Wednesday, July 30, 2008

Oh boy

a a long-ass post on health care. With all sorts of bullshit premises underlying a completely fatuous argument. Fun, and long.
To begin, Brad Delong sez

(1) We as a country seem to believe in a relatively small government. (2) We also seem to believe that health care should be provided on the basis of how dire your need is rather than how thick your wallet is. (3) And we have good reason to suspect that our health care capabilities will become larger and better as time passes. (2) and (3) are inconsistent with (1). (1) and (3) are inconsistent with (2). (1) and (2) can go together only if (3) is false. I think that (3) is true. That leaves us with a societal choice to make: do we abandon (1) or abandon (2)? I favor throwing (1) over the side, but this is an important issue we can talk about.
I don't know about number 1. The leading "small government" rhetoric hawking politicians tend to also be the biggest big government proponents, unless you want to distinguish the military industrial complex from the government, so the electoral success of Reagan and Gingrich doesn't really tell you much. It seems you can win some elections railing against humanitarian government spending and the press has largely accepted the position they're paid to advance that corporate crony capitalism = freedom, but since we all know Delong doesn't want to challenge that portion of the narrative it seems he has to drink some Kool-Aid. But I digress.
Megan responds
I agree with the good professor that (3) should be off the table as an area to "improve" on. But I think that at least some of the conflict between (1) and (2) comes from the way that America--and indeed, the rest of the industrialized world--approaches the problem of (2). That is, we target welfare problems directly, with service provision or vouchers, rather than with a comprehensive income strategy.
There's a shocker. Megan will have no part of reforming the way medical science is practiced, because rich old white men need to have billions spent researching redundant treatments to get them erect and keep their hearts from bursting when it happens. The profit motive aligns 100% with humanity's best interests here, so STOP CRITICIZING BIG PHARMA. THEY'RE GREAT, AND NO, MEGAN DOES NOT RECEIVE ANY KIND OF COMPENSATION FROM THEM SO STOP ASKING.
And now, a very bad idea, indeed.
Imagine if, rather than giving people food stamps, Section 8 vouchers, welfare payments, public schooling, and so forth, we simply had an incomes program to boost the wages of those whose productivity is not up to providing them a basic, decent standard of living? Leave the justice issues aside--I am not going to try, in this short post, to persuade commenters who disagree that all Americans should have the opportunity to avail themselves of things like housing and healthcare even if they haven't any particular skills. Just accept for the nonce that politically, America is not going to let its poor, elderly and disabled sink into the muck of immiserated poverty, and focus on more efficient ways to do what we are so obviously determined to do.
Note, first off, that public fucking schooling is included with welfare and food stamps and section 8 (essential programs all), because teaching kids to read is the same thing as.... no. That's worse than including stealing food with rape and random violence. She has brain damage. That's just not a coherent or rational association. Read some Aristotle, Megan. Learn what a category is. I must also note the sly rhetorical trick of contrasting her position with an even worse one, making herself seem like she gives a shit about the people whose safety nets (and right to learn) she wants to blithely dissolve.
As for the idea itself, let's give Megan a chance to finish showing how stupid it is, herself, before responding to it directly.
This would have a couple of salutory effects. For one thing, it would tie welfare to work (except for those who are genuinely too disabled to do anything.) That would add at least some small boost to the labor force, and hence GDP, thus reducing the cost of caring for those who can't quite care for themselves. It would also keep people on the employment train, a vehicle that can lead somewhere a lot better than a welfare check.
Forgive me for being a foolish (also) non-economist, but isn't our economic system currently designed to maintain a certain percentage of the populace as unemployed, so as to keep the salaried folk's sense of their own rights in check and to maintain a labor supply? Isn't the economy contracting, and shedding jobs? Where are these folk going to work? Has Megan not heard the horror stories of the welfare to work programs? How many rhetorical questions can I ask in a row?
But that's not all it would do; it would put choice back in the hands of the consumers. Do poor people want more car and less house? Great; why not give them that choice if it doesn't cost us anything? They could even (whisper it) save the money and do something really important with it at a future date.
And hey, if we end up subsidizing crack addicts or child porn fans (or people who steal food), their kids have the choice to try to survive it or to lay back and give in to despair and death.
Now, healthcare is a special case, because unlike most of the other "basic goods" we think everyone should have, the costs can vary widely from person to person. But there are ways to deal with this--alter the income transfer for different diseases, and then let people decide how to spend the money.* Maybe some of them will spend their healthcare money on a fabulous car and let their diabetes fester. This violates a lot of intuitions: the intuition that we only want to help people have medical care, not fabulous cars; the intuition that we have to protect people from themselves by ensuring that they spend the money on what they need, not what they want.
The intuition that we're not well served letting people slip into diabetic comas while they're out on public roads driving the Hummers the government bought them; the intuition that right now poor diabetic people have neither a big car nor sufficient treatment; the intuition that unless we're going to allow people to start dropping dead in public they're still going to be treated for their illnesses eventually; the intuition that Megan would be ok with letting people die at random in public of preventable causes provided they chose to spend a weekend in Vegas over living. Did I say intuition in that last one? I mean confirmation
As a radical anti-paternalist, you can imagine I don't have much patience with the latter argument. Who am I to say that your life is not better with a sports car and five years to live? And to the former argument, I point out that in fact, you'll probably end up giving the wastrels less money if they do fritter it away. Because once you've actually provided people a minimum income that is adequate to take care of their basic needs, there's no moral reason not to turn away those who decline insurance from the emergency rooms. Giving people more choices also means allowing them to live with the consequences of those choices.
Let them eat cake... they'll choke on it eventually.
This will not be perfect, of course. We'd still need the annoying healthcare administrative apparatus to determine, for example, how much to pay for diabetes care. But with a market in place, this isn't as hard as it is when the government is setting all the prices, because it won't be a brute force negotiation between providers and the government, with both lying and bullying the other. We'll have prices from the private sector set by the competitive action of a lot of brains trying to determine a fair price.
Holy fucksticks. I keep trying to wind this neverending post up, and she keeps writing something so stupid I have to quote it. The problem with the medical industry's costs today is that the government doesn't allow Big Pharma to charge whatever they damn well please. Fuck you, Megan.
She closes with a quote by The Sacred A. Smith, thus consecrating the sermon. Sure, the quote seems to suggest he would have found Megan's idea as stupid as the rest of us do, but she means it to dismiss the ideas of everyone else, not hers, so there.

*- This means Megan wants to turn cancer or AIDS into some kind of lottery/Russian roulette dilemma of treatment versus a brief period of fabulous wealth. You'd have people faking expensive conditions for money and the government would be all but forced into a defensive stance whereby it challenged each claim, such as with worker's comp. It'd be just like insurance based health care today, only the government would be trying to kill you, instead of your insurer. Great fucking plan.


Susan of Texas said...

I like the comment someone left on DeLong's site; why is everyone wondering what to do when foreign governments are successfully dealing with the problem? The only reason I can come up with is that univeral health care doesn't let you feel superior to the dirty rabble.

Anonymous said...

Because once you've actually provided people a minimum income that is adequate to take care of their basic needs, there's no moral reason not to turn away those who decline insurance from the emergency rooms.




...fuck you!