Posted tagged ‘Health Care’

By The Way, David Brooks Is Still Always Wrong

November 13, 2011

I know this is already long since fishwrap, but amidst the many disembowelings of David Brooks discovery that he has always been at war with Eurasia   always  loved Mittens, I have to rage, rage, at the relentless, endless, fetishization of the deepest, most degrading fantasy of the right.  No, not that one.  Nor that one either.  Nor this.

No it’s the almost touching faith evinced by Mr. Brooks and the entire GOP presidential field in the existence of a free market in health care.  So, just to flagellate a truly dead horse, let’s take a look at one specific passage from Our Lady of Perpetual Broderism’s Romney tongue-bath:

True Medicare reform replaces the fee-for-service system with premium support. Government gives people money, rising slowly over time, to shop around for their own private insurance plans. The system would reward efficiency and quality, not just quantity. Competition between providers would unleash a wave of innovation.

The only problem is that the marketplace for health care that exists in the world real people inhabit bears little or no resemblance to Brooks’ pleasant vision of informed consumers, with full information in hand, shopping around for the perfect combination of benefits and price they need — not just now, but through the life (and death) cycle all of us endure.

 

That is: most evocations of the free market in just about anything call up spherical cows, simplified (and dangerously convincing) models of what actually happens in the world.  But to imagine a genuine Ec. 101 free market in health care — and to praise someone as “serious” for building policy on the assumed reality of such delusion — that takes real effort, a true commitment to avoid knowing inconvenient facts.

At least, so says such a DFH as Daniel McFadden.  That would be the 2000 Nobel laureate in economics who has taught at such dens of raving lefty lunacy as USC, UC Berkley, and (ahem) MIT.  And that would be the same fellow who has spent quite a bit of time analyzing the notion of consumer driven health care.  Here’s what he had to say in 2008 in a working paper co-authored with Joachim Winter and Florian Heiss:

Most, but not all, consumers are able to make health care choices consistent with their self-interest, even in the face of novel, complex, ambiguous alternatives. However, certain predictable irrationalities appear – excessive discounting of future health risks, and too much concentration on dimensions that allow easy comparisons, such as current cost and immediate net benefit. Some consumers are inattentive, particularly when prior choices or circumstances identify a default “Status quo” alternative.

These behavioral shortcomings imply that some degree of paternalism is essential if Consumer Directed Health Care is to allocate resources satisfactorily. Health care markets need to be regulated to keep out bad, deceptive products, particularly those that offer “teaser” current benefits but poor longer-run benefits. Consumers need good comparative information on products, and they need to have this information brought to their attention. Consumers appear to underestimate the probabilities of future health events, [or] anticipate the resulting disutility, and as a result they systematically underspend on preventative or chronic care. Socially optimality will require that these services be subsidized, or choices regarding them be framed, to induce desired levels of utilization.

[From the second paper listed on McFadden's website, linked above: "Consumer-Directed Health Care: Can Consumers Look After Themselves?" pp. 19-20]

Note what McFadden et al. do not say.  They don’t say market mechanisms can’t work.

They do say that human beings display predictable behavior that makes it impossible to rely on an unregulated market to deliver health care.  They point out that those irrationalities fall most heavily in the area of guessing what you or I might need some years down the road…i.e. when we are likely to need good care the most.*

Hence, the need for what the authors above call “paternalism,” and what I would term the normal function of the concept of universal insurance — mandated if necessary under the particular policy choice — against risks all members of a society face.

McFadden and his colleagues are hardly the only ones who get this.  This paper is exemplary, not determinative.  And again, it’s not that these writers represent some radical wing of anti-classical economics clinging to the margins of the profession.  In fact, McFadden and his co-authors display some familiar, reflexive thinking.  I’d argue with the Nobel laureate in his offhand dismissal of a different approach, what he terms “a government single payer/single provider program.”

Partly, the difficulty I have with the expert here is that single payer is not the same as single provider.  Conflating the two allows one to damn one with the flaws of the other — which is hardly cricket in a serious policy discussion.  And when anyone — even a distinguished fellow like McFadden — says that he “believes” the problems of such a system will be the same as for private plans, then I become an honorary Missourian: “Show me.”

But that’s an aside.  The core point is that even folks with a deep institutional and disciplinary engagement with the idea of markets understand that you can’t run health care on the principle that the customer knows best.  We don’t — we can’t, really.  And that’s why Romney, and Ryan, and all the other GOPsters trying to transfer risk to the American people and profits to American insurers are never, ever “serious.”

Which is just another long way round to repeating the obvious. David Brooks is always wrong.  He kind of has to be, given how he has dedicated his career to the notion that Republicans belong in power, no matter what.

*Brooks — like the GOP candidates — might argue at this point that they never have contemplated an unregulated private market in health care.  Which may be accurate, but not true (to channel my inner Sally Field).  That is — the degree of regulation in the market to which all calls to repeal Obamacare would return us was the one in which a host of problems along the lines McFadden et al. point out, and many more besides.  More broadly — even if you take the GOP as sincere in its stated principles, they oppose “paternalism” in individual decisions.  Which means they oppose exactly what is needed in the delivery of health care.

Images:  Edouard Manet, The Dead Bullfighter, 1864-1865

Pompeo Batoni, Time Orders Old Age to Destroy Beauty, c. 1746

Megan McArdle is Always Wrong: On So Many Axes It’s Hard To No Where To Start/Outsourced Edition.

