Sunday, August 30, 2009
(There you go, Leslie, you've been just been referenced with Arianna in the same line. ;) )
Both of them make excellent points about the superb political leadership exhibited by FDR and LBJ during their administrations. Roosevelt fought bitterly for every plank of the New Deal, and the most difficult fight was over Social Security. Johnson had to cram the Great Society down the throats of Congress one bill at a time as well. However, both Huffington and Parsley neglect certain other key details of similarity between Obama on the one hand and FDR and LBJ on the other and one massive difference.
Like President Obama now, FDR and LBJ faced considerable difficulty with center-right-to-right insurgents in their own party. During the second phase of the New Deal, the most vociferous resistance came not from the Republican Party but from the right wing of the Democratic Party in the form of 'the American Liberty League' (ironically led by crusading progressive icon Al Smith, Roosevelt's former political archrival in New York, more due to old political grudges against FDR in New York state politics than to genuine ideological opposition)... who filed lawsuits and encouraged state governors to attempt non-compliance with the New Deal. Mark Sanford wasn't inventing anything new, he was copying a Democrat. LBJ's opposition came from the right wing 'Dixiecrat' element of the Democratic Party, led by senators like Robert Byrd (how times change) and Strom Thurmond.
When praise is given to LBJ's amazing skills at wrangling the center and center-right of the party into step with the Democratic Party's left wing, it is deserved. When FDR's leadership and communication skills in rallying much of the nation to his support regardless of political affiliation are praised, this is also deserved. President Obama is, perhaps, falling slightly short in this capacity. I believe that Obama, like FDR, is fundamentally a conservative operating in response to what he feels is a true crisis situation. The problem is that I am not certain the country understands, anymore, that crises are time for action. I find it difficult, completely, to blame Obama for not rallying public support when today's increasingly cynical public is much less willing to offer genuine support. I believe, however, that it is too early to compare Obama negatively to FDR yet. He's passed the stimulus, and the fight for the second New Deal was much harder than the fight for the first... so FDR had to take his lumps there just as Obama is taking his lumps with health care. Nor is the health care fight over, and President Obama could still win.
What is different is that, while the real opponent is the same (the right wing of the Democratic Party is far more powerful in this debate than conservative Republicans), President Obama is not able to avail himself of the same ally that other 'liberal' presidents have been able to access in the past.
FDR was able to ramrod the TVA (Tennessee Valley Authority) through Congress primarily due to the efforts of one political ally. This was not a Democrat, but rather liberal Republican Senator George Norris of Nebraska. Norris (and then Robert LaFollette Jr, when Norris left the GOP to run as an independent when the pro-Roosevelt faction of the Democratic Party in the Senate offered him committee chairmanships... though Fighting Bob Jr defected to the mainstream Republican camp due to his loyalty to the isolationist cause in 1938) was the leader of the original, pre-WWII 'Roosevelt Republicans.' Liberal Republicans like Norris and LaFollette were necessary for the passage of the New Deal. If the conservative rump of the party had been able to leverage the party to vote in a solid bloc, the votes of conservative Democrats would have ensured that none of the New Deal passed. Certainly not the TVA or Social Security. Republicans, liberal Republicans who bucked their own party to back Roosevelt, are as responsible for these programs as Democrats. Perhaps more, as their votes made the difference.
LBJ, in forcing civil rights legislation and the social safety net through Congress, was also opposed ferociously by the right wing of the Democratic Party. The team of Byrd and Thurmond were fantatically opposed to every one of Johnson's reforms, and the former leader of the liberal Democrats in the Senate (Hubert Humphrey) had been sidelined into the Vice-Presidency. While a young Teddy Kennedy and more nationally renowned (at the time) legislators like Eugene McCarthy picked up Humphrey's slack, Democratic votes alone would not have passed Johnson's bills. The man on whom Johnson was able to call for support, who himself was not in Congress but who influenced the entire left wing of the GOP, was New York governor Nelson Rockefeller. The votes of the 'Rockefeller Republicans' in Congress passed 'liberal Democratic' programs under the Johnson administration and without them, none of them would have passed.
So it is not his personal qualities in which President Obama suffers most by comparison, but the political conditions. There is no 'left wing' of the Republican Party anymore, but the right wing of the Democratic Party is as strong as ever. This means that liberal reform will continue to be difficult regardless of who is president or controls Congress for some years, unless the Midwest and South experience the kind of liberal rennaissance that Kansas and Nebraska and the other Great Plains and Rocky Mountain states underwent during the hard years of the Progressive Era and the Great Depression. I think such a liberal rennaissance is possible, but I don't think liberals are doing enough to encourage it. Nor do I think the centrist rump and right wing fringe of the Democratic Party really want it.
The left needs strong, outspoken, energetic advocates willing to stick to their principles in the manner the right has stuck to its own. They can, through sheer will and time and effort, start to 'sell' liberalism the way Newt Gingrich (who was considered a stereotype Southern Republican and a political joke before becoming Speaker of the House) sold conservatism in the 1990s or Ronald Reagan sold it in the 1980s.
The problem is that far too many of us on the left think that because we are so 'obviously' right in our observations and solutions of society's problems everyone will magically recognize the fact without our needing to go to any effort to prove what we're saying. It's this natural belief that everyone else understands what we're saying that gets leftists the 'elitist' label and makes people vote for George W. Bush over John Kerry. They want us to work for the sale, just like Republicans... and just as we want the guy selling us our car or our life insurance to work for the sale. A good product isn't enough, we have to earn the sale to get America on our side.
In that sense, President Obama has done more to 'earn the sale' than previous Democrats in his position. Whether or not it will be enough, even for the short term, remains to be seen. It isn't as if he is some kind of actual liberal committed unswervingly to liberal policy. So it may be a very small start, even if he wins every fight. It is, however, a start we can build on whatever else happens. It wouldn't be a bad idea for those who want to be the next salesman to start practicing their pitches, just in case.
Friday, August 28, 2009
Mr. Olmsted, once again, is taking on criminal justice... this time not so much the sole question of penal policy but the criminal justice system as a whole. Once again, he nails some very good points home very well.
I'll start with, perhaps, the least consequential portion of the piece... but one that casts a great deal of light on police culture and thinking:
"When LA Police Chief Bill Bratton recently announced his resignation, he trumpeted the fact that LA hadn't seen such a low crime rate since the 50s."
So, who else reads James Ellroy?
Ellroy is a novelist, of course, but there is a reason he chose the subject matter he did in 'L.A. Confidential.' The LAPD of the 1950s was a corrupt, brutal operation proud of its corruption and brutality. It marketed itself, nationally, as the model for the country's police departments even as it routinely violated its own due process in the interest of 'public safety' and senior officers financed their retirement packages with mob money.
That Bratton would identify himself with the LAPD of this era is a bit disturbing. It suggests that too many cops believe their own PR. I'm not really sure that's a good thing. Bratton was Rudy Giuliani's partner in cryptofascism in New York City, a police regime all too reminiscent of 1950s Los Angeles, and he was hired to bring that same style to Los Angeles. Who will Los Angeles hire next? I've heard they have some good cops in Singapore, with methods that might work well in the US...
From the LAPD, we move on to the media and to you and me in our living rooms:
"In the last 20 years, just as demographic trends have kicked in that probably explain most of the drop in crime, the local news culture of "if it bleeds it leads" has burgeoned. In any large media market, you could easily get the impression that crime has skyrocketed rather than gone down. Helicopter-filmed car chases will go on for an hour at a time, until we finally get a glimpse of the crazed meth-head as he jumps into traffic and police subdue him. The robbery of every 7/ll clerk is caught on tape, run over and over if there's a pistol-whipping. John Q. Public would doubtfully concur that his neighborhood is more Ozzie and Harriet than Beyond Thunderdome, even if the only crime he has personally been the victim of in the last decade is a stolen gym bag.
Ask people what they think the chances are that they will be hurt in a terrorist attack or get carjacked and they will give you massively inflated odds. This is the way the modern mind works. We are somehow convinced something we see on TV is more likely to happen to us. The irrational result is that the same person smoking 2 packs a day will be less panicked by the prospect of a fairly likely lung cancer than of catching a swine flu that has sickened 10 people 3 states away."
Which of course necessitates this modern philosophy of 'tough on crime' in our judicio-political system:
"The D.A.'s priority is not justice, it's a high conviction rate to run for office on."
