its a necessary condition ( though it took you dozens of comments to be that clear … sigh), and Chip keeps countering with examples that its not because countries with that condition have implemented the system he’s advocating for and countries without that condition have implemented the system he’s advocating for. meaning he’s providing examples to show its not a necessary condition either. That’s not misunderstanding your argument.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                Your argument is that what works in dozens of different nations around the world can’t work here, but you can’t come up with a variable that makes this so.

                Every single one you’ve trotted out has been falsified.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                No. The argument is that there are multiple necessary conditions and none of them are sufficient.

                And, yes, none of the conditions are, themselves, sufficient.

                But neither am I arguing that they are.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                Every one of your “necessary” conditions are lacking in at least one actual working model.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                We discussed this back in 2017, believe it or not.

                I remember it, anyway. I know that you don’t.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                I remember it very well, because then, as now, you couldn’t come up with a “necessary” condition which wasn’t also lacking in some other country with a working model.

                Has this changed?
                Because after dozens of your comments, you still haven’t been able to do so.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                Back then, we discussed the idea of an iron triangle.

                As an engineer, I’m sure you’re familiar with the concept:

                Done Fast
                Done Cheap
                Done Right

                Pick Two.

                And when it comes to health care, everybody seems to point out that Europe does it Right and Cheap and the Wealthy in this country have it Right and Fast and wonder why we can’t be like Europe.

                And, in the same way, they have checked boxes that we have decided not to check and we have checked boxes that they have decided not to check and there are things that they have sacrificed for the sake of a much more cohesive culture that we in the US have decided not to do.

                For example, my definition of how to measure openness to multiculturalism is something like “Official Languages”. Not that that’s everything involved in multiculturalism, of course… but it’s measurable and it provides a floor (for example, Canada has both English and French as theirs, the Scandanavian Countries have laws and cultural classes that new immigrants are invited to take, and so on). There’s also attitudes towards immigration that the US does not share despite being painted as being anti-immigrant. For example: Could *YOU* become a Canadian immigrant? Take the test!

                And it’s always pointed out that some places do it Right and do it Cheap and other places do it Right and do it Fast and so WHICH IS IT???

                WHY CAN’T WE DO IT FAST AND DO IT CHEAP???

                My answer is that we can… but you won’t like the outcome of that.

                If you want to know why we haven’t thus far, I think that my answer explains it. As for why we can’t get it through congress, the senate, and get the president to sign it… well, there are a lot of reasons that people are opposed and they include concepts that you seem to think that they shouldn’t hold (but they do anyway).

                But all that to say: I do think that we will have something like single payer at some point in the future.

                And we will do it fast and we will do it cheap.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                Aaaand, now we’re back to “multiculturalism”.

                And we’re supposed to ignore all the multicultural nations that have socialized healthcare and are working just fine.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                “You say that you have to do it Right and Fast, but here’s one place that does it CHEAP! You can’t explain that!”

                Yeah. I know. Plenty of multicultural nations out there that have Socialized Medicine. There certainly are.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                *Loincloth wearing man on horseback gets off, and stares incredulously to middle distance,, then falls to his knees and screams furiously.
                “You did it! God D4mn you all to hell, you did it”

                *Camera pans back to reveal Mount Rushmore, with the faces of…

                The cast of Schitts Creek.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                One thing that I think will absolutely follow Single Payer?

                Something that is the equivalent of Drug Testing for welfare recipients. Arguments against smokers getting more than the basic health care. Perhaps obesity above a particular level.Report

              • CJColucci in reply to Jaybird
                Ignored
                says:

                It’s not a toggle, it’s a gradient. How much fast will you give up for how much right and how much cheap? And so on. Waiting a few months for elective surgery, done right, that you otherwise couldn’t afford at all seems like a reasonable balance. But if you don’t like that one, there are others.Report

              • Jaybird in reply to CJColucci
                Ignored
                says:

                I suppose that that’s true and we are lucky that the majority of health care out there that most people need is for stuff that we’ve done a billion times.

                Oh, you have the flu? Oh, you have a broken arm? Oh, you have food poisoning?

                We’ve got most of that down and so you don’t particularly need Dr. House for most things that most people will need the most. We can get by with an NP instead of an MD. I imagine that we’ll get more and more granular as well. Hey, a guy in residency with access to WebMD can handle 2 out of 3 issues on any given day.

