Before I start, I have to say that I’m overjoyed at the Supreme Court’s decision to uphold the Patient Protection and Affordable Healthcare Act today. Friends and family members who sacrificed their health because they couldn’t afford coverage, or those who were denied coverage because of pre-existing conditions, can now rest a bit.
The key figure in today’s decision is Chief Justice John Roberts. He has voted solidly with the conservative justices, with Anthony Kennedy responsible for the swing vote in most cases. Today, he chose to vote with the liberal bloc. The headlines are declaring, “The Roberts Court is Born.”
I’m a little bit of a US Supreme Court history junky (maybe it’s that undergrad degree in Political Science), and I’ve been intrigued by Justice Roberts since he was first appointed. While there is no doubt that partisan politics and political ideology molds a Chief Justice and impacts their decisions, there are two other primary influences that I believe grow over time:
- They are the chief representative and embodiment of the institution of the US Supreme Court.
- They have a strong sense of their historical legacy.
There have been only 17 chief justices in the 223 year history of the Supreme Court. John Marshall’s career spanned that of six US Presidents, four of whom served two terms. Much of their job is defined by the precedents set by their predecessors: their decisions today are constrained by and they continually defer or refer to decisions. Perhaps even more than any other official in the US government, including the president, single decisions made by one or a handful of justices have tremendous power over the lives of millions. Think of Dred Scott v. Sanford, Brown v. Board of Education, or Roe v. Wade. Roberts is a relatively young chief justice. He has the potential to to be one of the longest serving (it’s hard to beat Marshall’s), and to be one of the most influential people in the history of the United States, and he is fully aware of this.
Combine this sense of historical and institutional perspective with the following fact (from the SCOTUS blog), and Roberts’ decision makes more sense to me:
No Supreme Court has struck down a president’s signature piece of legislation in over 75 years.
He wasn’t willing to break this long streak, and expose his court to criticism of judicial activism. But he’s not suddenly embracing liberal politics, either. Scanning through the decision this morning, it seemed to me to be largely technical. One of his key arguments was to say that by imposing a penalty for those who don’t buy insurance, Congress isn’t forcing citizens to engage in commerce (something beyond its authority), but is instead imposing a tax (an enumerated power). This morning Rush Limbaugh ran with the ammunition provided by Roberts, calling Obamacare the “largest tax increase in the history of the world.” Romney launched a similar barrage, saying that “ObamaCare raises taxes on the American people by $500 billion.”
Roberts, in defecting from his bloc to uphold the ACA, accomplished the following:
- He protected the Court from accusations of judicial activism and continuing partisanship,
- He gave the Republicans powerful tax ammunition to use against Obama in the upcoming election,
- He established his own legacy–He showed that he could resist the overt taint of partisanship while still playing a deft political game.
Well played, Chief Justice Roberts. Well played.
Today, the Ninth Circuit (the federal court in whose jurisdiction California falls) published its decision upholding the prior ruling that stated that Proposition 8 is unconstitutional.
Of course, this is a bit of a “duh” moment, but it’s still good news.
What follows is, I hope, an English translation of the decision for the lay-person. It is not intended to be a legal note on the decision (although I have provided citations for those who want to dive into the text). Others have likely interpreted the decision for the legal community far better than I can or care to. Read more >>
The above photo is mine, from a Prop 8 protest. I post it because of my description: “I got a little freaked out at one point when I realized the cop to protester ratio was pretty dang high.” This defined the police action last night against #OccupyLA
Many police officers must experience a powerful tension between their priorities to protect individual rights and to enforce the law. Civil disobedience lives in this hazardous borderland where rights and laws do not always play nicely together. Even when it is non-violent, effective protest provokes those who defend the status quo, and officers often have to rely on a different approach than what they seem to typically rely on when apprehending law-breakers–especially those who resist arrest. The media plays an interesting, complicating role in all of this.
I haven’t read any news analysis of the LAPD’s massive sweep of Occupy LA’s encampment last night and this morning, but I’m going to attempt to figure out the LAPD’s motivations behind their methods.
The operation was huge. Perhaps it is the largest in the Department’s history. Los Angeles has the third largest police force in the nation, and it looks like they mobilized anywhere from 1500 to 2000 officers last night–from 15 to 20% of the police force. And the operation seemed to progress in careful steps: police in riot gear assembled at Dodger Stadium around 8:30pm; a perimeter was secured around City Hall and no one was allowed in by 10:30 or so; by daybreak 1400-2000 officers (according to one major news outlet) had formed a human noose around City Hall and were arresting protesters.
