« Of Distances and Passings | Main | Read It And Weep »

July 16, 2009

Comments

I don't like this kind of argument because it presumes that people react the same way to 18,000 deaths per year by terrorist attack as they are currently reacting to the 18,000 deaths from lack of insurance (or 50,000 motor vehicle deaths).

I think it rather asks why they don't react the same way.

Well, actually, my point is that they don't react the same way. But I question the logic of the disparate reactions.

36,000 people die from influenza in the US every year. So if you took the $1 trillion and spent it on free immunisation for all Americans, and research on improved anti-influenza drugs, you'd save twice as many lives as spending it on government health insurance.

i can't see why advocates of health care reform and universal coverage should disagree with that, gareth.

if you want to argue that we should be willing to spend a trillion dollars on saving lives by improving health-care, esp. preventive health-care, then i am happy to agree with you.

now the question is simply a technical one:
is the money spent most effectively by putting into the development of a flu virus, or would we save even more lives by putting *some* money towards a flue virus, *some* money towards obesity-prevention, and so on?

i suspect that if you look at the question in these terms, i.e. what's our best value in life-saving per dollar, then you will see that universal coverage, with spending targeted at many different diseases and conditions, will be better than pouring the whole sum into a flu vaccine (esp. because there really is no vaccine on the horizon, even for a trillion dollars, that would prevent all 36,000 deaths or any large fraction of them).

but, hey, if that really is the best way to improve our nation's health for a trillion bucks, then i don't see why i should resist it.

Well, actually, my point is that they don't react the same way. But I question the logic of the disparate reactions.

People aren't likely to be killed by lack of health insurance on their way to work?

People aren't likely to be killed by a terrorist on their way to work, either. They're more likely to be killed by driving.

But humans are LOUSY and judging statistically uncommon events.

People aren't likely to be killed by lack of health insurance on their way to work?

Perhaps, a heart attack for untreated coronary condition?

re the original post: Apples to Oranges it seems to me.

In the first place no president stood up and said I will spend a trillion dollars and kill hundreds of thousands of people. So to suggest that the public bought that price for the war on terror and doesn't buy this price for healthcare is a false comparison.

In the second place, the public realizes that everything costs more than promised and works less well than promised. So, if the promise is 18,000 for $1 trillion than you can bet it is really 1,800 for $10 trillion.

In the third place, if spending $1 trillion on the war on terror has contributed to putting the country's finances in bad shape then it follows that spending another $1 trillion on this other program isn't going to be good for the country's finances either.

I won't argue the major point here -- a trillion dollars is certainly worth it, and the case against it is pretty dishonest.

But it's still worth looking at what lies they tell to understand why somebody may think it a different case -- according to conservative TPs, government control of health care leads to government control of people's lives in the most intimate of ways.* This leads to Americans having less control of their lives and fates.**

In this analysis, Obama's health care reform is as frightening -- if not more so -- than a 9/11 level terrorist attack.

*In a way that HMOs, somehow don't.

**Again, in a way being without health insurance somehow doesn't.

'Now what if 18,000 Americans were killed every year in a terrorist attack and the President made the same appeal? Would any "serious" pundits object to such a military campaign (or two)? Not a chance.

And yet when the President proposes spending $1 trillion to save the lives of tens of thousands of uninsured Americans, the proposal is decried as socialistic, an example of reckless spending, a deficit-busting giveaway to the undeserving delivered via a soak-the-rich form of class warfare (because to fund it, effective tax rates would be raised to the levels that prevailed during the Communist 90's).'

And do you, Eric, spend any of your time in an effort to understand why this is so? I guess this is what Obama calls 'empathy'. I view this in exactly the way you described, I liked and supported Reagan when he was president, but that support did not come about because I was somehow convinced of something by Reagan-era conservatism. Many who view this as I do simply see it through a lens filtered by their particular convictions of the role of government (particularly federal) vis-a-vis a person's right to individual liberty. Taxation is a way to decrease an individual's liberty since it replaces individual choice with group choice. I see government's role in protecting my liberty from the violent actions of others (the role of law enforcement or national defense) as distinctly different from government's role in protecting me from the more passive events and results of injuries and illness. The former I have little control over as an individual but the latter i feel as if I do. Let's not get into whether this is completely true and rational, it still informs my politics. I would count myself as one of those who, even though I know we can do better in our health care outcomes, I'm not ready to abandon what we have for something to me that is a total unknown.

If those of us who are like me are that way because we were convinced by Reagan-era conservatism, is it fair to say that those who see things as you do are that way because of Alinsky's rules for radical groups?

Let's not get into whether this is completely true and rational, it still informs my politics.

Is this what poker players call a 'tell'?

Popping in, looks like a number of posts reflect what I was saying sarcastically. Which makes my case, I guess...

"Let's not get into whether this is completely true and rational, it still informs my politics."