This is one of the key facts of our system. We have transformed prosecuting attorneys into our future congressmen, and they know a good case or a lot of convictions will help them get there. Liberal Democrats need to be able to prove they aren't 'soft on crime', while conservative Republicans are always happy to have a strong 'law and order' record.
Then, of course, sometimes the judge is being paid off by the company that owns the prison.
The biggest solution to the problem of crime is socio-economic. Sharp divides in the standard of living between the rich and the poor, coupled with a consumer culture that values buyers over workers, create an atmosphere in which the 'have nots' want what the 'haves' have got all that more intensely. Crime even becomes a sideways form of social protest to some. Of course, because of the structure of our society, other members of the 'have nots' are the most convenient and available targets for such crime. So the 'crime problem' serves, in many ways, to reenforce the class structure.
Mr. Olmsted offers his solutions as well:
"It's unfortunate this is perceived as a liberal/conservative issue. Stressing education, drug treatment, and job placement isn't about "coddling" criminals, it's about expanding the tax base and reducing the very poverty that causes the vast majority of crime in the first place. Meanwhile, letting offenders out before the end of their sentences is a perfectly sane budgetary remedy, particularly if it keeps us from laying off teachers. Every dollar spent in the classroom is a dollar that won't have to be spent on a prison cell."
Some of you have read my own feelings about education policy but, despite my break from the conventional wisdom of 'more school better all time' that is now dominating our education debate, I certainly won't argue that early parole for non-violent drug offenders makes more sense than laying off teachers. I'll also note that I think presidential pardon for non-violent drug offenders serving life sentences because of 'three strikes' laws would be a more telling statement by the presidency on federal drug policy than anything else.
I also favor voluntary drug treatment programs and job placement services for parolees very strongly. For those who genuinely wish to quit, treatment is a far better option than jail. And the biggest quoted reason for recidivism is economic frustration with the difficulty of (re)assimilating into the workforce.
I don't agree that education and drug treatment are magic bullets. Strong statistical evidence suggests that most non-chemical drug treatment programs have exactly the same success rate as individuals quitting on their own. I am strongly against forced methadone treatment (in which an addictive drug is treated by forcing the addict to become addicted to a much more deadly and addictive drug) and I tend to consider that the statement 'treatment or jail' is not truly 'voluntary.' So, in my opinion, the only option that does not violate the rights of citizens is the one with the extremely low rate of success.
Likewise, with education, the idea of a one hundred percent college educated population is certainly seductive. However, consider this: if everyone graduating high school finished at least four years of college, would there be enough jobs requiring college degrees to go around? Someone would still end up working at McDonald's flipping our burgers or at Olive Garden. We'd have the best educated fast food service workers in the world... but I'm not sure that would lower crime rates. While poor schools and a dehumanizing education system certainly contribute to crime levels, I am not sanguine that fixing those problems will solve the crime problem. Consider that the most serious crime is frequently a 'business' run by' educated' people. Street gangs may be composed of high school dropouts (or they may not), but the people higher up the ladder probably have their diploma.
The real solution to non-violent drug-related crime is to legalize drugs. That is the real solution to most violent drug-related crime too.
All of that said, the increased availability of non-chemical drug treatment and job placement services for parolees is a desirable thing. It is also desirable for people to have the more informed and accurate picture of the criminal justice system offered by articles like Mr. Olmsted's than to learn everything they know about crime and punishment from the TV news or Russian novelists.
Wednesday, August 26, 2009
On the contrary, Abner Mares is a professional boxer who represented Mexico in the Olympics when he was an amateur. All the same, he is the perfect archetype of the Mexican immigrant to the US. He came to the States to get a job and to escape poverty. His mother brought him (along with his six siblings) to Hawaiian Gardens, CA (a mix of working class/lower middle class neighborhoods and barrio in otherwise affluent Orange County) and worked two jobs to support them. Mares became a boxer in hopes of something better for himself and his family. He was good enough to become an Olympian, and he has parlayed that into a professional career. He has overcome adversity (a detached retina suffered in the course of his career) and has persevered in his chosen profession. He has learned lessons of life and experience and has certainly not asked the United States to pay his tab. His mother worked two jobs to pay her tab. He has fought, literally, to pay his own.
Naturally, most Mexican immigrants to the United States are not gifted athletes with professional careers ahead of them. Nor is Mares' success in his chosen career guaranteed, anymore that of any other professional plying their trade in America. He has that in common with his countrymen. They have something in common with both him and his mother:
As I have said before, Mexicans come to the United States to work. More of them come illegally than not, because of the restrictions on immigration to the US from Mexico and other Latin American countries. Like Mares' mother, they work hard. Most of them use their earnings to start businesses that become part of and help to support the American economy. Their children, like Mares himself, seek to further develop their gifts and take advantage of the opportunities that comparative prosperity (the barrio in Hawaiian Gardens is still safer and more affluent than any barrio in Mexico) offers and strive to succeed beyond their parents. Mares grew up in Hawaiian Gardens, but now he lives in Norwalk, CA. While Norwalk is not Beverly Hills, it is a step up the ladder.
Of course, this is the history of America. Immigrants from foreign lands (whether they be debtors fleeing imprisonment, as the founders of Georgia; or religious refugees, as the founders of New England, Pennsylvania, and Maryland; or simply looking to make a buck, as the founders of Virginia and the Carolinas) have come to America and worked their asses off to make good. While more of them have failed to build the American Dream than have succeeded, they have nearly always succeeded in building a better life for their children. Whether or not they have failed to build the American Dream, they have always succeeded in helping to build America itself.
They do so to this day, even when they aren't here legally.
Criticism of the current health care reform packages under discussion aside, very few legislators have contributed as much to civil rights, women's rights, and the social safety net as Senator Edward Kennedy. Now he's passed on. This is a tragedy. Teddy Kennedy deserves his share of the credit (along with liberal lions such as Hubert Humphrey and Nelson Rockefeller) for the passing of the Great Society and (along with Rockefeller and others) for the passing of much of the liberal legislation of the Nixon presidency. Regardless of his foibles of private character (and there are few in Washington sufficiently without sin to cast stones in his direction, despite the popularity of doing so among Republicans), he was a man of great public conscience that his sucessors in the Democratic Party do not always appear to share. He was a man unafraid, despite his reputation as a liberal warrior, to cross party lines to do what he believed right.
I don't know if Teddy Kennedy can be called be the last great senator. I have a great deal of respect for John Kerry, Vice President Joe Biden, and even John McCain and very high hopes for Al Franken (yes, he's a comedian, but as someone who has been reading his books for a long time he his a man of public conscience and commitment to meaningful policy of Teddy's stripe)... but Teddy Kennedy was almost inarguably the greatest living, serving senator of our current era.
We should all miss him, even Republicans.
Without Teddy, who will Republicans be able to hold up and say 'Well if he's for it, I guarantee my district will hate it!'?
Sunday, August 23, 2009
That was sarcasm, yes.
Obviously, a black president is going to guarantee that race is very much on everyone's minds for the four-to-eight years of the Obama Administration. That would be true even if that president's name were 'Barry Huntley Owens' instead of 'Barack Hussein Obama.' The first black president is a big deal, and people of all kinds and all racial attitudes are going to be talking about race constantly as a result. Some of this may be good and some of it may be bad, but it's all unavoidable. Anyone who actually believes a bi-racial president with an African father and a lifetime steeped in white American culture magically brings on an instant sea change in American racial politics is really, really naive. High minded post-racial rhetoric is good and a post-racial world is a worthy goal, but we're a long way from it.
That said, while dirty racial politics is to be expected and exacerbated under the current conditions, we don't have to like it. One of the constant ploys from the right is the desire to deliberately cast the left as racist, as devoted to stirring up racial hatred for political purposes, or both. One of the constant ploys from the left is to repeatedly bring up individual examples of racists on the right in an attempt to paint all conservatives with this brush. Both of these moves are 'politics as usual'... which means each side considers their own activities to be entirely above reproach and the other side's to be vicious and inhuman.
The fact is that both sides' attacks on the other tend to be more inaccurate than accurate. Today, here and now, racists are more likely to be Republican than Democrat because the 'traditional American values' championed in many red states include unfortunate racist legacies. However, President George W. Bush (this may be the only time you ever see me say anything good about the man, so keep reading) advocated amnesty for undocumented immigrants as part of his flawed immigration reform package. He was defeated by a bi-partisan hue and cry of aggressive nativism with both conscious and unconscious racist implications. Moderate and conservative Democrats are as guilty of such pandering as Republicans, and Hillary Clinton specifically attacked other candidates for the Democratic nomination who supported Bush's amnesty and immigration reform package. The locales in which the attack was given suggest a deliberate pandering to nativist white voters. Racism is a two-party problem.
