Merry Christmas 2012

Welcome friends!

Well, I see another Christmas season is upon us.  My my, how time does fly.  Always a great excuse to turn my attention once again to the problem of religion.  I took a quick scan of the papers to see what manner of religious lunacy we’ve had recently and the thing that caught my eye this year was televangelist Pat Robertson’s recent comments to the effect that Christians really need to come to terms with scientific knowledge about the age of the earth.  I found the story rather interesting because in some ways it gets to the heart of the whole problem of religion for me.  No, I’m not talking about the age of the earth.  Who the heck cares about that?  Well, actually, I do.  But not right now.  No, at the moment I’m talking about the relationship of the human brain to religion and just basically what it means to be human... Sorry but only selected archived (previous year) posts are currently available full text on this website.  All posts including this one are available in my annual anthology ebook series available at the Amazon Kindle Bookstore for a nominal fee.  Hey, we all need to make a buck somehow, right?  If you find my timeless jewels of wisdom amusing or perhaps even amusingly irritating throw me a bone now and then.  Thank you my friends!

Socialism Is What Now?

Welcome friends!

Can we talk a bit about something that’s been bothering me for a while now?  It’s the confusing way some people talk about “socialism” here in the US.  Well, yes, by some people I’m referring once again to conservatives.  If you read the papers at all you’ll know American conservatives seem to be finding so-called socialists hiding under every bed these days.  They used to find communists hiding under every bed when I was a kid but I guess now the USSR has faded into oblivion they’ve dropped that terminology.  (Well, for the most part anyway.  Conservative Tea Party favorite and former Representative for the state of Florida, Allen West, was in the news recently claiming there are “78 to 81 members of the Democratic Party that are members of the Communist Party.” He meant in the US Congress, which was the focus of the question he was answering at the time.  Well, I guess the question from one of the local Tea Party crowd was actually how many “card carrying Marxists” Mr. West thought there were in the US Congress.  Do Marxists really carry cards?  Anyway, I guess he didn’t get the memo that we’re supposed to be talking about socialists these days.)  Now you know how open minded I am, right?  People can be concerned about whatever they like as far as I’m concerned.  We can talk through issues like the pros and cons of socialism or communism or conservatism or any other ism you like.  In fact, I rather like talking through those types of issues because they’re interesting to me.  No, what really irritates me is when we can’t discuss the real issues because some people just can’t talk straight.  And it seems to me that’s what happens whenever certain people here in the US bring up socialism in the context of contemporary public policy issues.  I usually end up feeling a bit like Chef Skinner in the movie Ratatouille.  I actually had the following conversation the other day with a lawyer who stopped by my office for a little chat: Me: “They’re consorting with it, deliberately trying to make me think it’s important!”  Lawyer: “Is it important?  Me: “Of course not!  They just want me to think that it is!  Now they want me to see it everywhere.  Oooooo, it’s here!  No it isn’t!  It’s here!  Am I seeing things?  Am I crazy?  Is there socialism or isn’t there?  But oh no ... I refuse to be sucked into their little game!”

OK, let’s take a deep breath and just start at the beginning.  The first thing we should probably talk about is the significance of this whole idea of just being concerned about other people.  You may think I’ve gone back a bit too far at this point.  I mean, given that humans are essentially social animals one might wonder if there are many people about who would seriously maintain that one shouldn’t be concerned for other people.  Usually we just call such people sociopaths, which is a form of mental or psychological abnormality.  And the opposite of a sociopath is ... I don’t know what, a sane person?  I’m not sure the position even has a philosophical name.  So am I going to start talking about mental illness now?  No, not at all.  It turns out there is indeed a strain of thought in popular culture today that pretty much says one should not be concerned for other people.  That was the overall theme of the oeuvre of the novelist and philosophical dabbler Ayn Rand.  (Well, I guess some rather more serious people espoused vaguely similar views including Herr Ubermensch himself, Friedrich Nietzsche, and Vilfredo Pareto, the fascist loving Italian economist so important to neoclassical economic theorists everywhere.  However, one doesn’t hear American conservatives talking about them very much these days for some reason.  The relative density of the material perhaps?)  Now I’ve discussed Ms. Rand before, but the significant issue to keep in mind here is she is apparently quite the popular figure in radical conservative circles.  Indeed, recent conservative Republican vice-presidential candidate Paul Ryan said at one point his enthusiasm for Ms. Rand’s theories was the main reason he entered politics in the first place.  (You may recall he later recanted.  Talk about flip flops: life’s inspiration to dog house in the blink of an eye.  But you know conservatives say the darndest things when they get in front of a crowd, so who knows what he really thinks.  I for one wouldn’t be surprised at all to find Mr. Ryan once again singing the praises of his former idol at some point in the future.)

Now if one were an adherent of Ms. Rand or any of her ilk then I suppose one might be tempted to come up with a name for the unfortunate tendency of certain misguided people to be concerned about other people.  I mean, one wouldn’t want to go about complaining other people are sane, would one?  That would be ridiculous.  Since thinking about other people often translates to thinking about society at large, it seems to me these people have a tendency to start playing games with the definition of socialism to make it cover this basic human impulse.  However, that’s just confusing as hell to me.  First of all, it implies pretty much everyone with a conventional moral sense involving concern for other people is a socialist.  Now we can talk that way if we want.  It’s fine with me.  It’s just a word, and I suppose it does make a modicum of sense etymologically.  I’m perfectly happy describing myself as a socialist as long as we all know what we mean.  But it’s going to get rather confusing if we do that because that definition of socialism doesn’t actually correspond to the definition one finds in the dictionary.  According to the Merriam-Webster dictionary, socialism is either about “collective or government ownership and administration of the means of production and distribution of goods” or about the abolition of private property.  (There’s also a technical definition in Marxist theory but I don’t think we need to concern ourselves with that here, not being theoretical Marxians.)  So the dictionary has quite a narrow definition of what socialism is all about.

