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August 27, 2007
Dangerous, Rather Than Annoying, Arguments
Folks konw I think McMegan is an interesting writer. Some of you even hold it against me. But just this once, you can't stop e-mailing to tell me she wrote a really, really long post on health care. I know! I read it! It's very bad!
It relies on unproven and incorrect premises ("Most advocates of single payer, I think, care most about this justice claim. They may also think that they can make the system more efficient, but if one could somehow prove scientifically that a private system would be cheaper and better, they would still favor a public system as long as a substantial population remained uninsured); brackets the argument about efficiency then pretends it doesn't figure into reformer's claims; radically overstates individual culpability for illnesses; elides the fact that living a healthier life just means you die from something expensive later; mistakes an intergenerational compact (wherein each generation pays for the next, rather than making a one-time transfer) for charity; and appears to miss the fact that Medicare already exists, and so single-payer would not mean more resources would be transferred to the old, thus obviating the central point. And that's just a partial list!
But this is the type of bad I can get behind. McMegan's post is one I disagree with, but do not fear. Indeed, if some eager speechwriter plugged it into Mitt Romney's next address ("My fellow Americans, I think it's time we abolished Medicare, because the old don't deserve our help. And we should also stop caring for the sick, because that colon cancer is your own damn fault Mr. I-Don't-Eat-My-Fiber.") I think we'd have found the straightest line between here and national health care.
Lately, though, I've been trying to think more systematically about which health care arguments are dangerous to reform, rather than just annoying to reformers. Here's what I've got so far:
- The government can't do it. It'll be like the DMV. It's "socialized medicine." Do you love waiting times? etc.
- It'll be too expensive.
- Incrementalism-as-obstruction. i.e, "We should have a more "American" system based on tax credits and deductions!" These proposals don't have the downsides of real reform, but they don't fix anything, either. However, they do make it seem like the politician "has a plan." See Giuliani, Rudy.
- National reform will fail, as it always has, and the cause will be dealt an enormous blow, just like in 1994. Better to be incremental and just cover kids or something.
- It'll reduce pharmaceutical innovation.
Any more?
August 27, 2007 in Health Care | Permalink
Comments
Of course we hold it against you. McMegan isn't interesting, she's a bad person. She is a greed obsessed loon who is incapable of having a thought that does not entirely revolve around herself.
No, her argument doesn't need to be feared, but it should be hated. It represents a kind of unapologetic greed that is the closest thing to evil you're ever likely to see. She views the vulnerable in our society in the same way white supremacists do, as dead weight that we're better off without. That her views are are based on age and class do nothing to make them less repugnant. At least, not unless you're a upper class young man like Ezra Klein, in which case you can skip over entirely how ugly what she's saying really is.
Posted by: soullite | Aug 27, 2007 1:53:55 PM
I think just saying it will reduce "innovation" more broadly is a stronger argument. People dislike the Big Drug companies, but "medical technology" like better pacemakers and aeds are things people think are pretty good.
The GOP catch-all is "it will hurt the economy", followed by "taxy tax tax tax!"
But all of the ones you list are good arguments. The rejoinder to the DMV is obviously the VA ... but there aren't many good responses to the others.
Posted by: Nicholas Beaudrot | Aug 27, 2007 2:05:32 PM
"Someone ELSE will be choosing your medical care!!!!
This depends on the idea that you and your doctor choose it now, based solely on your best interest. But the specter of the government making a decision for you!!! seems to set people off. Don't know why having insurance companies make decisions for them doesn't hit the same chord, but I haven't seen it.
Posted by: Megan | Aug 27, 2007 2:08:47 PM
Am I the only one who's in and out of the DMV in less than 20 minutes every time I go? Maybe New York just got a lot more efficient than most states, but personally I think the "do you want something to become as slow and badly managed as the DMV" argument to be at least a decade past its prime.
Posted by: mad6798j | Aug 27, 2007 2:26:35 PM
Folks konw I think McMegan is an interesting writer. Some of you even hold it against me.
There's plenty of reasons we hold it against you. First, she's not an interesting writer - that is, she doesn't say anything that a bog-standard property-centric right-libertarian wouldn't be expected to say. Second, she writes almost exclusively on economics, but is actually astonishingly ignorant of economics; this makes her a rather bad and somewhat insulting example to hold up of bog-standard right-libertarian thinking. Third, she has a tendency to hold to the GOP line on a given issue long after any reasonable defenders have broken ranks; i.e., she's a party hack. Fourth, you know her socially, so linking to her over any number of other, smarter libertarians you don't hang out with makes your motives appear somewhat suspect - like you're promoting your pals instead of linking to the best people out there.
The reason I, at least, tend to harp on your linking/promotion of McArdle is that it's fairly different in character from the way you link to, say, Jonah Goldberg. Instead of an adversarial relationship - which is normal and healthy between ideological opponents - there's a cozy familiarity, and that leads to increased traffic and visibility for McArdle, and to the appearance that she's a reasonable, "acceptable" right-winger among lefty circles, which in turn makes her palatable to places like the Atlantic Monthly. So you and Yglesias end up promoting the career of yet another right-wing hack. I personally don't care how nice she is in person or how many cookies she's baked you; her political philosophy is stupid and vile, and in a media environment dominated by right-wing figures, we really don't need liberals going out of their way to help the careers of wannabe right-wing pundits. Here's a thought: why not try linking to professional commenters to your left for a while?
Posted by: Christmas | Aug 27, 2007 2:34:19 PM
Am I the only one who's in and out of the DMV in less than 20 minutes every time I go? - mad6798j
NJ used to be horrible. But they changed something, made a big deal out of changes being made, and suddenly anything at the DMV was super-duper quick. I can't figure it out. Nobody seemed to be working any harder before. There didn't seem to be any difference in the paperwork. There didn't seem to be more people.
Just all of the sudden things got better.
In FL, you don't need to go to the DMV for most things ... you can go to the Tax Assessor's office. E.g., getting an in-state license (when you have an out of state one) or registering your car is pretty darn quick.
