Fear of government

Tuesday, August 18th, 2009 · 60 Comments »

crazy_ideas

In one of our comment threads about healthcare reform, Elise brought up an interesting issue:

Why do those on the left trust the government with this?

It’s not a question of trusting goverment. It’s a question of using government for what it’s best at, which is managing shared resources and doing things which require society’s collective action. Government is just society imposing its will as a group. Good for building roads (and pyramids and water irrigation channels and rockets to the moon), setting standards for food safety, pooling funds to pay for the indigent, making sure everyone gets healthcare. (That last thing is something we know from studying every other industrialized nation in the world; we don’t have to guess.)

These are the things for which private enterprise is not suitable or is inadequate.

A drawback in this country is that government-funded programs are susceptible to political attrition, particularly when Republicans get in office; but at least we have recourse in terms of voting. Which, I note, we don’t have with huge corporations. Huge corporations can only be controlled by government regulation, which in turn is only distantly controlled by voting. The more layers there are between the ballot box and the bottom line, the less control we have. (It’s at this point that hard-core libertarians, otherwise known as people who can read Atlas Shrugged without laughing, start insisting that huge corporations are in fact subject to the market. They will tell you, with a straight face, that if your health insurance won’t pay for your cancer treatment, all you have to do is take your business elsewhere, to one of the many other insurance companies eagerly competing for your cancer dollar. This is how you know libertarians live in Candyland.)

The strange thing to me is why people on the right, who think government can’t find its ass with both hands tied behind its back, nevertheless trust government with vast powers to spy, imprison, torture, and kill. Those are the things I don’t trust the government with. But rightwingers are typically unconcerned or even enthused by the prospect of the government spying, imprisoning, torturing, and killing. I don’t get it. Social Security and Medicare are a fate worse than death, but having the government torture you at Gitmo is just peachy?

The only way it makes sense is if people on the right are 100% convinced that they themselves will never be the ones spied on, imprisoned, tortured, or killed. But that requires believing that the government never makes mistakes, and of course rightwingers don’t believe that at all. They think government is incompetent. So why do they trust it with Torquemada-like powers? The logic escapes me.

Rightwingers sometimes say that they entrust military and police powers to the government because that’s the only true purpose of government, but that’s ideology talking, not fact. Historically, government was invented to manage internal resources: irrigation channels, grain surpluses, commodity exchanges. That was the case in both Mesopotamia and Peru, the two places in the world where government was invented from scratch. In both places, government got started before there were any other big polities to make war or treaties with. It was all about managing what was going on inside the society. (And besides, war doesn’t require government anyway. Bands of humans have been making war and peace with each other for as long as there have been humans.)

Of course, bureaucracy is always a risk with government, as it is with any big institution. So is abuse of power. In truth, everyone in America is afraid of government for one reason or another, and not without some grounds. Leftists like me worry about government’s capacity to turn into the Spanish Inquisition. Rightwingers worry about bureaucracy and taxes.

The main difference is in what we think government is good at. For people on the right, the list is pretty short: war, law, certain perks and protections for businesses. For people on the left, for whom government means society exerting its collective will, the list is much longer. Five thousand years of history shows that government is dreadful at some things (witness the planned economies of 20th century communism), but very good at others. Roads, sanitation, irrigation, poor relief, disease eradication, mass education, scientific exploration, social justice, to name a few. Anything that requires collective action and the deliberate, fair allocation of precious resources. Anything that can’t be handled adequately by market forces or individual initiative.

Like healthcare.

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60 Responses to “Fear of government”

  1. myiq2xu says:

    I don’t trust the government with anything. But I trust corporations even less.

    Both of them need to be watched closely.

  2. yttik says:

    Violet, I understand what you are saying, but those on the other side have valid points about fear of government. For example, cops, a lovely service until you encounter a misogynistic jerk and find yourself tasered on the side of the road. Or live in a country with one of the highest prison populations per capita. The poor, minorities, even Bob Dylan, don’t want to see the government increase their power over ordinary citizens, what power they have already, sucks.

    I’d love to see health care run by the government, but I remember public housing run by Obama in Chicago and the whole Tony Rezko fiasco. It’s all boarded up now. I know some of the poorest people in the country who live on Indian Reservations and depend on the government. They are trapped and any attempt to free themselves is met with the likes of Jack Abramoff and pay for play scams all the way up the ladder. I want public health care, but I fear it as much as I fear inner city public housing.

    It really isn’t quite as simple as the government loves us and will deliver us health care like ponies and rainbows from above. The ordinary human beings that profit off of privatized insurance and people’s lives are the same type of ordinary human beings that would be in control of health care for the government.People don’t magically change all their stripes simply because they leave the private sector. People are people. The problem is that old saying, you can’t fight city hall. People are genuinely concerned that they will have no power over the government should something go awry. No recourse.

    These concerns could be addressed successfully if Democrats, liberals, didn’t suffer from this idea that they are all that is right and wonderful with the world and should simply be blessed with whatever they ask for because they are just that awesome. Seriously, that is the attitude. Anyone who so much as questions them is a mutant, troglodyte, Republican, who hates poor people.

    Most liberal people hate Reagan’s words, what he called the scariest words in America, “I’m from the government and I’m here to help.” But those words really resonated with people for a reason.

