Whatta maroon. Michiko Kakutani must be praying that “write a negative review, pay $150 million” doesn’t become a legal precedent…
Repeating a frequent argument, a commenter to this thread says:
How does one deter the freeloaders who take poor care of themselves and then overuse the system for years on end (as sort of mental health therapy)? “It will not happen” is a questionable response – it happens now.
Frankly, this gets us to one legitimate critique libertarians have of universal health care: it can be used to bootstrap lots more nanny statism. I can live with that given the net positives of having a better health care system, but it’s regrettable.
For this reason, however, it’s worth noting that the argument is lousy, a subset of the utterly bizarre belief that medical care works according to similar incentives as markets for consumer goods. As Malcolm Gladwell notes with respect to the claim that having health insurance (rather than paying for doctors out of pocket) represents a major moral hazard:
The moral-hazard argument makes sense, however, only if we consume health care in the same way that we consume other consumer goods, and to economists like Nyman this assumption is plainly absurd. We go to the doctor grudgingly, only because we’re sick. “Moral hazard is overblown,” the Princeton economist Uwe Reinhardt says. “You always hear that the demand for health care is unlimited. This is just not true. People who are very well insured, who are very rich, do you see them check into the hospital because it’s free? Do people really like to go to the doctor? Do they check into the hospital instead of playing golf?”
For that matter, when you have to pay for your own health care, does your consumption really become more efficient? In the late nineteen-seventies, the rand Corporation did an extensive study on the question, randomly assigning families to health plans with co-payment levels at zero per cent, twenty-five per cent, fifty per cent, or ninety-five per cent, up to six thousand dollars. As you might expect, the more that people were asked to chip in for their health care the less care they used. The problem was that they cut back equally on both frivolous care and useful care. Poor people in the high-deductible group with hypertension, for instance, didn’t do nearly as good a job of controlling their blood pressure as those in other groups, resulting in a ten-per-cent increase in the likelihood of death. As a recent Commonwealth Fund study concluded, cost sharing is “a blunt instrument.” Of course it is: how should the average consumer be expected to know beforehand what care is frivolous and what care is useful? I just went to the dermatologist to get moles checked for skin cancer. If I had had to pay a hundred per cent, or even fifty per cent, of the cost of the visit, I might not have gone. Would that have been a wise decision? I have no idea. But if one of those moles really is cancerous, that simple, inexpensive visit could save the health-care system tens of thousands of dollars (not to mention saving me a great deal of heartbreak). The focus on moral hazard suggests that the changes we make in our behavior when we have insurance are nearly always wasteful. Yet, when it comes to health care, many of the things we do only because we have insurance—like getting our moles checked, or getting our teeth cleaned regularly, or getting a mammogram or engaging in other routine preventive care—are anything but wasteful and inefficient. In fact, they are behaviors that could end up saving the health-care system a good deal of money.
As far as I can tell, here’s not much empirical evidence that the “moral hazard” has a major impact — it’s pretty hard to explain why the American system, which offers less insurance than other comparable ones, is so much more expensive, for example. The reason above is an important one: financial disincentives discourage you from preventative medicine, but not from treatment for more serious illnesses.
None of this surprises me, because the argument also strikes me as illogical on its face. The thing is, being healthy is its own powerful incentive. Maybe I’m unusual, but even though I have decent health insurance I don’t actually enjoy being sick, bedridden, in physical pain, spending time in doctor’s offices, etc. Do people really think it’s common — even subconsciously — for someone with a relatively healthy lifestyle to get health insurance and see that as an opportunity to go on that all Popeye’s, deep-fried HoHos, and Cutty Sark diet they’ve been hankering for? I don’t understand this reasoning at all. There may be room for some minor disincentives at the margin, but the idea that universal healthcare won’t work because the possibility of being bankrupted by medical bills is the major incentive people have to be healthy is bizarre.
From Nan Aaron:
The Post is wrong. Why are so many unions opposed to Southwick? Because Southwick voted against the interests of injured workers and consumers in divided decisions 89 percent of the time. Why are civil rights groups opposed? Because he also voted overwhelmingly — 54 of 59 times — against defendants alleging juror discrimination. That prompted his own colleagues on the Mississippi Court of Appeals to accuse him of “establishing one level of obligation for the State, and a higher one for defendants on an identical issue.” Southwick, they charged in a dissent, placed his “stamp of approval on the arbitrary and capricious selection of jurors.”