                “We’re just like Canada now”, we can say.Report

              • Michael Cain in reply to Jaybird
                Ignored
                says:

                One of the things I learned recently is that there are two million cataract surgeries in the US each year. This is almost exactly the same as the annual rate for bone fractures.Report

              • Jaybird in reply to Michael Cain
                Ignored
                says:

                I suppose GenX in general can look forward to exceptionally high-quality medical care for People Of A Certain Age by the time I get there.Report

              • Michael Cain in reply to Jaybird
                Ignored
                says:

                I maintain that it’s entirely up to GenX. This is not rocket science. Vote in large numbers for the party that says we can afford it.Report

              • CJColucci in reply to Jaybird
                Ignored
                says:

                You make that sound like a bad thing. Of course most of health care is stuff we’ve done a billion times before. We’d be in a bad way otherwise. And much of our medical care can easily be pushed down to nurse practitioners and residents, who are, after all, doctors.Report

              • Jaybird in reply to CJColucci
                Ignored
                says:

                It depends on whether you see getting treated by an NP or resident as health care in a different “tier” (for lack of a better word) than treatment provided by an MD.

                If you say “hey, health care is health care and it doesn’t matter if someone else is in a better tier than you”, then I’d say that it’s not a bad thing at all.

                Multiple tiers of health care seems like a pretty good way to distribute the scarce resources.Report

              • CJColucci in reply to Jaybird
                Ignored
                says:

                I wouldn’t use “tiers” because the real question is whether, for any given problem, the care given by an MD is actually better. I’m surprised to see you on the side of credentialism rather than performance.Report

              • Jaybird in reply to CJColucci
                Ignored
                says:

                Again, if you say “hey, health care is health care and it doesn’t matter if someone else is in a better tier than you”, then I’d say that it’s not a bad thing at all.

                I’m surprised to see you on the side of credentialism rather than performance.

                “This phenomenon exists.”
                “I’m surprised to see you on the side of phenomenon.”

                Personally, I think we, as a society, would be better off if Police and Doctors swapped expectations of Qualified Immunity.

                But that’s another thread.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                We should invite some of these people to comment here on that very issue:

                Almost a million Floridians are slated to lose their Medicaid coverage starting in April once the federal COVID-19 emergency comes to an end. Florida is one of 11 states that did not expand Medicaid through the Affordable Care Act, which means tens of thousands of Florida families are expected to fall into the Medicaid access gap.
                https://amp.miamiherald.com/news/health-care/article271418817.html

                They might have thoughts to share.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                Do we have any Floridians?Report

              • Dark Matter in reply to Jaybird
                Ignored
                says:

                Me.

                This is the first I’ve heard about it.
                We seem to care about it less than Chip does.Report

              • Chip Daniels in reply to CJColucci
                Ignored
                says:

                It’s crazy that people insist on talking about socialized healthcare like some freaky Planet Of The Apes science fiction when there are dozens of actual working models to learn from.

                Because yeah, they each have tradeoffs and price tags and limitations.

                But instead of looking at how actual people in Toronto or Brisbane or Kyoto or Stockholm or Paris or wherever get healthcare and what that’s like, people prefer to start gassing on about Econ 101 grand theories.Report

              • Philip H in reply to Chip Daniels
                Ignored
                says:

                Well of course – that’s a great way to obfuscate and misdirect.Report

              • Jaybird in reply to Philip H
                Ignored
                says:

                Yeah, posting stories written by people who are actually doctors who talk about what switching to Medicare-for-all will do to their own practice really obfuscates the whole “why can’t we be more like Denmark?” issue.Report

              • Dark Matter in reply to Chip Daniels
                Ignored
                says:

                The big difference, and problem that those countries weren’t dealing with, is we already have buy in for the existing system.Report

              • Chip Daniels in reply to Dark Matter
                Ignored
                says:

                Again, false.