  3. Alison says:

    Well ya know, I started mistrusting the government when I worked in New York City as a public school teacher. The way minority children are being taught and cared for in that city is criminal. Truly. It’s child abuse. It was absolutely shocking to see the hierarchy of government power in the little world of education and to see how it spat all over black children.

    I honestly believe there should be reparations given to the African American community in the form of private school education. Because the government has absolutely failed here, at least in New York city and many other major cities.

    So what is my point? I don’t know. I’m getting pretty close to supporting single payer even if it will have it’s own fucked up issues. But I think there’s a bit of candy land mentality going on in whomever trusts the government and I can see why people would think twice about extending their power. Also, there’s a difference between federal government programs, state government programs and local government programs. This has to be considered also. A lot of Repubs and Libertarians would prefer that government involvement be more local.

  4. Violet says:

    The ordinary human beings that profit off of privatized insurance and people’s lives are the same type of ordinary human beings that would be in control of health care for the government.People don’t magically change all their stripes simply because they leave the private sector. People are people.

    This is true, but you’re overlooking a key fact: the whole point of private insurance is to NOT pay people’s claims. Insurance companies are buying risk, and it’s in their interest to charge as much as possible (premiums) and pay out as little as possible. That is the fundamental structure of commercial insurance. No insurance company goes into business hoping they’ll get to pay for lots of burned-down houses and sunken ships. For a commercial insurance company, the ideal state of affairs is one in which they take in billions of dollars in premiums and never pay a single claim.

    That is why it is profoundly absurd to use commercial health insurance as a means of delivering healthcare.

    Medicare, on the other hand — or any other taxpayer-funded healthcare fund — exists to pay for people’s health care. That’s its purpose. There is no secret profit-driven bottom line, no overarching goal of not paying claims. The whole thing exists to pay for people’s healthcare.

  5. madaha says:

    yeah, where are the right wing saying “get your govmt out of my internet”????

  6. djmm says:

    Beautifully said, Violet. The people who run Medicare do not get bonuses for denying coverage.

    djmm

  7. myiq2xu says:

    How many health care claims are denied because “You’re not covered” rather than “You don’t need it?”

  8. Aspen says:

    I’m one of the people who, even as a strong proponent of single payer, I fall in to the (minority) group of people whose coverage will probably go down under the single payer plan compared to what it is now. I have a very comprehensive plan right now, and if I want, I can get the birth control pills that give me clear skin, lustrous hair, and white teeth, and get it for a couple of dollars copay. The insurance will cover it. If the US goes to single payer, I imagine it will be a bit more like managed care. They may choose the top 10 birth control pills, and say this is what we cover. You can choose one of these 10. We’re not going to cover 349 kinds of BCPs. So, if I want the kind of BCPs that have all the extra special luxury effects, I can pay for it out of pocket.
    That’s OK with me though. Because the plan I have now is wasteful. It’s not fair. It’s not sustainable.
    Yttik, I do see where you are coming from with your suspicion of the government. I have lefty friends who make similar points. That’s why a lot of lefties are anarchists. Actually, you sound to me like you might be a libertarian socialist? I don’t know if they exist in practice, but they do exist in ideology. I’ve read some of their stuff, and it is interesting.
    Right now, in the US, we are just swung so far to the side of huge corporations and a massive stratification of wealth. I can’t see how to get over that without having the government start to massively reign in the corporations. Which is going to be really hard, since the corporations and the wealthy own the damn govt. and the media. Ack, complaining about the media is so cliché, but it’s just awful. It’s not just that they lie, it’s that they totally mis-frame the issue, so the correct debate can’t even take place. Just like how they focus on Obamacare vs. the right wing non-plan, as if those were the two options, leaving single payer totally out of it.
    I do feel some promise when I find smart, thoughtful people online, though, like I do here.

  9. Hammer of the Dyke says:

    It’s not about trust. It’s not about economics (again, a complete pseudo-science). It’s about the amount people are willing to spend, in money or in time, to live in a decent, humane and civil society. Of course government programs need oversight! No one is arguing against that (although the lack of an educated electorate to do the oversight does pose the usual problem – see Madison and Jefferson on this issue). Ultimately, it comes down to a simple question: Am I my brother’s keeper? For many Americans, the answer is, “No!”

    I am not at all surprised about yttik’s account of public housing in Chicago or about Alison’s account of poor schools in black neighborhoods. But, this is not the fault of the “government,” in some distant, faraway place. You live in a representative democracy – you are the government. Are you willing to stand up to do what is right? Are you willing to help people unlike yourselves, even those who might offend your sensibilities, simply because it is the humane thing to do (as the god, so many claim to worship, did? Lepers, wasn’t it? And this, “Verily I say unto you, Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me?” – sorry, I am not a New Testament person, but most Americans are)? What I don’t understand is why there is a disconnect here. We are talking about a moral issue, an issue of beneficence – although I can understand why opponents never want to cast it this way. I think it all comes down to whether our societies think in terms of ‘me’ or of ‘us.’ Most of the world’s industrialized nations have managed to think as ‘us’ on healthcare. It is viewed as a public good that should be guaranteed, in spite of the fact that, as with any human endeavor, there will be failures.

  10. Violet says:

    I can get the birth control pills that give me clear skin, lustrous hair, and white teeth, and get it for a couple of dollars copay.