Posted by: DAS | Aug 27, 2007 2:46:43 PM
um, she doesn’t say efficiency “doesn’t figure into reformer’s claims,” but rather suggests that it is secondary to the justice claim.
i don’t understand why relying on free markets *up to* the point where people are not getting the healthcare they need *and then* dishing out subsidies is such a bad idea ..unless you believe markets don’t deliver optimal efficiency and single-payer would be more efficient (?!?)
Posted by: neil | Aug 27, 2007 2:53:08 PM
Ezra, you're on dangerous ground here because mcmegan's arguments are vile. Saying anything less than that only serves to justify her megaphone which, frankly, I don't she deserves for a large number of reasons.
To your arguments:
The government can't do it. It'll be like the DMV. It's "socialized medicine." Do you love waiting times? etc.
Yeah sure. Funny thing about that goverment, social security seems to work. Medicare seems to work. The entire bloated and mostly out of control defense establishment stills seems capable of blowing shit up.
So my rejoinder to the argument that the word "government" poisons it is, no, government removes the profit motive and insures everyone which is the way insurance is supposed to work.
It'll be too expensive.
Those of us who have health care already pay some of the highest rates on the planet. If we can get the administrative duplication and waste out of the system, it's possible we can improve it.
Incrementalism-as-obstruction. i.e, "We should have a more "American" system based on tax credits and deductions!" These proposals don't have the downsides of real reform, but they don't fix anything, either. However, they do make it seem like the politician "has a plan." See Giuliani, Rudy.
Tax deductions don't mean much if you aren't making anything. They're great to the folks who itemize and make decent or better money but if you think the magic republican phrase of "tax deductions" means anything to the folks for whom taking costs of pocket just isn't possible, you need to get out more.
National reform will fail, as it always has, and the cause will be dealt an enormous blow, just like in 1994. Better to be incremental and just cover kids or something.
Sorry, you lost me on this one. "an enormous blow"?
It'll reduce pharmaceutical innovation.
Pharma innovations is already stagnating. That is, unless it's an erection drug. Come on. Pharma will create things that people will buy. Does anyone really think that if all Americans could afford perscription drugs they'll buy less of them? What big pharma wants is what they have right now. Like the record labels, they're willing to fight their own customers to preserve a business model that is comfortable, not moral or efficient.
Oh, and once again, commenters like Soullite and Christmas are right on about mcmegan. Stop it Ezra. You're better than this. At least I hope you are. She's vile and that she gets a national voice is a symptom of the problems in our media.
Posted by: ice weasel | Aug 27, 2007 2:53:52 PM
McMegan isn't interesting, she's a bad person.
Soullite, do you ever go out into the light? You just make up half the things you say.
The reason I, at least, tend to harp on your linking/promotion of McArdle is that it's fairly different in character from the way you link to, say, Jonah Goldberg.
Thank God for small favors.
The extent to which people rail against McArdle is generally inversely proportional to the extent to which they've bothered to read carefully what they're railing about. She's fairly good at making her arguments.
Posted by: Sanpete | Aug 27, 2007 2:58:33 PM
Just like this article we're discussing, right Sanpete?
/plonk
Posted by: verplanck colvin | Aug 27, 2007 3:03:37 PM
Why are complicated arguments needed?
Last week was the right thought they had done a 'gotcha' momeent when some rube asked John Edwards at his bus window if he liked the movie SiCKO, and if so don't that mean that he thinks we ort to have a guvmit run system like they got thar in Cuba?!
Posted by: El Cid | Aug 27, 2007 3:03:49 PM
DAS: I can vouch for the greatness of the "new" NJ DMV (actually called the MVS). I was in fact writing a post about this until I saw yours. Anyway, it changed because McGreevey made it a point to change it. He hired better people to run it and streamlined it. Maybe the better people made it a point to train the employees better, I don't know.
Look at this passport mess we have. Is it any surprise an Administration which loathes governance and bureaucracy would allow this mess to happen? Then they go ahead and blame "bureaucracy" for it, forgetting about the fact THEY ARE IN CHARGE OF THE BUREAUCRACY! Forgetting the fact that we are supposed to have the "CEO President" in charge!
If the DMV is shit its because the people running it are incompetent or careless. Not because it's a government agency running it.
Posted by: Joshua | Aug 27, 2007 3:20:34 PM
I'll say what's left unsaid.
For a lot of us, denying health care is a form of murder.
Posted by: Karmakin | Aug 27, 2007 3:27:05 PM
"She's fairly good at making her arguments."
Yes and no. She's an ex-English major, so she's a good *writer*, but that isn't anywhere in the same zip code as being a good *analyst*.
Firstly, she's really, really fecking lazy with data. Really. Argue with her, and pretty soon she'll be Appealing To Experts She's Talked To.
Secondly, she's a Chicago GSB grad. That's OK, I know really sharp people from CGSB, but it leans her towards a crude application of cruder econ 101 models. There's been a wealth of research in the past thirty years on market failure and imperfect markets, and if you're gonna present yourself as an econ blogger, it'd help to be familiar with them.
Thirdly, she was burned on the whole left by being involved with Nader's PIRG when she was a young 'un. So she thinks most of the left is as exploitative, dishonest and wrongheaded as PIRG.
Posted by: Sock Puppet of the Great Satan | Aug 27, 2007 3:37:42 PM
"The extent to which people rail against McArdle is generally inversely proportional to the extent to which they've bothered to read carefully what they're railing about. She's fairly good at making her arguments."
The above is a factually false statement. She is horrible at making her arguments. She usually relies on the strawman for attacking liberals, but also has healthy doses of "facts" that end up being anectodal evidence. Additionally, she is afraid of making the final steps into libertarianism because it is so soulless that it horrifies even her, but then derides anyone just inches to the left of her. And finally, she doesn't know how to make her arguments short - they all seem to take several thousand words to make banal points.
Posted by: mickslam | Aug 27, 2007 3:56:40 PM
The DMV argument is a microcosm of a key part of the argument against national health care: simple refusal to acknowledge changed facts, gussied up in a variety of rhetorical tricks. A lot of DMVs did used to be bad...and they've improved. The Veterans Administration was once a disgrace...and the Clinton administration oversaw its impovement, and did so good a job that it took the Bush/Cheney administration years of serious effort to wreck it again. All the European national health care systems have been in place for decades and so their adoption struggle doesn't bear directly on the problems we'd fix...but Taiwan adopted national health care in the 1990s, with excellent results that do bear on ours. A lot of the statistics thrown around in arguments against national health care turn out to be obsolete as well as incomplete and massaged.
