I think I figured it (the liberal bafflement by Health Care) out.
I've been muddling along reading analyses of Health Care like Sonic Charmer's that fit perfectly my worldview.
I read a bunch of stuff at Volokh about why liberals don't really get it, with it being the fact that conservatives appear to be winning this debate. Then I read some stuff like Will Wilkinson that mildly challenges my worldview...And then I read Kn@ppster critiquing Wilkinson. And then the idea clicked.
I think that progressives/liberals had thought they'd won. We are on the right side of history, and the direction is settled. If the government wants to do something, it can. So says precedent since the New Deal. It's a settled issue. Sure, that overlooks a lot, but given Raich, and Kelo, and, hell, damn near everything since Wickard (Commerce Clause) and Miller (2nd Amendment). Since 1937, it has been the clear position of the court that in most cases not involving religion, the federal government can do whatever it wants. And my read says that (a) they are right, and (b) for most of the last 75 years, the supreme court has completely failed to act as a substantial check to congress.
The libertarian position is substantially different (can't speak for conservatives). We hold that the government has been slowly (and improperly) encroaching on the proper understanding of the constitution as a document whose primary purpose is to limit the power of government to screw it's citizenry. As such...we hold every new government action as in moderately clear violation of the purpose of the constitution, and in pretty clear violation of the letter of the law.
Heroic libertarian crusader Randy Barnett has nearly single-handedly (Richard Epstein? Alex Kozinski? Scalia?) transformed the debate into one that includes the original meaning of the constitution. When someone wrote "regulate" in the commerce clause...what did they mean? They meant "make regular"...prevent the states from imposing tariffs on other states' goods.
The liberals, thinking that 1937-2005 Supreme Court precedent was pretty clear on the topic, thought they could move on to other issues. The libertarians, thinking that 1937-2005 Supreme Court precedent was clearly wrong, and have been focusing on how to point out that it was wrong even in the face of stare decisis.
Heller, Citizens, and Obamacare are 3 modern cases where libertarian theory and the current court have come together to shake to it's foundations the liberal view of "what is settled". IF the liberals had been right: "the government wants to" is good enough, and that's settled precedent...then the Verrilli's argument was just fine. However, the court has been transformed in the past 10 years.
As usual, a lot of writing allows me to think.
Here's the question:
Is the stable state of precedent
(a) the modern one of near unlimited government power: 1937-2005?
or
(b) the historical one of highly constrained federal power: 1789-1937?
The Progressives thought the answer was settled as (a).
The Libertarians are pushing for (b). The conservatives are currently onboard with the radical libertarian attempt to do (b), but won't be for very long, as any real motion in that direction eviscerates government actions like the drug war as well.
I'm beginning to suspect that George Bush, biggest-government-proponent-ever (before Obama), was not bad from a libertarian point of view (Alito). And that Romney has a FAR FAR higher chance of appointing someone orignialist than does Obama. With 4 justices over 74...we are likely to lose one in the next 4 years.
Furthermore...I'm beginning to suspect that the libertarian strategy of infiltrating the academy (more academics appear to be libertarian than conservative) is working...we're getting the law to move in our direction.
Anyhow...I think that's the liberal position...and I don't think it's obviously wrong.
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I think that you're right, but would add another facet: the public in general is in favor of the libertarian positions in the cases you cite (Heller, Kelo, Obamacare re: the mandate) by supermajority. I'm not sure how much the SCOTUS reads the election returns these days, but part of what flummoxes the Progressives may be that they feel that their core positions are being decisively rejected by the body politic.
There's certainly a feeling on the left that the Sword of Damocles is always hanging over them.
I'd like to make the case for universal healthcare (i don't want to talk about Obamacare). I think its hard for people that aren't sick to understand what it's like to be sick from birth and what an effect it has on your life.
Personally, I come from a long line of sick people. My father is a type I diabetic, he has immune system deficies that caused him to have emergency surgery to remove his spleen, and had a very nasty heart attack when I was in elementary school. I've inherited the same health concerns, minus heart problems but plus asthma and bone deformities.