Are you honestly asking people to put aside the question of whether a given political opinion is logical?

Well, Point, I've never been without health insurance and I've never belonged to an HMO in my adult life. I'd venture to say we pretty much didn't know what such things were when I was a child. I also have never been homeless, starving, publicly naked, or unemployed. This probably has something to do with my sense of self-reliance. Again, I'm not required to be completely rational at all times.

you'd be surprised.

being publicly naked can do a lot for your sense of self-reliance.

provided that you can support yourself, of course.

I would count myself as one of those who, even though I know we can do better in our health care outcomes, I'm not ready to abandon what we have . . . I've never been without health insurance . . . I also have never been homeless, starving, publicly naked, or unemployed.

The call of the Great American I've-Got-Mine-You-Get-Yours, Loser conservative. If people are suffering or doing without, it's because they're just not doggone self-reliant enough.

Everything GoodOleBoy has ever done, of course, occurred in a complete vacuum, without a family, a social network, a culture, a support system, a society, or anything else. No sir, he done it all himself. Completely self-reliant.

"Well, Point, I've never been without health insurance and I've never belonged to an HMO in my adult life. I'd venture to say we pretty much didn't know what such things were when I was a child."

Such things probably didn't exist when you were a child.

Your sense of self-reliance makes it difficult to impossible for you to see the issue in any terms other than depriving you of your own, personal individual liberty.

Noted. We'll put you down as agin it.

The number of people who can afford to purchase a useful level of health insurance out of pocket is vanishingly small. The rest of the population is going to do what it needs to do to make sure their families can go to the freaking doctor without taking out a second mortgage on the house. Assuming they still have a house.

If that bugs you, you'll have to suck it up.

There was a guy without health insurance falling out of the inferno of the World Trade Center who was calling a doctor on the way down on his cellphone and the person on the other end asked him for his health insurance policy number.

He was denied service but luckily, for the sake of outrage, he was killed in the terrorist attack, to the outrage of all and the relief of some.

His unfortunate inclusion in the death toll of that attack was outrageous. His lack of health insurance was a personal, individual oversight and therefore made him expendable.

"In the second place, the public knows that everything costs more than promised, and works less well than promised...." he stuttered.

Those who speak for the "public" know even less than the public, who know very little to begin with, except for what they hear from loudmouths in talk media.

The public inhales cleaner air than they used to thanks to various kept promises but they still exhale the noxious wordfumes of ignorance.

On the other hand, that's not very cost effective, so you may have a point.

Some people argue that the Great Depression didn't end until we went to war. The implication being that only war could have done it. But, what is war but a use of governmental resources?

There should be a way to do that for positive ends without killing so many people.

Phil: "Everything GoodOleBoy has ever done, of course, occurred in a complete vacuum, without a family, a social network, a culture, a support system, a society, or anything else. No sir, he done it all himself. Completely self-reliant."

That's not what he said.

Russell: "Your sense of self-reliance makes it difficult to impossible for you to see the issue ..."

You both speak as if a degree of self-reliance is a bad thing.

Who puts your pants on for you in the morning?

Some personal observations.

I was having a conversation with someone of approximately my own age (52) recently. We both agreed that we had been extraordinarily fortunate to have grown up in, and seen, the best days of America. We also both agreed that we were not likely to see them again.

An example: I paid about $900 a year for full time tuition at an amazingly excellent state university from 1978 - 1981. If you lived on campus, it cost about twice that. I took a "physics for dummies" class that was taught by a Nobel laureate. I studied music under people who had international reputations. If you went all four years and lived on campus, that education would have cost you about $10K. Not $10K a year, $10K in total.

Lather, rinse, and repeat for public schools, libraries, highways and other public works, etc etc etc.

The folks of my parents' age -- the people who had grown up in the Depression, lived through WWII, and who constituted the great middle class of the postwar years -- were happy to be taxed at rates that would, nowadays, give even a liberal the vapors.

All so that they could invest in their own communities and nation, and make useful, helpful things available to everyone without regard to economic status.

It wasn't, by any stretch of the imagination, paradise. But the idea that your tax dollars might end up helping out somebody other than yourself was just not seen as a rude affront to your personal dignity and liberty.

It was just what folks did, because it was helpful, and it's good for everyone to pitch in and be helpful when it's needed.

It was a really amazing time. Anyone could go to college, anyone with a halfway decent job could buy a house and take their family on a nice vacation.

If you were black, or gay, or an unmarried woman, or even a married woman, not so great a lot of the time. That's definitely better.

But in terms of basic willingness to put your own, personal money on the line to make other people's lives better, it was head and shoulders over today.

The economy of this nation has been hollowed out. The government of the US is captive to greedy mofos who would see you die on the street like a dog before they'll surrender an ounce of their own privilege.

