So maybe this makes me a ‘centrist’ (a label I abjure because my conception of a ‘centrist’ is someone who can’t make up their damn mind), but I don’t see myself as being particularly partisan. A political party or movement wins my allegiance because I agree with their ideas today, not because I agreed with their other ideas yesterday. The whole phenomenon of “my father voted Republican, his father voted Republican, and right or wrong I’ll vote Republican too” seems equal parts idiotic and insane to me. Of course, voting Republican period seems idiotic and insane to me, so whatever.
This morning I talked about my approach for Canadian health care reform, which is nowhere near as big a political football as it is among our southern cousins. The ideas I put forward, as far as I can tell, don’t belong to any political party. They could be spun as products of either conservative thinking (“it’s time to stop throwing away hard-earned taxpayer money on a bloated bureaucracy that doesn’t deliver for Canadians. Let’s reign in spending by eliminating government waste!”) or liberal thinking (“we must find a fair and equitable way to deliver health care that focuses on providing the right service to the right person at the right time!”). The ideas aren’t good because Bob Rae or Thomas Mulcair thinks they’re good (or because Stephen Harper thinks they’re bad), they’re good because they’re good.
In the same way, I find the fight over the Affordable Care Act in the USA to be patently absurd. Aside from the fact that it is a massively watered-down version of a good law, there’s really not much in there to dislike:
Okay, explained like you’re a five year-old, without oversimplification, and (hopefully) without sounding too biased:
What people call “Obamacare” is actually the Patient Protection and Affordable Care Act. However, people were calling it “Obamacare” before everyone even hammered out what it would be. It’s a term mostly used by people who don’t like the PPACA, and it’s become popularized in part because PPACA is a really long and awkward name, even when you turn it into an acronym like that.
Anyway, the PPACA made a bunch of new rules regarding health care, with the purpose of making health care more affordable for everyone. Opponents of the PPACA, on the other hand, feel that the rules it makes take away too many freedoms and force people (both individuals and businesses) to do things they shouldn’t have to.
So what does it do? Well, here is everything, in the order of when it goes into effect (because some of it happens later than other parts of it):
Seriously – go read the list of legislated changes. There’s next to nothing in there to get upset about. And yet, the plan is wildly unpopular for reasons that beggar understanding. Either Americans are far more susceptible to propaganda than even I suspected, or the idea of having to buy health insurance is so abhorrent to the American psyche that y’all will happily cut off your own noses to spite your faces.
You know who doesn’t hate ‘Obamacare’, and therefore hates free-market capitalism and insurance companies? Insurance companies:
UnitedHealthcare — one of the nation’s largest health insurers — has announced that it will preserve a provision of the health care law that allows young adults to stay on their family health care plans up to age 26, even if the high court rules the law unconstitutional later this month.
The measure is one of several so-called “Patients’ Bill of Rights” included in the law that UnitedHealthcare will keep in place. The company will also continue offering preventive health care services without out-of-pocket costs and end lifetime limits on insurance payouts:
“The protections we are voluntarily extending are good for people’s health, promote broader access to quality care and contribute to helping control rising health care costs,” Stephen J. Hemsley, president and chief executive of UnitedHealth Group, said in a statement. “These provisions are compatible with our mission and continue our operating practices.” […]
You know why they don’t hate the idea of a larger pool of customers, most of whom won’t need to file a claim any time soon? Of course you do, because you’re not an idiot. Aside from the obvious though, when medical care isn’t a matter of financial ruin, people are more likely to go seek help earlier in the course of their disease (rather than when the pain/discomfort becomes so great that they can’t afford to not see a doctor). Most diseases are easier to manage the sooner you catch them, so this means big savings not only for policy holders, but for the insurance companies as well.
If human beings were indeed the rational creatures that economists pretend they are, this would be a no-brainer. A policy that, for a minimal individual investment, yields results that are better for poor people, rich people, citizens and corporations? Where do I sign up, right? But in the hyper-partisan morass of shouting that is the body politic in the United States*, this is an idea that struggles to get a third of the country to support it. Let’s not mistake ourselves – ‘Obamacare’ isn’t good (or bad) because it’s liberal; it’s good because it’s good.
