If you’ve read my book, you know my exact political affiliation. But I’ve never come out and plainly articulated it here. When you lean hard left on personal liberty issues and hard right on fiscal policies, it’s awfully lonely, and frequently annoying, to talk politics in this country. But a lot of that’s changing. The parties have driven us to a new nadir, where no one has any faith in anything taking place in Washington anymore, be it Democrat or Republican policy. People want something else, and not just in regard to one or two finite programs or issues. I get the sense we’re waking up and realizing we’re not being honest with ourselves about our reality, our expected standard of living… what we can afford as a nation. I think a lot of us are interested in reaching the broader arguments about what kind of country we are – a true capitalist nation or a banana republic welfare state for special interests and any entitlement class that can be congealed into a voting bloc.
I’ve touched on those issues before, here and here. But this time I wanted to offer a different perspective, from the angle of someone younger, along the lines of the piece I did with Alex J. Mann. And not a standard liberal or conservative, not even a classic moderate. Someone with a Libertarian bent, more interested in fiscal than social policy. A reader who writes at a political blog, Truthvmachine.com, under the title “Evil Conservative,” and who happens to work in an industry at the center of the current political debate over health care reform, volunteered. Here’s what came out of it.
PL: Why the name “Evil Conservative”?
Well I had to go with that name because “Evil Whig” sounded weird, and I’m not a Republican, although I mostly support them at the national level. Republicans at least let you put your hands on the desk when it’s time to bend you over to pay for their government expansion while the Democrats make you hold your ankles come tax time. I have a distrust of the two parties in power and prefer to focus on the real issues facing our country, particularly the economy. The deficit and debt will always be important to me. Those two things are spiraling out of control mainly due to entitlements that need to be drastically reduced in size and scope. A person that wants to do that is perceived as evil and uncaring so I embrace the label.
The name is also a response to the big-government evangelicalism that George W. Bush euphemized as Compassionate Conservatism, which is close to the platforms of Christian Democrat parties found in other democracies. You’ll notice in other democracies the differences in the parties is typically on social policy and only moderately different on economic policy. Instead of free markets they have social markets created by Handicapper Generals that decrease the number of lower outliers, but it also stifles the innovative and risk-taking outliers who can rise above. We have that compression here in America more and more everyday.
PL: I think a lot of the policy debates we’re having these days are proxies for the bigger discussion of which direction our society should take: personal freedom or collectivism. People appear to be seeking an Option C approach outside the orthodoxies the parties offer.
There should definitely be an auxiliary debate on the issue of personal freedom vs. collectivism during this health care reform campaign. Maybe we can finally start viewing money outside the preschool-level mentalities that use it as a pretense for class warfare or value it as an end instead of a means. Money should be defined as the primary tool a person can use to have freedom of choice in a free society instead of something to be acquired for acquisition’s sake or to be used to buy stupid crap.
Political organizations that support capitalism with an emphasis on individuals and small businesses seem to have brushed aside the importance of educating the public on the fact that capitalism is what got mankind out of the caves and fiefdoms, caused him to stop killing his fellow man and instead work together (to put a computer phone in everyone’s pockets). That second town hall debate between McCain and Obama was the worst defense of capitalism against collectivism I have ever seen in my life. I threw more things around my living room during those ninety minutes than during any Giants or Mets game. Okay… the Mets still have the record. But McCain is a close second place.
It’s also possible these organizations are deemphasizing support for personal financial freedom because it’s politically unpopular to scare people with the notion they’re responsible for themselves, as opposed to wards of the government, corporate America, or even the small business they work for. Being responsible requires a lot of work and being part of the collective is easier. It’s said democracies will naturally die out in a short period of time because eventually the citizens will vote themselves treasures from the collective coffers. We are definitely approaching the point of becoming an irreversibly Euro-socialist state and too many people are content with that.
EC: If you could change one thing about America with some Option C solution, what would it be and what do you think the fallout would be?
I’d decouple benefits from employment. It’s an outdated paradigm from the 50s that doesn’t work in the global economy. And no, I don’t buy the argument that it encourages broader risk pooling, which keeps the costs of benefits lower than it would be if we bought health insurance directly. We’ve never tried it any other way and the structure we have doesn’t work. What’s the definition of madness? Doing the same thing over and over and expecting a different result? The solution should be a total rethinking of the marketplace, with an emphasis on direct purchase – privity between the buyer and seller alone – not a more robust version of what we already have with government indirectly controlling the market via the public option.
It would also be nice to see Obama do a press conference defining the word “insurance” for the American public. “Insurance” is something you tap into upon the occurrence of an event you’ve paid to have covered. What we have now is a third party administrator ostensibly paying for every health care service, necessary or not, telling people after the fact whether a procedure is covered. That’s insane. What other industry offers services without knowing whether it’ll get paid? Could you imagine going to your mechanic, handing him a credit card and telling him, “My lender might pay for this service, or he might not. He’ll let you know in three weeks. If he rejects it, send me the bill.” Everything elective should be straight out of pocket. A patient shouldn’t even be allowed to submit it to insurance. Insurance should cover only what’s medically imperative. Preventative care’s a nice idea, but it’ll never cut costs. All that’ll do is encourage more consumption, and more bad debt write-offs for providers.
EC: As someone in the employee benefits business, I know health care from many angles. If we are going to buy individually, it needs to be mandated like car insurance. Insurance is based on the law of large numbers and if the numbers are too small there will be adverse selection. You raise good points I’ve expanded upon here.
PL: Back on the economy, you can’t be that upset with Obama. From what I’ve seen, he’s basically offering zero in terms of change. Morgan Stanley just did an offering of re-securitized toxic loans, and they’re not alone. It looks like we’re at the infancy of a debt based recovery. Which tells you a lot about the fundamental weakness of our quasi-Ponzi economy. All we can innovate or produce is more exotic debt vehicles to keep consumption moving. And Obama knows it. He knows he can’t try to recreate a strong manufacturing base because we can’t compete with foreign labor. He’s trying to keep the ship afloat with duct tape, the same way Bush did.
We are a completely consumer nation. So many jobs are what you’ve aptly described as “white-collar welfare,” where nothing is produced and the worker does essentially nothing all day. Either consciously or subconsciously most of these workers know that. So they go out and spend money on things to bring some sort of joy to their lives.
But that doesn’t excuse Obama for misreading his mandate to fix the economy. He’s got his eye way off the ball with Cap and Trade and Health Care. If the latter two pass, with the tax increases they’ll bring, the Dems are in serious trouble for 2010 if the economy doesn’t rebound at least a little.
The other thing I am upset with him about is we finally have a Democrat in power and he failed to take the executives of the financial ratings agencies out of their offices and threatened them with federal prison for rubber stamping the shitty quality of so many companies and financial instruments.
PL: How do we reverse the Democratic agenda? The GOP’s screwed. If the choice is between happy feel-good big government that gives millions of economically unproductive, non-tax paying voters cheap subsidized health care and big government cancered with Jesus Freaks, Neocons, crony capitalists and war profiteers, the Democrats will be in power forever.
These social conservatives need to rein back their desire to engineer social policy by banning gay marriage or abortion. First, that focuses on the behaviors of too narrow a segment of the population. Second, it turns off urban and suburban voters needed for a winning coalition. They need to tone down the religious language and develop more concern about secular problems, like how intellectually (and physically) lazy and undisciplined our populace has become. Those problems explain the desire for a welfare state on the part of so many. I’m a Deist (unless there’s a modern word to describe belief in the Blind Watchmaker), but I think there should be people teaching the wisdom of the ancients in schools, in little leagues. To take religion out of it, teach secular ethics from men like Aristotle. Or teach Aristotle alongside things like the Beatitudes, all from a secular perspective. We can modernize it with lessons in goal-setting as well as in winning and losing. Start with showing kids that there are winners and there are losers. It wouldn’t hurt to emphasize the “work” when they come to the chapters on work ethic. It’s only through some sort of disciplining of the citizenry that we can have any hope to regain a majority of people that want to be free and will responsibly live that lifestyle when it’s attained.
PL: I’ve said elsewhere, in the Platform 2008 thing, “Public buggery and white slavery are more popular concepts in modern America than ‘personal responsibility’ and ‘assumption of the risk.’” Telling Americans to live and die by their own wits will put the GOP out of power forever.
I take issue with you on the GOP being fucked. Everyone said the same thing about the Democrats after 1988, 2002, and 2004. There have never been permanent majorities in America. How many demographics George W. Bush did well with in 2004 switched over to Obama? If they shifted so dramatically after four years, why is everyone so certain they won’t shift back? The people proclaiming doomsday for Republicans were saying the same thing about the Democrats four years ago. It’s bullshit. That’s why my above suggestion is to tweak social conservatives, as opposed to purging them from the GOP. A dwindling political organization should not try to get anyone out of the party. Republicans have a really good chance in only three months to win high-profile governor races in two Obama states – Virginia and New Jersey. Winning either race would be a boost to the party’s morale and contributions for 2010.
EC: Do you think ‘tea bagging’ has been unfairly maligned by the Left?
Could you shove a pair of whole kiwis in your mouth without damaging them? We should celebrate that gift, not denigrate it.
Seriously, no. They deserved it. If Libertarians want to raise serious policy issues, they ought to raise them in a serious, sober fashion. Gimmicky’s cheap and silly, and the tea parties were all gimmick. Fiscal conservatives ought to frame their positions with numbers. Lay the debts on the table and ask John Q. Public, “How do you expect to pay for this?” Confront the elephant in the corner. Put down the tea bags and start doing what Representative Paul Ryan from Wisconsin has been doing – cross examining Democratic opponents and talking heads on the talk show circuit and forcing them to dead silence when they can’t explain how the country will ever emerge from its debts. Silence in response to those criticisms speaks a million times louder than a tea party protest.
PL: I’m with you on the debt issues. But I also see more subtle dangers to our economy, ones that might not be apparent for a few years. A huge one is decoupling lending from any social or, though I hate to use the term, “moral” compulsion to pay back what’s been borrowed. Crises like this banking mess expose more about how finance works than is healthy for general society to see. There’s a trickle-up effect in the economy. All lending is inevitably consumer lending. Where everybody at every level of society becomes a cynic and sees borrowing as nothing more than a risk proposition, and lenders as corrupt adversaries in the process, people will have no qualms about defaulting, which screws up risk assessment, making lending terribly difficult.
