Tuesday, May 15, 2012

"War on Budget" Logic Explains Things

I've been talking for a while now about what I see as a GOP "War on Budgeting," which basically means that (many) Republicans reject the entire notion that spending and revenues have anything to do with each other. When those Republicans use the term "deficit," they're not talking about federal government revenues minus federal government spending; they're talking, usually, about spending they don't like.

If you use this explanation as a secret decoder ring, it makes lots of otherwise goofy statements far more understandable. Two examples already today.

First, Suzy Khimm tweets:
Not sure why so many in Washington believe "short-term stimulus, long-term deficit reduction" is THE BIGGEST OXYMORON IN THE WORLD.
This confuses Khimm because she's thinking in terms of regular deficit reduction, in which the goal is to minimize long-term federal revenues minus federal spending. But if the goal is actually to reduce any spending you don't want, then spending lots of money on stimulus is, by definition, bad for the deficit, full stop, end of story, doesn't matter what happens down the road. No, really, that's it. What matters is spending money you shouldn't spend. There's no "how to pay for it" in this way of thinking (which is why House Republicans get rid of PAYGO rules every time they take the majority). There's no long-term. It's just about spending money that you shouldn't, in their view, spend. That's a deficit violation. You can't make that up in the future, because you can't unspend what's already spent.

Second, Jonathan Chait catches a Andrew Ferguson claim -- it's actually an oft-repeated claim by Republicans -- that ACA will certainly cost a lot of money and therefore increase the deficit. Chait is not confused, because he understands the GOP war on budgeting; as he puts it:
[W]hat Ferguson is defending is the supposition that increasing the deficit is an inherent feature of any universal coverage scheme. This obviously is not the case, but his offhand statement is telling. They may debate over the particulars, but the particulars don’t ultimately matter. Conservatives just don’t want to lay out the resources to provide universal coverage. 
That is: what Ferguson calls "increasing the deficit" simply means spending money on stuff Ferguson doesn't like.

This works on the tax side, too -- yes, Republicans have a whole song-and-dance about supply side effects and cutting taxes to raise revenues, but when it comes right down to it they don't believe that the Bush or Reagan tax cuts increased the deficit because that's not what "the deficit" means to them.

There are some Republicans who actually talk about the real, revenues minus spending, deficit (I think Tom Coburn is one), but for the most part they really don't.


  1. I don't think you can possibly make this point often enough. Nothing is more annoying than arguing with republicans (or libertarians) about the deficit and they say "the government doesn't have a revenue problem, it has a spending problem." As if that is just accepted fact, ignoring the Bush tax cuts and all. And these are smart people (supposedly scientists, which makes me wonder about their data analysis skills...). If you have any suggestions as to how to get through to them, I'm all ears.

  2. fwiw, the Chait/Ferguson/ACA discussion is an exquisite illustration of why conservatives distrust liberals on spending-related matters.

    Chait pulls out a blockquote of Ferguson's questioning the validity of the ACA's budget-balancing projections. Chait infers from this that Ferguson has an instinctive distrust of universal health plans; indeed, Chait sniffs that Ferguson apparently thinks that universal coverage inherently increases deficits.

    If you read Ferguson's column, you might wonder where Chait drew that conclusion. You might have noticed that Ferguson's very next sentence, after Chait's blockquote (but...interestingly...not included by Chait), explains exactly why the ACA, in particular, will explode the deficit:

    The act redirects vast sums away from Medicare, which should require cuts in service.

    Ferguson doesn't say it explicitly, but I will: the powerful senior lobby won't accept that, so that's gonna be a budget buster not in the CBO forecast. Ferguson goes on to note that Palin's death panels, currently residing in your Big Health Insurance, will take up residence in the government plan, to keep the thing deficit neutral. Ferguson also doesn't say it, but like the Medicare shifts, you won't like that either, so more deficit explosion.