Like this article? Follow me on Twitter!
*Don’t get me wrong. I blame the Republicans for this. Yes, the Democrats haven’t done a great job of convincing people why it’s a good idea to go down this road; the Republicans have been slashing everyone’s tires and wiping excrement on the steering wheel.
These two ideas are not mutually exclusive.
American health insurance is an artifact of the World War II era tax laws. With millions of men in the military and a booming economy* American companies faced a labor shortage. Because labor benefits were not taxed, many companies offered health insurance as a new benefit to their employees, effectively an untaxed pay increase. Group health insurance in the 1940s was relatively inexpensive (certainly compared to today’s prices) and so after the war most companies continued to give health insurance to their employees.
Since then the situation has changed drastically. Health insurance is now expensive and many small and mid-sized companies give minimal insurance plans or have dropped insurance completely. Yet the alternative, single payer insurance, is denounced as “socialism”**. All too many people have been told that “socialism is bad!” and they believe the propaganda. As a result, a large number of voters are acting in their own worst interests in refusing to support even the most minimal efforts of PPACA.
Sorry for the teal deer rant. You have to remember I’m an economist.
*Certain neocons and libertarians pretend Keynesian government spending didn’t end the Depression. More than any other reason, the Great Depression ended because of massive government spending on armaments for the war. This was true in every country, even those not actually fighting in the war. A large number of American and even Canadian companies subcontracted production to Mexican companies. Also Mexican raw materials and Mexican agricultural products were bought in huge quantities in both the US and Canada. So increased manufacturing, agriculture, and sales of raw materials brought Mexico out of the Depression. Officially Mexico was a belligerent, but the only Mexican forces involved in combat were one fighter squadron sent to the Philippines and some frigates escorting coastal convoys.
**I get quite annoyed at the accusations of “socialism” thrown at certain present or proposed government programs by people who quite obviously have no idea what socialism actually is.
As someone in the field of public health, this is our MO, and since our salaries tend to be paid with tax money (as well as grants), there’s an economic incentive to this: people who access healthcare often and earlier and don’t get as acutely ill generally spend more time at their jobs, working and earning salaries that translate into higher tax revenues. Wins all around.
Have to?
Why do you hate freedom, ‘Tis?
Well… anyone who votes for a Republican at the national level is automatically wrong in my book. Not because of partisan concerns, but for the simple reason that the rhetoric they use suggests that they reject the notion of good governance or the general welfare, dating back to Reagan declaring that government is the problem. I wouldn’t ask or expect someone from PETA to cook me a steak, or an extremist environmentalist to fix my car’s engine, so why would anyone expect a Republican to govern?
You WILL remember that I’m an economist and you WILL enjoy this remembrance! Or I’ll make life miserable for you. :-þ
(For the sake of this discussion, I’m just going to grant the majority view that the present medical interventions used to extend our lives are actually a good idea in the first place, though my thoughts around that are more complicated than simple agreement or disagreement.)
@1: Single payer isn’t The Alternative, it’s an alternative. Another alternative (which is significantly more socialist and also better) is a system of public hospitals funded entirely by public money.
@Crommunist:
You’re assuming a shared definition of “good”. I think the benefit to the rich and insurance companies (most of which are finance-sector corporations) are BAD, by virtue of being good for exploitative sociopaths and rewarding that behavior. I was not a fan of ACA, though my biggest objection was the result of the fact that I didn’t know it contained a provision capping insurance company profits. Without that provision, it’s a subsidy for insurance companies that does expand their mandated coverage pool but also assures them more than enough of a buy-in to counterbalance. I object to for-profit insurance, period, as it is a scam by definition (like everything in the financial sector): if people actually got their money’s worth, then there are no profits to be had. It would also be wholly unnecessary if we simply had public hospitals; by removing insurance programs from the path, we could save on the necessary overhead for managing them.
However, as the ACA caps profits (something I only found out about maybe six months ago, despite following this closely), it does not, in fact, force me to buy in to as much of a scam industry, so the cost to the greater protections it grants are not nearly as high as I thought they were when I vehemently opposed the law. To be clear: I don’t care about money I have to spend for a system I will not use – I favor public hospitals. I strongly object to a scam industry exploiting public policy to reap massive profits. The ACA is a bad law, especially since institutionalizing insurance the way it has makes it more difficult to do away with entirely; it’s just better than the old status quo.