But maybe these arch conservatives don’t mean to say simply having a concern for other people is socialism per se, maybe they just mean to say it leads inexorably to socialism as defined in the dictionary.  In that case, I would advise them to say what they mean and reserve the term socialism for things they actually think represent socialism.  That would make things a lot easier for everyone to follow.  And by the way, we can discuss it in more detail some other day, but is if this is what they have in mind then I think they are way, way off base.  I mean, yes, in some cases people have clearly started out with an ostensible interest in the welfare of other people and ended up in some pretty strange places.  In the twentieth century alone both Stalin’s Russia and Hitler’s Germany used the term socialism to describe their social and political philosophies, both were ostensibly focused on the welfare of their national populations at large, and we know how both of those particular systems turned out.  However, I would hardly conclude that the problem with their political and social theories occurred at the initial stage of simply professing an interest in the welfare of other people.  As I said, it’s a common belief and always has been as far as I know, and I think it’s clearly possible to hold that belief without concluding we need to set up a police state, kill off our political opponents, and eliminate minorities in murder factories.  I mean, don’t get me wrong, I understand the fear and outrage of the people who had the misfortune of seeing those systems up close.  I wouldn’t care to be packed off to a gulag or a gas chamber either.  But the diagnosis of the problem just isn’t very credible to me.  Can we dig a little deeper into these philosophies and come up with something that makes a little more sense?  Were there maybe some intermediate steps between professing a concern for other people and murdering them where these people may have gone astray?  I think we can be concerned about one another and yet not become fascists or communists.  We do it all the time.  We’re doing it right now.

Oh, and by the way, you may have noticed something a little funny in the way Herr Hitler and his cronies used the term socialism in the name of their political movement National Socialism.  It doesn’t seem to fit the current dictionary definition very well, does it?  I mean, the Nazis were all about private industry and fending off the Red Menace.  Nazi Germany was an authoritarian market state, not a communist state.  I’m just throwing this out to highlight once again the type of confusion that can result when we start talking about “socialism.”  Clearly, when German conservatives in the mid-twentieth century talked about national socialism they had something in mind that is not really reflected at all in the definition of socialism one finds in our current English dictionaries.  And it’s quite possible other people in other times and places have had things in mind when they talked about socialism that do not correspond to our current dictionary definition.

Anyway, to return to my main theme, I certainly don’t mean to imply all American conservatives are fans of Ms. Rand’s theories or other similar anti-social philosophies.  Indeed, I think a much more common and traditional interpretation of both economic and social conservatism in this country is that it is based on a particular theory of what is best not only for oneself but for society at large and hence does, in fact, reflect a concern for the welfare of other people.  Now if we were using the most general definition of socialism I discussed earlier, the one that doesn’t really correspond to the dictionary definition, then I suppose these conservatives would also qualify as socialists.  However, let’s stick with the dictionary definition, shall we?  I’m already starting to get a bit of a headache trying to keep track of what we’re even talking about.

The more general problem with trying to use the concept of socialism as defined in the dictionary when discussing contemporary policy issues is that the definition, although clear and reasonably precise, is largely irrelevant in most realistic situations.  Here in the US, as in most of the rest of the developed world, we have what might best be called a mixed system.  It’s basically a market system but with certain government policies in place to make things run a little more smoothly and equitably.  Over time we have found in some cases private markets don’t seem to work very well for various reasons, so we have regulations of various types to handle those situations.  Under certain particularly problematic conditions we just have government provide the services in question.  We also have had some concerns about how things are distributed in some cases.  We pay taxes for both reasons.  I don’t know how you feel about it but to me our system seems to work pretty well in general.  We have our private realm.  We have our public realm where we look after the national infrastructure we all need to keep things moving along (police, roads, bridges, whatever).  We rarely have huge market gyrations and economic pandemonium, at least when do nothing Republicans aren’t at the helm.  We try to help out people who are struggling so we don’t end up with an army of starving poor people standing about on street corners and the inevitable revolutionaries and malcontents that typically go with that sort of social pathology.  You know, maybe it’s not the best system in the world.  There’s always plenty of room for improvement, to be sure.  But it’s certainly not the worst system in the world by any means.  And it has the great virtue of being a very flexible framework we can use to address most of the problems that may come down the pike.

So let’s try to apply the dictionary definition of socialism and see where we are.  Well, let’s start with the easier bit.  One component of the definition is “a system of society or group living in which there is no private property.”  Now I don’t really see many people here in the US arguing for the complete abolition of private property, so I suppose that implies there aren’t very many people about who would qualify as socialists on that account.  However, I guess one could make an argument that condescending to pay taxes implies some limits to the concept of private property.  And this is where we start having trouble.  For my part, I think it’s completely consistent to believe we should respect private property in general but people still need to do their part for the common good and pay their taxes.  That doesn’t sound like the dictionary definition of socialism to me.  I mean, nobody’s abolishing anything as far as I’m aware.  However, if one flips things around slightly and instead of making the extreme position of abolishing private property socialism you instead make any infringement or curtailment of private property rights whatsoever socialism then I suppose you might arrive at an entirely different conclusion.  So is no one a socialist or is everyone a socialist?  Well, I think the dictionary implies the answer is no one, but is it perhaps a bit too easy to misread it as implying the answer is everyone?  And that’s why it’s just a lot clearer to me to not talk about socialism at all in this context and instead just talk about how one feels about paying taxes or whatever.