Posted by: Bruce Baugh | Aug 27, 2007 4:06:06 PM
Eric, lay off Megan. She's just a lovesick seventh grader with a crush on you. Or maybe that was a metaphor. You'll have to ask Dan Drezner.
Posted by: santamonicamr | Aug 27, 2007 4:15:54 PM
Am I the only one who's in and out of the DMV in less than 20 minutes every time I go? Maybe New York just got a lot more efficient than most states, but personally I think the "do you want something to become as slow and badly managed as the DMV" argument to be at least a decade past its prime.
Recently, it took me over 90 minutes for a change of address at the DMV in Chicago. I consider that pretty bad. It used to be better, they'd have dedicated lines for minor issues that used to go pretty fast. But now they've implemented this new computerized system that seems to bin people in such a way as to maximize wait times for everybody.
That said, wait times are considerably longer at nearby ERs. And at my old HMO a non-emergency appointment with my primary care physician was often scheduled as much as sixth months away.
Health care ain't Starbucks. You can drink all the free market happy juice you want, but none of that changes the fact that our patchwork health care reality is a nightmarish labyrinth where you won't have a hypothetical entrepreneur opening up Crazy Ed's House of Health, where you get treated in 30 minutes or your MRI is free.
Posted by: Royko | Aug 27, 2007 4:20:24 PM
IIRC, one of the most effective arguments in shooting down the 1994 health care plan was "You don't get to choose your own doctor" (Harry and Louise really hit on this). Might not be quite so effective nowadays, what with people herded into HMOs and PPOs with their in/out of system enrollments.
Also, sometimes they say "Post Office" instead of "DMV".
Posted by: FMguru | Aug 27, 2007 4:22:04 PM
"Folks konw I think McMegan is an interesting writer. Some of you even hold it against me."
Of course she's an interesting writer. She (Damn that Woman!) writes both you and I (and many others) off the page.
That I agree often with her ideas (as most around here do not) is not I think the important point.
She has got that manipulating the words thing, and yes I'm jealous.
No, she's never made me cookies.
Posted by: Tim Worstall | Aug 27, 2007 4:23:16 PM
And we should also stop caring for the sick, because that colon cancer is your own damn fault Mr. I-Don't-Eat-My-Fiber.
This made me laugh out loud.
Posted by: IIsabel | Aug 27, 2007 4:28:26 PM
Just like this article we're discussing, right Sanpete?
It's obviously a general claim, verplonken, like most of the others about her in this thread. The article here is complicated enough to make it less than an ideal case to judge by. I expect she wouldn't accept some of the interpretations the criticisms rely on, and would be able to explain others.
For a lot of us, denying health care is a form of murder.
Megan isn't for denying health care to those who need it.
Posted by: Sanpete | Aug 27, 2007 4:37:27 PM
Arguments dangerous to UHC? The innovation one doesn't strike me as an argument potent with the general public. The mechanism behind the idea seems like it requires some thinking; people hate that stuff.
Posted by: TJ | Aug 27, 2007 4:44:04 PM
'I've been trying to think more systematically about which health care arguments are dangerous to reform'
Since wisewon hasn't responded... how about the "cost growth" argument. I started out caring about other, typical arguments against UHC; but in reality, this is the only one that really resonates for me. I’ve get to see this properly addressed by UHC advocates, but am interested to see how a proposed UHC plan is going to manage this.
Posted by: DM | Aug 27, 2007 5:16:14 PM
Soullite is right, she's a horrible writer and thinker. If her writing and thinking reflects who she actually is, in some sense, she must be a horrible person.
Something that keeps getting left out of the health care "debate" although it figures largely in the education debate, is the comprehensive and coherent health care for all--especially for children--is an integral part of a healthy society for all. Without comprehensive and affordable or free health care there can be no serious response to any bio-terrorism threat. Anthrax? Small pox? TB? plague? the flu? Most americans simply won't be able to see a doctor in time to get any pandemic level illness diagnosed and isolated. The treatment facilities and beds aren't there. And the right to sick days or family medical leave that would enable doctors to quarantine sick people at home simply don't exist.
Since the first epidemiological insights grew out of the study of cholera and dirty water in cities we've known that individual health *is* public health in a lot of ways. And public health is, well, public and requires working collectively for a collective goal--good health for all or at least for most.
The entire thrust of the idiot McCardle's point is that good health is individual. Its not. Good health for society, and of a society, is collective. That's not a dirty word. Its just a fact.
aimai
Posted by: aimai | Aug 27, 2007 5:57:37 PM
Any more?
'Socialism!' 'French!' 'Cuba!' or any of Rudy's other healthcare tenets. Rudy's not dumb: he's appealing to the lizard brain. And I think that really shallow arguments -- 'look at the tatty seats in the NHS casualty waiting room!' -- are the most dangerous to reform, because so much of the US system is sold on superficies.
(As someone elseblog noted, the Jesuit line that it's worse to be lazy than stupid seems perfectly applicable to Megan McArdle. She's the Paris Hilton of political blogging.)
Posted by: pseudonymous in nc | Aug 27, 2007 6:10:22 PM
If her writing and thinking reflects who she actually is, in some sense, she must be a horrible person.
More gratuitous bullshit. If she's like her writing she's undoubtedly a very interesting person well worth talking with. People who can't disagree with someone without thinking they're evil have a real problem relating to others.
Posted by: Sanpete | Aug 27, 2007 6:13:29 PM
Megan's argument was pretty repulsive. But it was little more than the typical rehash of libertarian-ish principles with a hearty dose of narcissism and youth-induced ignorance.
Posted by: Ms. Clear | Aug 27, 2007 6:20:56 PM
Somewhat OT but apropos of health care, NRO's Corner offers up this morsel this afternoon:
Under any normal set of circumstances, children whose families make more than 250 percent of the poverty level (that's an annual income of more than $50,000 for a family of four, i.e. two children) do not need government assistance to get health insurance. Period. It amazes me that the argument to the contrary is taken seriously. Most conservatives can accept the idea of state governments reaching out to help the truly needy. But barring extraordinary circumstances, if you make that much money and you are not even buying insurance for your children, you should lose custody before you have any right to go on the dole.