    There are birth control pills that give you lustrous hair and white teeth??? Jesus, where was this when I was on the pill?

  11. Aspen says:

    Sorry Violet, I was joking. I should have put a joke warning/indicator there.
    There is at least one BCP that claims to provide clear skin. But it apparently isn’t really any different than the others, it’s just marketed that way, and probably got FDA approval to be marketed as such.

  12. Ted Stryker says:

    Violet, you’ve got it exactly right: Health _insurance_ is not the appropriate vehicle to cover health care. Insurance is, by and large, to cover low risk events that have a large potential cost: Your car gets totalled by an un(der)-insured teenager, your house burns down, or your kid has leukemia.

    Furthermore, you neglect that insurance is a highly regulated industry today. If you’ve got problems with insurance, it doesn’t take a national political campaign to fix it — your insurance commissioner/board/whatever is part of your state government. They’re very close to you and can be turned out with a small, local grassroots campaign.

    Regarding #9, most of the world’s industrialized nations manage to think as ‘us’ on “loser pays” (and similar tort reforms) that are off the table in the current health care^H^H^H^Hinsurance reform cluster-screw. They also manage to think as ‘us’ when they suggest that 85 year old seniors with severe dementia should be in a hospice instead of receiving heroic measures. Those two “thinking as ‘us’” measures would save enough money that, at the very least, you could throw some more money at Medicaid to cover the ~ 9 million uninsured folks that _really_ need insurance and still remain deficit neutral.

  13. yttik says:

    “Medicare, on the other hand — or any other taxpayer-funded healthcare fund — exists to pay for people’s health care. That’s its purpose. There is no secret profit-driven bottom line…”

    Actually there is and Obama has made a mistake by discussing it so much. He just can’t seem to shut up about fraud and waste, kind of problematic when you’re allegedly trying to build trust in the integrity of Gov programs.

    Anyway, there are numerous for profit industries trying to scam for medicare dollars, both legally and illegally. Hospitals, suppliers, nursing homes, etc.

    I’m not using this as an argument against government run health care, I’m just wishing in the wind that Dems had grasped the importance of the argument and brought up all the things the gov does to protect medicare recipients and to protect medicare consumers.

    Multi-state Medicare Fraud Crackdown Focuses Attention on Recovery Payoffs to Defray Health Reform Costs
    http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/08-05-2009/0005072397&EDATE=

  14. RKMK says:

    If the US goes to single payer, I imagine it will be a bit more like managed care. They may choose the top 10 birth control pills, and say this is what we cover. You can choose one of these 10. We’re not going to cover 349 kinds of BCPs. So, if I want the kind of BCPs that have all the extra special luxury effects, I can pay for it out of pocket.

    I never know whether to laugh or cry when I watch Americans theorize what single payer looks like. Like, where do you come up with this kind of stuff? *rubs temples*

    For one thing, it would be the visit to the doctor to get the prescription that would be covered, not the drugs themselves. (For what it’s worth, it works like this in Ontario: I go to the doctor for free; the visit is covered by OHIP. Dr. prescribes me the birth control we both want me to have, and I go to the pharmacy to get the prescription filled. I submit the receipt to the drug plan I get through work, which only requires an official tracking number – one that comes on every pharmaceutical receipt – that proves the drugs were officially prescribed by a licensed MD. They don’t care what it is, who makes it, whatever. Without a drug plan, three months birth control goes for ~$30; with it, about $5.)

    For another, in what bright bippy blue world would American pharmaceutical companies let themselves get their bazillion products locked out? Never would happen, from what I gather from American politics.

    I just… I’ve seen a lot of lunacy over the last few years, but watching the American discussion over health care has been eye-opening to say the least. And frankly… I feel pity, more than anything else. The steady diet of fear propaganda that gets drummed into you clearly paralyzes you from realizing that you deserve so. much. more.

  15. Adrienne in CA says:

    Right now, in the US, we are just swung so far to the side of huge corporations and a massive stratification of wealth. I can’t see how to get over that without having the government start to massively reign in the corporations. Which is going to be really hard, since the corporations and the wealthy own the damn govt. and the media.

    After I finished Paul Krugman’s book, The Conscience of a Liberal, I felt like we were on the verge. He goes over the other points in our history when corporate control had run amok, the gap between the ultra rich and the rest of us was as huge as it is now, taxes were regressive, and major media of the day was the mouthpiece for the wealthy. But our underlying democratic foundation made these excesses unsustainable against the tide of public will that drove reform. Laws got passed and, long story short, a whole lot of Gilded Age mansions ended up as libraries and universities and museums. It’s been done before and it can be done again.

    OK, so they selected Obama, and there’s a slight wobble in the arc of history. But it’s still bending toward justice.

    If we can just outlast the bubbling methane, we’ve got a chance.

    *****A

  16. octogalore says:

    Nice takedown re the hypocrisy involved in viewing government differently when it suits ones self interest.

    The examples are overly simplified, though. For example, very few people who are economically conservative are Randians. Many feel government regulation and participation is a good thing, but that government monopolies aren’t. eg, very few people with top flight talent take jobs making significantly less than they otherwise could, especially with high debt loads. It’s a reasonable question why a top med student, six figures in debt, would opt to become a government employee.