This show of force takes place in multiple contexts, but there are two I’d like to highlight: 1) recent incidents of police brutality have reflected poorly on New York City, Oakland and UC Davis’s police forces in particular, and eroded public trust in American law enforcement as a whole; and, 2) Rodney King. This was an opportunity for the LAPD to polish the image of both the city and its controversy-laden police department.
I think that this is one the main reasons the LAPD took the two extra days past the eviction deadline to carefully orchestrate this operation. I imagine that at least this much time was needed to plan, train, and mobilize the force. Because all it takes to descend into PR hell is one photo or video capture of the disproportionate of force by one rogue/stressed officer, I’m sure that every individual was told not to fuck this up. Finally, they took the additional step of heavily restricting which media sources got to go in and what they were able to report. For example, KTLA (CBS/Time Warner) reported that they weren’t showing news copter footage of the riot police moving in as part of their agreement.
I have no illusions that there is probably daily abuse and mistreatment of individuals by some fraction of the LA police force. Most of these victims are probably brown-skinned and/or impoverished. The public and the media aren’t interested in them.
Ultimately, OccupyLA’s protest and the LAPD’s response are performances. Without the media–mainstream and social and viral–there is no audience. This isn’t to devalue the motives behind these performances, but it shows how dependent citizens in any democracy are on the media to foster an environment in which political change can occur, and how much power the media also has to curb the excesses of use of force by the police.
Last night, both groups knew we were watching, and were subsequently on their best behavior. Kudos to them both.
Many of us have mixed feelings about Occupy Wall Street. I personally get excited at any signs of life in America’s normally apathetic citizenry, but have been confused and maybe a bit turned off by the festival atmosphere and the initial incoherence of the movement and its participants. We expect sound bytes: where’s the political platform that I can fit on a bumper sticker, or in a pithy, provocative tweet? Instead we get a cacophony of clashing, inarticulate opinions to the beat of drums and peace songs. And what the hell is this “We are the 99%” all about?
But you know, more I look, the more I listen, the more I realize that dismissing the entire movement because these individual voices seem unimpressive is like dismissing twitter because no one wants to know what you had for breakfast. Mass protests are like the screen on which you read this post: the picture emerges in the combination of all the individual pixels. The global Occupy Movement is a pointillist painting, each protester shivering in her tent right now is a dot of color, and all together you have a dramatic picture condemning universal frustration with economic inequality–inequality driven by corporate greed and unaddressed by representative democracy’s standard channels.
The Movement is Reason Enough
Occupy Wall Street will be two months old in two days. It takes some serious organization and dedication to maintain an encampment and to keep spirits up in the face of serious, sustained opposition. These folks consciously choose to risk injury, insult, arrest and lost opportunities and suffer from cold, boredom, frustration, and the lack of warm meals and facilities. However the media chooses to portray the movement, this is no Woodstock. I feel like they’ve at least earned the right to be heard through their determination.
Most of us have democracy handed to us on a platter. Maybe a couple of times per year we go to a local polling station, have a convenient menu of multiple-choice or true-false options presented to us, and in a few minutes we’ve done our duties as members of a representative democracy. But who picks what goes on the menu? And what happens if this manifestation of democracy doesn’t represent you? We can call or write our MPs or congresspersons. Or we can take to the streets. As Emerson said, “Sometimes a scream is better than a thesis.” (and this regarding his protest of the contemporary American genocide of the Cherokee nation known to us as the Trail of Tears)
“We are the 99%.”
This is the main sound byte to emerge from Occupy Wall Street, and it’s as powerful as any campaign slogan prepared on a ten million-dollar budget (this started as a free tumblr).
I’m going to let a couple of graphs talk for me here (click on the images to see the source articles):
Share of wealth held by the Bottom 99% and Top 1% in the United States, 1922-2007, from article by UCSC Professor.
From the Economist
The message is less about policy, and more about setting priorities. The protesters are saying to their government and to the wealthy: “We’ve gone along with your schemes for long enough now. We, the 99%, are tired of offering our backs to carry the richest 1%.”
Where do you stand?
I’m a Quaker now, and no longer Mormon, for a number of reasons, but one of the main ones is that the Society of Friends have generally stood on the right side of history, even when things were tremendously unpopular. Quakers fought against slavery a century before it was popular to do so in Britain, which was another half-century before Americans abolished it. Mormons were slow to support Civil Rights, while Quakers were helping to lay the groundwork in the Fifties. I went to a Quaker meeting in LA this weekend and listened to OccupyLA protesters and fellow Friends ask for bottled water and for people to help train protesters in peaceful conflict resolution. One guy was tired, haggard. These are not clueless, partiers with nothing else to do.