This goes back to the consequence-free culture that comes from a person being undisciplined in the first eighteen years of life then feeling entitled to things without working for them for the next sixty eight years. On the risk assessment part, the government is sending a bad message with these bailouts and stimulus handouts. People will think a check is coming every six months. There was an idiot like this in the news last week. A law graduate with $350,000 in student loans. So what did he do? He declared bankruptcy, said “I can’t pay them back, what are you going to do?” Thank God a judge said, “No dude, you have to pay that back if it takes you the rest of your life.” Bankruptcy shouldn’t be, “Oh shit, I lost the game. Can we press reset and try again?”
EC: Getting back to your point about being a consumer nation, what can we do to build up manufacturing or any other industries that need to compete with foreign labor? Protectionism isn’t the right way to go, but why does American labor have to drastically reduce their wages, benefits, and lifestyle because some poor Third World slave drew the short straw of being born under a corrupt regime and lives the rest of his life thankful for scraps?
Because we’re in a global economy now, and there’s no option. Until the cost of foreign labor meets the cost of domestic labor, we will hemorrhage jobs. Our workers, at all levels, retain wildly unrealistic expectations in a marketplace where they’re competing against emerging economies with huge, cheap labor pools.
As to the complaints people offer about that reality, well, they’re wasted breath. It’s going to get a lot worse for American workers before it gets better, and they can complain all day long and none of it will make a difference. We’ll never use nasty tariffs as that would tank consumer spending, along with many other sectors of the economy. The solution will be a new wave of borrowing and spending. The pent up demand’s boiling over, and all it takes is enough liquidity to get a new crop of buyers in housing to start it all over again. Madison Avenue and Wall Street will lead us out of this mess. Into another, of course. But that’s the way it’ll have to be for a while. Without easy credit, we don’t have an economy.
You know how economists historically chart bubbles with graphs of normal growth interrupted with what look like huge bell curves? We might want to invert those charts – assume that excessive speculation, debt and spending are the norm in this country, interrupted by divots in the chart where people pull back between binges. What’s the debt instrument at the heart of the next bubble? I don’t know. When you’ve reached the point where fools start drawing cash out of residential real estate en masse, you’re pretty dry on ideas. But I have faith – some lunatic is out there crafting the next financial Frankenstein.
PL: Let me put the policy stuff aside for a second and ask a question about your generation. Why are so many of you interested in coming off as hardasses? What’s this cheesy fixation with “player” culture? It seems to be the height of cool to not give a shit about anything anymore. Politics? Fuck it. Economics? Only learn as much as you need to make cash for yourself. I get a sense a lot of new graduates are purposefully staying ignorant about a lot of the world around them, but I don’t think it’s because they’re flawed. Sure, some of them are dumbasses, just like you’ll find in any generation, but I think a lot it has to do with the media they’ve been exposed to all of their lives. On one hand, the Internet showed them most of the systems around them were terminally flawed before they ever had a chance to have faith in them. On the other, it provided such a massive overload of information and stimulus in their lives that they naturally want to simplify things. The easiest way to do that is just watching your own ass and paying no mind to anything else.
Can you blame us? The generation prior took the new technologies of voicemail, fax, and email meant to connect people and used them to help them ignore sales people, ex-husbands, and bosses. Our generation has many more tools available to not only shut out everything, but to also create our own bubbles of reality. Many of these bubbles are distorted, filled with like-minded people, slanted news commentary, and participants all the same age. And those are the engaged people we still have a chance with. For the other 90% you can replace “slanted news commentary” with “gossip sites” and “ESPN alerts.”
And why wouldn’t we create our own worlds to help ignore reality? As Alex J. Mann pointed out in your previous interview, there have been tremendous breaches of trust on the part of institutions that should have been looking out for us. We’re the ones that loaded up our 401(k)s when the Dow was at 10-14,000 like we were supposed to. The investment projection charts stating if we put in 10% of our gross income we were guaranteed millionaires at 65 are completely off now. Despite our investing, often with our company matching, we have less saved now than we did a few years ago. And that’s not even mentioning the twenty-somethings who bought houses during all of this. We lost a lot of money and there’s no longer a projection of the stable retirement we expected.
As for the day-to-day of consciously choosing to not care, it goes back to your point of being over stimulated. When you have so much work to do at your job, you just shut down. Think of what it takes to stop being a hardass. You have to acknowledge you’re ignorant even though you publicly walk around like you know it all or assume the posture that it’s cool to not know about politics and economics. When you begin the process of learning you realize how little you know and how much work needs to be done to catch up. It’s much easier to go back to not caring.
The internet is merely the exclamation point punctuating a decade of schooling and exposure to movies and music cultivating a poisonous cynicism in our youth by focusing on the flaws of the country in which these same messengers are hypocritically experiencing success. We definitely need to teach kids a healthy skepticism for authority and activate their bullshit detectors, but a relentlessly negative perspective that starts at age eight and is maintained on the internet can be destructive.
EC: You’ve transitioned from internal and private musings toward external policy and philosophical discussions (at least on your site). Is this because you sense things are actually going to change this time because if they don’t, then it probably never will?
I don’t know. I’d have to throw out a favorite Melville quote often cited by an author I like: “Genius all over the world round stands in hand, and one shock of recognition runs the whole circle round.” I’ve always been in love with ideas, genius or not. How else can you so immediately and deeply connect with people? And what else spreads with such abandon? You never know where one might go. Maybe nowhere. Maybe the whole circle round.
What I worry about is that after the bailouts a large number of people will never trust the government’s claim that we have a free markets, and they kind of have a point. We’re better off with nationalized banks than banks that get let off the hook whenever they run into trouble. Our auto industry is basically nationalized. How hard is it going to be to get people to buy into an alleged free market system and convince them that it’s actually capitalism, and not rigged in favor of the biggest companies?
PL: Near impossible. Once you’re too big to fail, you’re de facto part of the government.
“the Internet showed them most of the systems around them were terminally flawed before they ever had a chance to have faith in them.”
That’s one of the saddest most poignant things I’ve read in a long time.
PL: I stumble into that every once in a while. Thanks.
why don’t you discuss lowering taxes, getting rid of government regulations, and fighting the trade unions? aren’t these things what really forced jobs overseas?
PL: I’m for all three, with these caveats:
1. We need some baseline regulations, simplified; and
2. Unions are actually capitalist enterprises. Workers’ capital is their ability to organize and compel management to concessions. If management can’t beat them, management isn’t acting as an effective capitalist entity. Hence, I’ve always found Ayn Rand a bit whiny. Beat the workers or lose to the workers. Bitching about them gets nobody anywhere. If it’s any consolation, lick your wounds remembering this: When the workers win, they eventually bring the house down on themselves. See: Detroit.
Aristotle is a secularist?
The idea of the non-contingent source of all being (or Prime Mover in non-ontological terms) is your Blind Watchmaker.
The ideas of Natural Law, Natural Rights (the only grounding other than relativism that Human Rights can ever have) and Virtue all require that we admit that there exists at least an Aristotelian or Platonic idea of God.
Almost the entirety of Catholic Theology is based on Plato (Augustine) and Aristotle (Aquinas).
Go Alastair MacIntyre and the reformation of small interconnected communities.
PL: I’ll leave this one for EC’s reply. Religion’s above my pay grade.
A large segment of the population will never surrender on the abortion issue. Once you are sure (and there are both religious and scientific reasons that could easily lead one to be sure) that a human life begins at conception then the natural and logical conclusion will be that abortion trumps every single other issue. With that belief in place, what is the difference between abolitionists and pro-life activists?
You might disagree with their belief, but it has an internal logic and a respectable interpretation of the scientific evidence and a respectable set of a priori principles.
Therefore, I’d like to say that while Republicans might be well served by dropping the gay marriage issue (and supporting the libertarian idea that marriage is none of the government’s business at all) dropping abortion is no where near the same thing.
PL: Jesus, are we that fucking simple in this country? Everything comes down to abortion? It’s ending a human life, no shit. But early on, it’s little more than basal cellular animation. And the woman’s right trumps. That’s how I see it, and advise me if I’m wrong here, but I think that’s how some enlightened Talmudic scholars see it. I’ll default to that view. They tend to be twice as logical as most Catholic scribes. And 7000x more informed and sensible than any arguments the Bible Belt or Southern Baptist Convention could vomit onto the issue.
And the secularization and teaching of The Beatitudes? You’ve got three options regarding Jesus. 1. He was who he says he was. 2. He was crazy. 3. Nietzsche’s interpretation of him was right and he was attempting to existentialize the denial of the human wish to dominate others (will to power) and his followers then couldn’t understand what happened and tacked on a belief in the afterlife.
1. Will not lead you to secularize the beatitudes
2. Will not fly with a good portion of America.
3. Is very interesting, but flies in the face of teaching Aristotle.
PL: EC? This is yours.
How was Ayn Rand whining about the workers? Remember, in Atlas Shrugged Rearden paid his workers more than anyone else in the business. His foreman was considered a “company man” because he never went on strike, but that is because Rearden rewarded competence and reliability with the best package any worker could want.
I believe what Rand dislikes is any “gaming” of the system by anyone. Unions that attempt to monopolize the labor market through creating a “trust” of labor are given the same disdain as those such as James Taggart who attempts to control the railroad industry through trusts and rent seeking.
She is pro-union to the extent that Unions break up the power of leeches like Taggart. She is anti-union to the extent that they attempt to demand that Readren give them a job they don’t deserve.
How is it whiny to say “I don’t need you leeches, I prefer to live with those willing to stand on their own and accept fair value for their contribution”?
PL: Capitalism is about getting ahead. The whole idea of it is to get the maximum for the minimum expenditure, not fair value. I don’t like it any more than she did, but that’s how it works.
Favorite quote of the week, from Joe Sestak, a guy who’s about to get bludgeoned by Arlen Specter in the Democratic primary: “The great American Dream is not about getting ahead (but rather) about doing well and creating a world for the next generation in which they are inspired to do the same.” Good luck, Joe. That one’s going to play magnificently.
Everything comes down to abortion in the same way that everything came down to slavery in the years before the civil war.
You’re right “some” Tamudic scribes assert that view but they do so by saying that the fetus is not yet a human person. To say that “it’s ending a human life” but then say that the woman’s right trumps is a twisting of what those Tamudic scholars have said. Some other Tamudic scholars assert different views as well.