There is, however, a fundamental difference between the approaches of the mouthpieces of both sides of the left-right debate to racism. Liberal writers nearly all agree that racism is a genuine problem. Conservative writers dismiss it as an occasional aberration. Liberals believe that action taken to ameliorate the effects of racism and to protect individual civil rights is desirable and necessary in a free society, while conservatives dismiss such action as unnecessary or attack such protections as unfairly depriving whites. The debate over Sonia Sotamayor's confirmation, the publicity surrounding the overturning of the case brought most prominently into the press by her nomination, and many of the absolutely moronic attacks on her person and character by conservatives included baldly ugly racist overtones that can't be dismissed or denied and these aspects were not disavowed by many (if any) conservatives.
I have been, and will continue to be, critical of the Democratic Party's approach to civil rights issues. I believe that treating black issues, Hispanic issues, women's issues, and LGBT issues as separate and independent agendas is fundamentally counterproductive. If the goal is increased protection of individual rights, then the narrow focus this approch creates is potentially disastrous. Civil rights issues are civil rights issues, and one coherent approach to individual civil rights is the only way to attack the problem. However, liberal Democrats are correct in acknowledging that there is a problem and seeking to take action to address it.
The single biggest problem (which conservatives recognize, though they support and perpetuate the problem rather than attacking it boldly) is the economic problem. Institutional racism is frequently unconscious, due to the simple fact that disproportionate numbers of black and Latino Americans are poor and that our society has gone out of its way (especially in the last twenty-five years) to stigmatize poverty and scapegoat the poor. Conservative 'reforms' intended to change the way the government address poverty have exacerbated the problems of the inner city. The Randian ethic of prosperity/virtue vs poverty/sin embraced (ironically) by both secular libertarians and Christian conservatives is tremendously damaging to minority Americans and serves to buttress institutional racism that has been slow to die.
In one sense, liberals are to blame. In 1865, the Republican government that freed the slaves decided against compensating freed slaves in order to attempt to preserve the support of pro-Union conservatives in slave states. This perpetuated a huge inequity between black and white Americans that has never been addressed properly since and may be impossible to fully rectify now.
However, it is conservatives who argue against even trying.
Saturday, August 22, 2009
Much of the health care writing on the web and in print right now is centered on the health care debate itself rather than health care policy. This is somewhat dangerous. Indeed, much of this writing attacks or defends the process in Congress or the administration without advancing constructive ideas. There is also, of course, well measured and intellectual criticism of specific problems with the compromises being made in the Senate Finance Committee in the name of bipartisanship. This second quote piece is from Ron Chusid of Liberal Values, who is likely one of the most sensible and sober writers on the issue on the net. Not only is Ron a doctor, and thus possessed of a knowledge of the subject not always present with the rest of us in the blogosphere. He has a great deal to offer both on the debate itself, and in support of many of the reforms currently on the table, in addition to the aforementioned critique of the finance committee bill. He's not so far out on the left as I am, myself, but who really is?
I'm not going to write, this time, about the debate. I agree with the majority of Ron's comments about the debate (I believe passing the current reform agenda in the form most palatable to liberals and most likely to pass muster is extremely important, even if not the final word), though I do believe that those on the left criticizing current proposals have important views that should be heard as well. I believe the left has been shut out of the debate on a more meaningful level even than the right, and I think it's inappropriate that so much sound thinking on the left was merely dismissed.
Instead, I am going to offer something tangible: a new American health care policy. While it is unlikely anything on this scale will be included anytime soon, it is important that such ideas be presented and circulate for the future.
I am going to start by identifying what I think are the most serious problems with the current system, and offer specific solutions to those problems. I will then attempt to predict the problems such a system might create, and create ideas to attack those problems as well.
1.) The chief problem with our current system is financial. This is not the problem of 'health care costs' as described by the pro-reform voices in the debate, but rather the high consumer costs created by the utterly inefficiant means of paying those costs. Rather than pool all the available health care dollars into one pot to pay the total health care costs those dollars are divided between individuals (both those wealthy enough to pay for most health care out of pocket and those too poor to pay any other way, as well as the dollars paid to insurance companies... as well as Medicare taxes), corporations (both through employee benefits and workplace liability laws), insurance companies (who collect money from both individuals and corporations, take their cut, and then pay health care costs), and the government (through Medicare and Medicaid... and also into insurance companies for government employees.) So there are four different entities who pay into multiple pools. In the case of individuals, the government, and corporations those involved all pay into at least two pools and sometimes more. For example: the same person pays Medicare taxes and insurance premiums, while also paying co-payments out of pocket. That person is paying three times for the same amount of health care. Employers pay into insurance pools while paying corporate taxes that go into the budget to pay for Medicaid, and also pays any workplace liability claims. The government funds Medicare and Medicaid and private insurance costs for government employees. That's a horribly sloppy division of costs and is practically impossible for all of that money to be properly applied the way it is spent.
The solution to this is obvious. Eliminate all the pools but one. Every individual pays a dedicated tax, based on the Medicare tax, into one pool of health care dollars. The insurance companies are eliminated. They are only a drain on the system anyway. Their administration costs and their profit requirements merely serve to suck money that could be paying for health care out of the health care pools. The drain on resources to pay for health care that they create does far more damage than the benefits they provide. While there are some excellent companies that would provide a useful model for a single-payer system or national health service (Kaiser Permanente, despite real flaws, would be excellent for the latter), even the best companies drain money out of the health care pool by their business models. The goal is to eliminate co-payments and deductibles for medical care and confine costs to one dedicated payment that would replace health care premiums.
Medicare and Medicaid would also be discontinued and this system would replace Medicare and be extended to cover Medicaid recipients as well. Importantly, this would eliminate the additional expense of Medicaid eligibility testing. An entire bureaucracy would be shaved off, the money saved to supplement the new health care system as necessary.
2.) Access to health care is, by far, the second biggest problem with the current system. This takes two forms: access to actual care and access to care of sufficient quality. The first is actually a set of several subgroups: those who are refused coverage by insurance companies because of pre-existing conditions despite the ability to pay, those who cannot afford to pay for health insurance and thus do not seek medical care under most normal circumstances, and those who have health insurance but whose provider refuses to pay for care for a variety of excuses. The second group consists of members of all the subsets of the third group: those who generate sufficient debt due to the cost of health care that their physicians will no longer see them until they have paid off their bills.
This problem is solved by the previous solution. Everyone is paying directly into the same pool and so everyone has access to health care when they feel the need to exercise that access. This increased access and the increased ability of health care facilities to receive compensation that results from increased access should also have the benefit of including the quality of care to which many people in the second group have access. The reforming of the Medicaid ghetto into part of the mainstream health care system would give people now on Medicaid access to a better quality of care. This would cause those clinics currently providing services to Medicaid recipients on a nearly exclusive basis to improve or be replaced by better facilities. In this sense (and in that of many people on low quality private insurance) this increase in consumer choice would actually encourage a more 'free market' competition between medical facilities and practices. If patients can go where they please with fewer limitations, then facilities must compete for patients more aggressively with better services and care.
3.) One of the major weaknesses of our current system is one that few people on the left or center properly appreciate, one of the few areas where the right is generally correct in their assessment: the economic burden paying for employee health care costs places on business. Many small businesses cannot afford to pay for health care for their employees at all, while more and more corporations are ceasing to provide health benefits or dramatically shifting the burden of paying for those benefits onto employees. The lifting of this burden would do American business far more good than any corporate tax cut. Current health reform proposals seek to shift more of the burden of paying for health care onto American business and to make it more difficult for corporations to opt out of paying employee health care costs by requiring those that do not to pay punitive taxes. Not only is this punitive taxation potentially a bill of attainder and thus legally questionable, but it aggravates what is already a major economic problem.
The system outlined eliminates this problem entirely. There's no need to add much more than that, and this one of the strongest arguments in favor of single-payer or a national health care system. It lifts a huge de facto tax burden on American business.