    Similarly, many economic conservatives disagree strongly with Bush’s and other rightwingers’ foreign policies. That’s why many voted for Obama.

    djmm says:

    “Beautifully said, Violet. The people who run Medicare do not get bonuses for denying coverage.”

    Really? Government employees do get bonuses for meeting budget. How do you think they accomplish that?

  17. janicen says:

    Violet, I agree with you that it is in the insurance companies’ interest to charge more and pay out less and I will add that it is their fiduciary responsibility to their stockholders. Back in the day, Blue Cross Blue Shield plans were not-for-profit and therefore received tax benefits. In return for their special status, they had to be “insurers of last resort” and provide coverage for members (policy holders were called members) who would be denied coverage by commercial carriers. Back in the early nineties, BCBS plans began to restructure themselves into mutual insurance companies. This was the first step before they could go public and become publicly held corporations. As we all know, going public in the nineties meant huge windfalls for the executives. As well, they now had the ability to merge and make even more money by being acquired by bigger companies. The employees suffered, the policy holders suffered, but a few people got very rich. My point is that there are no longer any health insurance companies which retain not-for-profit status. They are all publicly held and therefore are legally bound to do whatever it takes to increase profits for their stockholders. It’s a formula for disaster. We cannot have people’s healthcare dependent upon companies whose primary responsibility is to increase profits rather than produce positive outcomes.

  18. Aspen says:

    Like I said, I’m for Single Payer. I wasn’t trying to argue against it. It sounded like you thought I was trying to trash single payer?
    I’ve had managed care plans in the past, and typically they have a formulary, that is a list of which prescription drugs they will cover. And usually within that list, there will be an associated copay; and it’s lower for generics than for brand names, and, there are some meds they won’t cover at all; meds that have been deemed are unnecessary. Since drug companies are known to push out new only slightly different versions of the same drug every other month in order to extend their patent, it makes sense to me that a managed care program might want to limit the number of the different drugs of the same type they would cover in order to save costs, and to provide a deterrent against the practice of pharmaceutical companies would otherwise continue to be driven to make copy-cat/me-too/piggy back expensive drugs that aren’t much different or better than the last one; they do this just to extend the patent so the insurance company (or I, if it’s not on my formulary) has to pay them more.
    The doctor can prescribe whatever she/he wants, but when I go to the pharmacy to get it filled, how much I pay for it will depend on my pharmacy coverage. If the med I was prescribed by my doctor is on my formulary, and is generic, I pay about 3$. If the med is on my pharmacy and it isn’t generic, I pay about 6$. If the med is not on my formulary at all, I’ll pay the market rate for the drug, which may be 40, 50, 100$ or more.
    I don’t think it would be too unreasonable for a single payer system to have a drug formulary. I think it would decrease waste and remove some of the motivation of pharmaceutical companies to make copy-cat me-too drugs.
    If there is a better way to do it that will be sustainable, I’m open to that. My main point was, I’m willing to have fewer options for myself in exchange for others who currently have no or few options.

  19. Aspen says:

    Sorry, my comment up there is addressed to RKMK.

  20. Violet says:

    Octogalore, are you actually asserting that the insurance industry business model — which depends upon minimizing claims, aka “losses” — is identical to a taxpayer-funded healthcare plan? I can’t believe that you are, since that is, frankly, nuts.

  21. Violet says:

    By the way, I perhaps should note that in one of my past lives, I used to work in the insurance industry. I’ve learned in the course of the healthcare debate that many people haven’t the faintest clue to how insurance is structured.

  22. Aspen says:

    Adrienne in CA, Thanks. I’ve been wanting to read that book. I need to check the library for that one.

  23. Violet says:

    Aspen, on the other thing: I think RKMK may have been taking issue with your assumption that single-payer would be like the managed care you describe. Why would it be? It wouldn’t if it were a true expanded Medicare for All.

    Of course, there’s no telling what kind of crap bill will actually get through Congress.

  24. Aspen says:

    V – I guess it was my way of responding to claims that everyone who is for single payer is deluded that it will be idyllic disneyland. And I wanted to say that I am an example of someone who is prepared that it may not be that — but — even in the less than ideal system, I am still for single payer. I am only trying to be realistic about the possibility that in order to make single payer truly affordable and sustainable, we may have to make some concessions, those of us who are used to getting whatever we want. I associated the type of concessions I am thinking as somewhat similar to managed care.
    It could be I’m playing devil’s advocate too much here.

  25. Violet says:

    No, I understand what you’re saying. Heavens, I don’t think single-payer would be perfect. Nothing is perfect. And everything has its share of crap.

    What I am sure of is that single-payer would be far better than what we have now.

    It’s like Churchill said about democracy: it’s the absolute worst form of government in the world, except for all the others.

  26. Adrienne in CA says:

    BTW, have folks here heard what Aussie journalist John Pilger has to say about Obama? I’d never heard of the guy before today. This clip nails it!

    http://www.youtube.com/watch?v=gfVULT8vdUk&feature=player_embedded

    *****A

  27. Adrienne in CA says:

    Pilger is no admirer of Hillary Clinton, alas.

    We talk about last November’s US Elections and the arrival of Barack Obama, but he sees scant difference between any of the candidates.