                Every country that adopted some form of socialized healthcare, from the UK to Japan to Scandinavia, had an existing constituency of doctors, hospitals, insurers and taxpayers who liked the existing system just fine and resented any change.Report

              • LeeEsq in reply to Chip Daniels
                Ignored
                says:

                I’ve read some Japanese novels with a throw away line about doctors not liking the new insurance law and there is the most line about getting NHS passed the British medical establishment by “stuffing their mouths with gold.” Canadian doctors went on strike when universal health insurance was implemented in Canada. LBJ sent doctors from the United States to be scabs.Report

              • CJColucci in reply to LeeEsq
                Ignored
                says:

                A check mark showed up here. I don’t know why.Report

              • Dark Matter in reply to Chip Daniels
                Ignored
                says:

                And when did that happen? 1960s? 1970s?

                So, when the existing constituency was small as we measure the percentage of the GDP, it’s much easier to do these “large” moves.

                Let’s just look it up:
                UK: 1948
                Finland: 1972
                Portugal: 1979
                Spain: 1986

                Massachusetts tried in 1986 but couldn’t get the budget to work.

                Vermont actually did it in 2011 but gave up in 2014 because it broke the budget.

                I think I remember a few others finding the same thing.

                We have a bigger job than most countries because we’re putting 16% of the gdp into HC.Report

              • Jaybird in reply to Dark Matter
                Ignored
                says:

                California passed a Universal Healthcare Coverage Bill last year.

                We can look to them as an example for the rest of the country, I’m sure.Report

              • Michael Cain in reply to Jaybird
                Ignored
                says:

                California will discover the same numbers as every other state that has tried. To borrow from a Democratic Montana Governor some years back, “Give me the money spent on Medicare, Medicaid, the VA, Tri-Care, and the employer share of group premiums in Montana, and I will give you a better health care system than Alberta or Saskatchewan.”Report

              • Michael Cain in reply to Dark Matter
                Ignored
                says:

                I’ll stand by my previous comment. If the US had a parliamentary system for its federal government, the US would almost certainly have created single payer rather than the mish-mash of Medicare, Medicaid, the VA, and union-backed employer health insurance in the 1950s and 1960s.Report

              • Chip Daniels in reply to Dark Matter
                Ignored
                says:

                So now it’s “Size”, having burned through Monoculturalism/Multiculturalism/Demographics/Language/Shared Culture/Buy In

                But size works in both directions.
                America has the ability to spend vast sums of money for nearly an unlimited length of time as evidenced by decades long wars.

                And as you yourself have pointed out many times, a lot of that current healthcare spending is inefficient and its deletion would free up moneys to be spent elsewhere.Report

              • Dark Matter in reply to Chip Daniels
                Ignored
                says:

                So now it’s “Size”, having burned through Monoculturalism/Multiculturalism/Demographics/Language/Shared Culture/Buy In

                Some of those just make the politics harder, and for some of my answers I’m ignoring some aspects of why the politics is hard and focusing on other aspects.

                It’s easier to have a high trust culture in a mono-cultural society. If there’s high trust in the gov then it will be easier to create some of these programs. Inequality of scale is a thing. Dealing with entrenched interests is also easier when those interests represent small interests (as measured by percentage of the GDP) than when they represent large interests. Dealing with existing programs is hard when you already have buy in from the general population.

                We are dealing with the negative aspects of all of these.

                The EU doing single payer should be a good example of the scale and difficulty. If Poland insists that abortion not be covered, is that a deal breaker? Do the high productivity cultures pay for the bad habits of the low productivity cultures?

                a lot of that current healthcare spending is inefficient and its deletion would free up moneys to be spent elsewhere.

                Yes, very true.

                Do you agree that “deletion” means “firing large numbers of people”? Do you agree that markets have a history of doing this while governments really don’t?

                In terms of mass firings, the only example I can think of at this scale is getting rid of the army after WW2. After that… what… maybe Reagan firing the striking air traffic controllers?Report

              • Brent F in reply to Jaybird
                Ignored
                says:

                Yes, I’m saying you have no actual evidence that the United States of 1960s was less homogenized than the Canada of the Royal Commission on Bilingualism and Biculturalism era.Report

              • Jaybird in reply to Brent F
                Ignored
                says:

                No, no. We’re asking to create a system like Canada’s in The Current Year.

                Canada created their system in the 50’s or 60’s, depending on how you measure it. We’re wondering why we can’t create a system today like Canada was able to create in the 1950’s.

                After all… Canada did it.Report

              • North in reply to Jaybird
                Ignored
                says:

                I brought up Canada when you were on your “we can’t make it because you have to be a high trust monoculture like individual euro states to do that” leg which, of course, Canada sweeps away.