September 17, 2010

Yes, this will be largely outsourced, but just to get everyone in the mood let me quote from the introduction to Andrew Bacevich’s important new book Washington Rules (about which I’ve been blogging a bit this week).

That introduction channels (and explicitly cites) Henry Adams on the subject of education, which in both men’s tellings tends to begin only when one discovers the capacity to break free of the fetters forged through years of imbibing truths too obvious to be examined.

As Bacevich quotes Adams, “Nothing is so astonishing in education as the amount of ignorance accumulates in the form of inert facts.”

That revelation prompted this next reflection.  I want to emphasize that the identification of it with Megan McArdle is all mine — Bacevich bears no responsibility for that specific connection.  But as I read his couple of sentences describing those who attempt to get ahead within the Washington establishment by showing existing powers how perfectly you can recite your lessons, it seemed to me to describe McArdle to a tee.

Bacevich writes that:

Adopting fashionable attitudes to demonstrate one’s trustworthiness — the world of politics is flush with such people hoping thereby to qualify for inclusion in some inner circle — is akin to engaging in prostitution in exchange for promissory notes.  It’s not only demeaning but downright foolhardy.

Bacevich is a better man than I am: he writes to warn, to educate.

I don’t, at least not here.

I think Megan McArdle is past instruction.  She has made her petty-Faustian deal with the the little Lucifers of DC, and it is my bet that when the bill comes due, it will be far too late for any education to have effect.

Which leads me to today’s update in the Always Wrong™ chronicles.  This one belongs almost entirely to Susan of Texas, the stalwart at The Hunting of the Snark who has more stamina than I will ever have in documenting the case study in the death of American journalism that is the Business and Economics Editor of the Atlantic (sic!). (h/t TBogg).

Basically, McArdle links to a post citing an anonymous source accusing HHS Secretary Sebelius and the Obama administration of silencing a critic — a health insurance company — through the threat of regulatory retaliation.

Astute readers would (and did in McArdle’s comment thread) smell the obvious rat.  McArdle has long since demonstrated that she will say anything, no matter how risible, to defend her required position that the health care bill is an abomination (i.e. required by her overlords. See “promissary notes,” above).

So it comes as no surprise that she would leap at the attempt to advance the radical right-meme that government regulation = government jackboots at the door of innocent corporate citizens.  But given the convenience with which this post supports the pre-existing narrative, those who are familiar with her work know that one’s must needs check each claim.

Which her commenters do, admirably, and which Susan O’T meticulously chronicles. Go read Susan’s work — it’s fun.  Here I’ll just give you the short form, and one thought (all I got left on a busy Friday morning.)

Shorter:  McArdle takes another writer’s claims based on a “vetted” anonymous tip that a health insurance company has been silenced by a “gag order” issued by the  government.  Turns out (a) the “threat” was a widely publicized letter Secretary Sebelius sent to the head of the health insurance lobbying organization saying, in effect, that as the law requires, that insurers will be subject to regulatory review of potentially unjustified premium increases, and if that review returns confirmation, sanctions will follow.  To which she added the warning that falsely claiming that the new health care law drove the increases would not turn an unjustified increase into a justified one.

Now, you might not like it when a regulator in your business says the regulations apply to you, but McArdle had a great deal of difficulty explaining to her comment thread how this was a gag order — and in particular how this bore, at all, on her imputation that the administration was trying to suppress political speech (“dissent” in her grubby appropriation of a word whose associations with the to-her foreign concept of courage she seeks to steal).  Basically, she just made that bit up.

Actually, McArdle more or less told her readers right up front that she was doing so.  Susan noted that McArdle’s discussion of the so-called gag order began with this phrase:  ”Whatever the facts….”

My FSM!  She might as well have taken out an ad in Variety to shout that this was all bullsh*t.

I’m sure no one reading this will be surprised to learn that the facts aren’t with her.

The health insurer in question, when finally contacted by the initial poster denied the existence of the gag order.  That blogger excused his error by saying that it seemed likely to him that the adminstration might threaten someone, and that if they had, and succeeded, the gag order would have prevented the company from telling him so. Sic.

McArdle ultimately updated her post to reflect this fact, after being contacted directly by the company in question.  She added this remark:

I shouldn’t have linked the HCSC situation to Sebelius’ letter, which I’ve been meaning to write about for days; I took the words “gag order” to mean something they didn’t, for which I apologize.

Uhhh…”I took the words “gag order” to mean something they didn’t?”

Is is it just me or is she telling us here that she is functionally illiterate?

How many other things can those words mean than the one we all assumed she was talking about: that someone with power uttered a command to someone else to shut up?

Of course, this is really just word salad, the one dish I know that McArdle knows how to whip up.

Her problem was that she committed a fundamental journalistic sin in a journalistic setting.  She got something big wrong, and even admits, within the body of the piece, that she didn’t even try to get it right.

Remember: McArdle accused the Obama administration of doing something very bad that it did not do.   She used words like “creepy” and  ”thuggish” to describe this alleged exercise of totalitarian power.  There is nothing here that turns on a misunderstanding of the phrase “gag order.”

Instead what you see McArdle doing is to mask this great sin with a lessor one: I’m sorry, dude, but I just didn’t understand the vocabulary.  And the dog ate my homework.  And I was kinda right anyway.

To put it another way:  honest folk don’t have to make such excuses.