Occupy Wall Street is history in the making. And even if it fails utterly, I want to stand on the right side history. I want to say that when shit got serious, I wasn’t on the sidelines. I’m not sure yet what I’m going to do, just how I’m going to support this movement, but I’m in.
I’m slowly training Facebook ads that anything in the category “weight loss”, “traditionally female jobs”, or “baby anything” is “offensive”. Confused, it has now been showing me only martial arts and legal-related stuff. So I guess this falls under “legal-related stuff”…or it’s figured out that I’m a sucker for “random jewelry”. Either way, Facebook ads sent me to this website. We The People Bracelet sells silver beads with various amendments engraved on them.
It’s a cute idea, really, especially for ACLU types or just plain law nerds. I can get a keychain, for example, with the 13th, 14th, and 15th amendments (abolition of slavery, citizenship clause, & the civil rights amendment). Or a necklace with the 19th & 26th: women’s & 18 year olds’ suffrage rights, respectively (this is totally up my alley and I might just do this for my niece). Or “Victory Cufflinks”—which have the 1st, 2nd, 9th, and 10th amendments…and this is where we start to get kinda rightwing. Freedom of religion, right to bear arms, states’ rights 1.0 and states’ rights 2.0. But, okay. It’s the only set of cufflinks available (for some reason, you can’t make your own…maybe that’s because men only love victory) but maybe they don’t mean anything by it.
Let’s see what else they hav… What the what‽ This is the “Bill of Rights Silver Cross“: a clear misunderstanding of separation of church and state; and, I would wager, an intentional one. There is a bead above the cross that says, “Bill of Rights”. Since it doesn’t say “Freedom of religion”, which might actually apply to this kind of a setting, all I can think of is religion + right to bear arms, religion + jury trial, religion + states’ rights, and so on. All unsettling thoughts, to my [liberal] mind.
Or you can get the “Bill of Rights Necklace” which, instead of having a cross, has a 2nd Amendment bead (or a different one of your choosing, but really, isn’t that the most important one? After the one that lets us impose our religion on everyone, of course). The unsettling settings continue. There’s the incorrectly-named “Constitution Bracelet” which has only the 1st, 2nd, and 10th amendments (rather than, say, the Constitution), the “Paul Revere Bracelet” which has seven nebulous beads (what is “Paul Revere” right-wing code for?), and of course, the all-important “Independence Bracelet” with just the 1st and 2nd (since bearing arms is what we fought for, not representation to tax authorities).
I’m rather unsettled (can you tell?) by this product. Not for the product itself, which I think is pretty damn awesome and I’d consider getting myself or friends some of the beads (and I hope they expand their collection) but because of the militant religious undertone of the product. Am I reading too much into this? Does it change your mind to know they’re sponsored by the Heritage Foundation, the Freedom Alliance, Americans for Prosperity, and WABC (a talk radio station that is home to such bastions of freedom and the Constitution as Rush Limbaugh, Sean Hannity, Laura Ingraham, and, wait for it, Don Imus!)?
My first reaction to the site of “hey, awesome legal jewelry!” has turned into an uncomfortable sense of “I’m not the right kind of American for these people”. Which is unfortunate, because I’d love to display my love for the awesomeness of the 19th Amendment or 21st (accompanied, perhaps by the 18th!). I would imagine a number of activists would be interested in showing their love of the 24th. I wonder if the company plans to expand their available beads to the less-popular-in-conservative-circles amendments (although I’m impressed that the 19th, 13th, 14th, and 15th are included). I really want to think the best of the intentions of the artists, but their undertone of crazy clouds my ability to do so.
This is a guest post from CatGirl. It’s a write up of her experience so far at the FCNL Annual Meeting in Washington, DC. I plan on writing up something later–maybe Monday. She’s much more on the ball than I am! You can follow my twitter feed, as I try to tweet the conference.
Without further ado, here’s CatGirl:
Okay, so we’re here in Washington DC!
The trip here was easy, but utterly exhausting. I got maybe 45 minutes of sleep, max. And, of course, as soon as we got to where we were staying, it was 8:00 and breakfast time. (Admittedly I took a two hour nap later in the day.) The weather? Wonderful. It’s been raining (or at least lightly drizzling) the entire time. It’s actually not too cold, and the weather forecasts all say its supposed to get relatively warm this weekend. I’m absolutely loving the humidity and the seasons. The leaves are actually red! I have a whole bunch stuffed into the pages of my wonderful red Moleskine notebook, so that I can bring a little bit of autumn back home.
