Tuesday, February 1, 2011

how long

Part of the problem with political punditry is that its rules of politesse are a bizarre potpourri with no internal consistency or balance. There are all kinds of bad behaviors that are tolerated, but one of the great prohibitions is against accusing someone else of bad faith. This is a problem; people argue in bad faith all the time. Wishing doesn't make it not so. And the prohibition against calling them out leaves us disarmed against the least honest sophistry that we encounter.

I can't think of a better example of this than the health care debate. It's profoundly strange to me that I am not supposed to point out the fact that those who have argued fiercely against health care reform don't, in fact, want uninsured and underinsured Americans to get access to health care. Indeed, it's seen as the height of lefty vulgarity to say that those working tirelessly to undermine every effort to cover the uninsured don't want the uninsured to get covered. The stance that one can simultaneously oppose all real reforms but bear no moral culpability for the consequences of the lack of reform seems flatly wrong to me, but people insist on that idea quite doggedly.

Personally, I think denying people adequate health care coverage because of their economic condition or employment status is a practical and ethical failure equal to Jim Crow or similar regimes of racial inequality. Now you can know me by my extremism. And so the meticulously curated pose of believing in a theoretical regime of universal health care while opposing all real reform seems to me to be dishonest and worse.

But okay. Have it your way. Let's say that, for the time being, I'll accept that stance as genuine. I have a serious, non-rhetorical question: when does that change? When does intellectual seriousness compel people to present a real, actionable, and plausible plan that covers the uninsured, or else abandon the pretense that they want them covered? We have been debating health care reform that is like Obamacare since well before the '08 election. We've been debating the actual legislation for years now. So: when does it become incumbent on those opposed to PPACA to present a viable alternative or else abandon the pretense that they want coverage for the uninsured at all? Is there a specific date when I should expect a viable, realistic plan to emerge from the Republican leadership, one that actually could be passed as the "replace" part of repeal and replace? Is the time horizon literally endless? Ross Douthat, to pick just one, has written for ages about endorsing a conservative alternative to Obamacare. How long is he willing to wait? When can we fairly call him on it if such an alternative isn't forthcoming?

Me, personally, well. I think what is taken for libertarian or conservative economic policy is flatly incompatible with the goal of covering all people. The "free market," as conventionally defined, can't provide adequate, affordable coverage to the sick or the old or the infirm. I'm happy to be proven wrong, though. So ante up. Show me your version. I don't love Obamacare. I think it's a weak, insufficient compromise. But I had to set aside my dissatisfaction in order to support a qualified improvement. I think others can do the same.


ovaut said...

You should name the pundits you have in mind.

Handle said...

How about the Swiss system? Or Singapore? Both better than the crap that will be repealed two years from now.

Of course, I could make a similar "bad faith" accusation, and that is that Leftists don't really care (any more than they have to) about managing costs when it comes to health care. They really proceed from a more ideological and moral "program requirements" perspective instead of a "budget" perspective, with the idea that whatever is costs to achieve those requirements is tautologically justified and taxes should be raised to whatever levels are necessary to pay for it. If the real cost of those reckless promises falls on future generations instead of us, well, sucks to be them. Most of the concern with "budget deficit projections" and such is the half-hearted pandering needed to get the foot of socialized medicine permanently lodged in the door. What most leftists want is more taxes and more spending to cover the presently uninsured.

But maybe I'm wrong in my impression. Here's the test. Remedy my concerns. Promise me, in the very design of the law, that the burden of this program will not explode out of control. In fact - strictly control it. Make government health-care conform to a capitation-like hard-budget system, like every other program has to. "Here's the amount of money you've got to spend this year, you won't get any more regardless of what patients ask for. Do the best you can, the most good for the most, with what you're given, but after that we say "no more". "Spread the health care" instead of "Spread the wealth".

We are, for example, constantly told how other countries are able to provide well for all with a much smaller expenditure. "10% of GDP" is actually near the top of the developed world. Finland does it for 7%, Japan for 8%, Sweden for 9%. And these are the older "demographic collapse" countries who should be having an ever harder time than us, right?

Well fine then. Let's set maximum American Health Care expenditures at 10% GDP in exchange for socialist medicine. We could use the Ezekiel Emmanuel Health Care Rationing system or whatever variation you like. Right away, we would be saving a cool $800 Billion a year over what we're spending now. That could almost balance the budget without raising taxes. (I'm ignoring negative secondary effects, but I'm also ignoring positive secondary effects, so let's assume they wash). That's enough savings for even someone like me to be perfectly willing to abandon employer-provided and market medicine. I would exempt people who are willing to pay extra amounts out of their own money for extra services not provided by the government.