4.) Insurance companies and medical facilities currently compensate many medical specialists at a rate far beyond what Classical economists would consider 'market value.' Classical theories of labor, based on utility, would argue that the most important medical practitioners would be primary care physicians. However, because of the inordinately high compensation offered to specific specialists (cardiologists, endocrinologists, neurologists, oncologists, psychiatrists, and specialty surgeons all come to mind), the most necessary facet of medical practice is grossly underrepresented while specialty practice is overrepresented. Specialties like geriatrics and internal medicine are also frequently underrepresented, despite the incredible need for doctors in those fields.
The new, single pool for which to pay for medical costs would allow medical study of the need for specialists in various fields to be done to restructure more reality-based compensation for both general practitioners and specialists. Increased compensation for primary care physicians and underrepresented specialties would draw more doctors to those fields. More reasonable compensation for less necessary, but overrepresented specialties, would help to impose some small degree of basic cost control on the system.
There are at least two problems that such a thorough-going reform could create, which must be anticipated and addressed.
1.) Successful medical programs grow in cost precisely because they are successful. This has been witnessed most specifically with Medicare. The huge change it has wrought in the lives of American seniors has steadily increased the cost of the program because of the increased availability of medical care for seniors and the fact that seniors living longer because of increased access to better medical care means that there are more seniors needing medical care. It is only natural and logical to make a baseline assumption that improved access to medical care for all Americans would have a similar effect on the budget of such a system.
There are several things, however, that can be done about this. The most obvious is that purely elective procedures and medications (plastic surgery not directly necessary for reconstructive purposes, Lasik surgery, abortion in any case where the termination of a pregnancy is not necessary to protect the health or life of the mother, elective hysterectomies and vasectomies, ED treatments, etc) would need to still be based on the ability to pay. If this sounds unfair, then perhaps it is, but there is such a thing as economic necessity and that the more efficient allocation of health care dollars should allow the health care industry to lower the costs of elective procedures to a level where more people can afford to pay those costs.
Second, and perhaps most importantly, is this: the current SS/Medicare tax is capped and income over a maximum level is not taxed. A dedicated tax to pay for national health care costs should not have this cap. All income earned above the current cap should be taxed to pay for health care. Such a tax would still be lower, in all likelihood, than the insurance premiums/deductibles the highest paid Americans are already paying for their insurance, simply because of the need for insurance companies to funnel a percentage of their inflow into profits.
2.) Increased access to health care presents the problem of demand outgrowing supply. This used to be the right wing nightmare scenario, before they decided 'death panels' were even scarier. The image of flooded emergency rooms full of the miserably ill waiting their turn was flaunted by the GOP during the 1994 health care debate.
While there are definitely areas where this will be a problem, some of it is actually highly exaggerated. Emergency rooms are already flooded because of the inability of those without health care coverage to simply make an appointment and go to a doctor's office when they have non-emergency health care concerns requiring attention. The increased ability to see a doctor would reduce the strain on emergency rooms rather than increase it, particularly now that 'urgent-care clinics' have become the ongoing medical fad. The recent profusion of urgent-care clinics would relieve much of the current strain on emergency rooms without overcrowding the new clinics. Emergency rooms, more and more, would only be patronized in the case of actual emergencies. That would relieve the system of a tremendous burden.
The area where demand is likely to outstrip supply is primary care. The shortage of primary care practices could mean longer waits until new doctors enter the field. However, demand creates supply. An increased demand for primary care physicians would naturally generate more primary care physicians to meet that demand. The restructuring of medical compensation to pay primary care physicians more equitably would speed this process. There would be a short-term period in which appointments would need to be scheduled further in advance and waits at doctors' offices would be longer, but this would gradually normalize as new doctors entered the primary care field. PAs and nurse practitioners currently fulfill many responsibilities in this area and the expansion of both fields should be encouraged as well.
Besides, in the simplest possible terms, a medical system in which the biggest problem was the office wait for routine care would be a massive improvement over the current mess.
Tuesday, August 18, 2009
I haven't been terribly active either reading blogs or commenting on Huffington Post for a little while, as (excluding my period of burnout when I was not reading or commenting anywhere) I have been busier with my own blog and with reading/commenting on the blogs on my 'Required Reading' list. I get their daily brief in my email, however, usually check it, and read through those articles that particularly interest me.
Today, after finishing work for the late night/morning, I happened to open up my email and catch up on Monday's daily brief. I was very pleased find this article about life in the California Institute for Men in Chino, California, by Mark Olmsted. Mr. Olmsted, spurred by recent events there, shared his own experience as a prisoner in CIM and offered his thoughts on a possible solution to at least some aspects of the problem of prison violence.
"Those inmates willing to sign a statement committing to nonviolence and a rejection of racial politics during their sentence would be housed separately from those unwilling to do so. These "N" inmates would get extra privileges, like Saturday mail and more phone time. They could bunk or cell with any race. Any "N" inmate caught in a fight would be sent to housing in which inmates had not signed a pledge, where they could continue to fraternize exclusively with their own race, etc."
I have seen worse ideas, far worse. Of course, it's entirely possible this idea appeals to me solely because of my experiences and worldview growing up in the (pacifist) Mennonite Church. I have a natural predilection toward nonviolence that is as fixed in my philosophical make-up as opposition to abortion and gay rights is fixed in the philosophical make-up of many fundamentalists. However, a quote by HuffPoreader 'coaldust' makes me think it may not just be me:
"Mark; This may come as a shock to you, but I'm a conservative that occasionally comes to HP to get the other side of the story, whatever that story may be. A LOT of conservatives come to HP for that very reason. As you can guess, I don't post often, but I'd like to say that you make a very good point regarding separating non-violent inmates from violent ones. This is a point that I think reasonable people; liberal, conservative, or people in between, can identify with, and agree with. I think people get the mistaken image that prison makes animals out of people, but only because a lot of the "animals" were animals before they got into prison, and they prey on non-violent prisoners for their own purposes. Just as they prey on society."
Clearly, someone with very different views and experiences than myself had a very similar reaction to this article.
All of which, combined with the recent riots at CIM of course, has me giving penal reform a bit of thought again. While this is a problem with no easy solution, as none of the three main justifications for our prison system (deterrence, punishment OR rehabilitation) are being adequately served by our present system. This is primarily because these three competing justifications are all being advanced simultaneously, by different people and forces, without regard for the reality of the situation and often by people who somehow wish to combine three competing goals in ways that just are not possible. So instead of a place of punishment or rehabilitation, or a deterrent example, we have a place to warehouse people.
Many of the flaws in our prisons are much like the flaws in our school system. Indeed, it could be said the biggest flaw of our school system is that it is too much like our prison system. Both serve primarily, or so it seems, to warehouse dependent segments of society (the poor, in the case of prisons, and children, in the case of schools) so that none of the rest of us have to deal with them or their issues. Of course, the massive economic cost of warehousing our rather large prison population is at least as serious a concern as the right's obsession with the cost of Medicare. And unlike Medicare, where costs keep growing because the program is succeeding so far beyond expectations, I don't think most people would call our criminal justice system a success so far. Not when examining our prison population and comparing it to our crime rate. I think even the right wingers advocating harsher measures would have to admit they are advocating such measures because of the lack of success of the current system.
So what to do about it?
Well, for a start, we have to acknowledge that it actually exists and address it in our public discussion. We talk about 'crime' a lot, but really don't take the time needed to analyze our overburdened prison system.
It's about time we start.
Saturday, August 15, 2009
All the same, what do those of us who talk about immigration reform do with the topic between elections? I have to note, to my discredit, that I have not written on the topic of immigration policy since the Democratic primary. I don't even remember the original post to find and link it without digging through my entire backlog, since it is part of that portion of the blog I have not yet catalogued by label. This certainly is not something of which I am terribly proud.
However, I thought about the topic again the other day because a conservative asked (in the course of a question about former Pennsylvania Senator Rick Santorum's (R) possible run for the White House in 2012) if a statement that Santorum was 'anti-immigrant' or 'anti-illegal immigrant.' My initial reply on some of the details and history of the issue led to a brief runthrough of matters and because I had too many thoughts to share coherently on someone else's blog (this conversation was on Ron Chusid's Liberal Values), I decided I would post something more in depth here.