Let’s move on to the second definition of socialism: “any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods” (or the associated definition “a system or condition of society in which the means of production are owned and controlled by the state”).  Well, we’re basically in the same boat.  Again, the definition is perfectly clear but just doesn’t shed much light on realistic situations.  I mean, even at the most basic level I suppose the government in our system is enforcing certain laws involving contracts and private property, so I suppose one could say the government is administering the means of production and distribution of goods in some way.  No, I’m not being facetious.  After all, there is a philosophy that says government has no business getting even that involved in those types of issues.  That philosophy would be anarchism, which in a practical sense suggests we resolve these pesky issues according to whoever has the biggest gun.  So is everyone who isn’t an anarchist perforce a socialist?  Well, I don’t know about that.  But maybe that’s not what we mean by government administering the means of production and distribution of goods.  Conservatives are famous for their tendency to turn a blind eye to certain preferred government activities and to talk about “minimizing” government when they’re actually quite concerned government continue to perform certain tasks they consider personally useful.  So maybe the dictionary definition was written under this general sort of myopic perspective and is meant to imply government administration and control involves government taking on some role other than simply enforcing contracts and property rights.  Maybe we’re talking about regulation?  So if one supports regulating a particular market in some way, does that make one a socialist?  Well, again, I don’t know about that.  Does supporting a particular type of regulation in a particular case imply one is advocating the collective or government administration of the means of production and distribution of goods in some general or global sense?  I don’t think so.  Heck, even most economists see the advantages of regulating certain types of real world markets in certain ways in certain situations.  They have a whole theory of when that makes sense.  Are they all socialists?  Well, what about the most socialistic looking situation in which one thinks government should provide certain services directly because one perceives certain problems providing those services via private markets?  Again, to me that doesn’t necessarily imply one thinks government should control and administer all services, so even that doesn’t seem to me to fit the dictionary definition of socialism.  We’re back in this peculiar situation in which if one follows the dictionary definition exactly then basically no one in the US can fairly be called a socialist, but if you flip it slightly and make socialism apply to all of these mixed cases in which one supports any degree of government involvement at all then I suppose pretty much everyone turns out to be a socialist.  Again, wouldn’t it just be a lot easier to talk about what one thinks government should be doing, if anything, in particular situations?

Let’s have an example.  A few years back, right after the Republicans’ Great Recession, we had that issue of government propping up, with conditions, certain firms it deemed “too big to fail” that were on the verge of doing just that due to their own ineptitude.  (Particularly well compensated ineptitude in this case, but that’s neither here nor there.)  So that was an interesting and complicated real policy issue.  On the one hand, we don’t usually use public money to keep failing private companies afloat, with or without conditions.  On the other hand, we had a rather unusual situation on our hands and we didn’t necessarily want to sit by and allow the implosion of these particular companies drag down our national economy and harm people who were not really involved in any way.  There are all kinds of relevant issues I think it makes sense to discuss in this situation.  If we feel we need to intervene in this case, who’s getting the money?  Will the money be paid back?  When, and how?  What conditions go with the money?  What happens if we don’t put up the money?  What policies can we put in place to reduce the probability of having to take this type of extraordinary step again?  So those are the types of real issues I think people should be thinking about in this sort of situation.  Then we have the rather more sophistical issue of whether the policies represent “socialism” or not.  Hmm, sounds like hashing that one out may take a little while.  But I wonder, does it really help to set aside important substantive issues to play a parlor game of political definitions?

So why do conservatives talk so much about socialism if it sheds so little light on the real policy issues we need to discuss?  Well, as I’ve suggested before, I think it’s becoming increasingly clear contemporary conservatives just don’t like complexity very much.  Unfortunately, the real world is complex.  Hence, Republicans don’t seem to like talking about the real world very much.  They’re much more comfortable dealing with the sort of generalized paranoia and fear that relies primarily on emotion rather than intellect.  So their arguments are typically not about the complicated policy questions that arise in real world situations.  Their arguments typically sound more like the following: Our opponents are socialists!  They don’t believe in the American way of life!  They want to throw everyone into a gulag!  (Well, OK, maybe they don’t usually say that last one, but they certainly imply it.)  Oh my gosh, if I didn’t know it was so much hot air I’d probably run down to the local gun store to stock up on ammo with the rest of the loonies.  But I’m not sure Republicans realize most Americans have moved beyond this type of pandering and fear mongering.  I hope they do realize it someday soon because we could use a good public conservation about some of the real issues we face as a nation, and by a good conversation I mean one that doesn’t involve looking for socialists under the bed.

References

Florida Rep labels congressional Democrats as Communists.  CNN Political Unit.  April 11, 2012.  http://politicalticker.blogs.cnn.com/2012/04/11/florida-rep-labels-congressional-democrats-as-communists/.

Mitt Romney and His Gifts

Welcome friends!

I was about to say how happy I am that the recent election is over and I can finally get back to the more light hearted and varied fare that I prefer, but I see that “severely conservative” (in his own rather revealing words) former Republican presidential candidate Mitt Romney managed to flip the majority of Americans the bird one last time before presumably leaving the national stage with his quip about President Obama essentially buying the election with gifts.  And you know I’m not very good with that type of thing.  When I hear things like that I always want to leap up to my computer and defend myself.  Of course, I realize the guy is probably a little upset right now.  A lot of very wealthy and very powerful people put a lot of money into his campaign.  And most conservatives had managed to convince themselves that pretty much any fool could take the Oval Office from Mr. Obama in a landslide of righteous indignation.  But that’s not how things actually played out so of course some people are bound to be a little on edge.  And I know it’s a sign of maturity to be able to just let things like that go by in these sorts of situations without unnecessary comment, but you know what?  I guess I’m just not really that mature quite yet.  Hey, we all need something to look forward to, don’t we?  Now in a decade or so I expect I’ll become the unflappable and ever smiling buddha of progressive bloggers who will respond only to the most thoughtful utterances of my conservative adversaries.  But I’m just not quite there yet.  So let me go ahead and say a few words about this whole notion that President Obama bought the election with gifts, which by the way I understand is not just Mr. Romney’s idiosyncratic take on the election but is actually a popular thesis among conservatives these days.  But just between you and me, I am really of two minds about whether I should even address this one.  You know, I hope you’ll forgive me for showing a lack of forbearance if that’s what I’m doing... Sorry but only selected archived (previous year) posts are currently available full text on this website.  All posts including this one are available in my annual anthology ebook series available at the Amazon Kindle Bookstore for a nominal fee.  Hey, we all need to make a buck somehow, right?  If you find my timeless jewels of wisdom amusing or perhaps even amusingly irritating throw me a bone now and then.  Thank you my friends!