    And on and on. What's truly disturbing about this conversation, and the zeitgeist: though I think Jonathan Chait is a really bright guy, I fear he has no idea what Andrew Ferguson is talking about, and rather than try to figure it out, he fell back to the tried-and-true oh-those-damn-conservatives-never-make-any-sense.

    We live in a scary time.

    1. CSH,

      So this sentence, "The act redirects vast sums away from Medicare, which should require cuts in service," explains how the ACA explodes the deficit?

      The act eliminated Medicare Advantage, an inefficient boondoggle that transferred Medicare funds to insurance companies. They were vasty sums, indeed, and they weren't providing services to seniors. So those funds could be cut without reducing services.

    2. Ah, but CSH, now you get to the rub of one of the things that liberals find annoying about the whole conversation. You argue that seniors won't accept Medicare cuts, so the ACA will end up costing more than it does as written. I don't disagree. However, what frustrates liberals is that such points against tax cuts, war funding, etc., (aka, the spending we liberals don't like) also makes similar logical...ellipses, shall we say. The tax cuts are given 10 year sunset totals, when a more realistic number is the % hit to federal revenues (because, as we saw in 2010, tax cuts would be extended by the powerful, well, everybody lobby). Bush's Iraq and Afghanistan war budgets were handled as EMERGENCY spending (nevermind the whole "Iraq's oil will pay for the war without a problem") But, this isn't to trash you (and I've never known you to engage in such chicanery on this blog).

      (Warning: possible false equivalence follows) Rather, both sides would like to have the other accept their "dynamic" scoring. Tax cuts, if they stimulate the economy, would end up yielding federal revenues higher than a straight "10% cut in rates = 10% cut in revenues" assumption would hold. But, liberals are frustrated that the significant cost savings of pushing care out of emergency rooms and into doctor's offices is rarely, if ever, acknowledged on the other side. It's particularly vexing, since it was that side's idea to begin with. From my seat on the left, I think our dynamic argument is better than yours is. (If I didn't, I should start sitting on the right!)

    3. The act eliminated Medicare Advantage

      Since you bring it up, the particulars of said "elimination" are, again, a great illustration of Ferguson's point.

    4. Matt, thanks for the comment, I don't mean anything I write here in the moral equivalence sense; I fully detest your cited examples of Republican off-balance sheet finance too.

      Here's the deal: in my imaginary alternate universe, liberals would have pushed the ACA while simultaneously acknowledging that it was going to send the US through choppy waters. Acknowledging that Ferguson's argument has quite a bit of face validity (its hard to imagine extending the world's most expensive health care system to 43 million more people without making it more expensive still). The cost explosion may not occur, of course, perhaps your cited shift of care and others like it will provide enough offsets.

      The thing is, we both know Ferguson's concern is quite plausible. We also know that any fool can cook up a spreadsheet saying Ferguson's worry won't happen; pretty obviously, Ferguson is talking about the real world, not spreadsheet world.

      Then a conservative reads someone like Chait, obviously an intelligent guy, dismiss Ferguson out of hand with a throwaway "it is possible that (the CBO's) projections won't prove correct" (with an obvious sarcastic condescension in italicizing 'possible' - do liberals know the magical powers of spreadsheets, which conservatives have yet to discover?) That's kind of maddening on our side of the aisle, because it kind of suggests that a guy like Chait hasn't really thought about the ACA in the real world, he's pretty much just looked at some spreadsheets and satisfied himself with that.

    5. CSH, while we're adding next sentences, let's add the next one after that: "Palin’s 'death panel' was a bumper-sticker summary of a rational expectation—that the act will transfer the unavoidable rationing of health care from insurance companies, where most of it rests now, to the government, which will be forced to bureaucratically reshuffle the vast sums spent on end-of-life care."

      That's a defense? That it's better if rationing is done by insurance companies, which answer to stockholders, than by public agencies that politicians could catch a lot of shite for allowing to spin out of control?