Families of 4 making $50,000, please take note: you are now wealthy beyond the dreams of avarice.
Posted by: alkali | Aug 27, 2007 6:29:36 PM
Here are a few dangerous arguments I've heard recently. I have a couple of very smart but very misguided uncles with whom I was discussing this issue last month, and they made the following arguments:
1. American healthcare is more expensive than "socialized" alternatives because we pay our doctors their fair market value. Under "socialized medicine" doctor pay would be artificially capped by government monopoly, which amounts to "enslavement" of doctors. Yes, my crazy uncles used the word "enslavement."
2. Healthcare isn't a right.
3. Providing free healthcare to people who can't afford it is charity, and the government (and "liberals"!) don't have a right to demand that my uncles contribute to charities they don't believe in. Besides, churches and other non-profits can do a better job at administering charities than governments can anyway.
4. And my favorite: we spend too much on healthcare because the people who have insurance use it frivolusly, and the best way to get people to only spend money on healthcare they need is to make them have to pay for it themselves so they feel it in their wallets.
Yep, my uncles are crazy and all too willing to swallow the republican and libertarian propaganda. You'll just have to take my word for it that they're also actually otherwise very smart.
Posted by: Galen | Aug 27, 2007 6:43:09 PM
Besides, churches and other non-profits can do a better job at administering charities than governments can anyway.
As we should be so fond of reminding people, private charities have had 6000 years of civilization to try to provide education and end malnutrition. Finally, the government decided to step in and take care of the issue.
Posted by: Tyro | Aug 27, 2007 7:05:53 PM
You can see my opinions on the subject in her comments section. Really, it's been pretty amazing watching a blogger's commenters just destroy her on every single post. But that comes with the territory when you insist on making utterly vacuous and logically flimsy arguments. Seriously, I do think we need to separate argument that we disagree with, and argument that doesn't meet certain basic levels of intelligibility, intellectual honesty and logical coherence. I've never seen so much argument through assertion, straw men, and deliberate obtuseness anywhere. Reading her blog is like reading a high school civics class essay. Just brutal.
Posted by: Freddie | Aug 27, 2007 7:16:57 PM
Since wisewon hasn't responded... how about the "cost growth" argument. I started out caring about other, typical arguments against UHC; but in reality, this is the only one that really resonates for me. I’ve get to see this properly addressed by UHC advocates, but am interested to see how a proposed UHC plan is going to manage this.
Just to clarify, I don't think cost growth is an issue against UHC. It is an issue on how its designed/implemented and as I've said before, I'd argue it is the most pressing/complex issue for health care reform because of 1) no system has figured this out 2) astronomical cost projections for US and other health care systems over the next 50 years.
As for DM's question, I've written before but here's my high-level summary: take Massachusetts-style mandates (needs some changes to poverty levels/sliding scale) + Wyden's employer-to-individual transition/tax legislation with community rating + Obama's insurance exchange (modified)+ Clinton's best practice institute + Gravel's voucher concept (I've written on this before) + my previously proposed consumer-health concepts (quality-cost tradeoffs, better health information tools, health incentives) and you have the beginnings of a very good proposal that is better equipped to deal with cost growth than any system that exists today.
Posted by: wisewon | Aug 27, 2007 7:44:02 PM
"People who can't disagree with someone without thinking they're evil have a real problem relating to others."
A few hours earlier ...
"The extent to which people rail against McArdle is generally inversely proportional to the extent to which they've bothered to read carefully what they're railing about. She's fairly good at making her arguments."
So... more comments assuming people you disagree with are ignorant and less assuming people you disagree with are evil.
Posted by: Christopher Colaninno | Aug 27, 2007 7:58:31 PM
Closing italics.
Posted by: Brock | Aug 27, 2007 8:14:44 PM
Hmm... That didn't work. Maybe this will.
Posted by: Brock | Aug 27, 2007 8:18:20 PM
Wise,
I tend to use UHC in too general a term. The “cost growth” counterpoint is a good argument against Ezra’s brand of UHC: single payer. Granted, there are nuances in design, but a system to puts the core of cost management in the hand of the gov’t, whose managers are incented to get elected, not manage costs, is a recipe for trouble.
Posted by: DM | Aug 27, 2007 8:47:04 PM
She'll be a much more interesting writer when she turns 14.
Posted by: calling all toasters | Aug 27, 2007 8:59:32 PM
She'll be a much more interesting writer when she turns 14.
Posted by: calling all toasters | Aug 27, 2007 9:02:46 PM
So... more comments assuming people you disagree with are ignorant and less assuming people you disagree with are evil.
I don't assume anything. I observe the complaints about Megan, I go read what the complaints are about, and I usually find that the strongest, most vicious complaints are from people who have completely missed what she said. As I said above, her post linked to above is more trouble than it's worth to sort out, since there are so many things going on in it, but I recently read similar complaints about her at Sadly, No! (discussed here) about a follow-up to that post, a much simpler version, which seemed perfectly sound, if also somewhat underwhelming in its thesis. Sadly No fisked it and seemed very satisfied that it had demolished it, but had in fact just missed the point.
Posted by: Sanpete | Aug 27, 2007 9:19:08 PM
Sanpete,
I would only say if that you're going acknowledge that the article is "more trouble then its worth to sort out" and has “so many things going on in it” that maybe the root cause of people missing her “point” is that it wasn’t very well communicated.
Posted by: Christopher Colaninno | Aug 27, 2007 9:54:25 PM
Good golly, it's a simple argument she's making. In brief, McCardle argues that old sick people, do not, simply by virtue of being old and sick deserve transfer payments from the young and healthy. She further believes that many advocates of some form of 'single payer' disagree, and this disagreement is salient as the belief that the old and sick are entitled to transfers underlies much support of universal care. That's it.
What's so hard to understand?