I've been to the hospital a lot. My father has been there a lot. When he was sick for three years after his heart attack we lived in poverty. There were nights where there wasn't enough for me and my mother to eat. I watched her cry herself to sleep a lot. When my father returned she no longer loved him (because he was too weak to provide for her when he was sick) and while they stayed togethor they got in a lot of fights.
When I grew up my goal was to go to college and get the type of job that was stable and had good health insurance, even for someone with my conditions. I did, and I'm glad I did seeing as I ran up over six figures in hospital bills when I got sick at 27 in addition to all my regular medical care.
At the same time, working for megacorps is not really for me. As a +3SD non-neurotypical I'd be way happier doing start ups, being self employed, or working for some small company. But when your sick you need insurance, and when you have sick parents your always worried about having to support you take the stable megacorp job. Instead of asking myself what would make me happy and best use my talents, I asked what the way to minimize my family and myself ever having to live through poverty or be denied the best treatment. Yes, it's possible to feel like you are one illness away from poverty while making a high income.
What universal healthcare means to me is freedom. The freedom to live my life based on how I want to live and not based on what minimizes my chance of going without medical coverage. Most importantly, that any children I have, who will share the same problems, will also be free.
The freedom is worth a lot. We can talk till we are blue in the face about what % of GDP its worth, all I know is that making extra money doesn't get me what I want (freedom). The only thing that can give me true freedom is having a guaranteed insurance card that makes it possible for genetic trash like me to survive no matter what. No matter if I lose my job. No matter if it wouldn't make sense for some insurance company to cover someone with my conditions. I just get a card and I get whatever it is I need to be healthy.
Now, I know all about the healthcare system. I know Singapore or Switzerland or whatever are better ways to do it. But this isn't some tiny little island dictatorship. It's a giant democracy. And amongst giant democracies there is no case of a successful Singapore method. But thre are many of universal healthcare. So I'm all for it. It seems like the only policy solution that could get me the freedom I want.
Anonymous,
The choice you've made to take a stable job that pays for health coverage instead of the startup job that doesn't is a grown up, mature decision. However, it sounds like you regret having to make that decision. You could have just as easily said that you'd rather play in a rock band or be a professional paintball fighter. Life is all about hard choices. If you want X, the cost is Y, and it always has been so. My own father used to have to come get me from home when I was a teenager and have me help him climb up roofs to do repairs on commercial air conditioners because he was sick and one of the symptoms was vertigo. I lived through the poverty when he was no longer able to work, the times of having icicle soup and getting handouts from our church to live on. My father worked as long as he could, and kept going long after he should have stopped, because it's what adults do. They figure out what needs to be done and they do it. I've known many a man that gave up a dream of being a ball player, a singer, a fill-in-the-blank because they had a family that needed them and they had to go mine coal or install telephones to make enough money to keep a roof over their heads and food on the table.
Everyone has dreams that they want to follow. Very few people are able to follow them. That's because they have a price. Nobody's stopping you from working at a start-up, but you have to be willing to pay that price.
I keep hearing people say that the healthcare system is broken, that it's so terrible, and that people can't afford their medications, can't afford treatments, can't afford this or that or the other. Well, guess what? We live in a world of finite resources. If something requires an expensive machine to treat and there are only three of those machines within a thousand miles, the cost for getting in that machine is going to be high. If the drugs you need are made with frog hair, their costs are going to be high. People forget that medical research and development is done by COMPANIES that want a return on their investment, and they only have a short time to get that return before their brand new wonder drug becomes a generic produced by ten other companies, and is eventually surpassed by another new hotness drug. Then there are doctors. Doctors are people with specialized education that has cost them close to a decade of higher education and frequently over $100,000 worth of student loans or cash out of pocket. Do you want those people working for free so that you can have your safety net of universal healthcare?
You say the system's broken, but I don't see a usable solution coming from you. All I hear is you whining about opportunity costs. Life is hard, and you don't get all the free candy you can eat. Sorry.
Why should I have to pay that price because I was born sick? Especially when we have a system that works, and works pretty well, in so many other similair countries around the world?
If you want to make the case that people in my condition should be terminated because they are too great a cost to society, make it. I'll fight tooth and nail for my own survival but I'll understand why you want me to drop dead so your insurance premiums are a little lower and you can buy a bigger SUV. Because in a post scarcity world you should definately make the case that consumer luxuries distributed accross the majority is better then needed medical care for a minority.