      Also, Palin didn't just boil down a generalized fear into a bumper sticker. I'll grant that maybe she was doing that too, but the debate on '09 was over a specific provision in the ACA that involved encouraging people (IIRC) to make their own plans for late-stage end-of-life treatment, instead of letting the logic of a big, impersonal system take over at that point. In other words, she was defending something more like the Great Society approach against the good conservative principle of individual rights and responsibility. So Ferguson's effort to get the words "Palin" and "rational" in the same clause, while heroic, fails.

      Anyway, even factoring in the various further levels of inference you're suggesting (seniors will never stand for it, therefore the true costs will be higher than projected, etc.), Chait's point, and JB's, still holds: Nothing about any health-care plan, or any other government proposal that costs a fraction of annual GDP, inherently increases any "deficit." If a wealthy nation decides to pay for univesal health care, it can do that. Conservatives are making a moral / political argument about national priorities that they're unwilling to state openly (i.e. people are not entitled to health care), so they disguise it under green eyeshades.

    6. Jeff, two things:

      First: Chait claims: what Ferguson is defending is the supposition that increasing the deficit is an inherent feature of any universal coverage scheme. Since you read Ferguson's column, you're surely aware that Chait propped up an egregious straw man here; Ferguson makes no such claim, he rather asserts that specific characteristics of the ACA combined with characteristics of the US polity will explode the deficit. Your point about a wealthy nation having the capacity to offer universal care is happily conceded, though it is tangential to the discussion at hand.

      Second, re: which death panels one would prefer. Obviously, neither. Not sure I agree that the government death panel would be better. As you noted, Big Insurance's death panel is beholden to payout ratios that deliver profits to the rentier class that owns the stock.

      However, the ACA death panel is going to be beholden to whichever whiny party in Congress is pushing the PAYGO policy du jour. On the budget side, its probably a wash.

      The difference is: if Big Insurance's death panel gets out of hand, I can take my business elsewhere. If the ACA's gets out of hand, you'll still insist its all for the best, and anyway its law, so what recourse do I have?

    7. CSH, if most people could realistically take their health-insurance business elsewhere, we'd have been having a whole different debate these last few years, and the pressure for comprehensive reform would never have risen high enough to produce an ACA. The choice is ultimately between the appalling oligopoly we've got now -- which, remember, was dumping people off policies and making them uninsurable more or less at will -- and some public authority that's at least theoretically accountable to the people (i.e. subject to political pressures). I grant you that the latter is also bound to be imperfect, and the price of keeping it usefully accountable will be eternal vigilance.

      And, in return for your happy concession, I will happily concede that Chait may have misrepresented Ferguson (whose piece isn't about health care or even budgeting anyway). But the general point, as amply documented on this very blog, seems hard to deny: the word "deficit" has come to mean something different in GOP rhetoric than its dictionary definition. Chait -- not just here, but over the course of many recent articles and blog posts -- is challenging his opponents to come out and say what they apparently feel: that if access to some primary goods, like health care and education, is wildly unequal, that's not a sign that something's wrong, it's a sign that the system is basically working -- giving people (at both ends) their just deserts. I agree with Chait that we could have a more productive political conversation if ideas like those were openly advocated instead of hidden behind pseudo-budget-talk.

    8. CSH,

      Yes, it would have been nice to have more honesty from all sides in the healthcare debate. The Democrats should have been more open about costs, while Republicans should have been more honest about the nature and extent of the problem. It would be nice if people could be so honest even now. But, I fear it is useless to expect such.

      Now, why is it useless to expect such? Here I think Chait is right, although arguably one-sided. More especially I think Bernstein is right. Everyone talks in terms of numbers and budgets, but when you get right down to it, nobody really much cares. Liberals and Conservatives are much more concerned with their visions of the country. The budget is a servant and tool of those visions, and neither side much cares about it as a primary issue in its own right, despite what everyone says. Chait is probably quite right about Ferguson, and you are probably right about Chait. Call it sentimentality if you like, but it is human nature. In another thread you mentioned that conservatives often see liberals as enmeshed in sentimentality. Here in Chait we have evidence of the mirror phenomenon, also quite real. That is, liberals likewise see conservatives as self-indulgent and unrealistic, addicted to a deep sentimentality that is ultimately extremely dangerous.