Behold The Beauty Of American Democracy

Welcome friends!

Well, the presidential election cycle has finally ended here in the US and that’s something that I think we can all be thankful for, regardless of our political persuasion.  We haven’t seen such an incessant torrent of invective, distortion, rhetorical nonsense, and all around claptrap in many a year.  But that’s not the subject of my post for today.  No, my post today is actually about the beauty and power of American democracy.  What?  You think I’m being a little inconsistent?  I can’t get my story straight?  Oh, I beg to differ, my friend!

I think the point on which many casual observers can get themselves a little confused when trying to evaluate a democracy like the one we have here in the US is to make the conceptual mistake of viewing it as simply a technocratic system for determining optimal government policy... Sorry but only selected archived (previous year) posts are currently available full text on this website.  All posts including this one are available in my annual anthology ebook series available at the Amazon Kindle Bookstore for a nominal fee.  Hey, we all need to make a buck somehow, right?  If you find my timeless jewels of wisdom amusing or perhaps even amusingly irritating throw me a bone now and then.  Thank you my friends!

Why I Dislike Mitt Romney and the Republican Party

Welcome friends!

Well, I’ve been mentioning it for a couple of weeks now so let me just go ahead and talk a bit this time about why I really don’t like the Republican Party and its current champion Mitt Romney.  I have to admit it’s not something I was really looking forward to because there’s just so much now I don’t like about them I was a little afraid the whole thing would become unmanageable, which very nearly proved to be the case.  I guess summarizing is not really my forte.  Oh well, let me just grit my teeth and try to get through it.  I’ll go back to my preferred mode of one small issue at a time next time.  So, anyway, that’s my theme for this week: Oh, Republican Party, how do I despise thee?  Let me count the ways.  Or some of them, anyway... Sorry but only selected archived (previous year) posts are currently available full text on this website.  All posts including this one are available in my annual anthology ebook series available at the Amazon Kindle Bookstore for a nominal fee.  Hey, we all need to make a buck somehow, right?  If you find my timeless jewels of wisdom amusing or perhaps even amusingly irritating throw me a bone now and then.  Thank you my friends!

Happy Columbus Day

Welcome friends!

I know I said previously I intended to talk about my long list of issues with the Republican Party this week but something else has crossed my mind recently so it will just have to wait.  Yeah, I suppose another post on Republicans would have been entirely appropriate given the last minute momentum Mitt Romney has managed to generate in the recent debates by basically repudiating (or at least pretending to repudiate) most of his previous positions and thus further obscuring his beliefs and intentions.  (I had a good chuckle at President Obama’s quip after the event that he had been in a debate with someone claiming to be Mitt Romney.)  Of course I suppose it’s pretty much what one might have expected given that Republican strategists have been quite upfront about trying to take Mr. Romney and his ideas, or lack thereof, out of the equation as much as possible (which is pretty sensible, when you think about it) and make the election more of a referendum on how people think President Obama has been doing recently.  (A rather odd strategy in itself since I don’t think the guy has been doing that bad at all under the circumstances but that’s neither here nor there.)  However, after failing to accomplish this objective for weeks on the campaign trail who could have predicted it would play out so well on TV?  Is there something about that particular medium that makes glib dishonesty more appealing?  Is that why there’s so much garbage on TV?  Hmm, I’ll have to look into it some day.  Anyway, the bottom line is it now looks like we’re in a horse race after all, which is definitely a rather unpleasant development on many levels.  But life goes on.  Anyway, I thought I might put off my little summary of issues with the Republican Party until next time and instead go on a bit of lark and address what must surely be the most asinine and embarrassing of official American national holidays: Columbus Day.

Hey, everybody likes a holiday.  Me too.  But I wonder, what the heck are we supposed to be celebrating on Columbus Day?  ... Sorry but only selected archived (previous year) posts are currently available full text on this website.  All posts including this one are available in my annual anthology ebook series available at the Amazon Kindle Bookstore for a nominal fee.  Hey, we all need to make a buck somehow, right?  If you find my timeless jewels of wisdom amusing or perhaps even amusingly irritating throw me a bone now and then.  Thank you my friends!

Mitt Romney and the Famous 47 Percent

Welcome friends!

I know you’re probably getting pretty tired of reading about it, I know I am, but it’s just too irritating a story to let go without putting in my own two cents worth, so how about that secret tape of Mitt Romney talking to a roomful of fat cats about how his job is not to worry about the forty seven percent of Americans who pay no income taxes, are dependent on government, feel entitled to handouts, take no responsibility for their own lives, and are therefore bound to vote for President Obama.  (What?  Don’t like that fat cat jibe?  I don’t know, fifty thousand dollars a plate sounds pretty fat cat to me.)