Right. Which is, of course, might make him an attractive Republican Supreme Court nominee someday….
David Axe has a good post on Canada’s defense posture. Noting that the Canadian military has been remarkably effective in Afghanistan, he takes a look at how Canada is spending its defense dollars now. The upshot is that the budget looks well balanced for a power of Canada’s size and reach, almost remarkably so. Canada is purchasing ships and equipment that emphasize its expeditionary and logistical capacity, while ignoring expensive, big-ticket prestige items such as large surface warships and advanced fighter aircraft.
This made me think back to this old post, which discussed a bit how Canada narrowly avoided buying three Queen Elizabeth class battleships in the 1910s. This is interesting to me because Canada is one of a very few countries of its size to have avoided the dreadnought bug; even Australia, New Zealand, and Malaya ponied up dough to add a ship to the Royal Navy inventory. Although Canada had the third largest navy in the world in 1945, it owned no battleships, aircraft carriers, or even heavy cruisers. After the war Canada acquired a couple of light aircraft carriers from Britain, but that’s about it in terms of “prestige” naval vessels. As our resident Canadian detailed in a thus far unpublished paper, Canada also decided not to pursue the construction of nuclear powered attack submarines during the Cold War.
Canada is a wealthy country of significant size, and its defense establishment today shouldn’t look all that different than the UK, France, or Italy. Yet, its procurement strategy does seem different. Unlike Korea, it’s not buying large, expensive, high-tech surface warships. Unlike the UK or France, it’s not trying to build or maintain a large deck carrier fleet. Unlike Italy or Spain or Australia, it doesn’t appear to be interested in platforms from which F-35Bs could be launched. The way I look at this, Canada seems almost singularly uninterested in prestige weapons, and that disinterest seems to have held over pretty much the whole of the 21st century.
So, here’s my question; if this disinterest is genuine, what’s the source? Does it stem from Canada’s structural position, with tight alliances to both the US and UK, both of which are happy to invest in such items? Along the same lines, does the Canadian military establishment have a cultural preference for what might be called a “support” role, envisioning itself as operating in conjunction with either the US or UK, and therefore not needing the big ticket items? Although I suspect that both of those are true to some degree, I also have to wonder why Canadian civilians and the Canadian public seems immune to the “prestige” argument for big weapons systems. It’s not just the US, the UK, and France that fall for such arguments; lots of countries around the world view defense acquisitions as contributions to national prestige in addition to their more mundane uses. What about Canadian political culture makes these arguments fall flat, if indeed they do?
Moreover, as a class, the old and sick have some culpability in their ill health. They didn’t eat right or excercise; they smoked; they didn’t go to the doctor as often as they ought; they drank to much, or took drugs, or sped, or engaged in dangerous sports. Again, in individual cases this will not be true; but as a class, the old and sick bear some of the responsibility for their own ill health, while younger, healthier people have almost no causal role in the ill-health of others.
Virtually any healthcare thread will eventually produce someone making this kind of argument: we shouldn’t pay for healthcare for sick adults because it’s their fault for smoking, drinking, being fat, or some other lack of virtue. What these arguments leave out, however, is that 1)everybody dies regardless of their personal habits, and 2)people who die tend to get sick and rack up lots of health care costs at the end of their lives. For this reason, for example, it’s far from clear that smokers are more expensive consumers of health care; smokers consume more health care when they’re alive but also die earlier, which saves expenses later on. And then when you consider that as a class smokers are also much less expensive in terms of Social Security…this argument is pretty clearly specious.
What’s really going on here, in most cases, is what John Holbo in his classic review of Dead Right called “dark satanic millian liberalism“: to some libertarians, apparently, the fact that letting poor people die of preventable illnesses will compel them to be ascetic, conformist, risk-averse drones is a feature, not a bug. This puritain wing of the libertarian movement is especially easy to reject, and I don’t know about you but for me it’s not much of an argument against providing universal health coverage.
Lots of competition in this category, I imagine, but this is a unique species of awful:
ANAHEIM, Calif., Aug. 20 — According to local legend, the cliff swallows are supposed to return every March 19 to the old stone church at Mission San Juan Capistrano.
One of the cliff swallows, obviously a stray, returned Aug. 20 to Angel Stadium.
Phil Hughes grew up 15 miles from here. He rode his bike to Angels games. He had a cliff swallow tattooed on his back as a tribute to the place where he was raised.