Universal healthcare works. Doctors still get paid. Drug makers still get paid. Even when there are waiting lists people get access to 99% of the things they need to be healthy.
Anonymous,
It's not fair that you're born with what I'd estimate to be negative 2 sigma health. Should society nullify that disadvantage of yours?
It's also not fair that you were born with @3 sigmas of intelligence. Should society tax that a la the height tax to nullify that unfair advantage?
It's lastly not fair that being non-neurotypical gives you what I estimate to a 1 sigma disadvantage in the SMP/MMP. Should society nullify that as well?
Be very careful when you attempt to raise fairness to some sort of moral principle. It's perfectly acceptable to fight for your own particular advantage, or for that of your own group, but let's try to avoid deluding ourselves as to our moral standing.
Borepatch,
1. I didn't list Kelo, but did list Citizen's United, which the public is decidedly opposed to.
2. I am uncertain of the extent to which the public is pro- . Yes on Heller, Kelo, and Obamacare. No on Boumedienne (Guantanamo), CU, and others.
3. I am thoroughly unconvinced that the leftists think that the public is on our side. If it looks that way, the leftists are certain that it's a framing problem.
4. The sword feeling may be because they're no longer in control of the Supreme Court. Unfortunately, I may have to be pro-Romney for a little bit...see if we can't get a 7-member conservative majority on the court, if Romney + Rubio/Ryan can last 8-16 years...that's a substantial chance of 2-4 justices.
Anon,
I'm much more sympathetic to your line than most of my commentariat. I am, contra them, a left-libertarian.
Big answer to you in a separate post.
Phillip,
Said very well technically. You'd lose most debates, though, for coming off like a heartless jerk.
Jehu,
Very well said. Strikingly libertarian-leaning.
Aretae,
Libertarians and I agree on a fair number of premises, we just differ profoundly on conclusions because our values are different.
I don't have an issue with people advocating that society socialize their disadvantages while leaving their advantages intact, because pretty much everyone does it, and I'm not in the business of calling everyone fundamentally evil.
I simply prefer that they cut the moral language and have a straightforward struggle over it. To wit:
Jehu: Why should society socialize away your particular disadvantages?
Speaker: Insert Melian dialogue here
Jehu,
Naturally, we are all looking to get the most for ourselves. And we justify it however we can.
All I can say is I want it more. You might think that getting slightly lower insurance premiums by excluding people with pre-existing conditions is the most important thing in the world, but I doubt it. I doubt you really give a damn. I doubt you'll fight and die for it. Who knows if you'ld even show up at the polls for it.
But for me, it really is life or death. It really does make sense for me to focus on doing whatever it takes to get what I want politically, because as an individual I really do have no realistic high probability way of obtaining what I want.
There are a lot of things I think the government can do to increase the general welfare, because the utility values of different things are very different for different people. However, there is no market mechanism to maximize utility.
Does that mean I want a big stupid government in there doing those things. Not necessarily, my default assumption is it will fuck things up. That's why it ought to be:
1) Really important (like health, freedom, etc). If it ain't life or death best not to involve government.
2) The potential negatives are not disastorous (is it the end of the world if people have less discretionary income in exchange for never worrying about their health)
3) It should preferably have some track record of working (the conservative arguement).
4) It should have a stable and realistic political economy (which nobody really seems to consider on this board).
Jehu,
Jehu: Why should society socialize away your particular disadvantages?
Speaker: Insert Melian dialogue here
Aretae: Speaker, you are suggesting that we use guns to steal $ from some folks, and give it to you. I find that morally abhorrent.
Jehu: Everyone does it.
Aretae: Not the libertarians and anarchists.
I think that can summarize an awful lot of our disagreements.
Anonymous,
Yes, you demonstrate one of the key elements of the reaction thesis: when conflicts are open and not concealed behind universalist rhetoric, negotiation is actually possible.
When we admit that we fight for our own interests, and our adversaries similarly fight for their own as well, it is even possible to fight without creating lasting hatreds.