      I sense you get quite frustrated in these discussions, as does Matt Jarvis. I think the basic problem is that you are both trying to engage these budgetary issues as if they are politically and culturally real. But they are not. Oh, the economics and finance are real enough. But in terms of politics and culture these things are simply illusions of strategic rhetoric and cultural evangelism. Trying to engage with them is like slashing at ghosts with a broadsword. It would be nice to have the kind of discussions around ACA or universal healthcare that you mention, but we won't, because ultimately nobody really cares -- or perhaps it's better to say that the primary motivations of both liberals and conservatives are someplace else. In that Chait may be an example of the phenomenon, but he is also probably correct.

    9. More great comments here; in particular Anastasios' above taps in to further thoughts I had tonight. It specifically points to why I support the ACA, though with gritted teeth.

      Teeth gritted because it seems increasingly obvious that the landed US HC gentry will have to sacrifice quality to get to universal coverage. All of Anastasios/Jeff's points well noted, please indulge me: going from "70% world class/30% third world" health care to "100% parity", where the parity is still world class, requires a 30% reduction in cost per capita.

      No doubt there are planned reductions in the ACA. But 30% is an awfully big number. If there really is that much low-hanging fruit in cost savings, here's the issue: why hasn't your Big Insurance company, motivated by greed, picked it? I know, they're dumb. But surely some greedy entity in the industry is smart, and your company, though dumb, is nevertheless ambitious, such that they will follow best practices until the low-hanging fruit becomes industry standard, no?

      The ACA, and its' descendents, will thus doubtlessly harm the interests of the landed HC gentry in the US. The left-leaning folk in the landed HC gentry don't want to hear that, as they also ideologically support universal care. To Anastasios' point, when Ferguson brings this up, its like shoving a stick in the left's eye, and there's not much answer, at least not much better one than 'you're a hater', which is pretty much where Chait went.

      So if the ACA will doubtlessly harm my interests, why do I (tepidly) support it? Because of Anastasios' other brilliant insight above. Its true that I perceive the left to be self-indulgently irresponsible a lot of the time, but health care is the right wing's turn at that plate, as Anastasios noted. To borrow Jeff's phrase, perhaps the ACA will act as a wrecking ball, specifically targeting that very American trait of not wanting anything taken from me.

      A very American trait. Left wing, right wing, whatever wing. I pin this on the left (because I roll that way), but the truth is that we're all guilty. Its what made us great. Its what threatens us going forward.

      So I do forecast some cognitive dissonance on the left where the ACA is concerned, as they come to realize that Ferguson's circle is not easily squared. We'll all share that pain. Probably a good thing. Of course, if my kid gets into a lengthy queue for a crucial treatment in the new world order, I reserve the right to rescind all of this.

      For now, I think its for the best, even though I hate it.

    10. PS - if I may end this with a bit of levity: so I was processing the complex emotions of supporting something that may hurt me personally, and imagining the specific scenario, my kid in a dangerous queue, and for some dumb reason my stream of consciousness processed

      Anastasios, I screamed in vain

      I didn't then ride a tank in the general's rank, though one might hope that would be next when the wrecking ball is done with health care.

    11. If there really is that much low-hanging fruit in cost savings, here's the issue: why hasn't your Big Insurance company, motivated by greed, picked it? I know, they're dumb.

      CSH, I'm not an expert on the details here, but I suspect the answer isn't that insurance companies are dumb (though maybe that too), but that the current system has all kinds of perverse incentives. For instance, preventive care obviously saves money over the long term, but it costs something to deliver it right now -- and if you're an insurance company executive, you're probably judged on how low you kept the outlays this quarter or this fiscal year, not how much lower it will be in 2015 or 2025 because of steps you were willing to spend something for today.