The first thing that jumps out at me about this story is why do we have to start with a secret tape of a closed door meeting with fat cats?  If these are Mr. Romney’s real thoughts on the issue why can’t he just give a speech to everyone and talk about them openly?  ... Sorry but only selected archived (previous year) posts are currently available full text on this website.  All posts including this one are available in my annual anthology ebook series available at the Amazon Kindle Bookstore for a nominal fee.  Hey, we all need to make a buck somehow, right?  If you find my timeless jewels of wisdom amusing or perhaps even amusingly irritating throw me a bone now and then.  Thank you my friends!

Healthcare, Obamacare, and Freemarketcare

Welcome friends!

Well, maybe it’s not the most opportune moment but I guess I’ve put it off long enough, so let me just say a few quick words about the whole issue of health care in the US.  I have to admit I wasn’t exactly looking forward to addressing this issue at all because as you may or may not be aware the popular discussion of this topic seems to have gradually sunk to a really rather unusual level of idiocy, I suppose because the upcoming Presidential election has made getting people riled one way or another a top priority for the Republican Party.  Just as an example of the type of thing that’s been going on perhaps I can refer to what must surely be one of the most cringe worthy political ads we’ve seen in many a year.  In this truly amazing bit of mental pablum a woman intimates in that particularly unctuous voice usually reserved for manipulative animal welfare ads (surely the dark side of liberal politics if ever there was one; I’m talking about the means, not the ends) that President Obama said the health insurance mandate was not a tax but “now we know that is not true.”  I have a mental picture of some meticulously coifed dingbat sitting at a kitchen table in Kansas or Missouri and wondering to herself, “Is the health insurance mandate a tax?”  President Obama said it was a mandate, not a tax, but you know ... he’s a little swarthy, and he has that foreign sounding name and all.  If only someone would tell her, and then someone finally did.  The Supreme court said it was like a tax for Constitutional purposes.  Just as she had suspected all along: the President lied!  OMG!  Does she have dementia or something?  Should I not say anything?  Look, it’s a mandate.  Yes, it has some similarities to a tax, that would be the mandatory part.  And it has some dissimilarities to a tax, that would be the part where you don’t send a check to Uncle Sam as we normally do for things we refer to as taxes; you send it to an insurance company to buy some health insurance.  I mean, what’s so freaking difficult to comprehend?  Apparently for constitutional purposes the Supreme Court found it was enough like a tax to be discussed in that legal context.  Good for them.  That doesn’t stop it from being what it is.  I suppose if you’re hung up on the mandatory part then you’re good to go: yes, it’s like a tax in that respect.  You finally figured it out.  But if you’re one of those people who hates government and thinks it can’t do anything right then you should be gladdened by the fact your money won’t be going to those no good fat cat bureaucrats in Washington but to a private insurance company hell bent on making money off you any way it can (although fortunately the mandate actually came with some badly needed improvements to the regulations governing health insurance companies, so I guess it’s a little better case than your average business).  So if that’s what you’re worried about then it’s not really very much like what we would normally call a tax, is it?  My point is simply if you have any sort of brain you don’t really need anyone to tell to you if it’s a tax or not.

Anyway, after breathlessly explaining she now knows what the President said about the mandate was “not true” (because it’s a tax!) Ms. Einstein then goes on to say in the same disturbingly eerie and disingenuous voice she now understands it was all really a major power grab by the government.  Hello!  Conservative Paranoia Alert!  I mean, how is it a government power grab?  Does the government own the insurance companies?  Heck, I wouldn’t understand the argument even if we were talking about a government program instead of an insurance mandate.  Your average federal employee is there to administer a program.  Do you think they’re sitting around rubbing their hands together trying to figure out some way to wrestle power away from you?  What do they care?  Are they going to get some kind of kickback or something out of it?  Honestly, getting back to the insurance mandate, why would one think of it as a government power grab rather than as an attempt to solve a rather obvious problem involving health care costs and the national budget?  I think this kind of thing only makes sense in the fantasy world of modern conservatives in which they are perpetually locked in a sort of war against their own government.  Whenever I hear that type of thing I’m just happy we managed to lay out a lot of the cooperative framework and institutions of the country before this brand of hyper-egotistical conservatism really took root.  Can you imagine trying to do something like, say, introducing stop lights today?  You know that lady would be standing on some street corner yelling, “No power grabbing government bureaucrat can tell me when to stop my car!  I’ll stop on green lights and go on red lights if I want to!”  Yeah, you tell ‘em lady!  Now pass me a corn dog!

Well, that’s enough about that particular ad.  Let me just take a few minutes to look at this issue from a more general perspective.  Now it seems to me much of the conservative criticism of the Affordable Care Act and its famous health insurance mandate involves the idea that it interferes with the free market for health care, which we shouldn’t do because free markets are optimal and so on; you know the spiel.  One thing I find a little funny about the argument is that even if we set aside this latest foray into health care regulation I can’t really think of any market that is more heavily regulated than the current market for health care.  So if you’re thinking the issue with the mandate is an issue of regulation versus no regulation in the health care industry then I’d have to say you don’t really know what you’re talking about.  Don’t get me wrong.  We can talk about regulation versus no regulation in the context of health care but in that case we’d be talking about a heck of a larger issue than the pros and cons of the insurance mandate; we’d basically be talking about overhauling our entire system of providing health care.  (Which might or might not be a bad idea.  I’ll get to that.)  The second thing I find a little funny about the free market argument in this context is that I also can’t think of any market that is more idiosyncratic and thus potentially more in need of regulation than the market for health care.  So if we’re going to discuss regulation versus no regulation in this context then I think we need to be looking at some real world issues that arise specifically in the context of the market for health care.  OK, so let me discuss those two themes a little bit: the distinctive elements of the health care market and the ubiquity of existing regulations relating to health care.  Then we can conclude with a short statement about some options for changing things up.