Anon,
I agree that #4 is frequently ignored. However, in this case, it appears not to be a very strong argument. And 2 is a big gaping hole. More when I have time
Aretae,
Be honest, don't you prefer the Melian dialogue to:
Speaker: You're an evil and selfish because you refuse to pay more to ?
I certainly do, and those are the only two that are meaningfully on offer.
Responded to your health care drift thing.
As far as #2 and #4, I disagree with you on the direction HSAs were going in the private market and the political sustainability of that approach. I love Kaiser, and I love Singapore. But I don't think that's happening here, and I don't think it would have happened in the absence of any government action (in fact its 100% provable).
Universal HC seems like the only politically realistic reform that is going to guarantee the kind of freedom I'm talking about for people with pre-existing conditions. If its less efficient, well, I'm not making the perfect the enemy of the good. I've already realized additional consumer dollars do nothing for me, or I'd be making more. I want the freedom.
Anon,
Be careful on #4. John McCain's proposal was apparently Singapore-style HSA in essence.
Anonymous,
Given your likely life trajectory, my gut tells me that something akin to Singapore-style catastrophic coverage where everyone has HSAs is probably what is most in your interest. Were your particular parameters different, this would not be necessarily so.
Here's why:
The US pays most of the Non-recurring engineering costs of medical development throughout the world (yes, I know they call it something else in the pharma industry, but it's essentially the same). The US adopting a single payer system would likely choke off a lot of said funding, in addition to channelling it moreso to politically favored causes (read, not your particular problems). In your case, that's a matter of life and death. Given your age, it is entirely likely that if the center holds, your particular problem (type I diabetes) may well be largely suppressed before it seriously bites into your life expectancy. You're also likely to be making more than 100K in the near future if the center holds, so you'd be able to afford actuarially priced insurance without much of an issue.
If you didn't have net +2 sigma income potential, I could see it as being net in your interest to push for more medical socialization of your costs.
Anonymous - while you have my unrestricted sympathy for your health problems - and believe you me, you do - I cannot figure out how in all of the words you wrote that any of it justifies you forcing me to pay for your healthcare.
No one guaranteed you the ability to do whatever you wanted to do with no tradeoffs for your entire life. You were never promised the ability to run a start up, or to not have to work for megacorp.
I was, however, guranteed life, liberty, and the pursuit of happiness, and the right to be secure in my personal effects against unreasonable search and seizure. As much as I hate that you have health issues, i hate even more that you feel entitled to:
a.) Do whatever you want to do with your life at my expense;
b.) complain that life hasn't been everything that you wanted it to be (join the club).
And in case you think i'm being obtuse, and don't understand how hard it is to be sick all the time, my medical bills run in the range of $15,000 to $40,000 per year, every year. I, also, am a very sick man. And I also work for megacorp because it is the only way that I could ever get health insurance.
All i can say is "suck it up, buttercup." No one owes you anything.
Goober,
Well, and empathetically said. And welcome to the blog.
Goober,
Why should "I suck it up."? I think that's a legitimate question. Just cause? The strong shall dominate the weak. The weak should just accept their desperate condition without complaining.
Well, fuck that. We do what we gotta do to survive and thrive. When Jean Val Jean steals a loaf a bread, people are jumping on him as a terrible criminal. The guy that chases him is seen as an ogre. I don't think needed medical care is much different then the bread. Jean Val Jean would prefer to make the bread himself, as he did later in life, but what people here don't understand is that peoples ability to provide for themselves is based on factors outside of their control. And if those factors don't aling, they will do the only thing they can to survive.
Anon,
I think the JVJ example is wonderful. JVJ steals bread. But victor Hugo wa a master of the moral dilemma, where folks with different moral codes are each pursuing their conception of good, and those goods bring them into massive conflict with one another.
And the goal here isn't to find a one-off case, but a regular, applicable system that works for everyone.
You have and Goober have conditions that have real costs on the order of 100x my natural medical costs (That $14K appendectomy in '85 was more than half of my total medical expenses over my whole life).
Either you pay for it, you get someone else to pay for it voluntarily, you force someone else to pay for it, or you die/have a super-crappy life.
You are suggesting that "force someone else to pay for it", the European standard, is the best system.