The idea that all life that is human life deserves the same right to life is a simple idea, but simplistic?
I’m not interested in getting into a pissing contest about whether Talmudic or Catholic scribes are logical or wiser. But Augustine, Aquinas, Occam, Suarez, Grotius, etc are all first rate thinkers regardless of one’s background.
PL: I’m pro-choice however you cut it because to not be pro-choice is to be anti-woman. That’s the way I see the pro-life camp: anti-woman.
And yes, it is simplistic. The woman’s rights trump. I allow the issue to go no further in my head because I don’t view our biology as unique or sacred in any fashion. I think it’s a preposterous level of arrogance to affix to ourselves some chosen status above the rest of life on this planet. The maladies that take us all down are not that different. Your cat can fall prey to cancers not unlike those that will get you. A monkey’s but a few genetic tweaks away from us.
The sole basis for sanctifying human life at any stage is the continuance of civilization. It’s a survival mechanism, nothing more or less.
Isn’t one of the defining rules of workable capitalism (at least the Adam Smith style) that we strongly guard against the combination of those of the same trade?
You’ve mentioned yourself that we need at least some basic regulations. All I’m asserting regarding unions is that the same principles that apply to sugar manufacturing monopolies also apply to labor unions. And the corollary is that this isn’t antithetical to Ayn Rand’s philosophy and writings.
PL: Yes. But we don’t live in Smith’s capitalism. That he wrote an important book on the subject doesn’t make him its architect.
I hear your point, and all I’m saying is in negotiation, which is the heart of capitalism, the rule is, get as much as you can giving up as little as you can. The people on either side of the table are only governed or checked by the negotiating skills of the party across from them. Its your obligation to avoid being fucked over. If you don’t, it’s your problem, and your fault.
Even beyond any “arrogant” religious idea of human exceptionalism is the idea that “sentience life” is a special category deserving of protection also arrogant?
Those Talmudic scholars that you referenced earlier wouldn’t say that the destruction of the fetus is a murder, but it still would be a sin. Are they arrogant as well?
So any women who are also “pro-life” anti-women? Do agree with Wendy Doniger that someone like Sarah Palin (whatever her other faults) is only “pretending to be a woman”?
I believe that by asserting that the only justification the sanctification of human life has is a survival mechanism falls prey to Hume’s most famous point: Without an Aristotelian or Platonic theory of being (ontology) you can’t get an “ought” from an “is.” So is the only thing that stops anyone from deciding they are allowed to kill everyone they please the fact that society will kill him in return? Is there no objective morality? If that is what you are saying, alright, that is what you are saying. But not only do I think the idea is objectively wrong, but it also causes awful results.
PL: One can be female and anti-woman. Self-loathing policies are hardly unique, and from one as scattered and incoherent as Palin, hardly unexpected.
So it’s a sin. That’s significant how?
For a lot of society, the only thing that keeps people from committing all sorts of crimes is the threat of punishment. Look at our cries for regulation in so many industries. A large sector of us cannot be relied upon to do the right thing. I agree with you that it’s a lamentable thing, but that’s reality, and the debate on whether an objective morality exists seems a bit quaint juxtaposed against its lack of acceptance by so many.
>A huge one is decoupling lending from any social or, though I hate to use the term, “moral” compulsion to pay back what’s been borrowed.
DING-DING-DING!!!
And to think, a “modestly-credentialed” serf just stumbled upon Barry the Teleprompter Wonderboy’s long term fiscal policy.
Let me ask you this: when DeutscheBank (only minimal exposure to MBS market, thus no incentive to help investors delude themselves) says that 48% of American mortgageholders will be underwater by Q1 2011…what is their (mortgageholders) incentivized next move at that time? Might it be to default, like everyone else in the same position has so far?
Now what happens when the US govt does the same thing? HAAAAAHAHAHAHAHAHAHAHAHAHAHAHAA!!!!!!!!!!!
The only reasonable option Teleprompter Boy had upon taking office was “smash and grab economics”. Stimulus, cash for clunkers, free HDTV, bailouts, FHA loans, buying every rubbish asset America can possibly serve up and then offloading it to someone else. The US govt’s balance sheet was long-term fucked by 2004 if not before, so your choices effectively were 1)bankruptcy with free stuff 2)bankruptcy with no free stuff. Which is best? All this bellyaching about “fiscal discipline” is a total waste of time; that might have been pulled off years ago but was not, and now you’re fucked. Rather than have every halfway-coherent inland Republican goon jump on the “look how economically literate I am compared to that black president” bandwagon, it would be far more prudent for Americans to come together and fuck the Chinese like they’ve never been fucked before. They won’t, though.
Incidentally, your Woodford Reserve recommendation was bang-on. The stuff’s delicious. Thank you!
PL: I think the defaults will come, but in states where banks can sell the balance of the obligation between the sheriff’s auction price realized for the home and the remainder of the note unpaid to bottom feeders, who’ll in turn sue people for it, a fair number of people who’d otherwise default will think twice. This is why I think companies like Pennymac are going to do well over time. And we’re going to see a much broader wave of modifications. There’s no way the banks can process the inventory in a traditional foreclose-then-sell system. The pain of loss realizations on the balance sheet and hard carry costs in taxes, upkeep and legal fees are pushing them toward massive, across the board workouts. Entities like Pennymac, buying at steep discounts and making a margin servicing at less extreme discounts on principal and lower interest rates, are the best market solution.
Woodford’s the shit. Thanks.
Where to begin…well, first with this silliness: “As someone in the employee benefits business, I know health care from many angles. If we are going to buy individually, it needs to be mandated like car insurance.” Mandated like car insurance. My beef with this absurd argument is that owning a car is, for all intents and purposes, a choice; being and staying alive is really not. The Man says if you cannot afford car insurance, you can’t drive your car. Extrapolating, that means that, under the status quo, if you cannot afford health insurance (and you’re sick), you can’t live. That’s wrong on so many levels. You need to give under-advantged folks some help. The government run public health insurance option should be compared to public transit: “If you have the money to afford to buy and insure a car, knock yourself out. But, if you can’t afford it, there is a government run, low cost alternative called ‘the bus’. Either way, you’ll eventually get where you need to go.”
As for the abortion debate, the ‘life begins at conception’ thing is bullshit. You can take a fertilized human embryo and freeze it…keep it viable indefinitely. You cannot freeze a newborn and thaw it out later and expect it to be alive. Therefore, a fertilized egg is not a human being. At some point between when you shoot your wad and when your wife is in the delivery room cursing you to Hell, life begins… but it ain’t at conception.
But what was really missing with the economics was the discussion that nobody wants to have. It affects every aspect of the global economy, and it is called ‘population’. It is a variable in the equation that nobody seems to acknowledge. People constantly talk about oil, water, etc. being in a shorter and shorter supply, but never bring up the fact that we as a species are producing way more consumers than we can serve. We see these jackoff couples on TV with 7 or 8 kids, and we say it’s a ‘miracle’ or ‘wonderful’, while some poor dude driving an SUV is called a ‘wasteful asshole’. We live on a planet of finite resources, but “Hey, folks, we need to stop it with the unprotected fucking or we’ll go hungry” won’t win you an election. Every year, we have deer hunting season, with the argument ‘if we don’t kill the deer, they will over-populate and starve to death’. Why can people not see that the same biological mathematics applies to us as well? Sorry for the long rant, PL. Thanks, it was an awesome post, because it made me think. Can’t wait for the rest of L’esprit de l’escalier.
PL: I’m getting the edits done and expect L’esprit up this weekend. Sorry for delay.
On Point #1, I see your point. But right now, Obama’s plan is not to merely allow some to ride the bus. It’s to subsidize a huge number of people who’ll never be able to pay anything for health care to have it under the guise it lowers costs for all. There is no way in hell we grant so many who can’t afford it onto plans and save money over the long term. The numbers offered are sophistry, a pretext because he can’t sell it as what it is – a naked entitlement expansion.
On #2, nice.
On #3, brilliant. If we’re going to villify people for their carbon footprints, we ought to also start shaming them for having issue they can’t afford. Where are the critics on this issue? The right and left both deserve criticism on this. The right for not making family planning free to all Americans. The left for silence on the issue where they’re so quick to scold people for overconsumption everywhere else.
Josh,
Re: Aristotle, Natural Law, etc.
Like PL, I’ll leave religion out of this.
I agree with everything you’re saying (things are a little hazy as my class about Nicomachean Ethics was almost 10 years ago).
I wasn’t so much calling Aristotle a secularist as his ethics were taught in a philosophy class in a secular fashion. Other religious and philosophical tenets (the Eightfold path, etc) can be taught the same way – as secular wisdom that applies to today.
@Josh
1. Will not lead you to secularize the beatitudes
2. Will not fly with a good portion of America.
3. Is very interesting, but flies in the face of teaching Aristotle.
First, there’s a lot of things that aren’t flying in a good portion of America that better spread wings and get off the ground soon before we collapse under our narcissistic delusions and entitlements.
What I suggest is we engage the kids we are teaching in a debate. Like right now, you have Aristotle trumping Jesus. That’s cool. Someone else can make an argument for Jesus’ ethical philosophy to be superior to Aristotle’s.
Although nearly all philosophy is footnotes to Aristotle (as the saying goes), it doesn’t mean that we teach Aristotle and then never teach something that flies in the face of it.
For God’s sake we’re teaching Creationism and Evolution in SCIENCE classes. I think we can teach competing philosophies to kids.
One crazy idea would be to make students write essays taking one side over another and then ask them to defend their positions.
(That sarcasm was directed at our current eduation system, not Josh.)
This was brilliant, as someone who doesn’t generally have time to read too many sites, blogs, blags, novellas, and e-bitching your bringing in other people for interviews is extraordinarily helpful. I appreciate that. Particularly when the points made are so good.
I have a small textbook of comments, but don’t have time to write them, so I’ll just say that I picked up Woodford Reserve yesterday to give it a try (took forever to find in the frozen north, three liquor stores later and there it was) and will be consuming it tonight. Also, the culture of entitlement and ‘give it to me now’ that was touched upon in this interview isn’t going away. It’s getting worse.
Despite the collapse of the economy and the lack of delicious, delicious dollars in the hands of many, it’s already ingrained in anyone born in the nineties that you get what you want without having to work. If even a small rebound happens in the next five years, the number of kids without that sense isn’t going to increase, and we’ll be left with the same problem as we have now.