‘Tis, with your style of dictatorial socialism, you’d have made an excellent Canadian, except for your problem with the language.
“Sorry, but you WILL remember that I’m an economist and you WILL enjoy this remembrance. Or I’ll make life miserable for you. :-þ Sorry, eh?”
A lot in the PPACA does make sense. It’s certainly better than nothing.
But I still can’t get over how nuts it appears on its face for the government to be providing health care by regulating and subsidizing insurance rather than the healthcare industry itself.
Metaphor I came across at a web design conference was: People don’t buy 10mm drill bits because they want 10mm drill bits. People buy 10mm drill bits because they want 10mm holes.
Metaphor for web design was: People don’t invest in a website because they want a website. People invest in a website because they want a business outcome – leads, opportunities, sales, trust and credibility, etc.
How I think it applies here: People don’t buy health insurance because they want health insurance. People buy health insurance because they want health services.
I think that cutting out the middle-man insurance companies and subsidizing/regulating health service providers would be the naively obvious best way for cutting costs – because all those insurance companies need to pay their own staff and payroll from their premiums on top of paying for expenses.
This is obviously a naive and relatively uninformed view, given I don’t have access to any statistics or very much knowledge of the US healthcare system, so there might be some good reasons why my naive intuitions are wrong. If there are any, I don’t know them.
Cause I just happened to be reading this earlier today 😛 http://satwcomic.com/the-end-of-america
Most everyone can envision a better way of doing things, but forget that getting there is an even harder task. That’s likely why the USA is going the insurance route – because insurance already exists and cutting them out would step on a lot of toes, and likely prevent it from going through. That said, I think other considerations (besides public health) were treated way to kindly, especially given the brinkmanship games that were played, but that’s what you get if you want to hold onto democracy and peace in a nation with a largely self-destructive attitude towards politics.
No, that makes you an independent, which isn’t necessarily a bad thing.
A ‘centrist’ is someone who claims to be independent, but is always calling on the liberals (always the liberals, never the conservatives) to move further to the right because they need to appeal to this invisible block of “independent/undecided” voters that conveniently always lie between the liberals and conservatives, and who berates liberals for scaring all these “independents” when they make any substantive attacks on the conservatives. The über-centrist is Jonathan Haidt, who seems to use his research on cognitive biases exclusively as a hammer with which to pound his “liberals are just as bad as the lying threatening gun-toting conservatives!” meme into the public discourse.
I think there are maybe two definitions of “centrist” here, one which you are rightly denigrating, another which is not necessarily a bad thing (though it may be).
Call the one you are describing a “philosophical centrist”: someone who thinks the center position is always somehow fundamentally better. A seeker of the false middle. Fully agreed.
Call the other type an “accidental centrist”: someone whose political opinions happen to lie somewhere in between the dominant ideologies under which they are being classed as “centrist”.
By European standards, I’m fairly close to an “accidental centrist”. Probably a little bit to the left of that, but I certainly would not be considered hard left by European standards. It’s not my fault! It’s not that I can’t make up my mind; it’s not that I am seeking some compromise position between what I perceive as two extremes; it is simply the case that when I think about public policy, I fall only a little ways to the left of the European center. (Okay, this previous paragraph is maybe not entirely true anymore, as continue to drift left the older and more informed I get… but it was at least true at one point!)
This, of course, makes me a raging socialist by American standards. So you can’t say I am playing the role of “philosophical centrist” — in the political context in which I am most often evaluated (and most often evaluate myself), I am quite a bit further to the left of the mainstream liberal party. There’s no playing to the false middle there!
But there’s no doubt that “philosophical centrists” exist, people who want to split the middle regardless of how crazy one side might be. All your criticisms of those folks, I am right there with ya.
Either Americans are far more susceptible to propaganda than even I suspected, or the idea of having to buy health insurance is so abhorrent to the American psyche that y’all will happily cut off your own noses to spite your faces.