                For what it’s worth I think the “building single payer now with expensive modern medicine would be very expensive” angle you’re on now is more defensible.Report

              • Jaybird in reply to North
                Ignored
                says:

                I still would argue that Canada’s diversity in the 1950s cannot be compared to the United States’, even taking into account the Front de Libération du Québec.

                (And I’d also point out that Québec was pacified greatly by the passage of the Official Languages Act.)Report

              • North in reply to Jaybird
                Ignored
                says:

                You’d be wrong Jay, sorry. in the 50’s Immigration as a % of the population was about half again as high as it is now. Canada, like its big brother the US to the south, has always been a hugely diverse country even before you factor in Quebec.

                https://en.wikipedia.org/wiki/History_of_immigration_to_CanadaReport

              • InMD in reply to North
                Ignored
                says:

                I’ve always thought Canada’s relative advantage in some of this stuff had to do with its history, and much more meandering path to independence. It seems weird to say it but history matters! But at least Jaybird has a point on population. Running a system for a little under 40 million, which puts it on par with a bigger but well below the biggest European countries, isn’t the same as running one for 10x that.

                But anyway reading through all of the thread and the way terms like ‘socialized healthcare’ are being thrown around in such a general, undefined way to include basically any western country other than the US, I think the answer is that we already have it, with the combination of actually government backed programs, subsidies, and tax breaks. It’s just a poorly designed, inefficient version. Maybe one day conservatives will accept that and get to the business of helping to make it work better instead of looking for wrenches to throw into the gears.Report

              • Jaybird in reply to InMD
                Ignored
                says:

                “We have Poles *AND* Ukrainians!”

                If the definition of “socialized medicine” were as loosey-goosey as “diversity”, I think that the argument that we have (and have had) “socialized medicine” since the 1960’s.

                And that can turn into “but we should be more like Country X!” conversations all over again.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                Using Poles and Ukrainians sarcastically shows why your argument fails.

                Because you yourself don’t know what you mean by diversity, or how to measure it, or what threshold counts as diverse or not.

                There has never been a single moment in the past 50,000 years when the North American continent wasn’t ethnically diverse, and the diversity has only increased over time.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                The term does seem to be mutable, doesn’t it?

                It means one thing in one conversation and another entirely in the next! Without any acknowledgment of the shift in terms.

                Weird.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                You’re inadvertently being Woke.

                One of the forbidden concepts in the anti-Woke hysteria is that race is a social construct, but your posts here demonstrate the truth of it.

                What you see as “monoculture” versus “multiculture” is entirely arbitrary and constructed, ever-shifting and evanescent, which is why the premise is continually falsified by empirical history.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                “Race is a social construct” is a forbidden concept by the *ANTI*s?

                I’ll let Jessica Krug know.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                Its one of the principles of Critical Race Theory.

                Read up on it, while you still can.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                Wait, it *IS*?

                So people like Krug and Dolezal and Warren are bleeding edge CRT folks?

                I think that your description of reality and reality are not matching up.Report

              • Chris in reply to Jaybird
                Ignored
                says:

                Man, it’s gonna be wild when you actually read some CRT. “Oh wait, Conceptual James got this completely wrong!”Report

              • Jaybird in reply to Chris
                Ignored
                says:

                I’m still someone who thinks that it has something to do with transforming the relationship between law and racial power, and also achieving racial emancipation and anti-subordination more broadly.

                Maybe something about questioning the very foundations of the liberal order, including equality theory, legal reasoning, Enlightenment rationalism, and neutral principles of constitutional law.

                I didn’t know that meant that Dolezal was right!

                We should probably apologize to her.Report

              • Chris in reply to Jaybird
                Ignored
                says:

                It’d be difficult to do those things if you were a race essentialist, which is why you’ll find that none of the CRT theorists are, in fact, race essentialists. Gonna be wild when you find out what they mean by “whiteness”, for example.Report

              • Jaybird in reply to Chris
                Ignored
                says:

                “Whiteness” seems to be a theological concept, like “demons”.

                This allows for minorities to shoot other minorities due to internalized whiteness.

                It’s a lot like demonic possession.