But god forbid we surrender an ounce of our precious personal liberty to anything resembling a common effort. That would suck.

We lost World War II because the government just can't do anything right and bring it in under cost.

Milton Berle made a living not wearing pants and was completely self-reliant.

Personally, when putting them on, I jump into my pants both legs at a time all by myself with no hands.

It's when I'm removing my pants that I welcome a helpful hand because it's just no fun being alone at that special moment.

Who puts your pants on for you in the morning?

Your mom.

Costs should be put in terms of life years gained, not lives saved. Everyone dies, and medical care only buys time, not saves lives. By whatever metric you use, however, $55 million per life saved is far in excess of what would be cost effective for any medical therapy or regulatory agency.

The Iraq war was a waste of money; by your metric, so is universal health insurance.

russell,

I would choose that my contribution to common effort come from me freely and not through coercion. Many outcomes favored by commentators here I also favor, but we frequently disagree on means and sometimes on extent. I'm not sure what you mean in your reference to privilege. Maybe we should figure out how the economy got hollowed out and see if we can fix that. I agree with your sense that a few decades back we seemed to be able to get a better result in terms of reasonable costs for ordinary services and opportunities for most. Something insidious is indeed going on and it obviously has affected education and health care. I suspect this hidden evil villain prospers inside our corporations and halls of government (maybe equally). I would really rather do a fix than to just move the prime responsibility for continuing the problem from one villainous participant to another.

I second what russell said, and I'm female.

Beside the inexpensive tuition, and reasonable dorm fees, there was also an on-campus health center that took good care of sick and injured students. I think we paid, like, $15 a quarter to fund that.

There were also walk-in, free mental health clinics. I went to one for a couple years in high school. It was totally confidential, too.

I look back on the country as it was pre-Reagan, when there was still a sense of a common good, and the future was something worth paying taxes to invest in, and wonder sometimes if I dreamed it all.

The predator state we've constructed is not a model for leadership, or even long-term viability. I feel very bad for people who have kids.

"You both speak as if a degree of self-reliance is a bad thing."

Not in the least.

"Who puts your pants on for you in the morning?"

Who removes your appendix when it's inflamed?

"I would choose that my contribution to common effort come from me freely and not through coercion."

I don't disagree on principle, I just don't think that what can be done through personal, private contributions is going to get the job done in the case of health care.

"Maybe we should figure out how the economy got hollowed out and see if we can fix that. I agree with your sense that a few decades back we seemed to be able to get a better result in terms of reasonable costs for ordinary services and opportunities for most. Something insidious is indeed going on and it obviously has affected education and health care. I suspect this hidden evil villain prospers inside our corporations and halls of government (maybe equally)."

I have no argument with any of this.

Thanks -

"In the first place no president stood up and said I will spend a trillion dollars and kill hundreds of thousands of people."

Franklin Roosevelt effectively did. He didn't use those exact words, of course, but they were implicit in his date which will live in infamy speech.

He said:

[...] As Commander-in-Chief of the Army and Navy I have directed that all measures be taken for our defense, that always will our whole nation remember the character of the onslaught against us.

No matter how long it may take us to overcome this premeditated invasion, the American people, in their righteous might, will win through to absolute victory.

I believe that I interpret the will of the Congress and of the people when I assert that we will not only defend ourselves to the uttermost but will make it very certain that this form of treachery shall never again endanger us.

It was predictable that the cost would go over one trillion dollars, and would entail killing millions of people. I don't think anyone with any sense thought otherwise at the time.

Actual cost to the U.S.:

[...]That four-year war - in which 16 million U.S. troops were deployed on two fronts, fighting against Germany and Japan - cost about $5 trillion in inflation-adjusted dollars.
Interestingly, from earlier in that article:
[...] The United States has poured more than $500 billion into Iraq, mostly for military operations. But that figure is just a small piece of the much larger bill that taxpayers will pay in the future.

Because the money for the war is being borrowed, interest payments could add another $615 billion. A heavily depleted military will have to be rebuilt at a cost of $280 billion. Disability benefits and health care for Iraq war veterans, many of them severely injured, could add another half-trillion dollars over their lifetime.

Nobel laureate economist Joseph Stiglitz and Harvard University public finance Professor Laura Bilmes, both of whom served in the Clinton administration, have included those calculations in a new study of the war's long-term costs. Their estimate of the war's price tag: $3 trillion.

"We are a rich country, and we can, in some sense, afford it. It's not going to bankrupt us," said Stiglitz, a Columbia University professor, who published the findings in a new book, "The Three Trillion Dollar War."

But Stiglitz said the war has contributed to a weakening economy - partly by feeding the instability that has sent oil prices to record highs - and has saddled the country with debts that will make it harder to respond to a recession, fix Social Security or meet other future needs.