Last (hell of a shorter–ed.):  Whatever else happens, remember that Megan McArdle is not a journalist.  She is a shill.  A journalist would, affirmatively, actually report on claims before publishing them.

They’d ask. They would, at a minimum, read something as brief as a letter with some attention and care.

(Again, I’m just gobsmacked by that “I took the words…to mean” line.  Bluntly — if you can’t read declarative sentences in plain English with reasonable comprehension, then journalism is the wrong trade for you.)

Negatively, of course, “journalists” who routinely get basic facts in their stories wrong get fired.

If The Atlantic were even vaguely serious about its own reputation as an elite journal, it would react to the damage that McArdle daily does to the reputation of that publication and all who publish there, even those who are truly excellent writers and thinkers (thinking of you, James Fallows and TNC).

Again, there’s a simpler way to put it:  someone who can write — and not quail at pressing the upload button — the phrase, “whatever the facts”…

…is unworthy of your trust.

Image:  ”Chiron instructs young Achilles,” fresco from Herculaneum.

David Brooks is Always Wrong — NPR Edition, Part Two.

March 30, 2010

Back in Part One, we covered one of David Brooks’ many transgressions as a financial pundit, his claim, repeated last Friday on NPR’s “All Things Considered” that the new health care law is a budget buster.

I called it an error.  It is more precise to term it a lie, as the best available data, stuff that Mr. Brooks cannot fail to have encountered  – CBO estimates and other, less formally constrained estimates — all support what proponents of the law have said, that the reform is mildly deficit reducing over the next decade, with the potential, at least, for major savings to come in later years.

But now, let’s shift to a wider frame.  In that same NPR appearance, Mr. Brooks offered a corollary of the presumed budget busting nature of health care reform:  a familiar, ritual claim that portrays current deficits or deficit trends as inherently destructive, unsurvivable.  Brooks complained in the piece that if the deficit did remain at a projected 90% of GDP level by the end of the decade, that would be a disaster.

He’s wrong.

Here’s why:

First, the American experience with deficit levels in that range does not suggest disaster.  Since the start of World War II, US deficits as a percentage of GDP topped at over 120% in the late 1940s (after the war, as the US was rebuilding Europe and ramping up military expenditure at the onset of the Cold and Korean Wars.  As I recall, most folks thought the 1950s were a reasonably successful time in US history, at least as far as economic growth and the creation of a thriving middle class went.

You can see a similar dynamic in the chart of Great Britain’s national debt as a percentage of GDP.  Twice in the modern period, Britain’s debt rose to more than two and a half times GDP.  The timing of the second such peak is probably easy to guess; it correlates with the combined burdens of World War One, the Great Depression, and The Great War, The Sequel demanded all the resources the British could bring to bear and more, engendering debt levels that touched the 200 percent mark in the early ’20s, never went below about 120 percent before rocketing up to over 250 percent  in the late 1940s.  The other similar spike also came in the context of extended conflict — the long-century of war that Britain waged from the late seventeenth century through the defeat of Napoleon in 1815.  British government debt climbed to over 100 percent of GDP in 1750 or so, and topped out above 250 percent shortly after Napoleon met his Waterloo in 1815.*

What is all this history doing here?  Because of what must be obvious already to the readers of this blog.

Think what happened in Britain’s nineteenth century.  Think what happened in the US during the ’50s and 60s.

Observe the fact that Britain and the US both managed to bring their debt levels down as a fraction of GDP after their rises to historic highs and the US did it again in the 1990s after twelve years of GOP transfer payments from the middle class to the rich once again unhinged the budget.

And last, for a quick, back of the envelope correction to current hankie clutching by Mr. Brooks et al., consider this from Paul Krugman.

The shorter of that already brief post:  cutting away at the debt incurred in our current attempt to use Keynesian methods to return from recession will require only modest shifts in either revenue or expenditure (or, of course, of both).  Same deal as in the fifties and early sixties — or rather a less draconiann one than that which that famous socialist, Dwight Eisenhower achieved with his 90% highest marginal tax rate.

In other words, this is yet one more case of the GOP and its useful-idiot allies like Mr. Brooks inventing facts to advance a purely political calculation.

Pay no attention to the real world, they say, nor the record of historical experience. Listen instead to the mewling and puking of the GOP deficit babies until the cry “we’re doomed! doomed!” comes to be seen as fact.

But in making decisions about what the government should or should not attempt to do, reality does matter.  And here the story is clear:  deficits  – even ones much higher than Mr Brooks has said he fears — do not imply in and of themselves extended periods of economic hardship.

What’s more:  why you borrow matters.

Certainly, there is certainly spending that is truly wasteful, in the sense that it adds little to GDP as a return on government borrowing. (See the quote from Bilmes and Stiglitz* about half way down the post at the second link; I’d link to the Harper’s original, but it’s behind a subscription wall.)

But the lesson of historic rises in debt levels and their return to lower percentages in the US and elsewhere over the last century and before is that debt properly employed is not just acceptable, but remains a critical tool to foster both economic growth and social strength.  (Once again: Keynes, much?)

And on that point, health care reform clearly falls into the realm of policy that forms part of the long term context of economic growth (and by extension, healthy government revenues, which then constrain the expansion of a public deficit).

Why?  Because, as David Brooks could have discovered had only read his own newspaper, the social contract matters. All he had to do was to check out — and grasp –some of the coverage from the exemplary David Leonhardt, for one.   (Leonhardt remains one of the most significant reasons one still has to read the New York Times.)