PL: Lack of liquidity available to unproven credit risks might hamper those views.
Enjoy the Woodford. True Jesus Juice.
Great article. I heard a quote somewhere saying that Obama is going to force insurance companies to not turn down customers (if this public Health Care doesn’t go through) that have poor health records. That is the most backwards thing I’ve ever heard. Basically, you can wait until you get cancer, and then go get insurance. It doesn’t make any economical sense for the insurance companies to cover you. But I digress.
The whole public healthcare issue is such a touchy one because you can’t just look at it from the economic standpoint; you have to consider that people’s lives are at stake here (i.e. no health care can result in death!) It’s hard for me to put myself in the shoes of people that want the system publicized because I am a professional which has jobs that will provide more than enough money to either pay for my own healthcare or will subsidize it. I do feel sorry for the average joe that cannot afford health care but why should I have to pay for it? I worked hard to get where I am and would like to spend my money on myself!
PL: That can’t be serious. He can’t mandate something that absurd. That’s got to be a leverage tactic.
I shouldn’t have to pay for anyone else’s health care. If you make it cheap for me, however, I will happily do so. This plan does not do that. This plan is a redistributive policy draped in false economic arguments.
Jay,
“If we are going to buy individually, it needs to be mandated like car insurance.” Mandated like car insurance. My beef with this absurd argument is that owning a car is, for all intents and purposes, a choice; being and staying alive is really not.”
You’re correct that they aren’t the same thing.
I’m the last person that wants government mandates. But let me ask you this: if we decoupled health insurance from employment, then everyone will get individual policies or policies that cover the family in their household, right?
There are people (say a woman that wants to be/is pregnant) that will use tens of thousands of dollars in health care over the next few years. Those people MUST be put into a large number of people to spread that cost. In other words, ALL insurance is dependent upon many people paying premium and getting very little back in terms of claims to offset the high claimants (the pregnant woman, the cancer patient, etc.) who are paying way less in premium compared to claim costs.
If we decouple with no mandate, the ONLY people who will buy health coverage are people who already are going to be claimants and/or people who want to transfer the risk of owing medical bills to an insurance company. Do you know who isn’t in those groups of people? Young, healthy people who are the lifeblood for insurance companies: premium payers with little to no claims. Take away the mandate and you take away premium payers and leave insurance companies with only claimants and people worried about being claimants.
And if you guys think health care is bad wait until the anvil of end-of-life/long term care comes down the pike.
“The government run public health insurance option should be compared to public transit: “If you have the money to afford to buy and insure a car, knock yourself out. But, if you can’t afford it, there is a government run, low cost alternative called ‘the bus’. Either way, you’ll eventually get where you need to go.”
Yeah, but how many people that do have cars and can afford to not take public transportation STILL take public transportation? If there’s a public option, the mean and median income of people on it will be well above what anyone considers poor. Most people on the public option after only two years will be gainfully employed people that had health insurance two years prior through the very same employer.
I agree with EC that disconnecting health insurance from the employer is vital. I disagree that this means individuals should be bargaining with massive corporations. That is utter nonsense. There are unions who self insure. I’m sure there are a few benevolent orders who self insure. The advantage of insuring along social lines is that people can write contracts that tend to better serve their populations. The pipefitters union decided to self insure because their members couldn’t get coverage for detox. Seriously.
And what is covered by insurance should always be a matter of contract, and those contracts should be enforced. If insurance companies are sick of seeing plaintiff’s attorneys making money from suing them, the first thing they should do is pay out the good claims and worry about defending the bad ones. But that’s just from a guy who works in a plaintiff’s firm.
Lastly, I picked up a copy of your book the Thursday before the bar exam and got halfway through it by Monday morning. So far, its laugh out loud funny. Now that I’m drying out, I’ll probably finish it up in the next week or so.
PL: Thanks. Glad you like it so far. And yes, you make a good point – insurers are as sleazy as the frivolous claimants they demonize. Two rotten groups badly incentivized screwing up the system for everyone else.
So nice to hear someone finally make the statement on population. I’ve been saying this for years. There are far too many people bringing children into this world who do not have the time, money, desire etc. to properly raise and/or care for a child. That goes for the poor folks in the ghettos and trailer parks who can’t afford food and clothes all the way up to the soccer moms/dads in mcmansions who seem to view kids as an accesory and leave them to be raised by a f-ing nintendo. Not only do I like the idea for free family planning for everyone in America but I’d like to see a movement towards supplying birth control for people in third world nations. Instead of accepting more and more refugees, making our problems worse and sending more and more food and medicine to a situation where there is little to no possibility of the children ever having a decent life why not start helping people reduce the number of mouths they have to feed.
PL: No issue there. You want to reduce our carbon footprints by 10% in five years? Incentivize people to stop having unprotected sex.
TV is my abusive girlfriend. I believe you haven’t truly lived until you have an AIDS scare. I wonder if travelling back in time and having sex with me is a homosexual act. I don’t have a drug problem, I have a drug solution. I find comfort in the idea that all women truly need is a good dicking. I hope I get to ride the elderly to work as part of president Travolta’s “Look who’s Talking Now, Bitch” Act. This is what you are up against. My generation. “In Tyler we trust.” (I just plagiarized an Internet writer I like.)
Why wouldn’t we craft our own reality in HD and RPGs? I secretly suspect most of us are lost in the first zit.
Lao Tse said 2000 years ago: “A pure mind is of utmost importance. The air in your lungs can be cleaned. Blood can be filtered. A full stomach can be purged. The mind is like a delicate flower.”
Ironically, Fidel Castro has written about the mental sickness of the over-stimulated first world. He sustains that things like video games, the Internet, reality TV (specifically, “Big Brother” for some reason) and sports fanaticism with no patriotic context to put it all in perspective, short-circuits the brain turning us all into what we are now: champions not even of our own little neurotic-electro, psycho-narcissistic, codependent little worlds. Gotta give it to him. Good fucking argument. (I don’t think I’m being honest with my representations of the world.)
PL: KISS culture. As Carlin mused, “garbage in, garbage out.”
You both seemed to make note of the most fundamental underlying problem, namely, that most people are disconnected from the need to be responsible for oneself and produce something of value, yet you mostly focused on questions of large-scale policy. Do you think that at this point, no matter what policies are implemented, the President or Congress can do anything about this?
I ask because it strikes me that in our time we have both the means and the need to decentralize our economy along similar lines to what John Robb calls “resilient communities,” where much more production is local and which emphasize investment over profit. Ultimately, the idea is that more robust local infrastructure would make us more resistant to Black Swans, whether they be financial shocks or terrorist attacks (I know I am being vague, I can provide more details and links if you are interested). Only if people’s lives and work are tied to creating something of real value can I imagine Americans beginning to act once again as citizens rather than consumers.
PL: Yes, I think if we can dry up a lot of the spending, people will inevitably expect and demand less. Likely? No. But that’s no reason not to write about it.
On your second point, with technology comes a marketing and marketed culture almost impossible to change back.
Perhaps I’ve misread the details of Obama’s health care plan, but I thought it was well thought out and did a good job addressing problems in our current system. I’m not an expert, could someone clarify what I list below is wrong?
First, the plan addresses adverse selection on both ends. Insurers cannot refuse coverage, therefore they will not be able to cherry pick only healthy applicants.
On the other side, everyone must buy some form of insurance. This prevents healthy young people from opting out and only buying when sick. Most uninsured people are healthy and young. Forcing them to buy plans will increase the number of cheap healthy people in a plan, lowering its costs and making it more affordable to others.
The government plan is necessary to keep private insurers honest. The insurance market is anything but competitive, most states only have 1 or 2 companies available.
I remember reading that in the 90s a major cost saver for insurance companies would be to standardize forms, a simple idea. 10 years later, they still use drastically different forms and its a huge time waster to fill them (my mom, a doctor says this takes a huge part of her day).
I believe EC criticizes the government plan comparing it to public transportation. Because its subsidized, people who don’t need it will take it anyway. Why not make it like medicare? Medicare offers a basic package guarenteed. You can buy additional insurance through Medicare Advantage which gives more coverage and options. This way, everyone in America has some basic coverage but will still spend money to buy additional insurance.
Remember, we already subsidize uninsured people. Instead of getting a free appendectomy, an uninsured goes to the emergency room with a burst appendix, much more costly.
Its a very roundabout way to change the system, I prefer a single payer government system, but I believe its well put together. Like I said, I’m no expert and am excited to see what you guys think of this.
PL: The problem is we have 50 million people uninsured right now and I’m willing to bet only 15 million of those people can be mandated to buy coverage. How does Obama mandate that people who don’t can’t handle the expenses they have now start paying for health insurance? He doesn’t. He puts them in a subsidized category that winds up costing everyone else more than the current system does.
I heard an interesting explanation of the false presentation of Obama’s reform arguments yesterday – that we don’t have an aggregate health insurance crisis. We have millions of private health insurance crises, and the people having them want to fix it on the government dime.
I don’t mind the cost of health insurance, and I’ve paid it out of pocket in the past, in the high priced private market. It’s a life tax. What can I do? If someone else has a problem with it, that’s his to fix. If he’s indigent, give him a safety net of course. But have the 40% of the country happy with their policies subsidize everybody else?
On top of that, consider you’re dealing with the world’s biggest consumer economy, and one where drugs and procedures are pushed on the population on TV and the net. “Depressed? Drugs!” “Restless leg? Drugs!” Etc… Giving health care consumers more access to care will turn hospitals into the new Mega Malls. Costco for “getting your health on.”
I take issue with the association of the tea party event as being libertarian. Sure there were some libertarians who attended these things, but for the most part, this was something orchestrated by the neo-conservatives as they always do when they’re in the minority (These are the only times that they make even a little sense).
I would also caution you in your use of “hard left” in describing your leanings on social freedom. While the goals are often the same, those which are hard left differ in that they favor solving all social ills by using government coercion, such as outlawing hate speech and regulating media, among others. Hmm, actually, social conservatives would fit that bill too, but in a different Jesus freak kind of way.
PL: Language has limitations. The caution’s noted, but you got my point.
Jesus Freaks and Hardcore Liberals eat the same paste on the same short bus. One’s a black zebra with white lines, the other a white zebra with black lines.