Posted by: Ben A | Aug 27, 2007 10:08:42 PM
Christopher, I agree, and would hypothesize that she wasn't as clear in her own mind about what she was about as she could have been, not unusual for the blog format, where you put out ideas before refining and polishing. The clarity that leads to brevity and fewer detours often comes after you make your argument, not before.
Posted by: Sanpete | Aug 27, 2007 10:11:34 PM
I should have said I agree that's one of the causes. It isn't the only one. Also a major cause is that people have a hard time following arguments they think they don't want to agree with.
Posted by: Sanpete | Aug 27, 2007 10:14:19 PM
Hi - new lurker here, like the blog.
A simple answer to the "UHC reduces pharmaceutical innovation argument:"
According to OECD statistics,
US spending on Health Care = 15.4% of GDP
Nearest other country, Switzerland = 11.6% of GDP.
US spending on Pharmaceuticals = 12.4% of healthcare = approx. 2% of GDP.
Swiss spending on Pharmaceuticals = 10.4% of healthcare = approx. 1% of GDP.
Extra US spending on Pharmaceuticals = 1% of GDP.
So if the US could introduce a UHC system of comparable cost to other nations' systems, it could maintain its higher levels of Pharmaceutical spending (thus maintaining the support for innovation), and still come out ahead.
Posted by: slightly_peeved | Aug 27, 2007 10:19:50 PM
Under "socialized medicine" doctor pay would be artificially capped by government monopoly, which amounts to "enslavement" of doctors. Yes, my crazy uncles used the word "enslavement."
Perhaps Ezra knows more about this, but I haven't yet heard anything from the Dem candidates about the problem of medical school tuition, and the debt burden thereof. The Edwards approach seems to have room for a debt forgiveness scheme in exchange for sign-on to govt. insurance, but the problem is implementation, since it's the newly-qualified doctors (in hospitals, mostly) rather than lone and small practices who have the relatively small salary and extremely big debts.
As I've said, before, a debt-forgiveness scheme would also help with the divide-and-conquer -- bribe the medics, screw the insurance execs -- that I think is necessary in selling universal coverage to the public.
Right now, the professional line is "the median debt burden of a newly-qualified doctor is $120,000, but you'll be buying that third car in 20 years' time." I think there's room to say "be part of getting health coverage for everyone, and your med-school debt is wiped while you're still young enough to enjoy spending money on frivolous things."
Posted by: pseudonymous in nc | Aug 27, 2007 10:31:39 PM
As I always says, the brazilian health care system is the best solution: there is universal health care(That´s in practice is used only by the poor), but anyone who can afford pay for better and private care...
You have a safety net for the poor and good private solutions for everyone else... ;-)
Posted by: André Kenji | Aug 27, 2007 11:27:38 PM
There's no enslavement, but you better make sure they are paid a fair market value or they will go somewhere else. Considering 1/3 of the physician workforce is over 55 and if you go through with a UHC proposal demand will increase greatly. You need to keep them in the loop and motivated otherwise they will retire and make a bad access problem even worse. The vast majority of expenditures go to the hospitals and other sources not to physician reimbursement.
Posted by: Dingo | Aug 28, 2007 12:25:49 AM
Megan is a very good writer. The problem is that she's a blogger, not a writer. She writes on economics, and she isn't qualified to write on economics, having neither an economics undergraduate or graduate degree.
Even worse, she's the economics version of Rudy Giuliani as foreign policy whiz - she has NO INTEREST in learning about the single subject she professes to be an expert in.
Thus, she makes the types of errors that I, as a business econ major who doesn't use that major professionally, catch with the greatest of ease. She also
1) gets into punching bouts out of her league - with Quiggin and yourself, lately.
2) lies about relatively minor stuff (like having "decidedly proleteriat roots") when it suits her argument
3) assumes "facts not in evidence" without doing any empirical research (or even opening a book)
4) reduces complex arguments to simple ones (good) that entirely miss the essence of the argument (bad)
5) uses truthiness more than Stephen Colbert
She gets away with this alot because, once again, she's a very good writer. But being good with words doesn't make one informative. It makes one dangerous, perhaps - but not informative.
Erza, you should really stop posting to her. You're trying to be a health care guru, so what use is it getting into a debate with her about health care? You'll either go easy on her and make yourself look stupid, or you'll knock her out and look like you're attacking straw arguments.
Posted by: Justin | Aug 28, 2007 12:37:39 AM
So now she's a liar too. Justin, I doubt you'll get too far trying to persuade Ezra that Megan isn't the person he knows, nor that people who don't have degrees in economics shouldn't write about it.
Posted by: Sanpete | Aug 28, 2007 1:09:10 AM
Another vote in the 'hold it against you' crowd, and from my perspective -- with a vengeance. To me, your paying attention to the McArdles of the world is by far your worst quality.
An object lesson:
Growing up, I was blessed to live where I could pick up a good free weekly (the then-worthy East Bay Express), which was saddled with a deeply unworthy music writer, Gina Arnold. Ms. Arnold was, however, really good at one thing: being so @#$%! bad that she riled up any thinking, music-loving human being who happened to pick up the Express.
She generated A Lot of Letters to the Editor. All negative. Mostly unprintable. But for a free weekly, indeed for any media outlet no matter how grey and self-serious, attention is oxygen. The only cure for Gina Arnold was to ignore her. Eventually, the East Bay did, and she, predictably, moved on.
We are not talking about a real public figure here. To pay attention to a McArdle is to be, in your small way, responsible for her writing. Her every idiotic, capital-fellating note comes from your trumpet, bucko.
So, yeah, for so long as she and her fellow travellers hold sway at a magazine I had to give grudging respect in my irrationally radical high-school years ('84-'88, cheese), I shall hold your attention to her against you.
Please, don't rubberneck. The rest of us have places to go.
Posted by: wcw | Aug 28, 2007 1:50:50 AM
So now she's a liar too. Justin, I doubt you'll get too far trying to persuade Ezra that Megan isn't the person he knows, nor that people who don't have degrees in economics shouldn't write about it.
Did she or did she not lie about having "proletarian roots"?
Posted by: WB Reeves | Aug 28, 2007 2:25:53 AM
She didn't, but as if to illustrate the point I've been making, Justin isn't willing to accept any meaning of her claim but his own, making her a liar in his eyes.