                Quick! Get the exorcist!Report

              • Chris in reply to Jaybird
                Ignored
                says:

                Nah, you’ll have to actually read about it instead of making inferences from the sample of Twitter discourse you happen upon in your Twitter bubble.Report

              • Jaybird in reply to Chris
                Ignored
                says:

                I was quoting Richard Delgado…

                As for “Whiteness”, it strikes me as yet another Motte/Bailey.

                It’s something that minorities can internalize and white people can unlearn and is therefore somewhat independent from whiteness… and of course it doesn’t mean *THAT* when it kinda meant that last week when it was convenient.

                Like “Defund”, if I wanted an easy example.Report

              • Chris in reply to Jaybird
                Ignored
                says:

                Where are you quoting Delgado?

                And yes, whiteness is something that is internalized, but not like a demon, more like pretty much any other good thing you might have read about how culture and socialization have worked.Report

              • Jaybird in reply to Chris
                Ignored
                says:

                “(questioning) the very foundations of the liberal order, including equality theory, legal reasoning, Enlightenment rationalism, and neutral principles of constitutional law.”

                That’s lifting from him.

                whiteness is something that is internalized … like pretty much any other good thing you might have read about how culture and socialization have worked.

                Any other *GOOD* thing?

                I must be reading the wrong CRT.Report

              • Chris in reply to Jaybird
                Ignored
                says:

                I’ll just repeat my comment, then:

                It’d be difficult to do those things if you were a race essentialist, which is why you’ll find that none of the CRT theorists are, in fact, race essentialists.Report

              • Jaybird in reply to Chris
                Ignored
                says:

                Which brings us into the ever-shifting definition of “whiteness” and whether it’s yet another term that people don’t want to define lest they wander toward falsifiability.

                Stuff White People Like, I guess.Report

              • Chris in reply to Jaybird
                Ignored
                says:

                Man, there’s a whole lot of stuff in the CRT literature, and elsewhere (I recommend Noel Ignatiev) working to define it.

                By the way, what I mean by good stuff on how culture works, I mean good stuff about how we develop and internalize culture, not anything about race in particular. E.g., literally all the psychology of culture and socialization.

                So, if you’re reading stuff about how we are socialized, good. If you’re reading stuff that says culture enters our souls via demons, bad.

                We can of course argue about the utility of the concept of whiteness as an aspect of socialization, but we aren’t gonna do that here, if for no other reason than because I don’t think you’ve read a damn thing above the Twitter level on it. But when you have, feel free to let me know.Report

              • Jaybird in reply to Chris
                Ignored
                says:

                I would probably use the term “egregore” had we a definition of “whiteness” before us.

                Until then, I’m pretty sure that we’re going to be working with something that dances between the motte and bailey like they’re in a Men Without Hats music video that, surprisingly, is an unfalsifiable term that gets used for social control rather than something that can be measured down to, say, the zip code level of granularity.Report

              • CJColucci in reply to InMD
                Ignored
                says:

                From your lips…..Report

              • North in reply to InMD
                Ignored
                says:

                Indeed I’d agree with you. I brought Canada up only to defenestrate Jay’s concept that you need to be a non-diverse, high trust monoculture to institute socialized medicine. You don’t. Canada exists and Jays narrow point is disproven as far as I can tell.

                Ironically I’m closer to him than I am to our leftier brethren when it comes to optimism that some kind of medicare for all or other socialized medicare program in the US could be instituted. It’d be hard as fish. The practical path to doing so remains the same as it was when Obama took us down the first couple of steps with the ACA.

                And I’ll also note that this entire mega-thread is a non-sequitor regarding the GOP’s tax plan. Our zombie Republican party would be trying to slash taxes and funnel money to their plutocratic paymasters even if were were a minarchist paradise. If taxes were low they’d try to cut them further and if there were no taxes they’d be trying to subsidize the wealthy on the poors dime. It is what is left of the GOP is.Report

              • InMD in reply to North
                Ignored
                says:

                Yea, in full agreement, as is usual.Report

              • Jaybird in reply to North
                Ignored
                says:

                I was comparing Canada in the 50’s to the US in the 50’s and you’re comparing Canada to Canada.Report

              • North in reply to Jaybird
                Ignored
                says:

                So your assertion is the US had -more- of a monoculture in the 50’s than it does now? Or less? Because either way your point just implodes. You don’t need a monoculture or near monoculture to establish safety nets. I’m sure (assuredly) that it helps but it isn’t a requirement.Report

              • Jaybird in reply to North
                Ignored
                says:

                I’d say that it had more of one but I’d also say that it didn’t tip over into having something that I’d call a monoculture.