      I'm also still not sure how convincing I find your class-warfare model of health reform. I can't disprove it, but it just seems too pessimistic to me. The current system is such a mess, I'd be really surprised if there weren't a lot of win-win opportunities still available before we start talking about big reductions in anyone's care.

    12. CSH,

      I appreciate the compliments. And in return, if all conservatives and lean-conservatives were as willing as you to face unpleasant truths on this subject, we might have been spared a lot of pain the last few years. And yes, liberals should have been willing to own up to unpleasant truths about expense, as well. I will even go so far as to say that back in 1971 we would have been better off with someone like you, CSH, in the Senate than with Kennedy, as you would have seen the wisdom of cutting a deal with Richard Nixon on health care and, perhaps, we would be in a much better place (although I know Mr. Bernstein believes Nixon would have found a way to weasel out, but let's indulge a little harmless fantasy).

      I also like the Rolling Stones. If everyone could be in as good a shape as Mick Jagger (or even Keith Richards) at a similar age, that would be good for health care as well (although here ends the use of the Stones as models of responsible living).

    13. Jeff,

      I also hope we have some win-win scenarios that will mitigate the problems CSH forsees. But I really am afraid he is more right than wrong. Health care outlays are skewed drastically toward the end of life, which is to say they are drastically skewed toward outlays that benefit a growing, motivated, politically powerfully and historically privileged group -- i.e. elderly middle-class whites. Trying to deal with that will get very, very ugly.

      At one point in my checkered career I worked in a surgical unit. We had an 80ish year-old man come in suffering from arterial circulation problems in both legs. He also had hypertension and numerous other issues. His family pushed hard to do arterial surgery to save his legs. The Chief Resident on the service, not a very nice man I must admit but a very good doctor, very much recommended against it. Arterial surgery would by difficult, extremely expensive, and highly risky in a man his age, not to mention the recovery period would be prolonged and painful. He recommended instead that the patient and family be give a firm recommendation of bilateral below-the-knee amputation. That is quick, well tolerated, easy to care for afterwards, and cheap. Yes, the patient would be left in a wheel-chair, but frankly for an octogenerian with his issues a wheel-chair was probably appropriate, anyway.

      Well, the Chief Physician on the service balked. The man got his reconstructive surgery, complications set in requiring more surgery, infection began, more surgery occurred, and finally a myocardial infarction resulted in death some three weeks down the road. When it was all over the Chief Resident told me, "We have wasted hundreds of thousands of dollars on an old man who should have been in a wheel chair to start with, and who probably had only a few weeks to live whatever we did. But the Chief doesn't have the **** to be honest with the patient."

      Now, those kinds of problems are going to start multiplying rapidly whatever we do. Cost control, whether under ACA or some other system, is an absolute imperative just for financial survival, much less for expanded care. Under ACA, there is the added problem that all the pain and anger of those situations will increasingly be aimed at the government. In other words, somebody is going to have to grow some ****, and grow them fast.

    14. Anastasios, I take your point, and I don't mean to minimize what I agree are hard and very painful issues. But one reason I'm moderately optimistic about them is that there's a bunch of other countries that seem already to be dealing with them with reasonable success. You've got nationalized systems throughout the West that keep costs down, deliver universal care, and do not seem to be tense to the point of revolution over the level of care given to those of advanced age. So I figure if it can be done there, it can be done here.

      (Granted, they achieve this in the Netherlands by euthanizing everyone over age 60. I think that's what I heard on Fox News, right? Still.)