Posted by: Sanpete | Aug 28, 2007 3:05:39 AM
She didn't, but as if to illustrate the point I've been making, Justin isn't willing to accept any meaning of her claim but his own, making her a liar in his eyes.
I'm afraid this doesn't constitute evidence of anything but your own opinion. What's at issue is whether she made a false statement. That's not a matter of opinion, it's a matter of fact.
Posted by: WB Reeves | Aug 28, 2007 3:23:55 AM
You can figure it out for yourself the same way I did.
Posted by: Sanpete | Aug 28, 2007 3:29:10 AM
You can figure it out for yourself the same way I did.
Unlikely. Your approach is uniquely your own.
Posted by: WB Reeves | Aug 28, 2007 3:51:03 AM
"So now she's a liar too. Justin, I doubt you'll get too far trying to persuade Ezra that Megan isn't the person he knows, nor that people who don't have degrees in economics shouldn't write about it.
Posted by: Sanpete"
So...uh...anyone Ezra knows couldn't possibly lie?
I get it.
Oh and cheers to wcw for the Gina Arnold slap. I worked in the music industry in SF , for ten years and there was no more annoying, skanky loser in a job category dominated by, well, losers, than Arnold. She was a groupie with a column, at best.
Posted by: ice weasel | Aug 28, 2007 7:35:09 AM
You know, I plead guilty to being too lazy to try to track down her biography myself, but this should not be a complicated question. Did Megan McArdle say that she has "proletarian roots"*? Does she? Should reasonably expected to know the meaning of the word "proletarian" and the word "roots"? If the answer to those questions are "yes," "no" and "yes," then she was lying**, even if she's a really nice and honest-seeming person otherwise, or so crazy or careless about the truth that she was not lying but the difference is little more than nitpicking. Otherwise, she is/was not lying about that. Interjecting facts into this would be much more productive than assertions or insinuations about each other, which in this particular discussion, both Sanpete and WB are guilty of.
Wow, being a high Broderite is fun!
* While not playing some character, while sober, without immediately correcting it as a slip of the tongue, etc. Work with me, here.
** Whether having lied is the same as being a liar is another set of problems entirely. I would not necessarily say so, but I note that Justin didn't either.
Posted by: Cyrus | Aug 28, 2007 8:59:04 AM
okay, since this has gotten to be about Megan's penchant for mistruths rather than her more serious problems, I'll throw in my two cents and elaborate.
Megan wasn't asked "do you have proloteriat roots?" and gave an honest-but-wrong answer. She is a gifted writer who concsciously chose her words. She could have chosen more accurate words, but realize what she was making the point for. She was trying to defend against a particular attack - that she's indifferent about the working class. Saying that she has extended family in upstate NY who, though having the same pure blood as her, aren't rich, would have engendered no sympathy, and would have been a useless rejoinder.
There's no way, as sanpete says, that she could have used the words "decidedly proleteriat roots" as intended to give the impression that she has Mayflower roots, but if you go back a couple generations on one of the offshoot branches, you'll find MIDDLE CLASS circa 1900. Nor is there any way that she intended to give the impression that she (like everyone else on earth) (hey, we all have decidedly proloteriat roots!) has a few members of her extended family that live in non-urban, non-wealthy areas.
The problem is Meg could have made any number of honeset rejoinders, that are more honest about the fact that she doesn't have the type of established connections to the working or nonworking poor that her commenters had. But instead, she tried, at best, to tell a half-truth, an intentionally deceptive statement that she could defend if needed.
And if you're the Atlantic, that's dangerous. You don't want your writers shooting for plausible deniability.
Posted by: Justin | Aug 28, 2007 10:38:52 AM
So...uh...anyone Ezra knows couldn't possibly lie?
Eh? He knows her; Justin doesn't. As I said, Justin's not going to convince him she's what she isn't.
Cyrus, I haven't made any insinuations. I gave my assessment of Justin's accusation, based on what was actually said. You can read the relevant discussion here.
Justin, as is so often true of people who lightly accuse others of dishonesty, you're distorting the truth. (It's interesting how that works.) Megan was asked if she had ever known any old, working class people. She said yes, that she had decidedly proletarian roots. Under cross-examination from you she explained that both her parents were the first in their families to go to college, and that much of her family and neighborhood is still working class. That should have been good enough, but you're trying to take it badly. "Roots" are generally understood to go back more than one generation, but the Mayflower really has nothing to do with what she said.
Posted by: Sanpete | Aug 28, 2007 12:29:28 PM
The extent to which people rail against McArdle is generally inversely proportional to the extent to which they've bothered to read carefully what they're railing about.
I don't want to read her work, but I would like to know if it's serious or not. Is there a wiki I can read that will tell me?
Posted by: Exile on Ericsson St. | Aug 28, 2007 12:48:05 PM
Sanpete,
I know you aren't seriously interested in engagement rather than defending Meg and attacking me for the temerity of pointing something out, but she chose her words carefully - and those words were, at best, designed to promote a belief in something other than the truth.
Posted by: Justin | Aug 28, 2007 1:32:07 PM
Justin, you need to learn how to disagree with people without assuming they have improper motives, are being dishonest, etc. I already pointed out how what Megan said was perfectly accurate. You can try to explain why that isn't so, but attacking my motives won't accomplish anything.
Exile, the idea that people you dismiss can be serious scholars doing serious work seems to disturb you. Why? (Blogging is of course a different kind of enterprise, with different standards.)
Posted by: Sanpete | Aug 28, 2007 2:03:06 PM
Exile, the idea that people you dismiss can be serious scholars doing serious work seems to disturb you. Why?
I'm not disturbed at all. I just need to see Wiki confirmation before I can conclude someone is serious. Not correct, mind you. Just serious. I realize that reality has nothing to do with seriousness, that indeed the two are often at cross purposes.
Posted by: Exile on Ericsson St. | Aug 28, 2007 2:18:46 PM
"....are dangerous to reform..."
Which is to say :
1) Pose a hazard to gettting things properly fixed?
2) The fixing of which is hazardous to the fixer?
(or the endeavour)?
Which & wither?