So we reach our destination (stopping by the Firehook cafe on the way), take naps, get settled in, and then head out. Le Bon Cafe is our first stop, for lunch. (We felt guilty going in here after walking out of two other restaurants.) I ordered a mozzerella tomato basil sandwich and regretted not getting any tea, because the drinks were all served in bowls. It was delightfully charming.
Next we headed over to the Jefferson building–the main tourist part of the Library of Congress–to just sit and soak up inspiration.
The final stop? The location of the FCNL annual meeting. We arrived just in time to take off our coats, then put them back on again to head across the street to another building for what was basically a welcome session. We met all the other new people and some FCNL veterans, as well as learning what this was all really about.
Later that night we listened to Josh DuBois, head of the something-or-other cooperation committee (who works with Obama in one way or another). I think I was falling asleep during this, becuase I didn’t write a single note on what he said.
We woke up way too early to function properly, but still packed up our stuff and headed out to the FCNL hotel, where we would be staying the rest of the time. We stopped by the Firehook (again) for breakfast, then took the Metro the rest of the way. We arrived at the tail end of the arranged breakfast, and then headed into Meeting for Business.
Meeting for Business at a monthly meeting is usually five or so people making suggestions, counter suggestions, and sitting in silence. Quaker process requires consensus, so everyone has to agree on your decisions. Quaker process is also infamous for taking a very long time.
This Meeting for Business consisted of two hundred nitpicky Quakers, all determined to share their opinions. On most of the issues, everybody agreed and had consensus almost immediately. But when we were supposed to nominate people for the Naming Committee (who would nominate people for the Nominating Commitee, who would nominate people for the General Commitee) there was some dispute over whether or not someone was qualified (although they were all very polite about their accusations). Someone would stand up, share their opinion, and someone else would stand and counter it. It was, needless to say, absolutely wonderful.
The FCNL attendees then split up. We went to a session explaining the Peaceful Prevention of Deadly/Violent Conflict. It was actually very enlightening. Apparently this is a big thing for FCNL: the prevention of genocide and that kind of thing, instead of resolution of major conflicts. Sure, they do some resolution, but prevention is easier for a fairly small organization like FCNL.
Next was a session explaining FCNL’s position on the new Health Care Bill. I’m not sure why, but I don’t have too many notes for this one either. I remember that FCNL has been lobbying for a Native American rights bill for so long that they’d given up getting any part of it passed, but apparently the entire thing is now in the health care bill, which is interesting.
We ate dinner with the other Young Friends (which is anybody who looks thirty-ish or younger) at a Thai place. That was very fun.
So, yeah. That’s it! I’ll try to have days three and four up tomorrow afternoon or Monday morning.
I’m generally supportive of President Obama, and I am definitely in favor of universal health coverage for Americans. But I’m not sure I agree with him when he says:
Second, we’ve estimated that most of this plan can be paid for by finding savings within the existing health care system, a system that is currently full of waste and abuse.
Even if there is considerable waste in the system, do you believe that it is *feasible* for us to cover healthcare without lifetime caps, with coverage for all pre-existing conditions, with expanded coverage for millions of Americans who currently aren’t covered, and with “free routine checkups and preventative care” solely by finding and eliminating waste in the existing system?
What I’d like to attempt here is less of a polemic debate, and more of a reality check. For the purposes of this thread, let us assume that all who comment under this post are in favor of universal coverage in the United States. This support can be genuinely felt or just a rational thought experiment.
My questions are as follows: do you think we can pay for it, both in the short term (the next five years or so) and the long term (the next 15-20 years and beyond)? If so, how can we pay for it? What costs can we realistically eliminate or pare down? Would we have to raise taxes, or eliminate other government expenditures to pay for this?
Reminder: this particular thread is not the place to shoot down the concept of universal health care, or to argue against Marx and Canadians, or even spout eloquent but unsupported rhetoric in favor of socialized medicine. I may choose to delete comments that don’t follow this guideline, and this won’t be censorship, but your own inability to follow directions.
“On The Pier” (taken on 9/11/01) is Creative Commons licensed by *Hiro.
July 2nd, 2001 is Mind on Fire’s birthday. The birthing process was painful, since I hand-coded the site and put much more effort into the design and scripty goodness than I do now. Here’s kind of what it looked like on July 23rd and September 17th (it doesn’t work now, but the picture in the upper left showed different pictures of victims of 9/11 on each visit). Most of the comments from that period were lost in one of my migrations to another blogging platform, unfortunately.