The first thing that jumps out to me about the health care market in the US is that it basically involves going to a guy (and I mean that in the modern genderless way) for health care advice who stands to make a buck on your diagnosis and treatment.  Now you don’t have to be a financial genius to realize there’s something potentially problematic about that.  Yes, I suppose one can probably presume a medical doctor is also concerned about one’s health, at least to the degree it reflects on his or her professional responsibilities and reputation, but one thing’s for sure: he or she isn’t concerned at all about one’s financial health.  So take it from me you can expect zero pressure from doctors to keep down health care costs by cutting down on unnecessary tests and procedures and so on.  Indeed, I don’t know about your experiences but most of the doctors I’ve met seem to take a sort of professional pride in behaving as though cost is irrelevant.  Hey, they’re scientists, not accountants.  They’re above that sort of thing, don’t you know?  I think that’s why you’ll find if you go to any sort of medical specialist they’ll want to take their own X-rays and do their own tests even if you just had the same X-rays and tests done the week before by your primary doctor or by a different specialist, or you’ll get some sort of diagnostic test even though it doesn’t really make any difference at all to your treatment, or you’ll get a prescription for the latest brand name drug even though last year’s generic does nearly as good a job, or you’ll need to set up an initial appointment to go over some simple questions that could have just as well have been handled by a nurse over the phone or via email, and so on.  Let’s face it, most doctors in the US these days are in the game to make a buck and you’re the mark.  And they seem to be pretty darned good at it: medical providers in the US are a very, very wealthy group of people.  You know, the type of people who swan about in mansions and yachts and so on.  (When I grew up there was still this popular image of the humble family doctor who didn’t make a whole lot of money but was in the business to help people.  I think one could usually find him bicycling about the countryside helping struggling farm families and getting paid in livestock or apple pies or whatever it was.  Can you imagine?  How quaint.  It really was a different world back then, wasn’t it?  I mean to have a TV show like that and not fall on the ground laughing.)

So it seems in this market the patients themselves would really need to be the ones looking after the financial side of things.  They’re sure not going to be getting any help from their physicians.  Unfortunately, it seems pretty clear many patients are also not very adept at keeping a lid on health care costs.  Of course, it doesn’t help matters in this context that the medical profession is very organized and obviously very good at looking after their own interests, and that goal doesn’t really involve helping consumers control their health care costs.  For example, you may have noticed one rarely finds any sort of advertisement that would help one find lower cost medical procedures or providers.  It’s weird.  I can find all manner of advertising when I’m comparison shopping for other things that are lot less expensive than medical care: TVs, phones, computers, cars.  However, when I get to something like a budget busting medical operation I’m basically coming up with nothing.  And why is that? Well, maybe you haven’t noticed, but I think there are actually regulations and laws against that sort of thing, and you can bet political lobbyists for health care providers are behind it in one way or another.  Things like that don’t just happen.

And while I’m at it, I think another good example of doctors padding their own nests at consumers’ expense is this whole issue of prescription drugs, which are ostensibly so difficult to comprehend we dare not allow people to buy them on their own but instead force them to go to a doctor for a prescription.  Now that’s not very much like the market for other types of services, is it?  And what a bottomless pit of revenue for doctors.  I needed some asthma medication the other day of the same sort I’ve been taking for many years but my refills had run out.  Could I just call down and order some more?  No, not at all.  I had to go down to my doctor’s office, fork over $100, tell her I’m feeling fine, and then get my prescription.  And what did I get for my $100?  Something I didn’t already know from reading about the medication on the web?  Not likely.  A guarantee I’m not taking medications that conflict with one another?  Hardly.  I hear about that type of thing happening all the time.  You know, I understand the general idea behind requiring prescriptions in some situations but some times it does all seem like a little bit of racket, doesn’t it?

And you even get strange things happening on the supply side of the market.  Just take a look at our overall system of medical education.  Way, way back when I was going to school I remember one of the things I found a bit odd was that most of the basic pre-med type courses I crossed paths with seemed to have been designed mostly to “weed out” (as the common expression at the time had it) as many students as possible, which is to say far from being designed to make the subjects accessible the courses seemed to me to be calculated to do just the opposite.  The overwhelming impression was that the primary goal of the whole enterprise was more to control the supply of people going to medical school than to facilitate the creation of new doctors.  At the time I wrote it off as just one more of those seemingly illogical or counterproductive elements of the wider world.  However, I’m now wondering whether it doesn’t make some kind of economic sense for some people.  After all, there are people who stand to gain financially if we restrict the number of doctors, and those people would be other doctors.  Now I don’t want to overstate this argument.  I suppose it’s sometimes nice to have smart, ambitious, driven, highly trained doctors of the type that manage to make it through our medical education system.  But I don’t know, seems like a bit of overkill for many — strike that, let’s make that most — types of routine medical procedures.  If I’m sick, or I need some medicine, or I have a broken bone, or whatever it is, do I really need someone who has been put through an educational pressure cooker?  I doubt it.  Actually, I can usually discover whatever I need to know about those simple types of medical problems after spending a couple of hours on the web and without having any sort of medical training at all.  I’m just saying.  Do you think they could open it up a bit for these less complicated procedures?  Save the pricey A Team for the tricky, unpredictable, multi-system problems and procedures that really need someone to get all Poindexter on them?  It’s like we’re killing flies with a bazooka and then complaining about the cost of ammo.