I think the reason that most of us on the pro-immigration side of the reform debate don't say much between elections, is that despite the fact that we'd like to see the laws changed to make it easier for people to get here and prevent the people already here from being legally persecuted (in many cases regardless of their actual immigration status, on the thesis that because they are Latino they might be illegal) is that those of us not obsessed with the 'burning crisis of illegal immigration' are happier with the status quo than we should be. People come here, people work, people raise families, everyone is happy most of the time and we really don't stop to think about the legal status issue unless it obsesses us. Most of those who are obsessed by it tend to be on the nativist side, and most of them can be observed to have pretty baldly racist motives for their obsession. Whether people agree or disagree with them, on the political questions of immigration, most people simply do not take Tom Tancredo or Virgil Goode seriously and there is a reason for that.
However, the fact that the 'crisis' being manufactured by the nativist voices in our country is (as it always has been, since the days of the Know-Nothings) a manufactured crisis built on a primary foundation of prejudice, that does not make the immigration issue a real issue worthy of attention. Especially since far too many people are unaware of the reason there is even a question of comprehensive immigration reform or border security in the first place. While we have issues of illegal immigration with Asian nations, for instance, there is neither a call for reform on our Asia policy nor widespread fear-mongering on the topic.
While this many come as a surprise to many today, prior to WWII there was no immigration quota on applicants from other American nations. Immigrants from Canada, Mexico, and Latin America could (and did) cross the American border in unlimited numbers as long as they met basic immigration requirements. In many areas, transit across the border was easy and unregulated. In California (both the US and Mexican states), there was a large migrant worker population that travelled from the southern peninsula to the Oregon border (and points north) following the seasonal work. This was a core component of the West Coast agricultural economy in both the US and Mexico and while much of the migrant labor was Mexican, there were Americans who followed the same route as well.
After WWII, an America flush with victory and revelling in its destiny and exclusivity as never before changed its immigration policy vis a vis Latin America. Strict quotas were set, immigration guidelines toughened exponentially, and the borders patrolled with increasing vigour. With strict new labor laws, as well as flush economic opportunities, the local American labor pool dried up. This confluence of legal reform in labor law with counter-reform in immigration law had a two-fold effect. It served to simultaneously reenforce the dependence of West Coast agriculture on a migrant labor force consisting primarily of Mexican nationals and to criminalize that same labor force. There are those who posit complex conspiracy theories that this was the intended result, but I think it more likely that lawmakers did not foresee all the consequences of labor reform laws when coupled with the immigration restrictions.
Without the immigration restrictions, of course, this would have meant a significant rise in the standard of living of the migrant labor force and a significantly higher legal immigration rate. Coupled with the reformed labor laws, however, it created a situation where it made far more economic sense (from the point of view of a farmer) for farmers to hire illegal labor and pay their workers in cash, under the table, than to hire American citizens or documented residents and pay them according to the new labor regulations. This led to major economic exploitation that, itself, led to the unionization of much of the migrant labor force... an ironic situation, a legal union that represented many illegal workers. A balance was ultimately found, one where cheap agricultural labor and farmers could co-exist and both profit from the relationship.
It is terribly important to recognize how central this process was to maintaining stability in the agricultural economy of the West Coast during the 1950s. Prices for farm produce were kept down even as demand increased to a greater degree than ever, which meant significant regional growth. The region of Southern California called 'the Inland Empire', where I myself was born and raised, was built up and developed because of agricultural profits made possible by illegal labor. In many ways, the economic success and massive growth of California, post-WWII, is as dependent on illegal labor as it is on the aircraft industry. While many of the old agricultural communities have urbanized or suburbanized, the Sacramento and San Joaquin Valleys, Riverside County, the Imperial Valley, and San Diego County all contain significant agricultural sectors. Even the heavily urbanized counties of Los Angeles and San Bernardino maintain at least minimal agricultural activity. When one factors in the large agricultural sectors of the Oregon and Washington economies, one starts to have an even greater sense of just how illegal immigration supports the American middle class when they go grocery shopping.
The sad economic facts make exploitation by American business in the United States preferable to many Mexicans over exploitation by American or Mexican business (or unemployment) in Mexico. This isn't something than can be changed by law enforcement budget hikes or crazy racist quasi-terrorists policing the border. It's also important to note, from a critically realistic point of view, that actually putting an end to the current system of migrant labor could have grave economic consequences for both the US and Mexico and could pose a significant politcal and social problem in Mexico. Therefore, whatever the solution to a genuinely morally repugnant siutation might be, it's not throwing law enforcement or military dollars at the problem. Nativist political activists who insist otherwise are simply showing their ignorance of the real situation.
Thus immigration policy is a difficult choice between three options:
1.) Maintain a morally repugnant but mutually beneficial (in a purely economic sense) system of exploitation of illegal workers to preserve the highly successful status quo. Most people in politics, in both the United States and Mexico, have consistently chosen this option. From a purely utilitarian viewpoint, it is very hard to argue against this choice. By simple, zero-sum measurements, everyone wins with this system... except that it is the most morally repugnant agribusiness system in American history since slavery. Which makes stark utilitarianism less appealing. Moreover, while the 'crisis' of undocumented workers 'stealing American jobs' and overburdening American social services is manufactured crap, it is true that this system allows corporations to switch from legal to illegal labor if they choose to take that option... and some corporations have. This has a real economic cost, but it is intellectually dishonest to blame the immigrants and doing so is incorrectly defining the problem. In these cases, the real issue is not undocumented workers but corporations who smuggle them into the country. It is worth noting, as well, that many of the workers exploited in such a fashion are not part of the Mexican influx of which the nativists complain, but Asian laborers specifically smuggled into the country by or for corporate clients.
2.) We can spend a massive amount of money on the kind of enforcement and interdiction policies the nativists advocate... and have largely the same situation that exists now, with a police state mechanism incorporated that poses a real risk of forcing Latino Americans to prove their citizenship on demand. First of all, this is unconstitutional (yes, despite my disregard for the intent of the Framers in many constitutional questions I do believe the document itself has value). It is a bill of attainder, acting to stigmatize a specific class of citizens and not the rest of the population. It is also in violation of the 14th Amendment, denying one section of citizens their full share of their civil rights. Before you argue otherwise, consider... who will asked to prove their citizenship before receiving medical care or when pulled over by a traffic cop? The odds are that it won't be people who 'look like Americans.' Beyond the constitutional problem, this also vastly increases law enforcement costs and will necessitate far more public spending than the share illegal immigrants currently consume.
3.) Take a deliberate, critical, and holistic look at the situation and work to actually define the problem. The definition of the problem will be a key step toward finding the solution and the current definition of the problem, as given by nativists and accepted by many Americans, is pure bullshit. The share of public spending that goes to provide social services for illegal aliens is too tiny to justify massive spending on enforcement and deportation operations or writing a new set of Jim Crow laws targetting Latino Americans. So the question becomes the chief object of any policy undertaken. Is the problem the economic issue of corporate criminality and loss of opportunity for the American labor force? Is the problem the humanitarian issue of the economic exploitation of undocumented workers by American employers? Is it a combination of the two? Is it simply that lack of legal access and legal opportunity creates the demand for illegal access and illegal opportunity? Clearly, different problems require different policies and any policy with any potential for success must, automatically, consider issues over which we do not have direct control in this country: the Mexican government's border security, the Mexican economy, the highly charged atmosphere of violence currently permeating many northern Mexican cities due to the drug war?
Repeatedly, for reasons that only become obvious when one considers the degree to which American agriculture relies on the status quo, the American government has chosen option #1. This is a purely utilitarian decision that can be criticized on several different grounds, but is very easy to understand when the situation is considered in its proper depth. Full and careful consideration of the situation also requires that one admit just how counterproductive and wasteful option #2 really is, in addition to being entirely at odds with the spirit of the laws that govern our nation and tell us how we can and should govern our nation. Even the 'enforcement first' compromise approach to immigration reform offered by John McCain during the presidential election would require an effort and expense not justified by the problems posed. So the choice really becomes between option #1 and option #3.
In all likelihood, because of the real undercurrent of nativism in both political parties (witness both the violent reaction of the GOP against Bush and McCain's varying amnesty and reform proposals and the vicious attacks on her primary opponents over this very issue by Hillary Clinton), it is unlikely that option #3 is forthcoming anytime soon. This particular prejudice is one that heavily colors American thinking across the political dividing line and which cannot be labelled a 'conservative' or 'liberal' vice.