Neither’s really interested in bettering anything. The primary aim is to get other people to live the way they think people ought to live. If we could locate the gene that drives men to this obnoxious goal, we’d probably evolve ten generations in the span of three.
I think the first three paragraphs here (inadvertently) summarize the malaise: http://online.wsj.com/article/SB10001424052970203674704574328920789548170.html
Perhaps one should simply work at work. Or perhaps there’s no reason to, in a fabricated industry of abstract (read: nonexistent) value added. Perhaps inappropriate is a relative term – and perhaps gawking at walrus dick is no more inappropriate than the next productivity anesthetic. Perhaps.
PL: As Keynes said, “In the long run we are all dead.” The Big Dumb’s the Big Smart. Who’d have thought irony ultimately tanked the Republic? So 3/4 of its practitioners don’t know it… So what?
“Welcome to Costco. I love you.”
Budfox,
Blue Horseshoe loves the Single Payer Plan
This pre-existing condition bullshit is a red herring. It doesn’t happen that often. When it does it’s in admittedly heartbreaking situations. But to give you an idea of scale, you need anywhere from 50-100 healthy people paying premiums to offset one pre-ex person that will have high claims. We’re going to run out of healthy bodies then high claimants will vastly outpace the premiums.
But let’s just focus on “Forcing them to buy plans” – that doesn’t sound like freedom. If you guys read between the lines, a lot of us are getting a little tired of this bullshit of being forced to pay higher taxes, higher tolls, comply with more Byzantine regulations all to receive less services in the collective as more and more people drag ass or “hardass it”.
Administration is 20-25% of health care costs; the remaining 75-80% is claim costs. So let’s very optimistically cut all health care administration in half – there’s still 90% of the costs. The nation is unhealthy, that’s the problem. Even though administration is long overdue to be streamlined, until America gets healthier there won’t be a decline in health costs.
The Medicare base plan for the uninsured isn’t a bad idea and many have called government health care Medicare For All. The problem is Medicare (the old people one) is costing a FUCKTON more than we ever thought it would and we can’t ever take it away. Any sort of government health care entitlement can never be taken away; we certainly can’t afford it now and maybe never. Medicaid (the poor people one) is rife with fraud and abuse. Private insurance has very little fraud because the incentive is much greater to snuff it out as a corporation.
The government’s forays into health care in Medicare and Medicaid may be the best selling point against a single payer plan.
PL,
“We have millions of private health insurance crises, and the people having them want to fix it on the government dime.”
Or find a con-artist, trial lawyer to help get compensated.
Sorry to hear you had to pay for health insurance, way too expensive.
PL: The family needed it, we were self-employed and hadn’t set up plans through businesses or chambers of commerce and so I had to pay it. Thanks, but no need to be sorry. That’s how it works. Make the choices, take the results.
Don’t write my generation off just yet. Slowly but surely more and more people are starting to see the light. It’ll take a true disaster, not this hiccup, to bring about the change though.
My favorite quote is from that horrible Keanu movie called “The Day the Earth Stood Still” Where the professor is talking to the alien he says “Well that’s where we are. You say we’re on the brink of destruction and you’re right. But it’s only on the brink that people find the will to change. Only at the precipice do we evolve. This is our moment. Don’t take it from us, we are close to an answer.”
I just hope I’m right and one day we all wake up from our self induced comas. But eventually people are going to stop having the dream of being lil wayne and start seeking out realistic goals for themselves and become productive members of society…again I hope for all our sakes.
PL: Well, inevitably, everyone gains age and realizes the whole “player” thing is a fiction, bought, packaged and pimped to young men looking for answers at the most opportunistic moment. Been there. Seen it. Every generation gets a handful of specialized ethos sold to it by Madison Ave. One of the good trends right now, a 75% real, as opposed to marketed one, is being your own boss – start-up culture. One of the more embarrassing, accidentally comedic ones is being a hardass who doesn’t know a lot and wears it as a badge of honor. Silliness. Media entertains us. It’s not something to emulate.
You’ll be right. Hell even today’s socialists will eventually come around. “If you think health care is expensive now, wait until you see what it costs when it’s free.”—P.J. O’Rourke
To Evil Conservative
From Jay
Your dissection of my argument was nothing but surgical…well done. You were totally right about my ‘public transit’ analogy. As a former student of the actuarial sciences, I find myself a little embarrassed that I focused more on the theoretical and less on the math. When you say “There are people (say a woman that wants to be/is pregnant) that will use tens of thousands of dollars in health care over the next few years. Those people MUST be put into a large number of people to spread that cost. In other words, ALL insurance is dependent upon many people paying premium and getting very little back in terms of claims to offset the high claimants (the pregnant woman, the cancer patient, etc.) who are paying way less in premium compared to claim costs.”, you are spot on; insurance doesn’t work unless a large pool of people are paying into the system. But by that rational, the more people in the pool, the cheaper the premiums. So why not just put every single person into the pool, in a single payer system, rather than having hundreds of smaller companies picking and choosing healthy people and denying service to folks who need help?
I guess I have so many issues with the entire US healthcare debate is because I am Canadian, and I can’t see why you guys just can’t dump for-profit health care, and adopt a Universal tax-funded system. You can say what you want about our system, but my retired dad had a bypass operation within a week of being diagnosed, and it cost us nothing, and I bet that would cost an uninsured American around 200 grand. Obama is a smart guy, and I believe in his heart that he would like to have tax funded, Universal care for every American, like every other civilized country on Earth. But he knows it is political suicide, so he is trying to sneak it in the back door with the public option. I believe he hopes that enough folks will sign onto it that it will become the norm, and for-profit health care will be driven out, at a slow and gradual pace as to let the insurance companies transition to new enterprise (rather than mandate Universal care at once, forcing many of these companies out of business), and eventually arrive at free healthcare like the rest of us have. The argument that PL brings up about the fact that he shouldn’t have to pay more to cover healthcare for millions who have no money is totally legit, but if you had a system where everyone pays a little more tax in return for having everyone being able to see a doctor for ‘free’, you would not have to bitch about ‘paying for the poor’, because you’d be paying it anyways in your taxes. Plus, think of the millions of dollars freed up for small business owners who wouldn’t have to spend cash on health insurance for their workers. I assume we will have to agree to disagree. If you are curious, check out this link http://www.healthcare-now.org/canadian-union-writes-obama-congress-defending-canada%e2%80%99s-healthcare/
Have a good day, sir, and thanks for writing.
It’s been implied here, but not stated outright – the difficulty of finding a capitalist solution to health care is because the financial delivery method of insurance is by nature a collective.
Jay,
“But by that rational, the more people in the pool, the cheaper the premiums. So why not just put every single person into the pool, in a single payer system, rather than having hundreds of smaller companies picking and choosing healthy people and denying service to folks who need help?”
Putting the greatest number of people possible into the risk pool is only half the issue. The other half is that the claims are higher because of better technology as well as more frequent visits because Americans are the dual nightmare of insatiable consumers and insatiable eaters.
A major issue of insuring the current uninsured is the first 3-5 years when the public option gets ransacked by claims. Think about it, there will be tens of millions of people who haven’t been to the doctor in several years (because they had no coverage) suddenly going to providers. I’m surprised no one has put out the numbers of 45 million uninsured all going for one doctor visit in the first two years they are covered by a single payer system. No cancer diagnoses, no pregnancies, no surgeries, just one doctor visit for 45 million people over 2 years. That claim number is huge. THEN show the claim numbers if you take the actuarial data of the demographic of those 45 million and how many we guesstimate will have cancer, surgery, etc. and what that cost is. Again that’s huge and it’s an underestimation because those 45 million will very likely have a higher incidence of maladies than 45 million who have been insured for the last few years.
“I can’t see why you guys just can’t dump for-profit health care, and adopt a Universal tax-funded system.”
Alright let’s go to town. I believe that the best services and products are made by for-profit entities.
Non-profits and civil service pick up the dregs of warm-body wage receivers left over from the higher paying for-profits. People bitch about pharmaceutical and health insurers’ profits as well as executive salaries. Well guess what everybody? The best and brightest among us want to get PAID for being the best and brightest. Our most important industries need to have the highest compensation incentives to attract the best people. Once health care becomes exclusively non-profit, then the best and brightest will leave the field in droves. This has already happened with doctors. We need to import them because all of the incentives (salary and quality of life) lead the same types of people who became doctors 30 years ago to become dentists today.
That’s why Chris Rock, Jay-Z and Mary J. Blige all live near a dentist, not a doctor.
Where’s the innovation coming from in health care? Nearly all of it is coming from America. Anecdotally there are innovative human beings in every nation, but here is where we get the most. Other industrialized nations copy our products and procedures.
And the biggest difference between why America can’t afford universal coverage and other industrialized nations can is military spending. These homicidal maniacs aren’t saying “death to Sweden” or “death to Canada”. When our embassies are bombed and planes fly into our buildings we have a security tab no other country even approaches in terms of cost.
The link you provided was a letter by the President of the largest Canadian employee union addressed to Barack Obama and Kathleen Sebelius. Just a note, it was reported that even though Obama and Sebelius both read the letter separately they both asked the same question to their staff, “What the fuck is a Canada?”
Seriously, from the link:
“Our system speaks volumes about the character of our nation. It provides all Canadians with equal access to care on the basis of need, not wealth or privilege or status. Previous generations understood that sickness doesn’t discriminate and they made the collective moral decision that health care shouldn’t discriminate either. It was a courageous initiative by visionary men and women that changed us as a nation and cemented our role as one of the world’s compassionate societies. We will always defend the proud legacy we have inherited from previous generations of Canadians.”
The first few paragraphs of my post here state that our nation made its own collective moral decision and came to the opposite conclusion.
http://www.truthvmachine.com/?p=11325
I hope your dad is recovering well.
“Can you blame us? The generation prior took the new technologies of voicemail, fax, and email meant to connect people and used them to help them ignore sales people, ex-husbands, and bosses. Our generation has many more tools available to not only shut out everything, but to also create our own bubbles of reality.”
Yes, I believe you can blame them for having such a lack of self-awareness. I’ve been bombarded with the same amount of bullshit as everyone else in my generation, and for some odd reason, I have no inclination to turn myself into the next Lil Wayne, or buy a McMansion in the suburbs working a job that produces nothing, living with a wife and children that hate me, golfing and bbqing til death. I do agree that it’s not entirely our fault. Proving yourself to be right despite all logic opposing it and learning just enough about the system to be able to rape it has been beaten into our heads since grade school. But if we don’t start holding people accountable for a lack of humility and self-awareness, crap man, we won’t even make it to Idiocracy.