Anyway, let me return to my main point, which is that it’s just not very easy for people to make reasonable cost benefit decisions relating to health care on their own.  Our current system just isn’t really set up to facilitate that type of thing.  Indeed, even taking the bull by the horns and calling around on your own to different doctors to investigate what you might be paying for a given medical procedure from different providers is a lot more difficult than you might expect.  Believe me, I’ve tried.  I was in one of those high deductible insurance plans in which you pay for medical procedures out of pocket up to a certain level so I thought I’d try to call around and check prices for a procedure I knew I would be needing.  Yeah, that didn’t exactly work out too well.  If you’ve every seen a medical bill and you know how monumentally complicated and padded they can be then you’ll understand why.  You don’t just pay for a procedure; you pay for a consultation, maybe a test or two, maybe a choice of procedures, then you pay the doctor, the anesthesiologist, the lab, the hospital, and the list goes on.  And it’s not like there’s a rack rate for anything: everything varies by which insurance plan you have, if any, because they all negotiate their own prices with each individual provider.

And of course one of the biggest impediments to doing any sort of cost benefit analysis on your own is that no one can give you a definitive answer about what you actually need until you have the consultation and do the tests, and since they can’t or won’t use the consultations and test results from other providers, you have the choice of either flushing that money down the toilet and starting over with someone else or just letting them go ahead and do the procedure they recommend and grab as much cash as they can carry in the process.  It’s sort of like paying a hefty fee to visit a used car dealer to see if they have any cars you might want to buy.  How many would you like to visit before you buy?  Or maybe you’d prefer to just to spend your entire bankroll going from dealer to dealer and shopping around?

And then we have the whole benefit side of the equation: what you might expect to get for some additional financial outlay in terms of reduced error rates, better outcomes, and so on.  Holy cow.  Good luck on that one.  If you think you’re going to do a little comparison shopping for a medical procedure you’d better have a whole lot of time on your hands because brother or sister you’re going to need it.

And you may have noticed the entire time I’ve been talking about when you have time to prepare and can sit around at home researching medical issues.  How about when you’re actually in the hospital in the middle of an unfolding medical emergency?  What kind of decisions are you making then?  Actually, I could probably write a pretty funny scene about that: “We need to operate right away!  Wait ... (gasp) ... bring me ... my laptop ... must research ... best price ...”  I could just die laughing.

Well, to make a long story short, all I’m saying is it seems pretty obvious many people feel they just don’t have the expertise (typically quite rightly) or the necessary research time to second guess their doctors, or they don’t want to set themselves up against their favorite doctors by rejecting their professional advice.  (And by the way with respect to that last point: I wouldn’t necessarily diagnose an absence of backbone, although I understand how one might reasonably arrive at that conclusion.  In case you haven’t noticed it can be pretty darned difficult to find a doctor you like and trust.)  And of course that sort of decision gets even tougher when one starts talking about one’s loved ones rather than oneself.  I don’t know, maybe you’re comfortable making more or less informed cost benefit decision about your own health care and you can treat your doctor’s suggestions as just one more bit of potentially relevant data to consider, but I think you’d have to have a pretty strong commitment to your own analytical abilities to start making those kind of decisions for your loved ones.

So the bottom line is that when we get to health care most people just want to go along with whatever their doctors recommend, which given the incentives of doctors basically means acting like millionaires who don’t give cost a second thought.  It’s as though as a culture we’ve committed ourselves to denying the cost of health care and the necessity of making hard choices about treatments based on cost and efficacy.

Now of course, once we got into this situation in which everyone wanted to follow their doctor’s budget busting orders but no could really afford the outrageously expensive medical care that typically entailed we started having to make special financial arrangements with insurance companies to have any chance of pulling it off.  Now I think if anything this development probably exacerbated the problem because one of the unfortunate things about insurance is that it breaks or at least obscures the link between what you pay and what you get.  With insurance, everyone is now in a position of trying to get as much as they can out of their fixed insurance premiums.  Yes, if we all do that and the insurance companies play along then we all end up paying ever more for insurance premiums, but that’s the old tragedy of the commons, isn’t it?  Everyone looking after their own bottom line in the short run and getting screwed in the long run.

Insurance companies seem to me to be facing a sort of strange situation as well.  On the one hand, they would probably like premiums to be as high as possible so they can pocket more themselves, so I’m not sure they’re particularly averse to the high medical costs that generate high insurance premiums.  On the other hand, when it comes down to it they would like to pay out as little as possible.  Hey, that’s not a criticism: they’re a profit making businesses like any other.  The best of all worlds for an insurance company is to get everyone to pay high premiums in case they need expensive procedures and then find some excuse to not shell out when the time comes.  So it should come as no surprise that without regulations these companies can get up to all kinds of shenanigans to make a buck, such as insuring you when you’re healthy and then giving you the boot when you actually start to get sick and so on.  And then you have the insurance companies getting together with the medical providers to figure out a way to lift money from their patients and clients, oh sorry, I meant negotiate prices.  Yeah, right.  Some negotiations.  I was investigating costs one time and I found the hospital offered people with no insurance a fifty percent cost discount off the agreed upon rate they had negotiated with the insurance companies.  Isn’t negotiation usually about reducing costs?  You mean they were both negotiating about how much they could raise the rates for people with insurance over the rate for people with no insurance?  Yep, like I said, it’s a funny business.

And it doesn’t help that many people also seem to have some difficulties thinking about low probability but high consequence events such as medical emergencies and that many people are pretty much in denial about health issues and about eventually needing health care.  Yeah, those are the people who don’t need no damn health insurance, right up to the day they unexpectedly come down with a serious injury or illness, spend a week in the hospital, get sent a bill for twenty or thirty thousand dollars, and eventually end up living under a bridge.  Then they join the ranks of those who are a little irritated at the state of health care in the US.