Consider this one, on the significance of health care reform on innovation.

This is not to suggest that Mr. Leonhardt, as good a reporter as he is, is some gold standard of judgment on economic policy.  But his work and that of many people who actually know things about fiscal policy and health care economics have noticed that the particular form of a nation’s health care system can have enormous consequence for seemingly completely unhealth-related sectors of the economy.

For jsut one example: the social safety net helps in difficult-to-quantify ways because, it turns out, it is when people feel secure in their basic needs that they accept more risks.  They leave bad jobs to seek better ones; they invest in their own education; they, as Leonhardt details, are more willing to gamble on their own vision as entrepeneurs.

It may be difficult to quantify, or rather to predict the degree to which such easing of care will add to GDP, and hence increase government revenues, and hence to reduce the scale of government borrowing, but the underlying concept is just not that hard to grasp. The idea that you will be more adventurous economically f you know that you or your kid won’t lack for access to health care if something goes wrongis beginning to penetrate the mass media in such distant locations as the Fort Worth Star-Telegram.  Apparently, the news has yet to reach the more hypoxic floors of the Great Grey Lady (formerly) of 43rd St.

Update: Via Brad DeLong, see Mark Thoma saying the same thing, only better.

From that thought, let me hand the next step of the argument over to old friend Tim Ferris, who in his recent book, The Science of Liberty notes that Democrats have consistently achieved a better economic growth outcome through that party’s commitment to a market system with a social network and a regulatory framework, compared with the GOP’s pursuit of policies that underregulate the market and undermine — at least confidence in — the social safety net.

Arguing from a classically liberal viewpoint  Ferris reports what is available to anyone (are you paying attention, Mr. Brooks?) (No.  SASQ — ed.) with access to Teh Google, that economic growth is much better maintained by Democratic adminstrations and policies than by the GOP lip-service he pays so readily to the icons of budget puritanism.

Specifically, Ferris writes,

Party politics may be a crude metric, but the United States in the past half century has experienced faster GDP growth, lower unemployment, and higher corporate profits during Democratic than during Republican administrations. The stock markets performed better, too, with annualized returns on investment averaging almost 9 percent when Democrats were in office against less than 1 percent for the Republicans. (The Science of Liberty, p. 25.   Emphasis added.)

The details of what parts of the two competing approaches to governance actually make the difference are (a) enormously complex and subject to debate and (b) beyond the scope of this blog post.  But the key point is, or should be obvious.  Deficit spending in itself is not the driver of outcomes.  It’s what you do with the money, and whether you address critical social/economic needs with your borrowing that counts.*

Which means: the general claim of deficit apocalypse is bullsh!t, a right wing mantra now being pushed to counter Democratic efforts to solve some of the problems that eight years (and most of the last thirty, in fact) of often criminal misrule have left behind.

In that context, health care reform is more than a moral victory, a statement by our society that tens of thousands of people per year should not die for lack of insurance.

Health care reform is more than mildly deficit reducing, a small down payment on the much larger reform that could both enhance the quality and reduce the cost of care by creating a national body of knowledge about best practices whilst paying for care rather than procedures.

Rather, or on top of those public goods, health care reform as just enacted is one of a number of critical steps towards creating the economic context for the next sustained epoch of growth.  A society whose members gain a greater share of numbers three and four of Franklin Delano Roosevelt’s iconic freedoms is one that will be far better placed to prosper (and thus shrink deficits as a percentage of GDP) than one in which sclerotic institutions and an ever less flexible labor force constrain every attempt to come up with the Next Big Thing.**

In that context, I guess the only remaining question is why David Brooks — and his too-many allies on the right — so hate America that they’d rather see a budget balanced on the ill-health of the nation instead of a society betting on its own members to create a richer future.

*All this is not to say that medical care cost inflation isn’t a serious problem in the medium to long term.  It is.  But (a) the problem is worse without health care reform than with it; and (b) the real significance of health care reform is that it creates the context for further reform.  Clearly the proof will be in the pudding, but several next steps are obvious, and the new law contains several elements of cost-control mechanisms and the capacity to perform policy experiments

**And of course — if you take Ferris’s historical analysis seriously, and I do, then the first two of Roosevelt’s four freedoms are equally important to the formation of a creative and scientifically innovative society.

Images:  Maria Fyodorovna, “The Miser,” 1890

Great Depression photograph, courtesy of the Franklin Roosevelt Library and Museum,”Public Health nursing made available through child welfare services.”

Thomas Eakins, “The Agnew Clinic,” 1889.

David Brooks is Always Wrong — NPR Edition, Part One.

March 27, 2010

I know, I know.  It should be Megan McArdle up there; in some views, she’s retired that title, and it sits up there above the right field bleachers next to the 1, the 4, the 6 and the rest.  (Sacrilege!  Must this blog stoop so low?)

But the problem is, David Brooks is always wrong.  I keep on not finishing the piece I’ve been trying to get to you about a column he published last December, just because my brain explodes twice a week, and I faff and fiddle trying to figure out how to nail down that slab of jello that is Mr. Brooks’ approach to the task of reasoning.

Seriously.  His picture is next to that entry in the dictionary of quotations that reads ““It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.”

And so, though McArdle’s body of work remains a uniquely target-rich environment, Brooks, vastly more influential than Mme. Galt, and hence the more dangerous, must needs become the object of our attention with ever greater regularity.