Posted by: has_te | Aug 28, 2007 2:19:46 PM
Interjecting facts into this would be much more productive than assertions or insinuations about each other, which in this particular discussion, both Sanpete and WB are guilty of.
A fair point Cyrus, given my last crack.
Posted by: WB Reeves | Aug 28, 2007 2:20:53 PM
I realize that reality has nothing to do with seriousness, that indeed the two are often at cross purposes.
Well, Exile, you're illustrating that lack of seriousness and lack of reality go together just fine, in any case. I still wonder why the point you keep bringing up bothers you so much. But dealing with that would require both seriousness and reality.
Posted by: Sanpete | Aug 28, 2007 2:40:49 PM
I don't think she's a liar, and I do think a lot of people - sometimes deliberately - misread what she writes.
On the other hand, her writing is bad, and she doesn't seem willing to do the work of making the arguments that seem to be the point of her posts. I say her writing is bad because it is so often misread and her posts can usually be boiled down to a much clearer sentence or two. She wants to dismiss people who think that we as a society should take care of people simply because they're sick, but in the end her only argument in support of that is that she doesn't think we should. If she tried a little harder, she could make that argument less verbose and more persuasive.
Posted by: Aaron | Aug 28, 2007 3:05:55 PM
She wants to dismiss people who think that we as a society should take care of people simply because they're sick, but in the end her only argument in support of that is that she doesn't think we should.
I agree that her arguments aren't as well expressed as they could be, partly for reasons having to do with the nature of blogging, I think. But she has gone well beyond the idea that she doesn't think we should; she's explained why particular moral arguments for helping the old and sick through Medicare-style single-payer don't suffice, e.g. because some old and sick people don't need that help, etc.
Posted by: Sanpete | Aug 28, 2007 3:24:22 PM
she's explained why particular moral arguments for helping the old and sick through Medicare-style single-payer don't suffice, e.g. because some old and sick people don't need that help, etc.
Except that a general obligation to help others can't be refuted by the fact that some people don't require help.
Posted by: WB Reeves | Aug 28, 2007 3:37:43 PM
Those are efficiency arguments, though, not the broad moral argument she says she wants to pin down.
It just doesn't seem that complicated. There are different points of view on the ethics of UHC. If you take a deontological-ethics point of view, the fact that someone in our society needs health care makes them deserving of health care. On the other hand, if you're basically utilitarian, you're going to say that just because you happen to be sick doesn't mean I should help foot the bill for treatment unless it's somehow to my benefit.
If you can find some common ground those points of view share, I'm interested in hearing it, but McArdle clearly is a utilitarian on this, and she's not likely to convince anyone who's not already a utilitarian that she's right.
That's without getting into the fact that we all pay for health care, one way or another. If you can't afford it, and get sick, eventually you'll probably wind up in the ER, and we pay for it. And while you're sick and not getting health care, you're likely getting other people sick, too, because that's the way a lot of disease works. It's mainly a question of whether you want the costs up front or hidden, and which one is more cost-effective.
Posted by: Aaron | Aug 28, 2007 3:50:53 PM
Sanpete, I'm not *assuming* dishonesty. In fact, I very specifically pointed out the inconsistency and gave her a chance to respond.
But, look, if you're ever a criminal lawyer, and you act in an ambiguous way, and your explanation for your action is unreasonable, every court, state or federal, in the United States, is going to allow a "consciousness of guilt" inference. And given her response, that her reference to her "decidedly proloteriet roots" (which was coupled with a haughty "admission" that her roots go back to the Mayflower, is that:
1) part of her roots are Irish middle class
2) she has some unstated family who lives in Western New York (she makes no claim as to how related or how well off that family is)
Now, she defends her argument on two assumptions related to the facts, neither of which are reasonable
1 - that "Irish middle class" is the reasonable way to interpret the term "proloteriat"
2 - that people talk about proloteriat as an identity in the same way they talk about cultural heritage as an identitiy.
The second is clearly untrue - otherwise everyone would have decidedly proloteriat roots. Why does Megan even need, under her second definition, to rely on the Irish side of her family? The English side came off on the Mayflower, and we all know they were poor when they got her.
In any event, context kills her point. If she's talking about personal experience with the working poor, how would her great grandparents fit into this at all? The dictionary.com definition of roots is pretty clear:
roots, a. a person's original or true home, environment, and culture: He's lived in New York for twenty years, but his roots are in France.
b. the personal relationships, affinity for a locale, habits, and the like, that make a country, region, city, or town one's true home: He lived in Tulsa for a few years, but never established any roots there.
c. personal identification with a culture, religion, etc., seen as promoting the development of the character or the stability of society as a whole.
So someone with Irish culture has "irish roots" because they *personally identify* with that culture. But Meg doesn't even claim to personally identify with their proloterienism in any meaningful way: she's just trying, in weak defense, to make the word mean "ancestry" and get her sentence to be technically true.
The first is also untrue - particularly in context. Megan didn't randomly put those two words together, she used them in context to defend herself against charges that she was unsympathetic to the working poor. In that sense, proleteriat means more than "not aristocratic or rich." It means, once again going to dictionary.com:
. the class of wage earners, esp. those who earn their living by manual labor or who are dependent for support on daily or casual employment; the working class.
2. (in Marxist theory) the class of workers, esp. industrial wage earners, who do not possess capital or property and must sell their labor to survive.
3. the lowest or poorest class of people, possessing no property, esp. in ancient Rome.
Being middle class and from Boston, by itself, does not make her ancestors proloteriat - it just makes them middle class. Now, by middle class she may have meant poor, as almost all immigrants were. But that's the problem - if her definition of "decidedly proloteriet roots" is "someone up the ladder came to America poor," well, the vast majority of all immigrants came to the US as poor, and guess what, every native-born American is descended from at least one immigrant and most likely many.
so your defense of her makes no sense. While it is indeed true one could think of a benign reason for erroneously claiming to have decidedly proloteriet roots, none of them seem to make any sense in the context of Megan McCardle, who is an english major from Pennsylvania, who in both the past and today writes for a living, and who directly and expressly chose to string those particular two words to convey an argument that turned out to be quite false.