Um…yes? That is, both of the above. Americans are deeply suspicious of anything that can be labelled “socialism”. They also often have rather…odd…ideas about what the federal government does and doesn’t do. Like the famous sign demanding that the government not take over medicare. Who did the sign maker think ran and paid for medicare? I have no idea.
The lack of insurance, especially for young, minority Americans shows. Take AML, for example. Survival in AML in the US is LOWER for 18-24 year olds than for 35-44 year olds. That makes no biological sense and noisy data from other countries suggest that this drop is unique to the US. (Better data is needed to confirm this though…I’m working on it. Really.) Comparisons of survival for Hodgkin’s lymphoma patients in Germany versus the US show better survival in younger patients in Germany but equivalent survival in older (60+ years old) patients. There could be other factors involved there–the use of BEACOPP versus ABVD, for example, but it’s striking that the German advantage suddenly disappears when all patients in the US get insurance…And let’s not even get started on cancer survival in minorities versus non-Hispanic whites, because it’s not a pretty picture and everything points to lack of insurance as the cause of the problem.
The current rumor is that the Supreme Court is going to void PPACA. I have strong personal reasons for wanting to stay in the US another 9-10 years. But if this one fails, I don’t know that I’ll be able to put up with it that long. I’ve been holding on to the hope that “Obamacare” would end some of the ridiculous, unnecessary tragedies I’ve been seeing. Without that promise…what’s the point in trying to treat people when it’s clearly impossible?
On the former, never underestimate the power of propaganda. Six corporations now own 90% of formal American media organizations (print, broadcast, online). That figure doesn’t count individual blogs, for obvious reasons.
As to the latter, though, yeah. Most Americans hate insurance mandates. Conservatives hate them because they see it as meddling with the free market (that didn’t and won’t exist). Some liberals hate them because they see it as feeding the corporate machine, and propping up an unnecessary and vampiric middleman.
One of my long-standing questions is why PPACA is such a long law. It runs for over 970 pages. No ordinary citizen has time to read that. This means that everything they know about the law is going to come from the media, and the media’s interpretation of what it does. (Return to my early point about media consolidation.)
There seems to be a growing problem in Congress, made up increasingly of lawyers and businessmen, of micromanagement. Does it take 900 pages of text to establish a couple dozen effective goals? No, there’s no possible way. That means the vast majority of the law is implementation details.
Why not leave the implementation details to executive agencies? Congress ought to specify what, not how. Leave it to the actual experts to figure out how to accomplish the pertinent goals.
I agree with many of the effective goals in the PPACA. In particular, I strongly agree with:
(1) Promoting the use of generic drugs where-ever feasible.
(2) Pooling together as many people as possible. That’s how insurance systems have to work.
(3) Allowing young adults to remain on their parent’s health insurance to age 26.
(4) Eliminating pre-existing conditions as a barrier to obtaining insurance.
(5) Expanding Medicare and Medicaid around the edges.
(6) Requiring medium to large businesses to offer health insurance to their employees.
(7) Taxing insurance companies, pharmaceutical companies, and the rich.
(8) Eliminating per-individual medical spending caps.
(9) A minimum floor on the percentage of premiums that insurers must spend on care/treatment/services (80 to 85 percent, depending on the classification).
However, I don’t think it takes even 500 pages to establish these and a bunch of other worthy goals. (Accounting for the horrifically wide margins on most legal texts, perhaps the PPACA is “really” only 600 pages or so.) I’m thinking something like fifty pages really ought to be enough to establish what we’re trying to do here. Leave the rest to the executive branch and the courts.
There are substantial advantages to making the law general. First, it massively reduces the number of amendments and clarifications that have to be issued. Second, you have to hire new people to do the work of figuring out the best implementation of the abstract goals set out by the law, and some more people to actually do it. Third, when you do need to make adjustments, it can often be done to related regulations instead of the law itself.
My opinion is that the reason American laws end up with so many edge cases, nitpicking, deep implementation detail, and so forth is mainly that Congress has sold out to the highest bidder. It doesn’t take much text to serve the general public, but it takes a large number to serve every business and rich individual’s whims. All the more so if you want the law to be long so that no one will read it and find all the little provisions you snuck in there to pay off your campaign contributors.