Hence, this. (And this:  part two here.)

The occasion?  His weekly appearance last Friday on NPR’s All Things Considered, opposite E. J. Dionne.  There discussing the politics of the health care bill, he repeated two claims he’s making with increasing frequency as he grapples with the ongoing refusal of Barack Obama to take his advice.

These were that, for all that he applauded Obama and Pelosi for succeeded in the mechanics of passing the bill, he still hated it, because it was (a) a fiscal disaster, and (b) implicated in the projection that the deficit will be 90% of GDP by the end of the decade, which he termed calamitous (not his exact words — but the sense was there — Mr. Brooks sees current policy as driving us over a precipice.

The only problem?  Both of these statements are convenient nonsense. This is what conventional wisdom looks like.  Everyone knows — especially that professional everyman, Mr. Brooks — that spending on social programs is purely optional (and has no society-wide positive effect), that the current federal tax rate is the highest that it is possible to imagine sustaining, and that hence every choice to spend must drive deficits ever upward — and, as well all know, that deficits are the devil.

Now, this isn’t the post in which I’m going to dive deep into the usual — and true — observation, that it’s hard to take deficit hawks seriously who cheerfully swallow unfunded wars while rejecting explicitly budgeted reforms like the recent health care effort.  But it is important to push back on what seems to be the “serious” USDA approved™ meme on the health care issue — nice job, Dems, but you’ve bankrupted the country again.

So here’s the scoop.  Without being a Congressional Budget Office fetishist, it is important at least to acknowledge the data that one can gather.  And, as everyone knows who has paid even a scant bit of attention to the whole HCR farrago, the CBO has scored the bill that finally passed for its impact on the deficit.

It’s conclusion:  that the bill will lower the deficit by 130 billion dollars over the next ten years, and those savings could reach past a trillion over the next decade (though the CBO notes that such long term forecasts are wildlly unreliable).  For further discussion of these points, and some more conservative estimates of the deficit lowering capacity of this bill, see here, here and here.

That is to say, Mr. Brooks had it exactly reversed when he claimed that this bill was fiscally irresponsible.  It saves federal budget dollars.  It doesn’t do enough, IMHO, and I hope the murmurs are true that the public option and other cost-saving and coverage-expanding measures will make their way into the reform over the next few years, but it is better than what we got.  It is, to state it plainly, more fiscally responsible than any of the realistic alternatives, whether the status quo or the GOP death by rationing approach, by any coherent understanding of the term, “responsible.”

But for all of the annoyingly lazy repetition of what has been a false GOP talking point for months, (I heard you were supposed to be the thoughtful one, Mr. Brooks), it’s the second of the genial pundit’s two claims that is truly dangerous.  The campaign, in which Mr. Brooks is really no more than a willing subaltern, to portray the deficit as a kind of domestic policy al Qaeda, is really an effort to lock the current balance of power and social distribution of wealth into more or less it’s status quo.  It’s up and running with a vengeance, and at stake are not merely the spoils of wealth now, but the long term prosperity (and hence power) of the nation.  For details, please turn to part two.

For the second half of Mr. Brooks’ errors of fact and argument, please turn to part two.

Image: Albert Bierstadt, “Falls of Niagara from Below” before 1902.

Quickie Post, to let you know that David Brooks has finally revealed the secrets of conservative math.

March 23, 2010

I’m on the road again in yet one more Newtonpalooza, so no substantive posting is going to happen, but I saw in my morning check of Balloon Juice (the only source for news you can really use) that David Brooks has produced another of his considered analyses to explain the real meaning of critical events.

The whole thing is yet one more sample of the unique combination of credulousness and really dangerous hackery-in-defense-of-establishment-power that characterizes Mr. Brooks’ work, and I’m going to try to go blog-medieval on it in the near future.   But here I just want to point out the implications of the delicious sentence that Mr. Brooks writes one truly revealing sentence, the one quoted by DougJ in his BJ snark:

Nobody knows how this bill will work out. It is an undertaking exponentially more complex than the Iraq war, for example.

The overt dumbness has already been dealt with at Balloon Juice.

As the commenters there point out, the only honest response is “Uh…..noes.”  It is also all you need to explain why the GOP so badly botched everything about that war.  They thought and think this is true, that destroying a country and rebuilding would be simpler and cheaper than regulating insurance companies.

(On that note — about two years into the Iraq war I had the chance to talk, completely informally with Madeleine Albright.  Among much else interesting, she told me that in the briefing she and other former high-ranking Clinton and Bush I officials received in the run-up to the war, the Rumsfeld DOD had made essentially no after-conflict plans, which we know now to be exactly right.  She told me she raised the thought that this was wrong, that real post-conflict planning had to be done to deal with all kinds of things, from the vacuum in civil power to economic matters.  She was, she said, brushed off by the Bush version of the Best and the Brightest — the So-So and the Not-Quite-Set-To-Be-Watered-Twice-A-Day).

But enough of ancient history.  I’m still wallowing in the mess of trying to understand  Mr. Brooks tortured diction.  Just what the hell could he mean by “exponentially” in this context?

Well — math jokes are not for amateurs, and I certainly don’t want to dive into xkcd territory (No! No! No!  Quantum leaps are really smalllllll), but it occurs to me that Mr. Brooks’ statement is more than usually meaningless if you don’t know what exponent he’s thinking about.