My first post was called ‘Sincerity.’ I think that’s been the guiding value of this blog since then.
I rarely dig into my blog archives, but I was trying to remember how I reacted to attacks of September 11th of the same year. Here’s what I wrote on that day, at 7:10am PST:
just heard about the attack on the world trade center. i feel equal parts numb and sick to my stomach. fear and anger will spread across the u.s. and the world, and many in this world are already, both openly and in secret, rejoicing. the cycle of violence will escalate, and the terrorists will have won.
i will do my best to resist the fear and the hate::
In the next morning’s post, I expand on this desire to battle fear and I outline some of my actions:
terrorism’s number one goal is to instill fear…fear leaves us paralyzed. fear closed down our airports, wall street, the federal government, and countless state and local governments, businesses, schools, and amusement parks.
if we let fear conquer us, then the terrorists have won.
4. i will not allow fear to dictate my actions. there is no such thing as security. death can take us in the guise of an earthquake, cancer, a drunk driver, a crazed gunman at any moment. death is one of the great certainties of life.
Fighting fear is a recurring theme in my life. As I write and remember, I’m realizing that the conquest of fear is one of my core values. I’m a coward, but I try not to be.
- This desire influences my relationships: I don’t want to limit my children’s potential because of fear of harm coming to them, I don’t want to miss out on the opportunity of meeting new people because I’m afraid of embarrassment, and I don’t want to act against my conscience because of fear of judgment
- This desire influences my view of religion: I live in a pretty bleak universe. It’s tempting to escape to the comforting security of myths of eternal life and ultimate justice.
- This desire influences my politics: I don’t want to encourage policies based on fear of immigrants, fear of people who worship Allah, false fears of government bureaucrats on death panels.
It’s good to remember how terrified I was–how scared we all were–in the aftermath of the multiple attacks of 9/11/01. It’s sobering to think of how this national fear was transformed into anger and then manipulated to serve ends and interests that had little to do with seeking justice against those who perpetrated these horrible crimes.
The war on terror isn’t fought with weapons and soldiers. It’s fought in our own hearts.
Today, I recommit to fight fear. I will not let the terrorists–the obvious ones that carry bombs, the bombastic ones on talk radio, the subtle ones that whisper uncertainty into our ears whenever we embark on new personal endeavors–I will not let them win.
I’ve seen a lot of political debate recently on FaceBook. Sometimes the discussion is civil and even enlightening, but more often than not it begins with unconsidered slogans and degenerates into ad hominem attacks. (I don’t have problems with slogans and witticisms as a starting point, but people need to be ready to defend or qualify them with rational argument.)
The following discussion between a close friend (and economist) and an old colleague/mentor occurred on my FaceBook profile. It’s a heated debate between people who disagree, but their tone is respectful throughout, and they readily point to agreements, carefully define terms when necessary, and concede when their opponent has a valid point. It’s difficult to find sound bites.
This, my friends, is how such political discussions should proceed.
John: No one should die for lack of medical insurance & no one should go broke because they get sick; the free market can’t fix either alone. [my Facebook status]
T: I don’t think anyone disagrees with this sentiment, John. The disagreement is really over the best way to remedy these issues.
Yesterday at 2:08pm
M: really? I’m not so sure people agree on even this much. If they did, wouldn’t we have a public option?
Yesterday at 2:52pm
@M: Trust me. (Okay… You don’t know me from Adam, but as a pretty reasonable guy who opposes the public option…) Nobody wants these things. Really.
@Michael: So… Seeing as how auto insurance is *not* a federally administered program, sounds like you’re *also* opposed to the public option, right?
You’re absolutely right about the central problem though, Michael — the costs *are* outrageous, and they are *not* currently regulated by the free market, like auto insurance is.
The big debate (should be) about how to best achieve the cost control we’re all after.
…and your analogy is dead on, actually, in more ways than you may realize at this point.
Yesterday at 4:47pm
M: @T.. okay, if you agree with the statement, please explain how you expect to achieve it without a public option.
Yesterday at 4:50pm
John: : The health care economic sub-system, even when it’s dominated by private entities, does not operate like anything resembling an ideal free market (and historically, less regulated markets seem to favor corporations over consumers, which has made government regulation and intervention necessary in the past to protect consumer interests). In a complex market like health care, I see a vote against increased government involvement as a vote for increased (or status quo) control by large private groups, which often act against the public interest, which the public has less supervision over.