You see - it's called a "bargain" - you get something (care for all), you give up something (2011 American levels of health spending for those that currently enjoy it). I give up the market and my constitutional rights to make choices for myself, but I get enormous savings every year and a future cost-guarantee to assuage my worries. Deal.

And the beauty of it is, no matter what happens to demographics or medical innovation, the costs stay proportionately bearable according to the capacity of the generation paying the bills - it is "care" in the form of goods and services that compromises with the budget, not the other way around.

It preserves something like "balance" (or equal marginal rates of substitution) in our various important government expenditures, and is also makes sure the remainder of economic resources are available for all the other programs and investments we need to accomplish as a society instead of hitching our budget trailer to the most uncontrollable and emotionally-sensitive expense.

The problem, up to now, is that, because of "bad faith" on both sides, and also "bad blood", no one is even willing to work with the other side to make this deal. Too bad.

Riggsveda said...

Freddie, you're not going to get most reactionaries to ante up with their own solutions because they're too busy screaming about careening down the road to serfdom. And as you suggest, they really have no interest in insuring citizens, because at bottom they don't perceive medical care as a human right. They do like to describe ad nauseum how the mandate is different from requiring car insurance, because people don't have to buy cars and driving on the roads is a "privilege, not a right" (I shit you not), although someone born and living on a windswept plain a hundred miles from the nearest town might disagree. We'll be treated to a lot more of this dreck as the showdown at the Supreme Court draws near, I'm sure.

rootless_e said...

And one could take the same question to the "Progressives" who still lament the failure of the People's Mass Strategic Objective Public Option and consider PPACA to be a subsidy of insurance companies. The actual human beings who get coverage or to use a public health clinic or to enter medicare under this program are apparently nothing in the world of the Fake Left. And this is another case where they have a surface disagreement with the Right, but agree on substance.

Batocchio said...

Bravo. I agree completely, and wrestle with this issue often. By all means, an issue should be discussed on the merits, but when faced by someone with a dishonorable track record, say Newt Gingrich or Betsy McCoughey, it's folly to expect them to argue in good faith. Anyone debating them on air should prepare for their favored lies of the week. After a certain point, ignoring obvious bad faith – or ignoring obvious motive – feels like enforced naiveté, unworthy of adult conversation. Our mainstream press struggles to deal with liars, and the problem with our national discourse is a lack of honesty, accuracy and fact-checking rather than a lack of "civility." That's unless we define civility as "not lying," since dissembling about important public policy is awfully offensive. However, the chattering class generally views anyone who accurately calls out a liar as terribly uncivil. They recoil because they judge a statement by its harshness, or by its target (one of their own), not its accuracy.

Substantive critiques are always good, and most bad ideas can be exposed this way. However, most policy discussions – to the extent policy versus politics is ever discussed on air – rarely discuss the likely consequences of policy proposals, and that old question - cui bono, who benefits? Those should be included. If someone makes a really bad policy argument, it's only natural for the listener to ask, why did he or she make it? The sincere-but-wrong, the sincere-but-of-different-opinion, and the sincere-but-not-well-informed tend to discuss issues in a different manner than the professional liars. Generally, it's not hard to tell a wonk from a hack. Also, average citizens are typically more honest and sincere (whether wrong or right) than pundits and politicians. It shouldn't be forbidden to point out that different parties have competing interests. For instance, insurance companies want to maximize profits, but their agenda may be in conflict with the interests of the citizenry, who want good health care. Republicans wanted to deny Obama a political victory on health care reform, although the alternative was doing something to benefit their own constituents and sharing in the glory. Their "tort reform" proposal was a drop in the bucket and wholly inadequate. No Republican leader discussed health care around the world and the benefits and drawbacks of other models honestly. There was no attempt at crafting good policy from them. Instead, we got charges of socialism and death panels. (If that's not enough, there's also the infamous Bill Kristol and Frank Luntz memos that prove bad faith on health care reform.)

I think pressing opponents for their "plan" is wise from the very start. "Here's a problem; you don't like my proposal, fine – then what's your solution?" In the, um, reality-based community, theory informs practice and vice versa, constantly. One of the hallmarks of bad faith is when someone keeps hawking a talking point, or dogma, long after it's been disproven. (This is a good example in economic and fiscal policy.) Sometimes that insistence is due to zealotry, but more often it's because what they were saying was BS. Their argument was merely ammunition for a political outcome – most commonly, preventing any solution to an important problem – it was not an argument for better policy. Personally, I expect to keep wrestling with these issues and trying to find the best approach, but there should be a way to address lying and bad faith.

(By the way, I'm assuming from your blog title you're a fan of Camus.)