Not that material, but that was my original point - she's willing to make stuff up even on minor points.
Posted by: Justin | Aug 28, 2007 4:01:39 PM
WBR, she assumes we have the obligation to help those in need. She's pointing out that it doesn't follow that we have the obligation to help those not in need.
Aaron, I don't see how they're efficiency arguments. They're arguments about to whom we owe aid, and why.
If you take a deontological-ethics point of view, the fact that someone in our society needs health care makes them deserving of health care.
That doesn't follow, but she assumes, in any case, that we do have the obligation to help those in need.
On the other hand, if you're basically utilitarian, you're going to say that just because you happen to be sick doesn't mean I should help foot the bill for treatment unless it's somehow to my benefit.
That's not a utilitarian view but an egoist one, which she explicitly excludes. There are plenty of utilitarian arguments for UHC.
a haughty "admission" that her roots go back to the Mayflower
Huh? Justin, there was nothing haughty about it. She only pointed out the irrelevance of it, using her own relatives as the example.
In summing up her response in two points, you leave out the most salient point, that both her parents were the first in their families to attend college. Sounds like a proletarian background to me.
Now, she defends her argument on two assumptions related to the facts, neither of which are reasonable
1 - that "Irish middle class" is the reasonable way to interpret the term "proloteriat"
2 - that people talk about proloteriat [roots] as an identity in the same way they talk about cultural heritage as an identitiy.
Irish middle class is proletarian enough. Since none of her ancestors before her parents went to college, I think we can infer that they were either working class or wealthy enough to not need to work and uninterested enough not to attend college. She's pretty well implied the latter isn't the case.
I added the word you left out in the second point so that it makes sense, though I question your addition of "identity." I have English roots, but I don't identify as English.
There is no problem with the use of "roots" to mean "ancestry," which is among the most common meanings these days. She was referring to roots recent enough to be known to her, and I think what she describes fits just fine, both as to her family roots and her neighborhood. Nothing she said was false. She didn't make anything up. You're trying way to hard to make it so.
Posted by: Sanpete | Aug 28, 2007 4:42:26 PM
sanpete, it must be just fantastic to live in your world.
This is mindnumbingly annoying to try to talk to a brick wall, and you've managed to convince nobody.
Posted by: Justin | Aug 28, 2007 6:18:06 PM
Justin, I had no expectation of convincing you. You had already made it clear that you're committed to seeing this as a lie, facts be damned. What Megan said was perfectly factual, as shown.
Posted by: Sanpete | Aug 28, 2007 7:04:33 PM
I don't believe I'm explaining this, but I come from a family of poor dirt farmers in upstate New York. Some of them, like my mother, went to college and left town; some went to college and stayed; some didn't go to college, and are employed at not particularly remunerative wage labour. The question I was responding to was "did I know any working class old people" and the answer is "yes, all of my elderly relatives", who were either working class wage slaves, or farmers, which doesn't seem to have paid quite as well as being a working class wage slave. If you think that the Mayflower is a ticket to affluence and ease, feel free to email if you're going to be in Western New York; I'll be happy to take you upstate and introduce you to such luminaries as the Mayflower-descended service station attendant, the Mayflower-descended home-health-care aide, the Mayflower-descended physical therapy assistant, and the Mayflower-descended school custodian, all of them close relatives--i.e. aunts, uncles, or close cousins.
Obviously *my* life has not been nearly that hard, and I never tried to pretend it was. I was simply responding that yes, in fact, I am fairly intimately associated with working class people. Which in itself sounds incredibly patronizing of people who I love and respect, but I don't know how else to say it.
I mean, we can get all technical and say "The Kulaks are not good proletarians!!!" but I thought that I left that sort of thing behind when I declined to join the college Marxist reading group.
Posted by: Megan McArdle | Aug 28, 2007 7:29:30 PM
Sanpete:
They're efficiency arguments, because the moral question is "Do we owe it to sick people to take care of them"? Whether there are some people who, because we lack the resources to give everyone health care, or because they already have it and therefore don't need the help, are questions about the implementation of some UHC plan. That's an efficiency question, not a moral one.
If you, or Megan, think that we actually don't have a responsibility to take care of sick people simply because they're sick, then you (or she) need to come up with some other reason to explain why we should be taking care of some sick people - which, as far as I understand it, has been the point of her posts on the issue.
She explicitly does not accept that we have a duty to take care of sick people; that's why she wants some additional reason why some sick people would be deserving of care. She says she doesn't want to hear people saying "But ... THEY'RE SICK!!!" in response to her arguments.
And what you describe as an egoist view is also utilitarian. It is highly self-interested, to be sure. But McArdle's points (again, as far as I can make them out) are that there is, first, no fundamental moral duty to take care of sick people, and second, that therefore the people who make up society have to ask what's in it for them when they decide whether or not to provide care to the sick. Her argument against the transfer of money from the young and healthy to the old and sick is precisely this kind of utilitarian cost-benefit analysis.
It's certainly true that, depending on your point of view, you can make utilitarian arguments for UHC. She hasn't made them, though, and the arguments she has made seem to go against the claim that, regardless of the moral content of the actions, society as a whole is better off if everyone has access to medical care.
Posted by: Aaron | Aug 29, 2007 10:11:18 AM
They're efficiency arguments, because the moral question is "Do we owe it to sick people to take care of them"?
That isn't the only relevant moral question. There are many other moral arguments made, based on Rawls, or fairness. If you go to her blog and read the arguments, you'll see what's at issue.
Again, Megan assumes that we have an obligation to help those in need. Again, being old and sick obviously doesn't imply neediness.
And what you describe as an egoist view is also utilitarian.
No, utilitarianism holds that everyone's happiness and pain counts the same as your own and is directly opposed to egoism on that point.
Her argument against the transfer of money from the young and healthy to the old and sick is precisely this kind of utilitarian cost-benefit analysis.
It's a fairness argument. You may want to read her arguments at her blog.
She'll get to the efficiency arguments, which correspond more or less with utilitarian ones, after she's settled the fairness ones.
Posted by: Sanpete | Aug 29, 2007 1:18:01 PM
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Posted by: judy | Oct 11, 2007 6:56:51 AM