Yesterday at 4:59pm
M: Since this discussion is getting more wonkish, I’d like to draw a distinction between “free” and “competitive” markets, and to agree with John that neither exists currently or is likely to work. My initial point was that even a perfectly free market, which conservatives often claim to want, would not resolve the issues in healthcare. One reason is that healthcare appears to have increasing returns to scale, meaning it rewards big companies over small ones, so it would inevitably be ruled by large special interests. Healthcare is an inherantly non-competative market. The other is that ensuring everyon has reasonably priced access to healthcare is not the sort of thing markets do- it’s a moral imperative, not an economic one. If we want it to happen, we need regulation, and if we want regulators to have teeth we need to give them serious influence on the market. The most straighforward way to do that is with a public option.
Yesterday at 5:12pm
M: *competitive, not competative. argh my brain
Yesterday at 5:12pm
T: @M: I’d encourage you to study any of the several alternate proposals out there. I realize that you’ve thrown down a gauntlet, but I (personally) don’t have time to pick it up tonight. Sorry.
@John: You’re absolutely right about the health care market being unique. You’ll notice that I’ve not argued for complete deregulation. That said, efforts to actually move the health care market *into* an actual market where millions of people have incentives to understand and control prices with their individual choices (as opposed to the current situation, where individuals have very limited ability to make such decisions and the market *is* largely profit-driven) would have a much more long-lasting impact and be almost infinitely more sustainable than the plan currently on the table, in my opinion.
Yesterday at 5:13pm
T: Heh heh heh… Crossed posts with M there.
Again, almost nobody (certainly nobody here) is arguing for total deregulation or a “perfectly free market” here. This one is most certainly unique today — largely because of the way the health insurance industry has evolved over the last sixty or so years.
Economies of scale are not an inherently bad thing (often quite handy and efficient, actually…) nor are large corporations inherently evil — particularly when held in check by real competition, which can only be fostered by the ability of consumers to truly choose.
The moral imperative argument is great for shaming people into behaving a certain way in the short term in public situations, but long-term macroeconomics are very rarely driven by moral imperatives. In other words, just because it’s a truly morally superior idea doesn’t mean that people will (or should) voluntarily submit to the hardship it entails.
Yesterday at 5:24pm
T: In other words, there’s a really fundamental choice here about whether we will use “regulators with teeth” to force my Doctor to change his prices, or whether we will use a migration toward a truly competitive market to allow my Doctor to see that lowering his prices is the best way for him to maximize his business.
BIG moral choices are lurking in there, of course.
Yesterday at 5:29pm
M:2 issues with your response:
-I didn’t say economies of scale are bad, I said they make a naturally competitive market impossible, meaning regulation is necessary if the market’s as important as healthcare is. No truly competitive market is ever going to come about with regard to healthcare. Ever. Hence public option to compete with private ones.
-If people truly believe that no one should die for lack of healthcare and no one should go broke because they got sick, then the moral imperative exists. I’m not interested in shaming people, I want them to examine their own values and see if their politics measure up. In fact, I suspect that, if they’re honest, some people will find they have caveats on that sentiment. Hence stating it if you believe it is not meaningless.
Yesterday at 5:32pm
M:I’m not saying the government should unilaterally determine doctors’ wages. I’m saying it should be involved enough in the insurance system that private options have to compete with a probably more fair and transparent public one (sorry, mis-typed initially). I believe it will be more fair and transparent because it will be accountable to elected officials and thus, indirectly, to voters.
Yesterday at 5:33pm
M:Also, this is a side note but doctors aren’t typically determining their own wages. Insurance companies are setting them.
Yesterday at 5:35pm
M:oh wait, are you referring to the professional association thing? in which case, not exactly doctors themselves so much as a very specific group of doctors setting wages for all doctors, which I don’t see as being a good system… that’s a side issue, though.
Yesterday at 5:38pm
T:Gotta disagree with your assumption about economies of scale removing natural competition. The fact that almost every single town I visit for work has an Applebees, a TGIFridays, two Olive Garden’s and a Jack-in-the-Box (or Hardees, if you’re back east) would seem to be a rather strong data point for the contrary position. In fact, this situation (also) drives *my* choice to usually patronize more locally managed solutions, if you know what I mean.
I’m also not arguing that no moral imperative exists. I *am* arguing that the current proposal for “fixing” the system will neither fix it, nor solve the *other* moral questions that are raised by a coercive governmental solution.
I stand by the statement in question (and John’s original post) and I think that my values line up nicely with my politics, thank you.
Yesterday at 6:13pm
>> I’m not saying the government should
>> unilaterally determine doctors’ wages.
>> …Insurance companies are setting them.