    15. Jeff,

      I agree that other countries have managed to handle this. However, I am not sure we can look to their experience as a guide, since they put their systems in place long ago, when medical intervention was more limited and less expensive to start with. In other words, they never built the kinds of expectations we must begin to disappoint. Mostly, other countries put national health systems in place in response to the disruptions of the 20th century. These systems showed quick success in delivering care in strained, impoverished, and sometimes chaotic circumstances. When Britain created the NHS, for example, it provided increased access to medical services for the average British citizen. As CSH points out, we face the probability of actually decreasing access for a rather large segment of the population. That is a very different challenge. The Dutch and British, from a strong beginning, have managed expectations, and thus managed to avoid situations like that I outlined above. A Dutch friend responded to that story by saying a Dutch physician would have simply explained that amputation was necessary and then scheduled the procedure. Most Dutch citizens would accept the decision, not happily, but as the way the system works -- it's just what their experience of medical care has led them to expect. Our elderly citizens expect something very different, and I fear they will not react well when faced with something different.

    16. OK, I see that, Anastasios. And yet, AARP supports the ACA. Not that they've always been right in the past, but I'm inclined to wait to start worrying about this until they do.

    17. I'm inclined to wait to start worrying about this until they do.

      Two quick thoughts, one local and one global:

      1) ACA closes the Part D doughnut hole, which is an immediate benefit to (65+) AARP constituents, separate from what Anastasios argued above.

      2) Anastasios points out that the rich/poor gap in US HC is an unusual, potentially problematic dynamic where the journey to universal HC is concerned. Anastasios didn't say so explicitly, but its probably obvious that those on the wrong side of the current US HC fence will benefit tremendously from the ACA.

      Who are the folks on the wrong side of the HC fence? The poor, of course. The young. The un- and underemployed. And one other: those with nasty preexisting conditions (not having access to large group plans). The preexisting group ought to include a large number of individuals age 50+ who are not yet eligible for Medicare.

      So the AARP's two main constituencies largely benefit from the ACA: the 65+ crowd gets a help with the cost of their prescription drugs, and the 50-65 crowd should be disproportionate beneficiaries of the coverage for pre-existing conditions.

      Without passing judgment on the AARP's endorsement, it seems pretty clear that group's motivation is entirely unrelated to the concern Anastasios raises above. As such, I'm not sure I'd trust their endorsement much to cover off against the warnings Anastasios raises.

    18. OK, good points. I guess I'll just say then that I hope you're both wrong.

    19. I hope you're both wrong.

      I do too.

    20. Although I hate to be a downer, note the Washington Post story this morning -- as of now, the Census Bureau reports that non-hispanic whites are a minority of babies born in the U.S. The nightmare of demography is upon us. With each passing day, more and more white baby boomers require expensive medical care. With each passing day, more and more young non-whites (counting hispanics as non-white for this purpose) enter the world with their access to medical care restricted by the enormous demands placed on the system (financially and in terms of other resources) at the opposite end of the age curve. The ACA may not be pretty and it may be very expensive, but one look at those numbers shows that, as CSH has said, the alternative is much, much uglier.

    21. You know, one of the drawbacks of conservative ideology sometimes is a failure to recognize that the other guy is as self-interested as I am. In this discussion, a conservative lucky enough to be on the right side of the US HC fence might hope that those on the wrong side accept their fate and not make any fuss.

      However, its always the case that the havenots are just as interested in their own well-being as the haves are in theirs. When havenots pile up on the wrong side of the fence (per the WaPo story referenced above), their self-interest means you're going to have to get rid of that fence.

      It may be painful, but you have to get rid of that fence.

    22. Well, CSH, here we are back to the issue of sentimentality. Liberal sentiment tends to build visions of a better world that could just be if only ... whatever. Conservative sentiment is more subtle, but just as dangerous. It tends to idealize existing arrangements, claim that they are inspired by God or the result of the genius of the founders or whatever, and to say that the trouble with people who complain is that they are deluded or impractical or unappreciative of the wonderful things they have. Both kinds of sentiment are very powerful, and can hold out against the pressure of reality for a very long time.

      Of course, the irony is that each fears and hates the other even while each feeds the other and sets the stage for its triumph. Thus the Ancien Regime led to the French Revolution while the Revolution of 1848 led to the rise of the Prussian Sonderweg.