A lot of it has to do with horrible parenting and the media, but I think the hardass mentality you mentioned stems mainly from the media. I watched the BET awards a while ago. A vast majority of the “successful” people in the audience promote this mentality. Everyone wants to be like them since they do such a good job of marketing themselves. Just like professional athletes they promote a ridiculous fairy tale road to success, and then feed off it by giving people the illusion that everyone can do it exactly like they did. They’re all the fucking man, saying fuck the haters, spend money on ridiculous crap, etc, which I suspect played an important role in causing our current economic situation. And then they all give themselves a pat on the back and give credence to their way of life to all the consumers by sending some black men to medical school. All while being just as crooked as any politician and sucking money out of the economy with their clothing lines and endorsements and CDs filled with horrible, auto-tuned “music”.
There’s a lot of other stuff in the media that distracts people from reality (reality TV, nut shot videos, gossip sites) but what really pissed me off during the BET awards is this: these people do nothing of value with all the money they’ve made. They waste their money on clothes, jewelry and vacations, and start up clothing lines and record studios so their friends can do the same. And then they label themselves “ghetto popes” and people eat it up and love them. If they really loved their fans, they’d pool their fortunes together and affect some real social change. Just in the front row, there had to be a couple billion dollars. How much does it cost to start an insurance company? A solar power plant? A bank? A fucking school? And this is the kind of mentality that my generation is unconsciously absorbing. What’s really scary is that these people could honestly have a shot at politics in the future. I’m not sure how I feel about the House of Representin’ becoming reality.
PL: “Hector Elizondo Mountain Dew Camacho for President”
In fairness, this isn’t all the fault of the hip hop community. From Wall Street to Main Street to the Ghetto, get yours, get out and fuck everybody else has been the message for a long time. Hell, I filed all sorts of specious claims in Philly. Why? Because why not? Who knows what’ll get you paid, or what a client will pay for (I also had no choice – you do what partners tell you). More claims = more billables or more settlement leverage in contingency cases. It was never “What should you do,” but “What can you get away with.” That’s not hip hop’s fault. That’s just the way we do business in this country. You have to be a sumbag at a few junctures in life to make a lot of money. That’s just a fact. The problem is when we start celebrating it. That’s the tipping point. As a lawyer, one can and probably should be mercenary. He’s an agent of commerce. As a human, one should recognize such behavior is abhorrent, and not worth celebrating. Even the Mob observed a difference between business and real life.
And of course, the silliest thing about “player” culture is it’s fiction – .00001 of people enamored with it will ever make anything of themselves. It’s also pretty embarrassing. It’s just such obvious product for goofy suburban white kids to eat up.
I’ve read with interest the comments here on healthcare reform. I’ll keep my opinion on the matter to myself, but here are some things I hope those of you on all sides of the argument take in to consideration:
1. We don’t have a capitalist healthcare system in the US right now. Anywhere from 1/3 to 1/2 of the work I do in my job (Some inner city ER, some suburban family practice/urgent care) is paid for through government entitlements. That’s either BC/BS Federal Employees plan, Medicare, or Medicaid. Granted, n=1 for this study, but I bet other health care folks would cite similar stats. Private insurers base what they pay for procedures on what the government pays. Sometimes they overpay, sometimes they under pay, but the current system (both government and private) does not logically reimburse. Seriously – look into how these people come up with the price for things. Your fucking head will explode once you realize how arbitrary and random it is.
2. Even if you shit full comprehensive insurance for everybody tomorrow, that doesn’t mean people will get what they want out of the system. There are simply not enough primary care/generalist docs out there. Look at Massachusetts – it can take 6 weeks to see a doc. This is a symptom of the effed up reimbursement structure. Many med students have been matching into specialties that offer better pay and lifestyle for two generations now. It will take ten or so years from the word “Go!” to fix this – doctors are not made overnight.
3. Divorcing Americans from the actual cost of the care they receive (either Uncle Sam or Big Insurance is paying) is killing us. At least every 2 days I see someone who demands an MRI of a day old injury. Why not? They ain’t paying. This flaw also leads to things like ambulance rides for stubbed toes, fake abdominal pain to get a “free” ultrasound of a new pregnancy, or checking into the ED for a headache, because the Tylenol there is “free” and you have to pay $4 to get some from Walmart. Go upstairs to the ICU and feast your eyes on the 95 year old demented train wrecks who haven’t had a coherent thought since the Carter administration. They’re getting chemo, dialysis, and keeping a $10,000 per day ICU bed warm because the family wants “every thing done for Gran-Gran”. Once again – they ain’t paying. There is effectively no rationing in our system right now. There is no such thing as a “wallet biopsy” prior to care due to an unfunded Federal mandate called EMTALA.
Don’t believe me? Go volunteer for a week in your local big city Emergency Department.
3. Right now, Americans are unwilling to accept the fundamental reality of the classic Engineer’s Triangle. It applies to medicine as follows – good medicine, cheap medicine, fast medicine – pick any two. Americans want all three, and we’re mortgaging our future to have it.
Also, please be wary of the games people play with statistics in health care. One I hear bandied about a lot is the infant mortality rate. Here in the US, we’ll spend $1,000,000 dollars trying to get a baby that weighs 500g and is born at 23 weeks to survive. Most of the time we fail. That counts as an “L” in the stats. In many other countries, this child is called an “incomplete pregnancy” and never gets counted at all.
Just be very, very careful about what you choose to believe with regards to statistics.
Sorry, Philalawyer – I got off on a bit of a disorganized rant there.
PL: Disorganized? Hardly. These are excellent points. The dearth of generalists is something I think is going to give any American suddenly enamored with his new cheap, subsidized insurance a rude awakening. And wait until concierge medicine starts stealing the few generalists available. It’s quietly happening already. A doc I used to see years ago just sent a letter saying the practice was shifting to concierge. We may see a two tiered system where everyone who can afford it has a private fee for service general physician and everybody else waits 3 months to see one. Obama can wish for a system where everyone gets a similar level of coverage all he wants – the marketplace realities will thwart him every time. And no amount of regulation or tax incentives will fix that. Anything govt can attempt to mandate, lawyers and accountants can carve around.
On the statistics thing, great point. I’d never heard that before. Reminds me of the myth that the French didn’t have heart attacks despite eating tons of fat and smoking. Remember that? A few years ago it was disproved by simple analysis of death records indicating the French didn’t autopsy something like 30% of people likely to have died of them. If you were over 65 and had one, you just died of “natural causes” or something like that.
To Evil Conservative
From Jay
To his credit, Evil Conservative has made a myriad of valid points. Great post, by the way. If you guys missed it, check it out at http://www.truthvmachine.com/?p=11325 .
I offer my final argument. “A major issue of insuring the current uninsured is the first 3-5 years when the public option gets ransacked by claims. Think about it, there will be tens of millions of people who haven’t been to the doctor in several years (because they had no coverage) suddenly going to providers. I’m surprised no one has put out the numbers of 45 million uninsured all going for one doctor visit in the first two years they are covered by a single payer system. No cancer diagnoses, no pregnancies, no surgeries, just one doctor visit for 45 million people over 2 years”
You are totally right. Given an option to see a doctor for free, Americans, the most hypochondriac bitches on the planet, will exploit the opportunity to Hell. It will cost a shitload….in the short run. But once the novelty of free doctors wears off as it inevitably will, the exploitation of the system will ease out, and will result in a pace that the rest of the world has learned to deal with. Not to toot my own horn, but I made a similar argument on a different PL post about Pot and Tits (http://www.philalawyer.net/archives/if_you_want_som_1.phtml). In closing I think we should thank PL for letting us use his site as a message board. I assume know him, EC, but I don’t, and it is pretty cool of him to let a dickhead like me post so much garbage on his site.
PL: Thanks are unnecessary. Happy to do it. The whole idea of this was dialogue. The current arguments for and against health care reform, and the general course of are govt, are hijacked by people with agendas spitting false talking points. People who read this should be thanking you for taking the time to engage in an honest public dialogue the issues.
Jay, you are one thousand percent incorrect about the “novelty of free doctors wearing off after a few years”.
There is de facto free care in this country right now, due to the law called EMTALA I cited earlier. EMTALA states that any hospital that accepts government money (Medicare, Medicaid, Tricare, etc) must provide assessment and stabilization of anyone who shows up within 250 yards of the door, regardless of their ability to pay. I see the same “frequent fliers” all the time (n=1 again – I’d better dig up some stats). Some frequent fliers are narcotic addicts, some are non-compliant with chronic disease treatment plans, and some view a visit to the ED as a social call. Some just want a blanket and a sandwich. None of them are curbing their visits, and none of them are paying.
For those of you who see problems in health care and think of writing laws to fix them, I highly encourage you to look at what EMTALA has done to our system. It’s a law that sounds good on the surface – it prevents hospitals from dumping un/under insured patients on the street. It says you can’t let anyone die in the gutter, even if they’re poor. Sounds right and just, doesn’t it? I agree.
Here’s what it’s done:
By vague wording, it makes hospitals hemorrhage money. What does “stabilize” mean, anyway? You can’t stabilize appendicitis, cancer, or a heroin overdose – you’ve got to fix it. That costs money and skill. It leads to balance billing, that wonderful practice that ensures the insured pay $7 for a Tylenol. We give out so much crap for free that we’d go bankrupt if we charged a fair price. Too few people actually pay the bill.
It has driven specialists out of the hospital. In exchange for having privileges at a hospital, the specialists are obligated to be on call (the group provides 24/7 coverage to the hospital). This results in situations where, say, a hand surgeon has to come in at 3 a.m. to fix a drunk idiot’s hand. Most drunk, uninsured idiots who punch concrete can’t afford the several thousand dollar bill, so they don’t pay. In addition, the hand surgeon has to cancel/reschedule the paying surgical case he had for the next morning.
Why would somebody subject themselves to this night after night, year after year? The answer is – they don’t. They get together with a couple other surgeons and open a free-standing surgical center. Now the hospital has no hand surgeons for the drunk idiots.