Good. Are you aware, though, that insurance reimbursement rates today are *directly* linked to the Medicare reimbursement rates? In that sense, the federal government *already* is unilaterally determining doctors’ wages to a large degree. That part is really not working *now*.
Yesterday at 6:14pm
>> No truly competitive market is ever going to come about with regard to healthcare. Ever. Hence public option to compete with private ones.
No matter how you slice it, adding the federal government as a “competitor” (who incidentally makes all of the rules) will result in a single payer system in the end. In what other industries does the government have robust competition?
Mail service is one that comes up from time to time, but the USPS is actually *intended* to be self-sustaining, and not subsidized by any tax dollars (though they’re running a multi-billion-dollar deficit this particular year.) I don’t see *anyone* proposing that the new health care bureaucracy be self-supporting. Any others you can think of?
I recognize that single-payer is *exactly* what some folks are after in the end (not sure about you) but if that’s the case, arguing that the public option will only increase choice just becomes disingenuous. (Again, not saying that’s where *you* are coming from.)
Yesterday at 6:15pm
>> …doctors aren’t typically determining their own wages. Insurance companies are setting them. [with a lot of help from Medicare]
Exactly. Total agreement. This is a totally critical point
This is perhaps the largest shortcoming of the current system. Consumers do not currently even *know* the prices for medical care, let alone engage in any comparison or choice. Changing this aspect of the system would have a far larger impact than price controls, as it would be self-policing, with powerful economic incentives at the individual level to make the right choices.
Yesterday at 6:16pm
M: T, I agree with a couple of your points, disagree with a few, and need to think/research some others. Here are my thoughts.
Regarding 1 big public entity: there are two ways government can drown out competition in a market; either they can regulate the others out of existence (legal monopoly) or they can out-compete due to deeper pockets and/or lack of profit incentive. The former is very common historically. However, in this case I think there’s no question that a government insurer would have to abide by all regulations and then some, so you must be concerned about the latter. (Yes, there’ll be some subsidization, but there will be anyway… we want to get poor people insurance, right? I’d be happy for the public option to be self-sustaining in other cases.)
5 hours ago
I suggest that if the government out-competes other insurers there’s no problem from consumers’ perspective (at that point, all of us). A couple of reasons. 1) economies of scale 2) if they get inefficient, etc., enough to counter the benefits then some other company will have room to compete again.
I’m happier with government winning than with a private insurer because the private ones are really good at screwing people over in ways that would cause uproar if a public entity did them. They tend to be really vague on details of coverage and crap out just when you need them most. It’s in their interest not to pay the few who cost a lot, after all, even if that means they lose them as customers. This leads to the going broke because you get sick scenario.
5 hours ago
M:That last part is the reason I think it’s not just benign but vital to have a public insurer. We need an incentive other than financial reward in this market. Insurance is always sticky, but in something like auto insurance, someone who’s so awful they spend all their time in accidents probably just shouldn’t be driving anyway. It’s not problem if their rates go astronomical. In health insurance, we still want these people to live. For-profit incentives just don’t encourage that.
5 hours ago
M: I think I’ve missed replying to a lot of your comments (particularly on doctor reimbursement… I recommend this article: http://www.slate.com/id/2227082/) but I’ve tried to hit the ones that I see as most relevant to the issue. By the way, thanks for this debate! I’m sorry if I was over-aggressive initially. I felt that your initial post was a bit patronizing and anyway I’ve moved away from policy work because I tend to get too worked up too easily about this stuff. As it turns out, though, the discussion has been very interesting!
(whew! lots of posts! Facebook isn’t made for this stuff, is it)
5 hours ago
Another thought, something you may not know about healthcare in the UK. I’m sure you do know it’s a government monopoly in general (taxpayer-funded, free care for all), and that it’s been getting (well-deserved) heavy criticism recently. The market has also responded. Private providers have sprung up, with private insurance plans, that cut wait times, etc. Employers looking to hire good people have taken to offering these plans. In other words, even intended government monopoly isn’t necessarily immune to market forces.
5 hours ago
M: Now I’m obsessing idiotically, but I also wanted to clarify I realize you meant your initial comment to be light-hearted, not patronizing! I was just paranoid.
4 hours ago
John: I wish I could respond, but my online time is limited today…but I’ve read every response, and wanted to meta-comment that this is exactly the sort of civil and well-reasoned conversation we should be having! You both are setting a great example, and subsequently rock.