So, OK, if you’re one of those starry-eyed conservative market worshippers then I guess you didn’t really see the point of bringing up all these seemingly random and irrelevant considerations because, you know, markets are optimal and that’s that.  You know the type of thing I mean: if Granny can’t pay her medical bills then she should just drop dead.  Hey, it was her decision, wasn’t it?   How much to save?  How to live?  What job to have?  Whether to buy insurance?  How much health care research to do?  Actually, now I’m thinking about it I guess one’s reaction to this sort of argument might serve as a sort of litmus test on how one really feels about the moral attributes of our current method of distributing resources.  It’s one thing to go on about how fair and equitable everything is when one is talking about buying a new TV or something else most people probably don’t really need anyway.  Heck, any half hearted conservative can do that.  I might even do that myself sometimes and I’m not even a conservative.  But the moment of truth comes when we get around to people dying because they can’t afford the medical care they need or, to get even more real, to kids dying because their parents can’t afford the medical care the kids’ need.  Now in this post I don’t really want to argue the point so if that’s what you believe that’s OK with me ... for now.  We can discuss it some other day.  If you’re curious and can’t figure it out from my other posts let me just say I have nowhere near the confidence in the moral significance of our current distributional system I would need to be comfortable with that kind of conclusion.  But, that’s not the point here.  At least this view makes sense to me and we can discuss it, which is really all I ever ask.  So that’s one way we could go.  Just treat the market for health care services like any other market and get rid of all those burdensome government regulations.  Let people buy whatever drug they like and can afford and let them take it rightly or wrongly.  Let people pay for expert advice if they think they need it and let them just do whatever they like if they don’t think they need it or they can’t pay for it.  Let anyone hang out a shingle as a medical doctor and let people investigate and go to whichever so-called doctor they like based on whatever information they feel is relevant and have the time and resources to dig up and who they can afford to see.  Handle any perceived ethical issues relating to the distribution of health care along with similar issues relating to the distribution of other products and services via some type of redistribution scheme according to whatever criteria one finds ethically relevant.  I don’t know, I’m a little of two minds on this one.  What do you think?  Would that be an improvement on our current system or a step backwards?

If that idea doesn’t grab you, if you don’t have that kind of confidence in the ethical status of our distributional system and you don’t think you can fix any perceived problems with a redistribution scheme, if you think there may be some unique considerations at play in the health care market, if you think people need help making these sorts of decisions, then I’m sorry to have to tell you but in that case we’re talking about government regulations of one sort or another.  We’re not talking about a free market any more (unless we want to play the game of adjusting our definition of a free market to account for whatever regulations we think make sense in the context of particular markets, which is always a fun exercise but confusing as hell terminologically).  So if we’re talking about regulating the health care market the question then becomes do we want to keep doing what we’ve been doing or do we want to change it up?  And the answer is that we want to change it up because what we’re doing now isn’t working very well at all.  We have an expensive system that gives inferior outcomes at outrageous prices, financially destroys a few unlucky people, leaves some people without access to medical care, and if allowed to continue will eventually destroy the national budget because of our current obligations in that respect.

So that leads us to the idea of trying to work through existing insurance companies.  The fact is that for insurance to work for budget busting expenses like medical care you need a lot of people in the system relative to the people who need the cash at any particular moment.  Otherwise you’re just not spreading the costs around enough to do much.  Of course, all we’re doing there is finding a way to pay for expensive medical care; we’re not really reducing or even controlling costs.  You need regulations to do that.  But Obamacare has that too.  It’s not just an insurance mandate.  Now Republicans know full well this is one reasonable avenue to explore if we want to get a handle on national health care expenses, and before they got all weird and political about it they were doing a lot of thinking along these lines themselves.  Ask Mr. Romney, who often still trips himself up by taking credit for coming up with something similar when he was governor of Massachusetts.  Now that the Democrats actually did it at the national level the Republicans have been working themselves up into a faux frenzy over the horror of it all, but never mind.  You and I both know it’s one way to go, right?

I suppose the third major alternative would be to just get rid of the entire private health insurance layer and that whole gravy train and just work directly with government provided health care, paid for by taxes, and dispensed by health care experts who try to tackle the tough decisions about the types of procedures that are worthwhile in different situations and who are prepared to get tough about medical costs, unnecessary tests and procedures, exorbitant doctors’ fees, and all the rest of it.

Oh, you were thinking more along the lines of the fantasy solution where no one worries about costs at all and yet we can all get whatever health care we want whenever we want it?  Uh, yeah ... that would be good too.  Actually I should have specified I meant to talk about the real world just then, not some crazy pipe dream about how you would like things to work.

Other realistic alternatives?  Well, I don’t know, but I’m all ears.  Maybe we can think about some kind of mixed system where we have one system that provides the most vital, proven, and cost effective medical care (either through regulated insurance companies or government agencies) based on authoritative medical knowledge, but then have a parallel open market track for more dubious procedures on the old cost benefit dimension for those are willing and able to pay for it?  Just thinking out loud.  I’m not saying I have all the answers.  Far from it.  But you know, thinking this all through would probably be a lot easier if conservatives would get real for once in their lives and start putting some thought into the issue instead of putting everything in the context of their asinine political rhetoric about the health insurance mandate being a government power grab and so on.  At least the Democrats have tried to do something serious with the Affordable Health Care Act so we might as well give that a try.  We can reassess in a few years and go from there.  Better than anything the Republicans are offering up right now.  Faux outrage is fine and dandy but it doesn’t pay the bills.  Well, not for most of us, anyway.

References

Tara Parker-Pope.  Overtreatment Is Taking a Harmful Toll.  New York Times.  August 27, 2012.  http://well.blogs.nytimes.com/2012/08/27/overtreatment-is-taking-a-harmful-toll/?src=me&ref=general.