EMTALA and the fear of lawsuits are a binary nerve agent for our healthcare system. Every single person is entitled to come in to the ED and be treated. They can also sue the doc who missed something. This leads to BILLIONS in defensive medicine – CT scans for kids who bumped their heads, ECGs for cocaine induced chest pain, dialysis for alcoholic, non-compliant obese diabetics, etc.
I’m giving you all this info on EMTALA because fixing healthcare is not as simple as passing a few laws. Every law passed will have unforseen second and third order effects, and once you give something to “The People” it’s almost impossible to get it back from them.
The road to Hell, as they say, is paved with good intentions.
Frankly – and maybe this is the secret Euro-weenie in me – I can’t possibly see how anyone can see health care as anything other than a basic human right. How anyone can approach the debate with the idea that it’s OK to leave millions of people without access to basic medical services is totally unfathomable. Perhaps it’s all the paste I’ve eaten.
PL: The debate isn’t whether everyone will receive some level of basic care where urgently needed, or some level of care for chronic conditions. There have been and will remain safety net programs providing that care to the un/underinsured, at state and fed levels. The debate is whether we should enhance that care to something approximating the care people with insurance receive, with the insured subsidizing the enhancement.
Well, first I want to thank everyone (especially PL for hosting) for a discussion that didn’t fly off the handle like so many political and emotional topics tend to do. It would be really great if there were forums and television programs that were like this. O’Reilly and Matthews each had something going in the 90′s, but they’ve both been intolerable for most of this decade.
Russert and Stephanopoulos are good, but one of them is dead and they almost exclusively talk to politicians and agenda-driven people. If anyone knows of any place in the media (from TV to the internet) where we can get the level of discussion here, please let me know. Thanks.
Savage Henry,
First post:
For points 1 & 3: where is all of the transparency we were promised so we could be educated health care consumers when the Health Savings Accounts came out 5 years ago? Where are the databases to tell us things like MRI’s are cheapest at Facility ABC, but most comfortable at Facility XYZ?
On point #2: One more thing here, there are suddenly tens of millions of new patients being covered for care they would not have sought out otherwise. It won’t be long before a percentage seek out lawyers to start suing the shortage of providers.
Second post:
Why are there not more Urgent Care centers? Would that help our nation’s health care costs?
I know some hospitals have already split their emergency room into two. One side of the ER has the critical patients rushed right in or have a shorter queue and the other side is a completely separate queue for less urgent care like waiting for X-rays. When I wanted to check my hand out after hurting it at a Slayer concert, I waited 5 hours in an ER on a Saturday night ($700 bill, I was responsible for $35 copay) instead of being able to go to a 24 hour, non-critical care facility down the road with a shorter wait that can handle X-rays, stitches, and other minor crap.
Jay,
A second thanks here to make a reasonable case from the country with one of the best universal health care systems.
PL: The media will rarely host debates like this. Better to have a zero sum game between a pair of advocates working 12th grade debate contest techniques out on each other.
Fucking fantastic exchange, if this kind of thing actually made it onto CSPAN or Hardball we’d be a lot closer to fixing what’s wrong.
The only broad topic you guys didn’t really get into is the issue of wealth concentration, which has been getting a lot more acute over the past few yeas.
One way to capture it is by examining what portion of America’s total income the top 1% of earners receive. The share of that top 1% has nearly doubled since 1970, and it’s now the same size as the income earned by everyone in the bottom 40% of earners combined.
So the very few families who make up the top 1% of all earners have a combined income that matches the incomes of all the families in the bottom 40% of earners.
Looking at economic well-being another way, in terms of financial wealth or “stocks, bonds, real estate, businesses, and other financial instruments,” as of 1998 the top 1% of families controlled nearly half of that pie, with the top 20% controlling fully 93% of it. Meanwhile, the bottom 40% of families actually have negative financial wealth – their debts actually surpass their assets.
And this cavernous gap has only been widening, between 1998 and 2001 the net worth of families in the top 10% of America jumped 69%, significantly more than any other group. In the years leading up to that point, between 1988 and 1999, the difference in net worth between black families and white families grew by $16,000 and the gap in net financial assets grew by $20,000. By 2004 white families had an average net worth of $81,000, and black families an average net worth of just $8,000 – roughly a tenth the average white family’s.
Everything else being equal, wealth inarguable isn’t. I don’t know what kind of real social solutions there can be when the level of economic inequality is still growing. Addressing that would seem to overshadow pounding out the nitty-gritty of many more subtle issues, and although I couldn’t pull a concerete solution out of my ass right now – the first step is always to admit that there’s a problem.
#citations at http://www.tremblethedevil.com/my_weblog/vilest-deeds-like-poison-weeds.html – section vii#
PL: Economic inequality is reality. Capital begets capital and so it goes. Trying to fight it is like trying to fight social Darwinism. Sounds great, but it never works because at our base, we’re animals and — no losers, no winners.
Our inequities don’t accrue from flaws in our system. Technology speeds inequalities, the same way it did in the Industrial Revolution. The masters of the new age are taking the spoils for a time. It corrects a bit inevitably.
Anyone who wants to understand health care needs to read this New Yorker article.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
It’s the strangest thing I’ve ever read. The difference between the Mayo Clinic and the most expensive health care area in the country doesn’t have to do with pre-existing health conditions, unhealthy living, tort issues, medicare versus private payment, or quality of care. The issue is that doctors are acting like rational economic actors, pushing procedures onto patients in order to make more money, milking money off of optional procedures, and focusing on the bottom line almost exclusively. Our health care system has become more capitalist over the past fifteen years, and it is killing us.
I just say we need to scrap the system and either start over or borrow from the Swiss or the British. We aren’t going to save a significant amount of money. The insurance companies have a 3% profit margin and the administrative costs aren’t going to save much. If the people who are actually running this circus debate want to fix health care overutilisation somehow needs to get into play.
Of course, I guess that’s the problem. The debate on health care isn’t a debate on health care, it’s a debate on the issues that the special interests regarding health care want to bring up. Everyone brings a bias into this debate, and because the issue is so huge it becomes a purely political matter. Nobody is interested in finding the problem. They already think they have the solution.
I remember you writing about how this forum is supposed to be a place to put in radical ideas that might save our lazy asses. I’m not sure whether you mean radical ideas or radical ideas (TM, copyright libertarian party), but to me that article’s ideas are radical, defensible, and not getting nearly enough attention.
PL: I read that article at the gym a while back and found it interesting, but hardly conclusive. It’s nowhere near the final answer to the question, Why have costs ballooned?
The piece is simplistic and fails to look at why docs act in the economic fashion it suggests (not surprising, as the NYer’s almost as slanted as VF in its approach to these issues). Docs have to make up for lost margins taken by insurers, their own liability insurers and the tort pirates.
Docs deserve to make a half million or more a year. I want the guy following my health to be fattened, wealthy and undeterred by business issues, so he concentrates on me. The cure is to cut out all of the actors eating away at the docs’ margins and take the money they’d receive and give to docs, so docs could make a fat living doing what they do, as opposed to having to play real estate developer, book keeper, accountant and regulatory lawyer on the side to maximize their take home.
Left leaners love to talk about how a society is measured by the way it treats its weakest. A society is better measured by how it treats its most important, most essential. I can’t think of any class of professional more important or essential than doctors, and we’ve been treating them like dogshit for the last two decades. They ought to strike and teach us all a lesson.
To: EC
There is no transparency in health care because the whole business is as clear as mud. It is more complicated than the Space Shuttle, and more mysterious than Stonehenge.
You asked a simple question that any provider of a good or service should be able to answer, namely “How much does this widget cost?” In health care, the answer is “Well…that depends.” Here is a hip pocket, wayyyyy oversimplified answer:
Everything in medicine is dependant on CPT and ICD-9 codes. There are codes for everyfuckingthing. There is a CPT code for a nurse wiping your ass, and ICD-9 codes for spacecraft accidents (Fact! Look up ICD-9 code E845.0 if you’re bored). Different insurers, groups within insurers, and government entitlement programs have decided they will pay varying amounts for the same codes. They also offer different “discounts” to their patients depending on what group of doctors the patient sees, and what circumstance the patient is in when the service is rendered. An emergent head CT (Cat Scan) for a patient with Medicare Advantage will be reimbursed at rate X. It’s Rate Y if the CT scanner is in an outpatient facility, and Blue Cross will pay Rate Z, but only if the patient goes to Hospital A. It’s like that for every single service you can get, from a tetanus shot to an emergent thoracotomy and an hour long resuscitation attempt including complete cranial-rectal inversion.
It is literally impossible for the doctor to know what the final cost for a procedure will net him. There is a whole profession dedicated to figuring out who to bill and what to collect – medical billers and coders. You can go to college and get an Associate’s Degree in this shit.
Who sets the prices, you ask? Near as I can figure it, the easiest answer is lobbyists and Uncle Sam. Different medical specialties have lobbyists, AARP has lobbyists, patient groups have lobbyists, etc. They all smoke pole at the Centers for Medicare and Medicaid (CMS). CMS factors in the lobbyist’s requests, then figures out how much money they have, then assigns a price. The private insurers take their cues from CMS, and typically offer a bit more for stuff. If the doc wants to participate in the program (i.e. accept an insurance or entitlement program) they have to accept the negotiated reimbursement. The price is not always coupled with how much skill, equipment, or expertise it takes to perform the task. The government has the hospitals by the balls, since most of the medical care (money made) involves old people, and old people have Medicare. It is impossible to operate a full service hospital without accepting Medicare – even Kaiser takes it, at least in my area. Thus, the government can set conditions for participating in the program, like the aforementioned EMTALA. Private insurance companies can set conditions like following JCHACO guidelines on so called “never events”, but their hand isn’t so heavy. If an insurance company gets to be a pain in the ass, the doc can (technically) opt out of their network. Hospitals can technically opt out of CMS, but in practice they’d go bankrupt.
Holy shit – I know that is over-simplified because I left out an alphabet soup of acronyms. Like PL said earlier, this goat rodeo is leading to many docs moving to concierge style practices. Basically, they negotiate with their patients for payment. Docs are free to charge what they’re worth, and the patients have some skin in the game.