When Hughes took the mound for the Yankees on Monday night at Angel Stadium, he knelt down and pawed at the dirt. Finally, he and his swallow were home.
Fortunately, I’ve already had my breakfast of Xanax and Prilosec, or that would have befouled my day. I’m also thankful the Marlins play in the National League, so I never have to hear about the dolphin tattoo on the small of A-Rod’s back.
The story about the Bush administration pre-empting states from expanding healthcare programs for children reminds me that I forgot to comment on the latest Michael Gerson joint. To follow up on a point I’ve made before, Gerson is often used an example of how conservative evangelicals can be brought into the fold to support Democratic economic policies if only women, gays, etc. could have their policy priorities thrown under the bus. But this is the problem:
First, Rove argues that Republicans win as activist reformers, in the tradition of Lincoln, McKinley and Theodore Roosevelt. “We were founded as a reformist party,” he said in our conversation this week, “not to be against something, but to help the little guy get ahead.” The models he cites are 401(k)s and the mortgage interest deduction — government policies that encouraged individual wealth and ownership.
Yes, Gerson talks in the language of social justice, and is probably sincerely concerned about it. But the problem is that his conception of social justice and helping the poor manifests itself…in support for highly regressive tax breaks and William McKinley being his idea of a reformist president. At any rate, the idea that conservative evangelicals are a “moderate” position on abortion away from joining the Democratic Party is dreaming in technicolor. The vast majority of Republican evangelicals support Republican economic policies, whatever language they express that support in.
In Daniel Lazare‘s smart and biting review of books about America’s incarceration culture, appearing in last week’s Nation, he highlights an incendiary argument from Marie Gottschalk’s book, The Prison and the Gallows (which I have not yet read but which is on my Amazon wishlist. Hint hint). Here’s Lazare’s take on Gottschalk:
Gottschalk’s assault on ’70s feminism is sure to raise the most eyebrows. She argues that the women’s movement helped facilitate the carceral state by promoting a punitive approach to sexual violence that was unmitigated by any larger political considerations. This single-minded focus led to what The Prison and the Gallows describes as unsavory coalitions with tough-on-crime types. In the State of Washington, women’s groups successfully marketed rape reform as a law-and-order issue so that, when the measure finally passed in 1975, it was “in part by riding on the coattails of a new death penalty statute.”
In California a new rape shield became known as the Robbins Rape Evidence Law, in honor of one of its legislative sponsors, a conservative Republican named Alan Robbins. In pressing for limits on the cross-examination of alleged rape victims, feminists “generally did not consider what effect such measures would have on a defendant’s right to due process,” Gottschalk adds, even though due process at the time was under assault from a growing war on crime. More radical elements, meanwhile, strayed into outright vigilantism. In Berkeley, antirape activists picketed an accused rapist’s home. In East Lansing in 1973, they “reportedly scrawled Rapist on a suspect’s car, spray-painted the word across a front porch and made warning telephone calls late at night.” In Los Angeles, a self-styled “antirape squad” vowed to shave rapists’ heads, cover them with dye and then photograph them for posters reading, This Man Rapes Women. A feminist publication called Aegis ran a notorious cover showing a gun with the warning, “You can’t rape a .38; we will defend ourselves.”
The National Rifle Association was no doubt delighted. Gottschalk contends that such activists wound up “profoundly co-opted,” since “by framing the rape issue around ‘horror stories,’ they fed into the victims’ movement’s compelling image of a society held hostage to a growing number of depraved, marauding criminals.” She notes that feminists threw themselves into the battle for the Violence Against Women Act, which passed in 1994 as part of an omnibus anticrime bill that “allocated nearly $10 billion for new prison construction, expanded the death penalty to cover more than fifty federal crimes, and added a ‘three strikes and you’re out’ provision mandating life imprisonment for federal offenders convicted of three violent offenses.” Yet feminists’ involvement was relatively modest two years later when a few liberals tried to rally opposition to Clinton’s plan to abolish Aid to Families With Dependent Children, which heavily benefited poor women. Like their nineteenth-century forebears, who advocated bringing back the whipping post to deal with wife beaters, late-twentieth-century feminists got more excited about punishment than defending the welfare state.
The trouble for me is this: Gottschalk is probably on to something. Which bothers the prison reformist part of my brain. But the fact that the feminist movement would be criticized for doing its part to protect women’s sexual autonomy also rankles me — men’s sexual power over women, sometimes expressed through rape, is a big part of what the second wave feminist movement was fighting against (and what third- and post-wavers continue to fight). This conflict is perhaps nowhere clearer than in my posts about exonerations: because of the availability of DNA in their cases, the vast majority of those exonerated were wrongly convicted of rape or rape/murder. The fight to hastily “get” alleged rapists and to make examples of them clashes with the desire to ensure that defendants’ due process rights are not infringed.