    “Had Bill Clinton not been around all those years ago and had John McCain not been in prison (as a shot down pilot in Vietnam), it would have been a perfect marriage between McCain and Hilary Clinton. They are two of a kind.”

    Drat! Is there no one who can offer principled opposition to Obama from the left that is not suffering from CDS? (Besides you, Violet)

    *****A

  28. sister of ye says:

    Well, I hope everyone who distrusts “the government” avoids publicly funded roads. I mean, if we can’t trust the government to do anything right, better avoid them.

    But “the government” doesn’t build the roads, you might say. That’s private workers paid by the government.

    Bingo! That’s what single payer would be. If we throw out Bush-era “reforms” that funneled public money thru private hands, we could have a decently run system.

    Contrary to popular belief, public workers don’t sleep all day on the job or indulge in other “wasteful” behavior. (At least no more than private workers.) And as Violet said, public workers can be held to greater accountability.

    For those who might point out, after my first example, that too many roads are filled with potholes, I say that’s because people are picky-ass cheap regarding up-front costs of projects that actually benefit them, while quietly acquiesing to trunkfuls of money thrown at the defense department in the name of “national security.”

    In other words, we’re paranoid and willing to get scammed to provide alleged protection against the slim risk of foreign terrorists. But if your problem is cancer or heart disease, your life is no longer worth protecting on the public dime and you’re on your own, jack.

  29. SweetSue says:

    As a child of the fifties and sixties, I remember getting a shot of the Salk polio vaccine and, later, taking the oral Sabin vaccine as did every other school age child and for free.
    The US government had bought enough of the vaccine and gave it away for free, and, voila, we live in a world without polio, that terrible scourge of childhood.
    Can you imagine if only the wealthy had been able to purchase these precious vaccines to immunize their children?

  30. SweetSue says:

    BTW, I want those damned lustrous hair, white teeth pills! Whaaaaa!!

  31. Hammer of the Dyke says:

    This sums it up as only the Austin Lounge Lizards can:

    http://www.youtube.com/watch?v=xNuCfD5bICQ

    http://www.youtube.com/watch?v=WgoB2h_Wkco&feature=related

  32. RKMK says:

    Aspen, on the other thing: I think RKMK may have been taking issue with your assumption that single-payer would be like the managed care you describe. Why would it be? It wouldn’t if it were a true expanded Medicare for All.

    This. I shouldn’t post when I’m half-asleep, I don’t communicate as clearly.

    Of course, there’s no telling what kind of crap bill will actually get through Congress.

    This is my caveat to my “don’t be scared of single payer!” rants. Countries have great single-payer systems, but also have a greater collective impulse to work co-operatively for the greater good with the aim of serving its citizenry, and I don’t think that impulse gets cultivated overmuch in the American political philosophy.

  33. RKMK says:

    And, clearly, I don’t tag well before my first coffee.

  34. quixote says:

    The problems of government control — Chicago housing, NY public schools, companies parasitizing Medicare, etc, etc, — are problems of corruption, not of government as such. Corruption happens in the private sector too. It’s not logical to compare state activity + corruption and private activity – corruption.

    Compare Medicare + scammers and Blue Cross + scammers. The only reason we hear less about the latter is because Blue Cross is not answerable to taxpayers. They just up the premium.

    I realize that corruption can be so endemic that it’s impossible to see a government without it.

    But that’s different from saying the government can’t do anything right. That’s saying we’ve moved so far toward a stereotypical banana republic that we don’t know how to climb out.

  35. octogalore says:

    Violet, re #20 — no, of course I’m not asserting they are identical. I am asserting that the hopey-changey assertion that government employees aren’t incentivized by their bosses to manage cost outlays is, frankly, nuts.

  36. Violet says:

    But no one suggested that, Octogalore. No one. Of course government employees may be incentivized to keep to their budget. Everyone usually is, in government as well as business. That is wholly different from a business model that is fundamentally built on not paying claims.

  37. octogalore says:

    I think the statement that “The people who run Medicare do not get bonuses for denying coverage” does suggest that there is no incentive for managing cost for the gov’t employee. However, I agree that the current employer-run system is in need of reform and that covering the uninsured is critical — I just don’t think single payer is the way to do it. I’m not defending the current system.

    The essential difference between healthcare and these other services (police, fire, etc.) is that those services don’t cost astronomical amounts of money. You don’t have to have constant research and innovation with police and fire depts. So over time, the costs are fairly constant. Healthcare requires constant research and innovation and new technology that is expensive. We can’t afford to have the govt pay for all this through taxes. Look at the incredible waste of money in military spending. Healthcare will become for liberals what military spending is for republicans — a place to throw more and more money. Plus, the federal govt doesn’t run the fire depts and police. Those are run by state govts. It would be a different story if they were all run by one central body.

  38. RKMK says:

    I’m pretty sure research and innovation is conducted by universities, pharmaceutical companies, etc, not your local GP. And I’m pretty sure insurance companies don’t fund them, and that’s the role a single-payer system would be taking over.

  39. Violet says:

    Octogalore, I think you don’t quite understand how insurance works. Healthcare insurance is not designed to pay for healthcare. It’s designed to collect premiums and NOT pay for healthcare, otherwise known as claims, otherwise known as losses. Every claim is a loss for the healthcare insurance company.