That said, I believe real immigration reform is ultimately the choice that the country must take. We are a country of immigrants, except for what amounts to a tiny handful of the population we are immigrants or the descendants of immigrants. The American exclusivity which drive the nativist current that has always inhabited American politics is built on ethnic and religious prejudices which are not the sort of political ideals compatible with America as a country or a concept. Utilitarian economic necessity may force that reform to be a knee-capped guest worker program of the kind proposed by President George W. Bush the final decision America reaches, and if it does that would be better than the situation as it exists now. However, in my opinion, the real solution is the removal of the quotas imposed on immigration to America from Latin America in the wake of WWII. The original thinking behind the original policy was that all of us, from Canada to Argentina, are in some sense 'American' and that our doors should be open to our neighbors. That this is no longer a feeling broadly shared throughout our national society is... upsetting.
Regardless of whether we choose option #1 for many years to come or what form we decide option #3 should take, it is time for another amnesty. The people here are part of our society. They have done jobs we have not wanted to do for pay that we would not be willing to do it, and their willingness to do so is part of what puts food on our table. Anyone who argues against this, Democrat or Republican, is simply wrong. Perhaps they don't understand the real nature of the situation, as many of us simply trying to live our every day lives do not. Perhaps they are something worse, like Tom Tancredo or Virgil Goode. Either way, they are not the people who should be given the forefront in this discussion and it's time America stops simply taking their line at face value without really considering the reality of the situation.
Adopting the slash and burn enforcement policies of nativists would be biting the hand that feeds us.
Friday, August 14, 2009
On the right, there is a failure to understand that one is frequently advocating what one is professing to hate and fear. Namely: rationing, the writing off of human life for utilitarian benefits conveyed to society by so doing, and ultimately a far greater number of otherwise preventable deaths. This is the horror scenario presented by the right to frighten us all out of supporting what is, essentially, far from 'comprehensive health care reform' but rather a health industry bailout following on the heels of the bailouts of the automotive manufacturing and financial industries. There are lots of reasons for finding fault with the House health care bill, and even more to find fault with the Senate Finance Committee bill. None of those reasons are vaguely related, however, to socialism, government takeover of health care, or rationed care. The current system, as it exists now, is a system of rationing: economic rationing. The ability to pay guarantees access to care and those unable to pay face significant health risks and even greater economic burdens. 'Free market based' reform of health care will simply be a crystallized, finalized statement that economic rationing is the correct social decision.
Jenn Q Public quotes an Atlantic article by David Goldhill on her blog, an article highly critical of current health care reform efforts that Jenn rightly (in my view) refers to as 'mommy kisses and a Dora the Explorer band-aid.' Mr. Goldhill is a business man and registered Democrat who begins his piece with a very moving personal testimonial about his father's death and how a hospital hand-washing procedure rejected by doctors as 'unnecessary' could have prevented it. He then moves on to discuss how the experience drove him to research health care problems and solutions. Clearly, he put some work in.
Goldhill is correct in his fundamental analysis of the fact that the current reform package will affect the problem of fundamental health care costs: it won't. He is also correct in his characterization of the reform bills currently under consideration as merely fundamentally re-cementing the foundations of the current system. As I said above, what is being discussesd now in Congress is not so much 'comprehensive reform' of the health care industrty, but a comprehensive health care industry bailout. Goldhill certainly recognizes that and is not afraid to say so, to his credit:
"But fundamentally, the “comprehensive” reform being contemplated merely cements in place the current system—insurance-based, employment-centered, administratively complex. It addresses the underlying causes of our health-care crisis only obliquely, if at all; indeed, by extending the current system to more people, it will likely increase the ultimate cost of true reform."
I can't disagree with that assessment at all. Nor with:
"Health care simply keeps gobbling up national resources, seemingly without regard to other societal needs; it’s treated as an island that doesn’t touch or affect the rest of the economy."
The problem, however, lies in how Goldhill sees health care reform and how he defines failure. It is important graps this definition of 'failure' and the full consequences of such thinking in the long run. I don't know if Goldhill grasps them or not. It's very reflective of much of libertarian and conservative thought about health care reform and it reflects the blind spots and rationalizations inherent in many of their arguments and solutions.
"But even leaving aside the effects of price controls on innovation and customer service, today’s Medicare system should leave us skeptical about the long-term viability of that approach. From 2000 to 2007, despite its market power, Medicare’s hospital and physician reimbursements per enrollee rose by 5.4 percent and 8.5 percent, respectively, per year. As currently structured, Medicare is a Ponzi scheme. The Medicare tax rate has been raised seven times since its enactment, and almost certainly will need to be raised again in the next decade. The Medicare tax contributions and premiums that today’s beneficiaries have paid into the system don’t come close to fully funding their care, which today’s workers subsidize. The subsidy is getting larger even as it becomes more difficult to maintain: next year there will be 3.7 working people for each Medicare beneficiary; if you’re in your mid-40s today, there will be only 2.4 workers to subsidize your care when you hit retirement age. The experience of other rich nations should also make us skeptical. Whatever their histories, nearly all developed countries are now struggling with rapidly rising health-care costs, including those with single-payer systems. From 2000 to 2005, per capita health-care spending in Canada grew by 33 percent, in France by 37 percent, in the U.K. by 47 percent—all comparable to the 40 percent growth experienced by the U.S. in that period. Cost control by way of bureaucratic price controls has its limits."
The indictment of Medicare as a Ponzi scheme is extremely harsh and is reminiscent of neoconservative indictments of Social Security. In a Ponzi scheme, the sucker gets nothing for his money. The swindler pockets or spends it all and walks away with it. Moreover, a Ponzi scheme is a deliberately orchestrated fraud for profit. One pays off early investors with later investors money, pocket the remainders, and skips town. It's worth noting that the only people actually discussing so treating Medicare (or Social Security) are the Republicans who want to slash it entirely. I have not heard their plans to reimburse all of us paying Medicare taxes. So who are they really fooling? Goldhill's solution to 'the Ponzi scheme' of Medicare is the same as theirs... pocket the money and walk away rather than fulfilling the program's obligations. This is a fundamental flaw in the indictment of the program.
The description of growing health care costs is accurate, but more central than the weakness of the 'Ponzi scheme' analogy is the failure to recognize why Medicare costs (and the costs of health care in nations with thorough health care policy) grow so steadily. It is because Medicare works. If Medicare did not work, it would be the cheapest government program ever.
Consider this: before Medicare, senior citizens frequently lived in circumstances of crushing, absolute poverty or entirely off the support of their younger relatives. The reason that the age of 65 was chosen as the date of entry for Social Security was that the average American life span before WWII was 63. To put it bluntly: old people died more. No one spent anything on their health care... because they were dead. Medicare came along, and old people started living longer. Not only because they got better medical care at far less cost, which they did, but also because the financial burden their health care costs imposed on them had been affecting their entire standard of living. Not only were they able to get medical treatment for their medical problems, the increased ability to provide for their material needs meant that they were far less likely to die (or suffer medical problems) because of the influence of economic factors on their health. Their younger relatives also had more money as a result of the program, contributing more fully and vibrantly to the economy. So their standards of living were beneficially affected as well. Medicare was good for everyone and the country and still is.
So, by pure analysis of what many consider to be the core test of success (whether or not it meets its explicit goals), Medicare is the single most successful government program ever. So much for right wings paens to the United States Postal Service as the only thing the government ever did right. Medicare has done everything it promised, and even exceeded expectations for its success.
Of course, people living longer means more old people visting their doctor twice a month. Which means more medical costs. This is an inherent problem in the system, certainly, but I prefer paying those costs to adopting the Malthusian attitude toward human suffering necessary to lower them.
Here's where it's time to be really frank: when the right talks about how 'the free market' will lower health care costs they mean that only those who can afford health care will have access and everyone else will do without. This certainly eliminates the 'free rider problem', so the people paying for their health care experience cost reductions and the government certainly saves a lot of money on the budget. On the flip side, we're talking about Victorian Era living conditions reimposed on a significant portion of civilized society. Do any of us want that, even if it means lower taxes?
Goldhill's solution to the problem of health care costs is much like right wing solutions. His description of the ideal health care reform package sounds very much like the perfect Republican utopia:
"The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result."
Now, it's true, that the right doesn't want to see any direct subsidy of those unable to afford health care. In that sense, Goldhill's proposal is superior. However, the reason that the system of comprehensive health insurance that exists today came into being is because it was already, during the 1940s and 1950s, becoming incredibly difficult for individuals to pay for their own health care. Fundamental costs have risen since then, every bit as rapidly as administrative costs, and eliminating the administrative costs of the insurance agency and government bureaucracy will not reduce the fundamental costs one iota. Real wages are lower than they were in 1950, real health care costs higher. If the working man could not afford to pay for his family's medical care without comprehensive insurance in 1950, how could he possibly hope to do so today? Ignoring these economic realities is very dangerous.