Prison reform and criminal defense work are not the only areas in which feminists have forged odd alliances in order to facilitate their goals (and in which they have allowed themselves to be co-opted after doing so). Most notoriously, Catharine MacKinnon worked with conservative Christians in her fight to ban pornography. But her alliance came back to bite her: the first books and films confiscated under the Canadian law based on her theories were from gay and lesbian shops.
Most damning to feminists, I think, is the movement’s general passivity (which Lazare notes) when it came to opposing laws that would hurt (predominantly poor and minority) women, like the 1996 Welfare “reform”. It’s not fair to feminism to make generalizations about the movement based on the old trope of the middle class white feminist leader. Feminists were, in 1996, on the whole opposed to the parts of the welfare law that incentivized marriage and allowed further intrusion into women’s private and sexual lives. Still, Gottschalk’s portrayal is not far off: historically, it’s been easier to rally the feminist movement offensively than it has been defensively. Reproductive rights advocacy is a stark exception to this, since we have always been on the defensive. But it’s not an exception that I think we should hold up as a model of effective feminist activism.
What to make of all of this? The tension I feel is a microcosm of the tension in the feminist movement: at what price women’s autonomy? Or at what price a less aggressively carcereal state? I’m not sure. This is uncomfortable and, I think, should remain so. Problematic alliances and mis-steps are part of any political movement. The question is how to resolve a tension that sometimes seems intractable.
(Also at Feministe)
The Anti Defamation League has fired its New England regional direction for insisting that the group recognize as genocide the circa-1915 slaughter of perhaps a million Armenians by the Ottoman Turks… A resolution pending in Congress would make it official U.S. policy to recognize that the Armenians were genocide victims. But the ADL, along with other leading Jewish-American groups, apparently considers friendly relations between Israel and Turkey–whose government takes genocide claims as a massive provocation–more important than the underlying historical question
In other words, the Anti-Defamation League is trying to prevent recognition of the Armenian Genocide, an event that Adolf Hitler *explictly* used to justify the Holocaust.
. . . She had a heart?
I suppose there’s a good argument to be made that if Helmsley had been a man, her crimes wouldn’t have earned more than a year in the clink. Still, she was a noxious human being who abused her employees and cheated the Reagan administration out of millions dollars it could have spent on pointless weapons systems, tax breaks for Helmsley’s wealthy peers, and illegal, covert operations in Central America.
Under the headline “White House Acts to Limit Health Plan for Children,” I just read this gem:
The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.
Administration officials outlined the new standards in a letter sent to state health officials on Friday evening, in the middle of a month-long Congressional recess. In interviews, they said the changes were aimed at returning the Children’s Health Insurance Program to its original focus on low-income children and to make sure the program did not become a substitute for private health coverage.
After learning of the new policy, some state officials said today that it could cripple their efforts to cover more children by imposing standards that could not be met.
So. During a recess, the president acts to prevent implementation of a law that Congress has passed and for which it could likely override what would be a very unpopular veto. Because the Bushies are so afraid (at least ostensibly) of the specter of socialism (so far off at this point that it’s laughable), that they prevent kids (KIDS!) from getting health insurance.
It gets worse. One of the conditions the Bush administration wants to impose is to mandate that states which set their cutoff for SCHIP participation at a level the federal government deems too high (above about $50,000 per year for a family of four) must require a family to be uninsured for a year before the children of that family can benefit from SCHIP. So a kid must be uninsured for a whole year before she or he can be covered by SCHIP. Nevermind what might happen during that year.
Jaw on the ground yet? Mine is.
Go read the whole article to find out more about the Bush administration’s vindictiveness.
And while it seems painfully obvious, we have recklessly abandoned our duty to teach our young. Public school education is worthless. Bottom line is if you can’t afford a private school that actually educates (as opposed to indoctrinates), you must home school.
Of course. Because families that “can’t afford private school” would be engaging in perfectly rational behavior by withdrawing one potential wage-earner from the labor market, while somehow mustering the additional resources they’d need to dodge the ideological poisons emanating from a free public education. Better to follow Pammy’s own model and devour the children in their cribs as they sleep.