                And that’s without using a definition so loose as to question whether monoculture is possible at all.Report

              • North in reply to Jaybird
                Ignored
                says:

                Ok, well I’m confused then. Your point, which I originally was addressing, was that a country needed a monoculture and/or high trust environment to institute a socialized medicine system. I pointed out that Canada instituted a socialized medicine system in the fifties and they were as, if not more diverse and multicultural than the US was. This seemed to falsify the premise that a monoculture and/or high trust environment is needed to institute a socialized medicine system.

                Now you’re agreeing that the US of the fifties was more monocultural and less diverse than Canada was. Yet Canada did institute socialized medicine. I’m stuck being a little confused.Report

              • CJColucci in reply to North
                Ignored
                says:

                Rest assured you’re not alone.Report

              • Jaybird in reply to North
                Ignored
                says:

                I was taking shortcuts because this topic comes up every couple of years and I remember the previous times and that bit me in the butt.

                I’d say that a sufficiently high trust society is required for a sufficiently robust social safety net (which includes, but is not limited to, single-payer healthcare). There are things that make the high-trust easier and things that make it a bit tougher. Monoculture is one of the things that makes high-trust easier but it isn’t the only thing. Defining “monoculture” is nigh-impossible so one of the things that I use that is actually measurable is stuff like “an official language” and “immigration screening” or maybe even “assimilation requirements”.

                Each of these is pretty much measurable and we can say “yes, this thing exists” and point to it.

                Following WWII, there was very much a push for some sort of “National Identity” thing among the various nations of the world and something like socialized medicine sprung up in most of the WWII adjacent countries.

                One of the things that most of the world had following WWII was this national identity thing and we see that it evolved over the next decade or so once the Cold War established itself (when it comes to Quebec, we can see the transition from the old Catholic party to the Liberal one).

                The Robust Social Safety Net established, there are new laws that show up to tighten the whole “National Identity” thing. Language laws, immigration controls, assimilation requirements.

                The US did not do those things. Hey, just show up. Jump in the melting pot. Gramma speaks Italian fluently, Mama speaks conversational Italian, the grandbabies know a handful of phrases to make Gramma smile.

                Official language? We don’t need one! Assimilation requirements? Hey, they’re called “rent” and “electric bills”. Robust safety net? How’s this? We’ll patch up some of the holes in The New Deal with The Great Society. There you go.

                And we see a War on Drugs in there following The Great Society which struck (and strikes) me as some heavy duty unofficial norm policing in response to the much-more-robust social safety net (and I’m sure there’s another essay that deals with taxes/tax cuts) but I feel like I’m repeating myself for the umpteenth time.Report

              • North in reply to Jaybird
                Ignored
                says:

                Ok, gotcha, thanks. I think I understand your general gist. I am not sure I agree but I think I grok it at least.Report

              • Jaybird in reply to North
                Ignored
                says:

                The fundamental assumptions are pretty much these:

                In an iterated prisoner’s dilemma, you’re going to get better outcomes with high trust.

                Low trust will lead to defections and further defections will lower trust even more.

                You can try to enforce collaboration, but that leads to strategic defections.

                And I just ask stuff like “are we on a good vector for trust?” when I see calls for greater collaboration. If I suspect that we’re not, then I know that whatever program relies on greater collaboration will fail.

                Whether you see that as pessimistic or optimistic probably depends on whether you see me looking at the system and saying “we’re on a good slope!” or not.Report

              • Jaybird in reply to Jaybird
                Ignored
                says:

                Oh, and to answer the obvious question: Tax Avoidance (not Evasion, Avoidance) is also a defection.Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                In which an example of a “Sufficiently High Trust society creating a robust social welfare system” includes um, *checks notes*, the Jim Crow American South and the European states in the immediate aftermath of the bloodiest war ever fought.

                So by this standard, America 2023 qualifies.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                You mean, like, Canada and England did their version of a Robust Social Welfare System while the US version of doing the same was Johnson’s Great Society?

                Would those examples meet your criteria?Report

              • Chip Daniels in reply to Jaybird
                Ignored
                says:

                No, our New Deal robust social welfare system was created by a deeply divided and distrustful America in 1936 while the credible threat of revolution hung in the air.