Catastrophic health care insurance is a key portion of Goldhill's program:
"First, we should replace our current web of employer- and government-based insurance with a single program of catastrophic insurance open to all Americans—indeed, all Americans should be required to buy it—with fixed premiums based solely on age. This program would be best run as a single national pool, without underwriting for specific risk factors, and would ultimately replace Medicare, Medicaid, and private insurance. All Americans would be insured against catastrophic illness, throughout their lives.
Proposals for true catastrophic insurance usually founder on the definition of catastrophe. So much of the amount we now spend is dedicated to problems that are considered catastrophic, the argument goes, that a separate catastrophic system is pointless. A typical catastrophic insurance policy today might cover any expenses above, say, $2,000. That threshold is far too low; ultimately, a threshold of $50,000 or more would be better. (Chronic conditions with expected annual costs above some lower threshold would also be covered.) We might consider other mechanisms to keep total costs down: the plan could be required to pay out no more in any year than its available premiums, for instance, with premium increases limited to the general rate of inflation. But the real key would be to restrict the coverage to true catastrophes—if this approach is to work, only a minority of us should ever be beneficiaries."
Great... except that unless he is advocating the government completely subsidize medical costs below $50,000 for everyone who doesn't have fifty grand lying around in case they need life-saving surgery, I don't see how this system of insurance would help most Americans. Despite Goldhill's blithe assurance that competition will naturally lower those costs, I'm highly skeptical. My partner had life saving surgery and the bill (most of which was paid by her workplace insurance) was $56,000. Under Goldhill's system, we would have been responsible to pay for all but six grand. We are facing a certain financial burden from our health care costs as it is, but $50,000? That's an awful lot of debt for the average working American to rack up from one trip to the OR. And my partner is a fairly well-paid employee of a major corporation... but she $50,000 is a lot more than a year's wages for her. It's probably more than the sum of both our yearly incomes. I'm all in favor of the government subsidizing health care in such circumstances, but I'm not sure most of the people who might like Goldhill's plan would be.
Goldhill's solution also relies greatly on personal health care savings accounts, another favorite Republican idea. In his world, like theirs, everyone pays their health care costs out of pocket at point of service. HSAs would increasingly pay people's health care costs as they aged. Except people have a great deal of difficulty saving under current economic realities as it is. What is to make it suddently easier for them to save to pay for their health care? Goldhill is speculating that all that money spent on insurance premiums will be available to go into the bank and he is also speculating that companies, no longer paying for health insurance for their employees, will pay more money. Great... except there is no actual way to guarantee it will actually happen that way. Indeed, in today's corporate culture, the predictable outcome is that corporate employers will simply pocket the savings and reinvest them in increased corporate management costs.
Ultimately, Goldhill's final answer to 'what about those who can't pay' is that the government needs to pick up their tab. For someone who is arguing that health care should be simplified, because the system is too complex, his solution is awfully complicated. HSAs, catastrophic insurance, sliding-scale health care deductibles based on age...
If, in the end, you want everyone with money to be able to buy their own health care and the government to pay for it for everyone else then I'd have to say that single-payer, a national health care service, or the kind of everything-at-once hybrid system used in countries like Sweden makes a lot more sense. Goldhill's agruments for a free market based solution are going to be most attractive to conservatives who will see many of his arguments as echoing theirs... and who will entirely oppose the idea of the government paying any of the costs.
Wednesday, August 12, 2009
Current congressional inquiries into the firing of U.S. Attorneys in the Bush Administration are showing the challenges and difficulties of pursuing partisan investigations of one's political opponents on charges of corruption, malfeasance, or misconduct. They show just how dirty politically motivated investigations get even when the evidence is pretty cut and dried. After all, a Justice department internal inquiry already found political considerations to have categorically been a part of at least four of the firings. For those of you who can still remember last year, when everyone in both parties was upset at the Bush Administration and Karl Rove, Attorney General Alberto Gonzales resigned over the ensuing scandal when it became too difficult for him to avoid answering questions from Congress despite every ploy to invoke executive immunity. The information about just what degree the political side of the administration had been influencing the operational and bureaucratic procedures of the Justice department is already common knowledge.
John Conyers (D - Michigan), chairman of the House Judiciary Committee, has stated that documents reveal the White House's political operatives were deeply involved the decision to pursue voter fraud allegations in purple states and in the decision to fire those US Attorneys who did not do so do to the lack of significant evidence. The transcripts of testimony in the committee's hearings point to Rove as the central, responsible figure.
To quote the Associated Press:
"The documents show that staffers in Rove's office were actively seeking to have Iglesias removed after Republican figures in New Mexico complained that he was not pursuing voter fraud cases they wanted. In 2005, Rove aide Scott Jennings sent an e-mail to another Rove aide saying, "I would really like to move forward with getting rid of NM US ATTY.""
Republicans in New Mexico wanted David Iglesias fired for not pursuing the cases they wanted pursued. They complained to Rove's office. Rove's staffers were eager to fire Iglesias. Rove spoke to White House Counsel Harriet Miers on the topic. Iglesias was fired. The circumstantial evidence in question is damning enough, and Miers careful choice of the words 'I don't recall' brings to mind the quasi-senile testimony of Ronald Reagan at the Iran-Contra hearings. As it turned out, President Reagan had a legitimate medical excuse. To the best of my knowledge, Miers does not. Remember that, in a court of law, the issue is whether a charge can be proved beyond a reasonable doubt. To my mind, the Republican responses to the facts are not 'reasonable' by any stretch of the words.
Despite a Bush Justice department internal inquiry's statement to the contrary, Rove denies the facts:
"Rove issued a statement Tuesday saying the documents "show politics played no role in the Bush administration's removal of U.S. attorneys, that I never sought to influence the conduct of any prosecution, and that I played no role in deciding which U.S. attorneys were retained and which were replaced.""
For a congressional Republican's take:
"Rep. Lamar Smith of Texas, the top Republican on the Judiciary Committee, said the documents show no evidence of wrongdoing. "Democrats need to stop wasting taxpayers' time and money on political investigations that are nothing more than the politics of personal destruction," Smith said."
Now, clearly, Republican definitions of 'wrong-doing' are entirely subjective. That cannot be denied or forgotten. Does anyone remember the horrific abuse of power the Clinton family's wish to restaff the White House Travel Office was presented as, by Republicans, in 1993? The Justice department, which actually fulfills a function of national significance, would seem to be required to be even more tamper proof. Again, the Bush Justice department itself ruled that political considerations were clearly involved in at least four of the firings and that was as far as they were willing to go to fall on their swords for Rove and Miers... waffling on whether or not other considerations influenced the firing as well, and confining it to four of five cases.
All of this, of course, is the core problem with political investigations. They are political. Democrats in Congress feel pressure from their constituents to bring officials in the Bush Administration to justice for their corruption. Therefore, they are motivated to do so. It doesn't matter that the individuals in question are corrupt, it's the political necessity of satisfying angry constituents that is their primary motivation. I'm not trying to minimize the corruption of the Bush White House (without a doubt the most corrupt since Reagan's two terms) or the importance of actual justice. I am simply noting that House Democrats are impelled by politics as much as principle.
Which is the problem. Republican congressmen are then impelled by politics to support their own, because otherwise their own conduct in the Bush Administration is open to question. Which makes Congressional investigations of Bush officials a sort of kabuki opera of partisan politics instead of a genuine probe for the facts of the case, which are mostly already known to all the principles involved. After all, the very reason there is political pressure to see justice done is that the corruption in the administration has been widely and clearly exposed. The reason House Democrats are taking the lead is because the very nature of the alleged crime currently taking center stage, political influence of criminal prosecutions and political consequences when the prosecutions fail to occur, the Justice department is in a difficult situation. White House pursuit of justice might appear to be more of the same, and involvement between the political side of the White House and the DOJ would automatically come under close scrutiny by the other side. The politicians feel handcuffed by the very nature of the scandal, to avoid appearing to be guilty of the exact same thing.
Of course, since the alleged crime was committed on behalf of Republican congressmen and senators, they are forced to draw their lines tight and deny a crime was committed. Otherwise they are accessories. Of course, by impeding the investigation now, they are making themselves accessories after the fact.