    Every commercial insurance company in the world is based on the same model: I’ll cover your risk, but I’m betting I won’t have to pay. And every insurance company is geared towards maximizing premiums and minimizing losses (claims).

    That’s the fundamental business model. It’s not a question of keeping to a budget, which is a bookkeeping task for any project, private or public. It’s the fundamental business model. It’s how profits are made.

    This is why it make no sense to use commercial insurance to pay for things everyone expects to happen and, indeed, wants to happen: trips the doctor, health care, medicine. Nor does it make sense to use commercial insurance to pay for things that everyone agrees must be covered as a human right: catastrophic medical care in the event of great illness.

    Commercial insurance is simply the wrong model for this. And that’s why we pay 30% more than we have to in this country: because we’re paying insurance company profits, plus the administrative overhead involved in the insurance companies frantically minimizing their losses. Losses to them, benefits to us. Fundamental disconnect.

    It is not true that healthcare is ridiculously expensive because of constant innovation, etc. That is a rightwing myth. France has the best healthcare in the world, and they pay half of what we do per capita.

    I strongly urge you to actually look at the studies that have been done of other industralized nations. Government-funded healthcare does not become a boondoggle; in fact it is vastly more efficient and all-encompassing than the American system, which is the worst in the industralized world.

    Even in the U.S. right now, we can compare Medicare and TriCare to the private insurance sector, and see how much more efficient it is. Medicare’s overhead is 3%, compared to 30% for private insurance.

    The cheapest, most effective way to cover healthcare is for everyone to chip in the amount required to a pool. The stupidest way to cover healthcare is to filter it through a 30% overhead racket like private health insurance, which denies coverage and claims and is out of reach of 47 million Americans.

    Our current system is costing us half a trillion dollars more than is necessary. That’s pure waste.

  40. Violet says:

    We can’t afford to have the govt pay for all this through taxes.

    If we had Medicare for All, the cost to each person would be significantly less than what we’re paying now. A small payroll tax, but no more private insurance premiums, co-pays, or deductibles.

    Also, what RKMK said. Insurance companies don’t pay for medical research, and neither would the government under single payer.

  41. octogalore says:

    Violet, I agree that there is a lot of waste in the insurance-based system; as I said above, I’m not defending the current system.

    I also don’t believe systems like the one discussed here
    are the solution.

    Medicare is going bankrupt (http://www.newsweek.com/id/199167), so I don’t see that as a great example, and also would agree with McArdle as to whether universal coverage is the solution to it: http://meganmcardle.theatlantic.com/archives/2009/05/medicare_is_going_to_bankrupt.php.

  42. slythwolf says:

    The way I look at it is, the only reason we as individuals have any interest in submitting to the rule of government is if that government does its goddamn job and makes sure we all have access to shelter, food, health care, and education. Those are the things that, really, if the government is going to be able to run, it needs all of us to have. Those are the reasons we as a species have for banding together in groups in the first place, and if I’m going to join a group large enough that it has a bunch of arbitrary rules and abstract bureaucratic bullshit to deal with, it had better provide those basic needs.

    Our government and our society is failing because it only provides those things to the people it has decided, based on bullshit criteria, “deserve” them.

  43. Violet says:

    Megan McArdle? Oh, lord. Okay, well, I don’t think there’s much to say then. McArdle is about one step above Pat Buchanan. If that’s what you’re basing your conclusions on, then you really are hard-core.

  44. octogalore says:

    I’m surprised, Violet. I cite to both left and right publications where I happen to agree with them. If you’re going to take one name and issue a blanket verdict on who and what I am, without any knowledge of my overall level of agreement with McArdle across the board, it’s a cheaper way out of a debate than I’ve ever seen you take in the past. I see no reason for this to devolve into ad homs.

  45. Violet says:

    No, I didn’t mean it that way, nor did I mean to be rude. I just meant that if McArdle makes sense to you on healthcare, then I think we are too far apart on that issue to make much headway with each other.

    But obviously we agree on many other issues.

    Also: ad hominem? I’m talking about libertarianism. I’m sure McArdle is a nice person, but I think her ideas are absurd.

  46. m Andrea says:

    That cartoon almost summed up the entire “debate” for me. Throw in another panel describing all the wacky fears which are being conflated, and it’s over.

    Logically, it is extremely inconsistent to assert, as a principle, the need for publicly funded anything while claiming that health care is magically exempt. Which is why they need either an actual REASON for their objection, or a whole lotta EXCUSES.

    Btw, where’s that big tent? Seems like most folks do agree that health coverage for all would be a net benefit to humans, and yet as each objection is deflected another rises to take it’s place — which indicates to a reasonable person that there is no actual REASON but merely fear or some other non-logical fweeling.

  47. octogalore says:

    Violet — appreciate that, and agree.

    By ad hom, I thought saying that because of her economic ideas she’s one step removed from Buchanan, who we all know stands for bigotry of all kinds, was an ad hom. I’m actually not a regular McArdle reader, but from what I’ve seen she seems moderate on social policy. I am well to the left of her in that regard, but I’d certainly not make any compare her to Buchanan. I may be wrong on this, but I think Buchanan’s more known for his (idiotic) social policies than his his economic positions.