                The Great Society welfare system was created in the mid 1960s while entire blocks of American cities were still smoking rubble from race riots and, once again, revolution was in the air.

                The third robust social welfare system was created in 2010 by a deeply traumatized and polarized America in the wake of the Great Recession when mobs of Tea Partiers carrying guns took to the streets and threatened revolution.Report

              • Jaybird in reply to Chip Daniels
                Ignored
                says:

                Uh, yes they were. Yes, they were indeed.

                Would you like some examples of defections that followed or are you going to say that you’re focusing entirely on whether or not they get established in the first place?Report

              • Philip H in reply to Jaybird
                Ignored
                says:

                Knock it off. Clearly you see this as some big game theory mental exercise. clearly you don’t support it. And clearly you don’t want it implemented until all your necessary AND sufficient conditions are met.

                Here’s the thing. History is messy. Politics is VERY messy. Policy is only slightly less messy. Economics literally tries to make the rational out of t he irrational.

                There has been – and likely never will be – a time in human history when everything was “perfect” to do something like this. So sitting on our hands, waiting until we somehow get back to “high trust” which we may never have had and thus never lost, isn’t a necessary or sufficient criteria for doing social good through public policy. And yammering on about defections and iterated games may make you feel good. Maybe even smarter then Chip and me.

                But its not convincing anyone. Its not moving the needle. Even Pinky didn’t buy your argument.Report

              • Jaybird in reply to Philip H
                Ignored
                says:

                I think it will fail.

                It is because I think it will fail that I do not support it.

                And it’s not a “clap harder” situation. Would that it were.Report

              • Dark Matter in reply to Chip Daniels
                Ignored
                says:

                created by a deeply divided and distrustful America in 1936

                “Deeply divided” isn’t supported by the math.

                In 1936 the Senate had 76 Democrats and 16 Republicans.

                mobs of Tea Partiers carrying guns took to the streets and threatened revolution.

                Far as I can tell, the number of people killed by these “mobs” was zero and never threatened to be more.

                Searching on wiki for “guns” and so on in the “Tea Party Protests” article finds nothing. Further Obamacare was not created to buy off the Tea Party.Report

              • Dark Matter in reply to Chip Daniels
                Ignored
                says:

                Having the money to pay for a robust social welfare system is probably also needed to create one.

                IMHO “High Trust” is more a multiplier than a bar. Think about how hard it was to pass Obamacare and how little it does. That was because lots of people didn’t trust the gov to meddle with their health care.

                Obama had to strongly say if you liked your medical care you could keep it. Even though this was the lie of the year later, the various Leftish truth evaluators claimed at the time it was wrong to doubt him.

                “High Trust” means you trust the gov enough to meddle with the system and also trust them enough to fix it if they’ve broken it.

                Obama barely got that to work and faced strong opposition, not only from the GOP but from the public. Even with a super majority he didn’t have the votes to pass Single Payer because he needed buy in from the existing insurance companies and medical providers.

                Single Payer needs either the public screaming for it (or at the very least, not worried about losing their current stuff) or it needs strong buy in from medical providers and the existing insurance companies.

                Politically introducing market forces would be MUCH easier just because it would be less scary to the public.Report

              • Philip H in reply to Dark Matter
                Ignored
                says:

                Think about how hard it was to pass Obamacare

                That’s because the GOP Decided to tank their own ideas rather then give Obama a win. They could have said “Democrats can’t offer you anything because to do this they had to pass a Heritage Foundation plan we came up with in 1996” and cruised to a substantial majority – maybe even the White House BEFORE Trump. But they didn’t. They decided to obstruct. After 13 months of negotiations and 72 Republican amendments.

                Politically introducing market forces would be MUCH easier just because it would be less scary to the public.

                Right. Because the market forces currently driving inflation – which are essentially legalized greed – are so easily swallowed. The public trusts companies to do the right thing even less then government.Report

              • Dark Matter in reply to Philip H
                Ignored
                says:

                Right. Because the market forces currently driving inflation – which are essentially legalized greed – are so easily swallowed.

                Without price feedback there is no market. Without a market the phrase “because market forces” is nonsense.

                The public trusts companies to do the right thing even less then government.