This always has been and always will be the primary reason political corruption is so hard to actually punish. Political corruption is, by its very nature, political. Thus partisan politics trumps the questions of fact and wrong-doing that should be the focus. While American Congressional investigations may lack the life or death consequences of Stalin's Moscow 'show trials' or the Nuremberg and Tokyo war crimes tribunals, they carry the same basic flaw: when politics is more important than the core question of criminality being examined, it becomes impossible to address that question seriously or effectively.
A man we all believe to be a criminal is being shown to be a criminal, and it doesn't matter because it is just another political issue to those most intimately involved with the matter. That very factor will almost certainly keep Rove from ever being indicted, let alone convicted. The irony is that, in the end, the only defense against such political corruption is itself political.
The only way to prevent political corruption is at the ballot box, and can only be enacted by clear eyed voters who are themselves able to step away from partisan politics to discern the character of the candidates in question.
Yeah. Problem solved. Right.
1. A robot may not cause harm to a human being or, through inaction, allow a human being to come to harm.
2. A robot must obey all orders from a human being unless doing so would violate the First Law.
3. A robot must preserve its own existence, unless doing so would conflict with the First or Second Laws.
Now, what does this have to do with politics, economics, or philosophy? Well, one can see Asimov's own ethical framework in the Three Laws. First, do no harm to others. Second, serve others as long as doing so does no harm to others. Third, protect one's self and one's self sufficiency while taking care to do no harm to others or prevent one's self from serving others. There are far worse ethics, though I suppose Ayn Rand would have thrown a fit at the idea that serving one's own needs would be at the bottom of the list of the three 'commandments.' If one studies it closely one can find its model in the Bible... 'Love they neighbor as thyself.'
Of course, the specifics of the Three Laws are not the point. The point is that 'I, Robot' was followed by three novels featuring the man-machine detective team of Elijah Bailey and R. Daneel Olivaw. The former was a human police detective from Earth, the latter a humanoid android from the space colony of 'Aurora.' In the third and final book, we are introduced to another robotic sidekick, the telepathic Giskard... who can read human minds.
One sequel to the 'Robot Trilogy' was written: Robots and Empire. It serves as a link between all three of Asimov's major groupings of novels the 'Robot', 'Empire', and 'Foundation' series of novels.
In Robots and Empire, Elijah Baley is long dead. The heroes are the robots, Daneel and Giskard, acting to attempt to stop a madman from Aurora who is bent on destroying Earth out of rage at the slow disintegration of the static utopia of the star spanning society of the original space colonists and the rapid expansion of the new wave of colonists into a potential galactic empire. As they move to prevent this disaster, they discuss the philosophical problems inherent in protecting humans from a human being and the startling subplot in which it is revealed an entire world was destroyed by robots who were programmed so thoroughly and minutely that they each recognized only their own masters as 'human.' In response to much of this philosophical difficulty, Giskard postulates an unwritten '0th Law of Robotics' which he believes trumps the three programmed laws. He figures it, roughly, as:
0. A robot may not harm humanity or, through inaction, allow humanity to come to harm. This supersedes the First, Second, and Third Laws.
This is, obviously, a double edged sword. It is both the justification for legitimate violence necessary to defend individuals and society and the excuse for utilitarian nightmare in defense of 'the greater good.' It requires a moral judgement of which many people are simply not capable of exercising.
Again, however, the point is not to judge the Laws of Robotics on their merits but rather to communicate the idea that an underlying, unwritten preconception of reality can create an overriding philosophical principle that trumps the actual written law. Giskard hypothesizes that those who wrote the Three Laws of Robotics were not seeking to simply prevent individual robots from killing individual people, but rather to protect humanity as a whole for potential robotic uprising. From this flows the 0th Law.
This is an important idea because our Bill of Rights has a '0th Amendment' which is not written, which is not communicated, and which exists only in the preconceptions and prejudices of the Framers. It was not written into the Constitution itself or the Bill of Rights, but it neverthless colors everything the Framers said and did... from the Revolution, to the Declaration of Independence, to the reaction to Shays' Rebellion, to the framing of the Constitution, to the bitter political fight over passing the Consitution, and even the first three American presidencies. Not to be aware of it is to be unaware of many of the real underpinnings of American political theory and our progress since the Framers... and most Americans are not as aware of it as they should be, because of the natural tendency in this country to canonize the Framers.
To understand the '0th Amendment' one must understand the underpinnings of Western liberalism. While we owe the doctrine of 'natural rights' to that liberal tradition, natural rights are secondary to economics in that tradition. It is economic rights (specifically the rights of the owners of property) that most concerned the liberal thinkers of the pre-Revolution. This is why conservatives in Spain, Italy and Japan call themselves 'Liberal Democrats.'
The fundamental right in the Western liberal tradition is the private right of an individual to own property. The second foremost right, which often trumps the first in practice, is the right of the individual to protect his property. Government, in the eyes of this tradition, exists only to guarantee the property rights and contracts of individuals and has no business meddling in anything else.
The 0th Amendment, prologuing the Bill of Rights, can then can be read very simply:
"Everything that follows applies to citizens of means, no one else really counts."
In this sense one can certainly argue that the Republicans (especially the neoconservatives) are far closer to the true beliefs of the Framers than anyone else. The question then becomes one of just how much the intent and desires of the Framers should matter to us today. Do we still believe that the protection of the property of those who own it is the chief justification for government or do we have a more educated and inclusive view of society today?
The alternative to a liberal democracy is a radical democracy. This means accepting that natural rights are of greater importance than property rights and that a citizen's rights cannot be enumerated in full in ten paragraphs. The rich man, the poor man, the wife, the single mother, the working woman, and the wage-laborer all enjoy the same basic natural rights in the same share and are entitled to the same protection and consideration under the law independent of their economic status, race, or gender. Those who do not own property are deserving of as much protection from the owners of property as those who own property are deserving of protection from them. Great concentrations of property in few hands are threats to the individual rights of the rest of society's members. Economic opportunity and property rights should be more openly 'democratic.'
I am not advocating communism or socialism in an economic sense, though I believe that certain socialist models (the workers' co-op and revenue sharing policies) work exceptionally well in a capitalist economy and Saturn (before GM bought the workers out to get a bigger share of the profits and ruined the company) and the NFL have provided us with the positive proof. The NFL is the most successful 'merchants' collective' in history and includes a tremendously successful 'workers' collective' in its operating system.
What I am proposing is that the values of the Founding Fathers, as they pertained to the role of government in society and the value and priority of individual rights, may not apply in a modern society. They were slightly ahead of their time and are far behind ours. In a perfect world, we would do what other nations have done when reaching such a divide between the philosophy of their constitutional law and the reality of their values system. They have written new constitutions and we should sincerely consider doing the same.
Of course the problem is not that universal values have advanced from the time of the Framers. While many have, many Americans believe exactly as the Founders believed on issues of wealth, property, government, and natural rights. They believe that 'equality' is a dirty word, that 'social justice' is proof of an argument's communist intent, and that wealth and freedom truly should be interlinked. They would argue that the alleged market stability created by monopolies and cartels outweighs the social and economic cost of such an imbalance of economic power... if they actually gave a straight answer. More likely they would spin a story about the 'free market' that bears no resemblance whatsoever to the facts of an unregulated business community. They defend the social and legal inequities that show the poor are treated very differently in the judicial system than the rich, and that the criminal justice system has failed to uphold the equity of justice with which it is charged.
This is not 'conservatism', which is a principle of safeguarding the good and measuring the effects of new ideas with sober seriousness. It is a blatant and reactionary support for the inherent rights of the wealthiest members of society or of concentrated business interests at the expense of the rest of society. It is a disregard for natural rights in favor of property rights and a belief that enumerated rights put on paper are of greater value than natural rights. It is a belief that the letter of the law trumps justice and mercy alike and that constitutional law prevents judges from fulfilling their constitutional role of interpreting the law in the changing world. It completely voids the idea of common law or moral law.
It is difficult to blame the Founders for many of their foibles at a time when their virtues were far greater than those of many of their contemporaries. They were a product of their time and managed, in many ways, to be ahead of it in philosophical matters. However, their time is not ours and we must operate in our world and not theirs. Many of their ideas were simply wrong, then and now.
Giskard 'died' because the 0th Law of Robotics was not compatible with his programming, and acting on it destroyed his circuits. The 0th Amendment is not compatible with the other ten. They need to apply to all of us, to have any value whatsoever.