  48. quixote says:

    I just cannot believe that on this planet, with plenty of countries providing universal health care, anyone can use the argument that “But we can’t afford it!”

    By the numbers, it costs half as much to insure everyone, as it does to use our current system. Half as much. This is not a guesstimate. This is based on the budgets of all the industrialized countries with universal health care. The spend about half as much.

    If you’re worried about Medicare running out of money, insist on universal health care. It will cost half as much. Half as much.

    (Am I feeling furstrated? Why, yes, I’m feeling frustrated. why do you ask?)

  49. quixote says:

    I should add that for about half the money, they’re getting better outcomes. Lower infant mortality. Lower maternal mortality. Greater longevity. Less disability and illness in old age. Etc. etc. etc.

    They are getting a better deal for half as much money.

  50. Violet says:

    Octogalore:

    My Buchanan reference wasn’t clear. I was in a hurry and trying to comfort my dog (we’re having a big thunderstorm here, and in fact the power went out at almost the same moment I posted that comment).

    Anyway, I have a personal mental class of “people who are famous political pundits despite saying crazy things.” It’s a scale actually, a spectrum. And what I’m measuring is not bigotry but what I consider intellectual absurdity. Ann Coulter is on the bottom. Pat Buchanan is further up. McArdle is a step above that: manages to give the impression of sounding reasonable despite writing nonsense.

    My impression of McArdle isn’t based on her social views (actually I’m not sure what those are), but on reading her columns, ostensibly about economic issues, and thinking, “wow, this person has no idea what she’s talking about!” To me, her ideas seem to be such a mishmash of wrong-headedness and misinformation that I don’t even know where to start.

    But you see, if she makes sense to you, then all this will be offensive. Hence my conclusion that there’s probably not much to be gained by even engaging on it.

  51. Violet says:

    This is not a guesstimate. This is based on the budgets of all the industrialized countries with universal health care. The spend about half as much.

    quixote, are you an American? If you are, then you know what I know, and what I felt like explaining to Hammer of the Dyke upthread: international comparisons don’t matter to most Americans. Exceptionalism is strong in this country. Most people cannot quite believe that anything learned in any other country really applies to America.

    It’s enormously frustrating, of course. But I don’t know any way around it. I think we may have to get further along in our descent from World Superpower. Kind of the way Britain had to stop being an empire before it could really deal emotionally and psychologically with being one of a number of small European countries.

    A friend of mine likes to cheer on the Chinese. Take our crown! she says. We’re ready for you to take over as the Evil Empire!

  52. Toonces says:

    What I don’t understand is the need to make everyone abide by these fears. If you don’t want to join the public option (if there were a real one), just don’t. Why the need to make sure no one else can?

  53. octogalore says:

    “But you see, if she makes sense to you, then all this will be offensive. Hence my conclusion that there’s probably not much to be gained by even engaging on it.”

    I agree.

    One caveat, though. I’ve cited stuff from communist websites, Paul Krugman, National Review, Huff Post, American Thinker, New Republic, socialist sites, all over the map. This has very little to do with my buy-in to the authors’ complete oeuvre, but more about my agreeing with them in the narrow instance of the cite.

    So a response here that “I disagree with McArdle on the specific issue here re medicare” seems like a fair argument. A response that “she’s unreasonable so if you cite her you must be too” doesn’t.

    That said, internet dynamics often result in dissent becoming disruptive, and that’s the last thing I’d want to risk with a blogger I so admire.

  54. The Racists are now “left of the left” Oxymoron (emphasis on ‘moron’) « The Confluence says:

    [...] is what is in store for us if we let the ‘left of the left’ spread its vicious propaganda of the efficiencies of government and economies of scale instead of individualized policies, lovingly customized for the special needs of each and every one [...]

  55. Hammer of the Dyke says:

    You’re very right that international comparisons are ineffective, but I think that those in favor of the public option need to seize the moral high ground. It is an issue of morality and, jumping Jehoshaphat, Americans are big on portraying themselves as the epitome of righteousness! We need a fire-breathing William Jennings Bryan to give us the “Cross of Misery,” or such like, speech. Bush was able to sell the public on a phony war by casting it in those terms (with a little “white man’s burden thrown in – you can’t go wrong with Kipling, either).

    For many of the Town Hall “protesters,” the issue is cast in moral and/or apocalyptic terms. Somehow, these individuals truly became convinced that first it’s healthcare, then they’re comin’ fer our guns (although I fail to see why the cast of Deliverance needs an armory). It is political theater, and we need to upstage them using their vocabulary to do it.

    This is kind of what I mean (and look at the venue):
    http://www.youtube.com/watch?v=4wxjl2ERhnI

  56. simply wondered says:

    ‘Kind of the way Britain had to stop being an empire before it could really deal emotionally and psychologically with being one of a number of small European countries.’

    lordy, vi – you mean we are gonna have to grapple with that one soon??? time to start swimming.

    and it seems the british right are breaking cover and admitting that a far cheaper form of healthcare than funding the nhs would be the traditional ‘piling the dead in the streets’ system. now THAT is one great leap forwards.

  57. Ted Stryker says:

    Regarding “Privatized Food Safety” present in the cartoon, I don’t suppose anyone here has ever heard of Underwriters Laboratories?

    http://en.wikipedia.org/wiki/Underwriters_Laboratories

    They are an NGO that certifies all manner of products present in your house today. They create ANSI standards for safety, which brings up another useful NGO.