And then it became clear.  The only way any of Mr. Brooks’ attempts to assert some connection between his thought and that fundamental tool of science, mathematical reasoning actually makes sense, given the gap between reality and his accounts of it, is if that exponent contains the factor “i.”

That is all.

Image:  Nicolas Neufchâtel, “Nürnberger Schoolmaster Johann Neudörffer and a Student,” 1561.

Go Do Some Post-Health-Care-Vote Reading…

March 22, 2010

And start with Brad Delong’s front page — a bunch of must reads and a delightful sense of history (and literature) to go with it.  I particularly like that item which for now stands at the top of the page in question.

Image:  Vincent van Gogh, “Corridor in the Asylum” 1889.

Health Care Comment-Without-Words (None Needed edition)

March 22, 2010

Everyone Chill The Fuck Out

I Got This.

(h/t John Cole)

Image:  Guess.

Sometimes One Can Rage, Rage at the Dying of the Light…and Sometimes One Must Laugh: Mostly Outsourced McArdle edition

March 21, 2010

John Cole has done all that is necessary to demonstrate the lasting waste of perfectly good bytes that is Megan McArdle.  He merely quotes her accurately, and then stands back and laughs.

There really isn’t anything more that needs to be said, except to note that it is by their behavior in extremis that you get a unique measure of someone’s quality.  (See, e.g. Conrad, Joseph, weighing the effects of a mighty wind on the mettle of a man.)

But, as I while away the time until the various health care votes, a little mischievous fisking seems like a fun idea.

So…how’s this:

Are we now in a world where there is absolutely no recourse to the tyranny of the majority?

Thinking ahead to November 2,2010, that would be a “no.”

Ms. McArdle seems to have forgotten that (a) the House of Representatives is set up to respond to the will of the majority party (as the Senate, as we have learned so well lately, is not) and (b) that the check on that lower chamber is the frequency with which all of its members must face the electorate.  In less than eight months, Ms. McArdle and all those who fear the dimming of American freedom at the hands of a conservative bill retaining the role of every stakeholder in the current public-private health care system, may have at it, and throw the bums out if they can.

Republicans and other opponents of the bill did their job on this; they persuaded the country that they didn’t want this bill.

People often note that McArdle is a bad writer — sloppy in her diction, imprecise in thought and word, and unlovely in the execution (sic!…ed.) of her prose.  This is a mere nibble at what such critics (like me–;) are talking about.  McArdle means that Republicans, et al., persuaded the country that the country didn’t want the bill. What she said was that Republicans, et al., persuaded the country that Republicans (et al., I know) didn’t much care for this legislation.

Ah well.

And then of course, there is the more serious problem that, she is always wrong.  Astonishingly, after a year of disinformation, lies, and truly disgraceful scare tactics (death panels, anyone?) the latest Gallup Poll shows the country almost evenly divided on the reform package being voted on tonight.  That lots of people oppose this bill is true certainly.  The “country,” whatever McArdle thinks she means by that word, does not display any unitary opinion on the matter.

And that mattered basically not at all.

Has she been paying attention these last twelve months and more?  Scratch that — it’s a rhetorical question to which the answer can only be “of course not,” if by attention one means attempting to grasp the meaning of real events happening in determinable space-time coordinates. The bill majorities in the House and Senate sought included, among other things, a public option…itself a relatively mild reform, and one that would reduce the total cost of US medical care and government spending compared with the bill we are actually going to get.

The reason we are getting an inferior and more costly health care reform is precisely because the GOP et al. campaign of lies, misinformation and fear — in which Ms. McArdle took her own, honorable (sic? … ed.) part — along with the craven surrender by key Democratic senators to pressure and precisely weighted rewards (bribes?…ed.), managed to eliminate the public option from consideration.  The efforts of the opponents of the bill did matter a great deal; sadly it was to make the final package, though still worth having, much less so than it should be.

If you don’t find that terrifying, let me suggest that you are a Democrat who has not yet contemplated what Republicans might do under similar circumstances.

Let’s see.  Lots of folks in John’s comment thread have already had their happy whacks at this one. (Careful.  This is a family blog…ed.)

The short form is that we’ve had plenty of time to contemplate the disasters of unchecked majority rule over the eight years prior to January, 2009.

We know what the Republicans did with a much smaller mandate:  wars based on false claims, to be paid for by our children and grandchildren; tax burdens shifted from the rich to the middle; the enshrinement of torture as official policy; assertion of the right to suspend the rule of law at the President’s whim; not to mention economic policy that left us with a decade of wage loss, financial collapse, accelerating dependence on foreign creditors and all the other ways in which American power and autonomy have been eroded..and so on, in a list whose length and consequences are too depressing to ponder.

If McArdle wants to argue that IOKIYAR to wreck the country, but not for Democrats to try to wrestle into some better path the enormous, shrieking tsunami of fail the GOP has left behind it, then that’s her right.  But the point, of course, is that this administration, to the despair of those like me who wanted to take our real majorities out for a spin, attempted for a full year to engage Republicans in a real dialogue on health care.  Instead, we found those across the aisle constantly working to bring us to our Waterloo.  I think we’ve learned our lesson, (and, tonight, that contrary to the expectations of the GOP Elba-ists, it seems that President Obama more closely resembles the Duke of Wellington than the little Corsican.)*

Farewell, social security! Au revoir, Medicare!