What bothers me the most is that the audience for this specific conversation is so limited. I feel it would be a great service to let others in on it. Would you two mind if I lifted this discussion, and rebuilt it on mind on fire? (attributing both of you, or replacing your names if you’d like to be pseudonymous)
4 hours ago
T: … M, your comments from this morning are good, but as you might expect, I do want to respond to some of them.
3 hours ago
M: T, I look forward to your response! I realize that being a student has definite benefits when it comes to internet discussions
3 hours ago
Discrimination against gays persists, democratic protests are trampled in Iran, Kim Jong Il keeps flashing the nuclear bird at the US, but all this pales in significance when compare to the most important news of last week: The White House Beer Summit:
|The Daily Show With Jon Stewart||Mon – Thurs 11p / 10c|
|White House Beer Simulation|
About 1:30 into the video, there’s a clip of Fox News pit bulls attacking the President’s choice of Bud Light. Bravo, Fox News, for dodging all this “racial tension” bullshit and going right to the heart of matter.
Attention, all of you Bud Light drinkers out there. You call yourself red, white and blue-blooded Americans, but we here at Mind on Fire know that you are actually sleeper agents for a Belgian and Brazillian conspiracy for world domination. If you are a true patriot, you will go to your fridge, extract your Costco 48-pack and pour each can out on that French Tarragon plant growing by the shed in the corner. You have my sympathies–these foreign powers patiently waited to let Budweiser sink into the American psyche for 150 years before forcefully taking it over. (If you want, you can piss into cans for later consumption. This beverage will be American, and probably taste better. We’ll wait.)
Now that we know that our president imbibes a Brelgillian blend, what can we, we who truly love our country, do about this? Well, we won’t take this lying down! We will sit on our fat asses, with remote in one hand [editor's note: most remotes not made in the USA] and a real American brew clenched angrily in the other.
We propose the creation of all-American liquor stores. The shelves would only be stocked with Sam Adams and Jack Daniels and other beverages named after American patriots. Former border patrol agents will guard against encroaching tequila and Corona, and Congressmen Ney and Jones will make sure to block any French wines and wines that come places too close to San Francisco.
Beware: liberals may point to “craft brews” from local establishments. While technically brewed in America, these are known to have a lingering socialist aftertaste. Also, watch out for un-Christian beers with names like Kilt Lifter, Happy Ending, Damnation, and He’brew, The Chosen Ale. And although the reporter on Fox News suggested that Coors is an all-American brew, it’s actually a product of Molson-Coors, an all *North*-American brewing company, with half its leadership in Montreal, which is practically France. We advise against drinking Coors, except at hockey games.
In other news, apple pie was bought out by a Japanese-Chinese consortium, and Johnny Appleseed will now be referred to as ジョニー林檎種. The Stars and Stripes are sewn in Thailand and Guatemala. And your mom is owned by a syndicate operating out of BFE, but you already knew that.
I catch about one of the President’s weekly addresses each month, and half the time I’m distracted from his message by the skill of his delivery. His messages are clear, precise, and accessible. They actually make sense and sound like they’re being spoken by someone intelligent, who in turn respects your ability to reason.
I was going to say that maybe he’ll raise the bar for what we expect from our leaders’ oratory abilities, but I’ll be satisfied if he just puts the bar back up from where someone else kept knocking it down.
Anyhow, it’s hard for me to picture his predecessor saying anything like the following (from his 5/2/2009 address on H1N1):
And the White House has launched pages in Facebook, MySpace and Twitter to support the ongoing efforts by the CDC to update the public as quickly and effectively as possible.
As our scientists and researchers learn more information about this virus every day, the guidance we offer will likely change. What will not change is the fact that we’ll be making every recommendation based on the best science possible.
If twitter wasn’t mainstreamed before, it certainly is now.
The other quote comes from the narrator’s wrap up from the latest episode of Pseudopod, the weekly horror podcast, which I listen to more religiously than any Sunday sermonizing. This story wasn’t particularly memorable, but Alasdair Stuart’s insight into human character, related in his gorgeous accent (Manx?), struck home:
“I’ve met hundreds of people in my life, and not a single one of them was intact. We are all broken, all carrying our faults on our backs and in our hearts, all of us consumed by the sneaking suspicion that we are terrible disappointments, that the people who say they like us are only saying that, that we are tolerated at best, mocked at worst.
We are all wrong. We are all extraordinary.”
This is just a snippet of a few minutes of similar philosophizing and encouragement that begin 18:00 minutes into the podcast. And maybe many of you will agree. Part of the reason I present myself fairly transparently to the world is so that you all will have no excuse to love me or like me, because certainly the true me is abhorrent?
Amen, brother Stuart. We are all broken. We are all extraordinary.