I am suggesting that there's a lot of room to discover what the best system is. However, as with anything else, there should be a strong presumption against "force other people to pay for it", if there are other options.
I assert that it is overall a much more all-counts ethical (univeral -- I ain't Jehu) line to help you with your medical bills, but not pay all of them. As Jehu says...you're trying to socialize your disadvantages (health), while keeping your advantages (IQ). Should the poor healthy stupid gym-rat with 5 kids down the street help pay for your health care? It is at the very least true that this is not obvious.
Furthermore...you're ignoring all the tradeoffs that are relevant. I believe that you want your health problem to go away. I don't believe that you have picked the best method to make it go away...nor the best method to help even most folks in the general category as you. It may be best for you in particular, though. If your condition is comomon enough that the single-payer bureaucrats decides it's politically expedient to cover your condition.
Anon,
Before going further...I'd like to point out that we appear to agree on a LOT of things.
1. Insurance being tied to employers is a relatively bad option.
2. Medical Insurance (the current US standard) itself is a relatively bad option.
3. Most folks would think it is fair to socialize *some* of the medical costs of particularly sick folks.
4. All systems deny care to some people (Scarcity is real), and all systems will have people for whom the system is better than other systems, even in terms of getting their conditions treated.
Others have said it better than I could, but I will point this much out: Anon, you really summed up a part of this that gives me the heebie-jeebies when you said, "I don't think needed medical care is much different then the bread." One thing I haven't heard discussed is the Pandora's Box that government hands in healthcare opens. Take your statement...why, then, would it not also be imperative for government to provide food for everyone (universal, not just for "the needy"), given your assertion?
Okay, now what about the full-on single-payer system that the left dreams of? Some of the biggest healthcare costs are a result of poor lifestyle choices, particularly surrounding diet (or so they tell us...some interesting information out there about just how little we know on this topic, but gov't hasn't jumped on that bandwagon yet...). So, shouldn't government control diet in order to control healthcare costs, which are a huge concern in single-payer systems? What about exercise? Do you fancy having to report to a government health adviser on a regular basis to be sure you're meeting your quotas? Do you honestly think that these discussions aren't going on right now in the same circles that advocate and agitate for single-payer? If the government is paying for something, don't they own it? Shouldn't they have the ability to control the costs if it is them paying the costs?
This is Pandora's Box without the hope; always has been.
Anonymous - your freedom, my chains. You also say something to the effect of '...universal healthcare works...'. Where? Canada? UK? My Canadian relatives would disagree with you, long waiting times and rationing being the rule. UK no better. Medicare? Doctors don't want those patients because they can't make the money. Creation of a massive bureaucracy is not the answer, it will fail and in the process will lead to overreaching government power. If you want to talk about deregulation or special policies and consideration for those who are not insurable today I'm with you, but when you talk of government taking over I don't think you're looking at the long term problems.
This discussion has been constrained to an extremely small mind space, ie - insurance is expensive, someone else needs to pay for it, for whatever I need.
Missing is:
What is health care insurance?
What is the purpose of health care insurance?
Why is health care insurance expensive?
So, to review - health care insurance is to pay for unexpected health care needs, not for routine maintenance - the intent is to cover catastrophic needs, something that most people might never experience. Health care insurance is expensive now because (1)it is expected to cover everything from a snotty nose to sex changes for the confused to chronic conditions as anon above & (2)it is rationed now and will become ever more rationed in the future.
It is only in the last 20-25 years that the expectations of (1) have grown and then exploded - the belief is that once one pays for insurance - everything should then be free. And that someone else should subsidize my insurance.
The rationing issue (2) is due to governmental involvement in EVERY aspect of health care - from regulating who can provide it, where it can be provided, and how it can be provided. Defining, creating a monopoly ALWAYS leads to higher cost.
Healthcare is a monopoly.
Get government out of health care.
Government, as usual, is the problem masquerading as the solution.
Ask Canadians or Britons with chronic health conditions how well government health care is working for them.
You think now is bad, just wait.
itor
Anon2/Itor,
Well said. I'd emphasize your point 4 -- Health Care is already rationed. Someone is deciding what isn't going to be provided. Unlimited health care is a fiction...it's just who makes the decision about who gets screwed.
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