      Smart statesmen understand this and, if the times allow (a big if) work to avoid this dreary cycle. Bismarck, no progressive he, wisely understood that progressives had to have a stake in the New Germany, and thus threw his weight behind very generous reforms in German society. FDR, no conservative he, likewise modeled his reforms on traditional forms of American economic activity that conservatives could understand and at least live with.

      Too bad we don't have that kind of wisdom today. I won't set off a storm on who is to blame, although I have strong opinions. Let's just say that I heartily agree with you, CSH, and wish that more conservatives had the wisdom of Eisenhower -- or even of Mitt Romney in his gubernatorial years. On the other hand, as I've said above, I wish Ted Kennedy had been wise enough to strike a deal with Richard Nixon on healthcare back in 1971. So from your lips to the Tea Party's ears.

      I strongly suspect that the ACA is going to fail, by the way. I just don't think SCOTUS will uphold. Pity. But in the end, as you point out, there will be no choice. It's just a matter of how ugly things get between now and then. Sigh. To quote Ben Franklin (how's that for being TP'esque?) "Experience is a hard master, but fools will have no other."

    23. It tends to ... say that the trouble with people who complain is that they are deluded or impractical or unappreciative of the wonderful things they have.

      Or, conservatives say that everyone should have the gumption, the grit, the get-up-and-go to be successful. I once heard a hilarious example of this on Thom Hartmann's radio show, from a conservative guest who argued that everyone could go and become a millionaire just as he himself had. (Thom failed to point out that if everyone were a millionaire, inflation would wipe out the value of being a millionaire, and we'd be right back where we started.)

      Put another way, it's fine to be concerned with providing for one's family and protecting one's children and so on. But you need social arrangements that are scaleable, i.e. that take account of the fact that everyone else has those impulses too. The reason we have modern liberalism isn't just that some people are sentimental, it's that the market failed to deliver such arrangements -- health care being merely one of the most egregious cases in point.

  3. Perhaps the essence of the American exceptionalism that we all hear so much about is that America is the only advanced economy that can't afford health care.

    1. We can afford universal health care, we conservatives and libertarians just do not want to pay for the lower order's health care with our hard-earned money. Sucessful people obtain better food, better clothing, bigger houses, and nicer vacations than unsuccessful people due to their financial success, and we see nothing wrong with successful people obtaining better health care as well.

    2. I don't doubt for a moment that "successful people" will continue to obtain better health care under ACA as well, just as they get better education today despite universal access.

    3. We can afford universal health care, but we'd rather spend the money on contracting defense corporations to reduce third-world countries to rubble.

      Fox News is turning conservatives into Dickensian caricatures.

    4. Can I be part of the "lower order?"

  4. Some libertarian surgeons have a growing practice based on upfront pricing and openness. Things look dark now, but we may yet have market medicine even with all of the cartels and govt obstacles:


    1. Open markets make most goods better and cheaper than govt monopolies. Medicine is on piously no exception.

    2. On piously? Learn how to operate a spell-checker and you'll be a more effective corporate tool.

      Some people want something for our society other than a more efficient exploitation of natural and human resources by corporations. But you'd have to have some moral intuitions for that to make any sense to you.

    3. Regardless of who's paying, lower market prices for goods and services are always better for everyone. I (like ~all libertarians) would like for the govt to end the tax-advantaged status that corporations have in buying medicine so that employees aren't stuck to their employers.

    4. Libertarianism is a parlor game which has nothing to do with political reality except as disinformation to keep Tea Party buffoons like yourself obediently voting to support the corporate-friendly status quo.

    5. I'm pretty sure that Tea Partiers are more averse to giving loan guarantees to corporations and bailing out rich bankers than is Opapa... I mean Obama.

    6. Right, which is why the Tea Party caucus in Congress is refusing campaign donations from Wall Street, and backing tough measures to prevent future bailouts! Or, uh..... oops:


    7. Jeff,

      You're right. All politicians are bought. They have the guns. They're worse at the national level where the most acomplished power brokers are to be found. Thanks for keeping me honest.