    @39 — where does that $.5T number come from? If I use your 30% figure on total private spending, I get $360B. Actually, it should be $324B (30-3=27) Even that number is too high, as some of that $1.2T of private spending includes out-of-pocket costs and charitable organizations. If you’ve got a 27% overhead on using your debit card to cover a co-pay, well, you’re doing it wrong…

  58. Violet says:

    You’re actually asking if people have heard of UL?

    There are many third-party institutes and consortiums that work on standards, testing, etc. But of course their findings have zero force in law — except to the extent that city or state codes refer to these third-party standards as required. Which happens a lot in the U.S.

    Personally I think Consumer Reports is one of the best third-party groups; my parents have been CR subscribers since I was a kid.

    As for food safety, if the food industries were capable of self-regulation, then the 1906 Pure Food and Drug Act would never have been necessary. But of course, in the libertarians’ Parallel Universe none of that happened, because food adulterers were led by Enlightened Self Interest to stop poisoning and cheating people.

    Healthcare: total private spending is about $1.5 trillion; 30% of that is $450 billion. Estimates of potential savings vary; I’ve seen higher estimates.

  59. Elise says:

    I would summarize Dr. Socks’ answer as follows:

    1) Everyone in society should have healthcare. This is a moral imperative.

    2) Providing everyone in society with healthcare is best done by a single-payer government system.

    That seems reasonable. I agree with the first statement but not the second.

    I believe conservatives would argue similarly:

    1) Everyone in society should have protection against attacks from other countries and outside entities. This is both a practical necessity for society to function and a moral imperative.

    2) Providing everyone in society with such protection is best done by a single government military force.

    In this case, I agree with both statements.

    Which is why I found Dr. Socks’ comment #51 quite surprising and rather discouraging. I always believed that conservatives who insisted the Left actually *wanted* the US diminished and would be overjoyed to let others – India, China, possibly Russia – become the globe’s super-powers, were paranoid wingnuts. Sure, I would say, the Left wants the United States to use its power and wealth differently but it doesn’t actually want the US to be at the mercy of other countries, a couple of which have remarkably lousy records on human rights. I now realize I’ll have to go abase myself for being so naive.

    However if you’re really serious about using what works well in other countries to decide what’s best for the United States then I’d like France’s electricity from nuclear power; Norway’s off-shore drilling; Canada’s oil sands production – but Singapore’s health care system. According to the BBC:

    - Singapore spends 3.4% of its GDP on health care; Canada spends about 10-11%.
    - Singapore spends about $1,228 per capita; Canada spends about $5,100.
    - Singapore’s infant mortality rate is 2.1 per thousand live births; the CIA 2009 figures say 2.31 versus 5.04 for Canada; the UN says 3.0 versus 4.8 for Canada
    - Life expectancy in Singapore is 79.7 years; the CIA 2009 figures say 81.98 years versus 81.23 years for Canada.

    It looks to me like Singapore wins hands-down.

    Logically, it is extremely inconsistent to assert, as a principle, the need for publicly funded anything while claiming that health care is magically exempt.

    Um, no. It is quite logical to believe that police protection or national security should be publicly funded while believing health care – and, say, grocery stores – should not. Police protection and national security are not very divisible: it’s extremely difficult for me to have access to them while you do not. Health care and grocery stores are very divisible. It is quite easy for me to have access to them while you do not. This is why the idea that everyone should have health care – or food or shelter – reflects a moral imperative rather than a practical necessity.

    Megan McArdle almost always makes sense to me but in the article octagalore cites I believe McArdle has missed something. And there are still not-for-profit BC/BS companies. Or as McArdle put it, if we end up with co-ops we’ll have gone to a lot of trouble to re-invent BC/BS.

  60. Violet says:

    It is quite logical to believe that police protection or national security should be publicly funded while believing health care – and, say, grocery stores – should not. Police protection and national security are not very divisible: it’s extremely difficult for me to have access to them while you do not.

    No, not difficult at all. For police protection, all you would have to do is live in a neighborhood that had paid its private police force for protection. And all the poor suckers who don’t live in a rich neighborhood with a private police force would be SOL.

    National defense is less local, but there are still geographical differences in susceptibility.

    But as for healthcare, you say “it’s logical” to believe that healthcare should not be publicly funded. “Logical” of course, meaning in accordance with whatever Ayn Rand novel or Milton Friedman hallucination is informing the libertarian worldview. Which is the problem: libertarians and free market fetishists live wholly in their heads, basing their conclusions on “logical” theories that don’t bear up under realistic scrutiny.

    Nobody on the left is arguing that healthcare should be funded by a government pool of money because that’s what ideology dictates. People argue for single-payer because it works: it works here, with Medicare, and it works in other industrialized countries. It’s the pragmatic solution. And we have several decades of experience with private insurance to know how inadequate and inefficient and unfair it is.

    The problem with free-market fetishists is that their ideology blocks them from considering the full range of possible solutions. For them, a government fund or program can never be the solution, even if that’s the cheapest, smartest, fairest way to go about it. Never. In their minds government is always wrong.

    Also, Megan McArdle is an incredibly foolish and ignorant person. Her inane blathering is famous.