Uh.  What can one say. As several noted in the above linked comment thread, Ms. McArdle certainly reads the GOP id correctly. This is what they want to do — as Rep. Paul Ryan, the GOP’s latest Brightest Man In Congress™ has kindly made explicit.  He has proposed the destruction of Social Security, and has proved a little less than pleased when that and the general fecklessness of his “plan” was pointed out.  And Medicare too would fall to his knife as part of the GOP’s master plan to transfer yet more wealth from most of us to the wealthiest of us.

But it’s not news that the Republicans loathe the social safety net.  But the striking sound you don’t hear is of the GOP leadership rushing to embrace the man who is not just their alleged best and brightest, but the ranking member on the House budget committee.

Why not?  Well, here McArdle gets something sort of right:

The reason entitlements are hard to repeal is that the Republicans care about getting re-elected.

That’s right.  People without independent means actually like not fearing a diet of dogfood in an untreated-illness and foreshortened old age.  They are likely to vote against those who would wish such fates on them. Who’da thunk it?

But, of course, there is some internal compass within Ms. McArdle that makes sure that momentary glimpses of reality never last too long.  Consider this:

If they didn’t—if they were willing to undertake this sort of suicide mission—then the legislative lock-in you’re counting on wouldn’t exist.

So, let me get this straight.

Barack Obama campaigned on, and won a recent-historically notable victory, and Democratic candidates for the House and Senate achieved victory in dominant numbers while promising their potential voters major health care reform.  They are delivering on that promise.

And what was the alternative?

Failure to do so would, as we have seen over the last few by-election examples, deeply dampen Democratic base voter interest in the political process.  Yet passing the first major overhaul of US health care in a generation is a suicide mission?  I’m not sure what world Ms. McArdle actually inhabits, but I begin to feel it must include a large number of people all of whom are convinced that they are the one true Napoleon (see below) while all those hand-in-coat flaneurs are imposters.

And on the other hand, it seems to me that if there is any party that has talked itself into a suicide pact, it would be the GOP.

Certainly, David Frum seems to think so, and though I think his analysis of the substance of the bill is a joke,  his political point is pretty persuasive: Women who have survived breast cancer who come to realize that not losing health care because of a pre-existing condition is a good thing, or young voters for whom the option of remaining on their parents care is the difference between being able to risk some new venture or not, or seniors for whom drug prices fall under the new legislation are not going to rush to embrace a party that swears it will take all that away.

If the GOP really wants to declare that it is the party of repeal, of the withdrawal not just of goodies, but of provisions that are literally matters of life and death…then go for it, I say, and were they to do so, then I will agree with Ms. McArdle: the GOP will have proved itself willing to undertake a suicide mission.

Which is the point that Ms. McArdle seems to miss in just about everything she writes.  That the GOP, and not the Democrats seems to be on the verge of a suicide run is because in the real world, as opposed to that landscape lit by the endless sunshine of a spotless, glibertarian mind, is that social problems are real.  Attempts to solve them, however imperfect, resonate with voters in ways that attempts to deny their reality (“We have the best healthcare system in the world”), in the end, do not.

Signing off, +2, with 1 more to go with which to toast San Francisco’s favorite daughter, the Speaker of the United States House of Representatives, the Honorable Nancy Pelosi

Image:  William-Adolphe Bougereau, “The Difficult Lesson,” 1884

*Under the circumstances I may hope to be forgiven if I take the opportunity to suggest that Speaker Pelosi’s role may thus be imperfectly mapped onto that of the Prussian commander, Blücher, whose forces assaulted Napoleon’s right flank in one of the decisive efforts to break the French position near the end of the battle.  While passing over in mild wonder which Republican leader could be serve as the analogue to the perfectly named French Marshal Grouchy, commander of Napoleon’s right wing, I will take the obvious cheap shot, and offer this video to capture the GOP state of fear and loathing as the contemplate the victorious commander whose efforts have produced the wreck of their hopes:

My Email to President Obama on Health Care

January 23, 2010

Tim over at Balloon Juice is trying to lead in the fight over health care. He’s absolutely right:  we have to contact our representatives and senators as often as we can to reinforce their sense that we have their back if they take action on health care, and we will drop them like a rock if they don’t.

But there is another center of gravity in this debate, and that’s the White House.  It is my hope, if not quite my expectation, that President Obama will use the State of the Union address to lay his markers down.  But I’m growing fearful that what we see in his White House is a political shop that has consistently misread both the mood of the country and the actual dynamics taking place at the other end of Pennsylvania Avenue.  So I think we need to push there too.

If you agree, here’s where you go to send an email.  The comment line phone number, closed until Monday at 9 EST, is 202-456-1111.  I’ll be calling first thing.  The main White House switchboard number is 202-456-1414.  I plan on calling that and asking to speak to someone in the policy shop.  I’ll let you know if I get anywhere.

Here’s what I sent in to the White House today.  Please…keep ‘em coming, and if you do, feel free to post them in the comment thread here.

Mr. President,

I am one of your most ardent supporters, and I spent as much of the summer and fall of 2008 as I could trying to make sure we won, and won big.  Now I have a request to make.

The time for a “hands off” management approach to the health care issue is clearly over.  I ask you to take the lead, using your prestige, your formidable powers of persuasion, and all the levers of power the office of the President possesses to lead the Congress to the passage of health reform.