                The concept of a company being forced to show prices to the public is a good thing and exists for the rest of the economy. Ditto the concept of being forced to honor those prices.

                Unlike Obamacare’s many thousands of pages of command and control which isn’t humanly understandable, this reform would fit on a single sheet of paper.

                The heavy opposition would come from the HC industry who would know they’re not going to be allowed to jack people left right and center anymore.Report

              • LeeEsq in reply to Jaybird
                Ignored
                says:

                Will you just come out and say that America had African-Americans and other Non-Whites rather than just beating around the push?Report

              • Jaybird in reply to LeeEsq
                Ignored
                says:

                But Canada had African-Americans as well, Lee! Canada was a major stop for the Underground Railroad!

                And having a small amount is the exact same thing as having a larger percentage when it comes to measuring diversity!Report

        • LeeEsq in reply to Dark Matter
          Ignored
          says:

          There are areas of the United States that are very low density but most Americans live in some pretty dense areas. California has 40 million people in an area about as big as Sweden. Maryland and New Jersey are just as dense as the Netherlands and Belgium. A plurality of Illinois population lives in one country and the majority live in the surrounding counties. Plus a lot of the sprawl is forced by law. Building densely is basically prohibited in most sunbelt cities.Report

  8. Slade the Leveller
    Ignored
    says:

    The phrase “taxable property or service” is where we need a lot more discussion. As someone who files hundreds of sales tax returns a year, I’ve seen the games legislatures play and how various taxing bodies interpret the legislation. If the Fair Tax goes this way it’s not going to solve the complex tax code problem at all.

    One of many examples is IL’s tax on groceries. For most items it’s 1%. Candy, pop, and, bizarrely, prepared food items are taxed at a higher rate despite the fact that most people would call them groceries.

    Imagine this: https://www.taxjar.com/sales-tax/grocery-items applied to many other types of purchases.Report

    • Philip H in reply to Slade the Leveller
      Ignored
      says:

      This get’s back to my working thesis that this proposal is another round of the GOP’s attempt to create Two Santa Clauses without doing the hard work of proposing actual cuts to government to make this happen. They are fiscal cowards, not fiscal conservatives.

      Its also worth noting that at $13.7 Billion (the final expenditure in FY 2021) the IRS is 0.44% of the federal budget. So cutting it doesn’t even get to rounding error for federal outlays.Report

  9. Marchmaine
    Ignored
    says:

    There’s probably a Grand Bargain ™ somewhere between UBI (removing state run programs) and Consumption Tax/VAT (removing bespoke tax incentives). But I’ll be golly darned if I see a way to get there.

    And, to JB’s point way above, there’s really no way that Congress won’t introduce new taxes and/or new bespoke exemptions from the VAT/Consumption Tax. It’s the only thing that makes them money personally (in terms of literal or figurative payback), so giving up tax code lobbying in favor of a single TAX NOB to turn ™? Unpossible.

    But, if the goal *really* is Revenue Neutral / UBI Offset / Tax Production not People and we have to pick your poison between an Acquisition Tax and a Consumption Tax, our druthers really should be for Consumption Taxes.Report

  10. LeeEsq
    Ignored
    says:

    I see lots of excuses being made on why the United States can’t have nice things and why we need to continually underperform compared to other developed democracies.Report

  11. Jaybird
    Ignored
    says:

    Speaking of being more like Britain:

    There are going to be tradeoffs that we’re going to be surprised by.Report

    • Philip H in reply to Jaybird
      Ignored
      says:

      Does NHS – the national healthcare provider – own or control the ambulance service? What’s the rural vs. urban call times? Do they dispatch fire engines as first responders like we do?

      See, you want us to be all doom and gloom but you are also being very selective here about the data you provide.Report

      • Jaybird in reply to Philip H
        Ignored
        says:

        I am *NOT* being Doom and Gloom.

        I am saying that “being more like England could very well entail being more like England”.

        What’s the opposite of “doom and gloom” that relies on “maybe the things that happened to the people we’re trying to emulate won’t happen to us”? “Sweetness and light”?Report

  12. Casey
    Ignored
    says:

    “One of the most interesting aspects of the Fair Tax is that taxation largely becomes voluntary. If you choose not to buy new items, you pay no tax. That’s a libertarian’s dream.”

    I stopped skimming after reading this. A libertarian’s dream is everyone else’s nightmare.Report

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