    8. backyard, sincere question: What do you see as the solution? I myself would like to see major reforms in campaign financing, starting with an end to the Supreme Court's doctrine that money is equivalent to speech. But I imagine libertarians would object to that. How else, then, can we get to a political system in which our representatives aren't "bought"?

    9. That's a goo-goo fantasy. After they leave "service" ex-govt types are paid off by corps and other interest groups via speaking engagements, jobs, junkets, and whatever else is dreamed up. While they're in office, their parties keep them in line with those interests through endless means. There is no hope

    10. No hope. OK, duly noted.

    11. Jeff,

      This is kind of obvious, right? Why would politicians choose to sacrifice their future sinecures and their current gerrymandered seats where they can lord it over the peons? To make some powerless goo-goos happy? To make some civic-minded capitalists happy? Bah ha ha!

    12. Coming in late, but calling a strike on perusha. Please cut out the personal insults, or I'll start zapping comments.

      (And thanks to backyardfoundry for not escalating).

  5. More stream of consciousness: trying to take my partisan hat off a moment, the structure of the health care debate (the partisans-talk-around-each-other one Anastasios mentioned) is pretty clearly tilted against the left. It seems possible to me that Obama Administration and influential liberal leaders realize this and have resisted promoting the ACA accordingly. If so, that's pretty smart on their part, and does inspire a bit of confidence.

    Ferguson mentioned the 43 million uninsured Americans. I understand there's another 43 million or so underinsured; that is, not having the benefit of world-class large group care. What we are discussing, then, is a transition from a system that provides expensive services to 210 million Americans (for, say, $100 total) to a system that will provide substantially similar services to 300 million people for $99 total. I think many folks would inherently recognize that the second system is going to be of a lower quality than the first. They may recognize that offsets or other minor differences between the system would mitigate against that effect (surely that's the case with the ACA). But its hard to imagine those offsets significantly negating such large differences.

    This is where the problem for the left comes in. The appropriate pushback against that conservative argument is: the alternative to the ACA is going to be worse, and life sucks, so get a helmet. If someone like Jonathan Chait makes that argument, he would doubtlessly receive a torrent of tweets and emails and comments from liberals saying "Wait...what? We need a helmet? I thought we could have our universal health insurance and not sacrifice anything!"

    So its not easy for liberals to parry the strike of the Ferguson monster without causing their own forces to melt away into the landscape. Better not to fight (or just dismiss Ferguson as a hater, which he probably is). This is a delicate business, but it seems like Team Obama is more or less handling it as well as they can.

    By the way, good call on the Glimmer Twins, Anastasios. Its hard to shake the impression that they will, eventually, cost the NHS a pretty penny, like the end-of-life care described in your post. But maybe not. Maybe they just go on forever, like non-biodegradable plastic. In any event, I did Sympathy for the Devil earlier, probably a better Hot Rocks-era song on health care for the Right (and the Limousine Left) is this.

    1. "I support the ACA, though with gritted teeth.

      I just hope the pressure eases before your teeth give out.

    2. Conservatism is a CultMay 16, 2012 at 12:23 PM

      "...the structure of the health care debate....is pretty clearly tilted against the left."
      The reason for this seems clear enough to me, CSH- conservatives, like Ferguson & Palin, tend to be deceitful people. Righties have made a bunch of sensationalistic claims about what ACA will produce- exploding deficits, long waiting times, rationing of care and totalitarian government ordering the elderly and disabled be put to death (a "rational expectation" according to Ferguson). To disprove these claims, one would have to prove a negative. Lefties, if they're being honest, can't say for sure how well ACA will work, but there aren't any compelling reasons (that I know of) to disbelieve the CBO's assessments.

    3. @Scott Monje:

      I'll get a bite splint. Unless those Obamabots running the ACA regime refuse to reimburse me, in which case I will go without, until I become a toothless* illustration of what a bunch of mean old meanies those folks are.

      (*double entendre entirely intentional)


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