As long as I’m oversimplifying, I’ll take a stab at what our problem is in health care: Middlemen. The doctors are dependant on the middlemen to get paid, and the patients are divorced from what their care actually costs. As a patient, why would you settle for Doctor Family Medicine when you can go see Dr. Super Endocrinologist for your problem? The only difference for you is a $20 vs $40 co-pay. Doctor FM has some disincentives for treating you, as well. Dr. FM might get paid around $50 from Medicare, $60 from BCBS, or $35 from Medicaid to see you. Since the reimbursement is so low, he’s got to burn through 30 patients a day to keep the lights on and the nurses paid. He doesn’t have time to research the latest treatment modalities and do the heavy thinking. Plus, if something goes wrong, he’ll be up on the witness stand answering all kinds of awkward questions like “Why didn’t you refer this patient to the appropriate specialist sooner?” The specialists are out there, worrying about how they’ll pay the mortgage on their specialty equipment, and the debt incurred in the years of extra training he needed.
Since the patient doesn’t care what things cost, they demand/expect the absolute gold standard of care, every time. If Little Billy fell on the playground and has a bruise on his noggin, Mom demands a head CT. After all, she heard what happened to Natasha Richardson! The lawyers are fuelling this, driving the so called Standard of Care asymptotically towards perfection. If the doc misses a one in a million diagnosis because he didn’t order a test, the lawyers ask more awkward questions. “Why didn’t you order a CT, doctor? Little Billy is a vegetable now, and you had a CT machine not one hundred feet from him the whole time he was in the ER!” Plus, the docs really don’t want Billy to be a veggie. Since no one is putting the brakes on, they order a $1,500 test (among others) to rule out that one-in-a-million brain bleed. Everybody’s happy, and your taxes/premiums go up and up and up.
Okay, you ask – why not get rid of fee-for-service? Pay everybody a salary. Level the field. This is a bad idea in the same way communism is a bad idea. What incentive do the docs have to see more patients? Why should they stay late? Why pick up the next chart? I work in a teaching hospital where the resident physicians are salaried ( a first year resident makes about $40,000/year, BTW). They have no real incentive to accept patients onto their service. The Internal Medicine guys are getting paid the same to take it easy carrying five patients or busting their ass with twenty. The surgery guys get paid the same if they do peri-operative care (before, during, and after the surgery) or they just consult/follow on a case (do the surgery and leave peri to someone else).
Let me tell you – sometimes it is a cast iron bitch to get a patient out of the ER and up to a floor. If you want a bigger example, go to a VA hospital. Try and get a test ordered after 4:30 pm. After you’re done tearing your hair out, you’ll recognize that fee-for-service has some benefits to the patient.
If PL doesn’t mind, I’ll blather on endlessly about this stuff.
Fine. Doctor’s should be wealthy, and it shouldn’t be like Germany where doctors make 70k, but at the very least they should be wealthy for being wealthy. Quite frankly, tort is most likely irrelevant because, as was noted in the article, there are extremely stringent tort laws in Texas and McAllen’s costs are still ridiculous. As for the other two issues, under a single payer the government could start doing things like rewarding the doctor for having healthy patients. The issue is that in Europe, there are giant entities worried about keeping the people healthy. In the US, there are doctors worried about making money.
Of course, Obama’s plan is just going to make things worse in this regard by opening up a larger government money bag right under doctors’ noses, so the costs will just go up and another panic will happen if this even passes. Oh well. Thought the guy would have a spine and focus on using his oratory to push the things he talked about rather than using it to set up his own re-election. Guess this is what I get for being optimistic. (Not that I’m mad, of course. If McCain won office we’d either be at war with Iran or wouldn’t have passed any stimulus at all.)
PL: It’s not Obama’s fault the plans he offered in the run up are not coming through as promised. The economic realities don’t allow what he promised and, to be honest, a lot of his followers expected some pretty exceptional stuff and were a bit deluded about how the process works. Politicians lie to get elected. He’s been more honest and pragmatic than most, but he had to do what he had to do to get elected. Our public wouldn’t elect an entirely honest candidate.
I have one more thing I’d like to bring up.
People who say health care is a right are fundamentally misunderstanding what rights are. Rights are limitations on government power. You have the right to bear arms, the right to free speech, the right not to incriminate yourself. None of those things obligate anyone to give you anything.
I believe those of you who say health care is a right are misusing the term. You could call it an entitlement, or a moral obligation, or just a heck of a nice thing to do for a guy.
PL: Absolutely. And that’s the real nut of the debate here. We’ve been perverting the intent of the Constitution’s negative rights in favor of public policies that smooth out some of the meaner effects of Capitalism for years. There are sound arguments for that, but where does it go too far? I say this redistributive “reform” is too much.
The article was fantastic and the commentary even better. I’m afraid I fall into that twenty-something group that is ignorant of much more than we are willing to admit. I think the main problem it has to do with is that finding reasonable places to get unbiased news is a bit difficult. The general news is usually filled with murders/kidnappings/rapists/etc. that we just couldn’t care less. At least at this point I have realized the ignorance is harmful and that I need to start caring again.
Also it was very refreshing to read from PL and EC about ideas that are very similar to my own but much better and more mind consuming. I tend to agree that the government continues to feed on a lot of people’s sense of entitlement that does nothing to help better our country. Like someone already said, once you give it to the public, you aren’t going to be able to take it away. It’s a disturbing trend I see among a lot of people my age who see no problem with giving more money to those who don’t care to work hard for it. It seems to me that our general disconnect with politics allows for a lot of people to believe that the money is free and it’s not going to hurt our bottom line.
I have a hard time with universal health care reform due to several issues. I believe that by forcing us into a system where everyone receives equal care, with no regard for the amount paid in, will only cause the level of quality that we currently have to go right into the dumps. ER lines are long now, and I completely expect them to become completely unbearable if everyone felt that they could go for whatever reason and not pay. Not to mention I have a hard time giving anything to anyone who hasn’t worked hard for it. That isn’t a popular way to look at things, but its the way I feel. I realize there are always exceptions, and I realize you will have to take account for those, but we need to stop giving everyone the we’re all equal routine. We’re not, and that’s what makes us great.
PL: The American Dream is you being left to succeed or fail on your own – nothing more, nothing less. The station you’re born at is either your advantage or disadvantage. Don’t like it? Find a way to rise above it. Hopefully you’ll succeed, but there’s also a good chance you’ll fail. If you do, it’s your fault. One way or another, you put yourself in the situation you’re in. There may have been other actors in the process, but ultimately, the fault, or credit for success, lies with you. Not just your hard work or lack thereof, but the decisions you made along the way.
Losers in the game bitch about how the system’s rigged against them. If you’re smart enough to spot how it’s being rigged, you’re smart enough to profit from the rigging. If not, shame on you.
I have been holding this in for several months, and I just have to say it:
If language is at least one of the factors that governs our reality, that is we make sense of phenomena by using language to describe it, and language is always evolving to meet the needs of a people in a moment then how the fuck am I supposed to take someone who identifies himself as a teabagger seriously (unless of course, this man were to be describing a sexual proclivity, in which case, God bless ‘em)? Sweet Jesus, it’s like a massive section of the population suddenly turned into Tobias Funke and decided to be “analrapists.” It’s not that I don’t see there point, or that I don’t want vigorous, informed debate. I desperately want those things. Do I want old, tenured conservatives and trustfund douchebags vigorously teabagging? Well, now that I say it aloud, I guess I would watch that if it was posted on the net. Sorry for the rant – I just wish people would give enough of a shit to take the time to craft a response to the prevailing winds if they have a disagreement and to really think about what they want and the best way to say it. It’s like James Carville said: do I think that transgendered transexual satan worshippers should be allowed to adopt children? Yes. Do I think that should be the centerpiece of the left’s response to what seems to be conservative tide, advocated and promoted in prime time? No.
PL: Tobias Funke… Damn that’s a great reference. When are they going to make the fucking movie of that series?
Language is limited, dude. Some people just can’t say what they mean. Exhibit A – the town hall screamers. Somewhere in there’s a point. The problem is, they lack the powers of articulation to cough it out coherently. So instead they get mad and replace what ought to be calm, concise analysis with volume and vitriol.
Tremble The Devil, you know I love you…but…you fundamentally misunderstand what (most) doctor’s relationship with money is.
Look at the opportunity cost of becoming a physician. They must do ridiculously well in college. They must jump through an unbelievable amount of hoops to get into medical school. In medical school, they spend two years studying their asses off, and a further two years drinking from the firehose of knowledge in their clinical rotations. During this time, they accumulate six figures of debt. Then the abuse really starts – 80 hour work weeks for about $40,000 per year. Even the very shortest residency is three years of this, and there are a few residencies that last 11 (eleven!!!) years. After that is the holy grail, the end of the tunnel – board certification. By this time, our young, bright eyed idealist is 30, with nothing in the bank and $200,000 of debt. After all that, a beginning Family Medicine doctor can expect to make $130,000 per year. In ten years of private practice, the doc can earn enough to be comfortable. I know a shitload of docs, and none of them are wealthy. They have nice houses and might drive nice cars, but in today’s system, the upper middle class is where 97% of docs end up.
If you rolled that salary back to 70k/year, I’m sure you’d get a few true believers, but I’ll bet many pre-meds would switch to Engineering or Business. Don’t fall into the trap of taking the docs dedication, sacrifice, brain power, and tremendous powers of delayed gratification for granted. More and more slots for generalist physicians go unfilled every year, lending truth to what I’m saying.
Regarding malpractice reform:
It it something that needs to happen, but it will not contribute significant savings to health care for a generation or two. The fear of lawsuits is too ingrained in the culture of medicine. If we implemented a sane malpractice system tomorrow, we’d need physicians to practice under it for 10 years before they allowed it to influence the way they practice. Then, those physicians would be able to train the next generation of physicians to practice in a more fiscally aware manner.
PL: That and the tort lawyers own the Democratic Party. Trust me. I’ve seen that firsthand. Bought and paid for years ago. Notice how gingerly Obama danced around the tort reform issue. He knows tort reform would be a plank of any real health care reform, but he’d be damned to say it out loud. The task of shoving that down the throat of the tort lawyers was going to have to be outsourced, spread around Congress and ultimately blamed on Republicans.
But it will come. In a future of fading margins, the “lottery” system that encourages thousands of shysters to fire up frivolous strike suits a year using a “one out of three settles for good money” formula to the detriment of hospitals, the court system and honest personal injury lawyers who find themselves maligned for the sins of their scumbag colleagues will need to be curbed.