What I seek is what is being touted as the grand compromise:  the House passes the Senate bill, while, with yours and the Democratic Senate leadership’s public commitment, advancing a bill through the reconciliation process that addresses those of the House’s concerns that can be enveloped in that legislative approach.

There is both moral and political need for you to lead here.  If we fail, 30,000,000 Americans will lack health care that could have it — on your watch — and as we know from studies of the consequences of lack of coverage, thousands of them will die of “financial arrest.”

I do not want that on my conscience as a Democrat — and I’m sure neither do you.

At the same time, as volunteer on Democratic campaigns since 1976, I can tell you that the impact on me and every other grass roots Democrat that I know will be awful if our party, with large majorities in the Congress and your good self in the White House, were to collapse into a puddle of self-pitying inaction because we lost a special election in which our candidate happened to run a truly terrible campaign.

We’ve come too far; we’ve worked too hard — you’ve worked too hard — to let go now.

All this is said in the context of respect for the job you’ve done across a huge number of complex issues, and thanks for your calm and reflective approach in this very dangerous and complex times. But every now and then both the politics and the policy demand something different.  This is such a time.

With all best wishes,

Tom Levenson

Image: John T. McCutcheon. Political cartoon depicting local politicians struggling to keep up with president Theodore Roosevelt during his visit to Chicago. Early 1900s.

Albert Einstein’s Christmas Message: the Modern GOP Fail/Health Care Reform edition

December 24, 2009

I’ve been reasonably obsessed about the health care debate — its certainly had an impact on my blogging output, among much else.

Like many of us, I suspect, I got trapped in the horror/fascination of the battleground within the Democratic party:  what would happen to the public option, abortion language, why we can’t offer Medicare to more Americans and so on.  I felt the surges of joy (yay! I”ll be eligible for Medicare in a few years) and rage, (Joseph *#@!*& Lieberman did what?) and wailed that even after a legendary shift in nominal party power we Democrats couldn’t get the most basic plank of our platform erected in good order.

But now, with the latest (and perhaps the tallest) hurdle leapt, with the prospect of a highly imperfect but much-better-than-what-we’ve-got-now approach to health care in this country that much closer to hand, I’ve remembered what should have been at the front of mind throughout.  Bad as the Democratic party has handled at least some of this, the real revelation of this entire season has been the moral desert that is the contemporary GOP.

Recall that this is, more than ever, the party of ostentatious Christianity.  Prominent Republicans have never been bolder in asserting claims of superior values, truer faith, as against their presumptively impious Democratic rivals.  I’m racing family celebrations and a nine year old who wants to play Vikings with me (let us smite!), so I’m not going to dig up the links we all know anyway — the nonesense that Sarah Palin utters any times her lips are seen to move; Huckabee’s self righteousness; name your Senator (who will never, ever, comment on the GOP values represented by Messrs. Ensign and Vitter), and so on.

And in that context, thinking today of the ceremonies to come in honor of the traditional anniversary of Jesus’ birthday (and yes, I certainly know of the ahistoricity of Christmas), I am once again stunned, as only someone who is much younger and less steeped than I in the hypocrisy of the travesty that the GOP has brecome should be, at the extraordinary gap between the Republican Party’s leadership and base assertion of Christian righteousness and an approach to governing this country that would make Jesus weep.

Which is to say:  whatever you may wish to argue as a policy wonk about the best way to fix American health care, no sentient being can argue that the current system is anything but a moral evil.  I mean that literally:  any system which by its design, by what happens if it works as each component is supposed to, must kill tens of thousands unnecessarily each year, seems to me as clearly seen as evil as any human act.

Add to that all the sorrow and woe that comes from the system short of death, and the daily erosion of our economic and political power that ensues as a result of such a misallocation of capital and government resources.

So, looking back on the last six months or so, what truly stands out, for all the tumult and gnashing of teeth on the Democratic side of the aisle, is the total, unanimous, undifferentiated rejection of any attempt to change that situation for the better by Republicans who are, after all, putting themselves forward as those who should return to governing power within a year.  It’s not that they had different approaches to this problem.  It is rather, as everyone by now has noticed, that their only answer to Democratic proposals was to say, in effect, the status quo, the murderous, costly, America-weakening status quo is just fine.

Recall:  not one GOP senator proposed a meaningful amendment in the recent process.  No one came forward and said if you address this or that concern, I’ll cross the aisle to permit more American families to gain access to hospitals and doctors and the rest.  Even that allegedly thoughtful GOP solon, Olympia Snowe could not in the end vote for a bill that had answered every objection she raised during months of negotiations…because it was, she said, too rushed a process.

In that context, it is clear to me, at least, that for every church service the GOP leaders and its base may attend over the next 24 hours; for every swelling in their hearts they may feel as they contemplate the birth of that figure said to have formed the essential bridge between flawed humanity and divine perfection; for every time any of them condemns any Democrat for failures of faith or patriotism…

…those who chose to answer the question of can we do better by ourselves and our fellow citizens with such an unrelenting “No!” have some ‘splainin to do.  Not to me, but to that figure three kings are said to have travelled far to adore.

Or, as Albert Einstein put it when asked his opinion of what was going on across Europe not too long before the Christmas season in that grim year of 1915:

Why so many words when I can say it in one sentence, and in a sentence very appropriate for a Jew: Honor your Master Jesus Christ not only in words and songs, but rather foremost by your deeds.

That is all.

Image: Quentin Massys, “The Adoration of the Magi,” 1526


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