"The best way to think about it is: What could we have done with $3 trillion?" he said. "What is the best way to spend the money, either for security or for our national needs in the long run? The stronger the American economy, the more prepared we are to meet any threat. If we weaken the American economy, we are less prepared."

Another estimate:
[...] Monetarily, in 1940 dollars, the estimated cost was $288 Billion. In 2007 dollars this would amount to approximately $5 Trillion.
" So to suggest that the public bought that price for the war on terror and doesn't buy this price for healthcare is a false comparison."

Oh, you're quite right, there: the Bush Administration lied like mad about what the war would cost. Do I really need to provide cites on that?

"In the third place, if spending $1 trillion on the war on terror has contributed to putting the country's finances in bad shape then it follows that spending another $1 trillion on this other program isn't going to be good for the country's finances either."

I'm not following this logic. It seems to run identically to this: if I have no medical insurance, but I have cancer, and I have total liquid assets of $10,000, and I pay that $10K towards curing my cancer, I will be no better off than if I spend the $10K buying popcorn.

I'd tend to think that what one spends money on, and what one gets back from it, actually might be relevant here. What do you think?

That's not what he said.

When one contrasts "self-reliance" with "being homeless, uninsured, starving or unemployed," it's certainly what one is attempting to imply. It's just another spin on the Reagan-era "welfare queens" baloney.

"Maybe we should figure out how the economy got hollowed out and see if we can fix that. I agree with your sense that a few decades back we seemed to be able to get a better result in terms of reasonable costs for ordinary services and opportunities for most. Something insidious is indeed going on and it obviously has affected education and health care. I suspect this hidden evil villain prospers inside our corporations and halls of government (maybe equally)."

At the end of WW2 the US had on of the few industrial bases that was untouched by war. It was essentially the workshop of the world in those early years after the war. This brought great prosperity to the middle class. Over time other countries reestablished their industrial bases and began competing with the United States. First the competition was in low value things. I remember when made in japan meant it was a 2 cent pressed metal toy. Then, over time, they moved up the food chain until they were competing on an equal footing. Japan and Eurpoe emerged in the sixties. The asian tigers (taiwan, singapore, and s korea) emerged in the 70's. and so on for brazil, malaysia, s. africa, and then china and india. All of this undermined the middle class jobs.

It is easy to point at Reagan who came in 1980 and say 'before him things were pretty good'. One is tempted to blame Reagan because he existed at the same time and was instrumental in changing the tax regime.

Taking a long view, I think it is more proper to say that 'the american century, 1900 - 2000' was a result of the temporary decline of europe due to it's world wars and to the decline of china from about 1850 to 1990.

I must say this is a great article i enjoyed reading it keep the good work.

Sigh. How to say this?

Well, Point, I've never been without health insurance and I've never belonged to an HMO in my adult life. I'd venture to say we pretty much didn't know what such things were when I was a child. I also have never been homeless, starving, publicly naked, or unemployed. This probably has something to do with my sense of self-reliance. Again, I'm not required to be completely rational at all times.

Posted by: GoodOleBoy

What you seem to be saying is that this is your opinion, and that nothing anybody can say or do can change it. That is, yes, this is an irrational and rather dim-witted statement. In fact, yet another Palinesque display of pride in ignorance and/or stupidity.

Now, if that's how you want to present yourself, fine. But from over here, it makes you look like someone whose opinion is of no account. Why even bother to post with this sort of attitude? Is it just to stir the pot? That seems rather likely.

"'Now what if 18,000 Americans were killed every year in a terrorist attack and the President made the same appeal? Would any "serious" pundits object to such a military campaign (or two)? Not a chance"

Two points on this:

First, yes but if 18,000 are dying a year in Iraq or Darfur(far more than 18,000) we will get a post at some point on how we should find a way to stop that so we worry about the problem we are most indignant about today?

Second,

The human resources part of the budget has grown from 1 trillion in 1998 to 2.6 trillion in 2010 (before healthcare reform),

The defense budget from 298 billion to 690 billion.

Using some of the 2.6 trillion more effectively might be better than adding another trillion.

I am not sure Reagan has anything to do with my objection.

"The defense budget from 298 billion to 690 billion."

Correct typo, 690 should be 590

All numbers from here: http://www.gpoaccess.gov/usbudget/fy09/pdf/hist.pdf

I would choose that my contribution to common effort come from me freely and not through coercion.

Well, Good Ole Boy, that's something entirely under your control: you get to decide whether you are willing to contribute to the common effort, or if you are unwilling and have to be coerced. You may be unwilling to save 18,000 people a year whom you feel are dying because they lack your "sense of self-reliance", but it would be unfair to make your unwillingness to contribute to the common good everyone else's problem, too. If you feel you have achieved your present state of comfort merely by being an effective, self-reliant kind of person, and could do as well without the infrastructure everyone pays for, you could always move to a small desert island with no infrastructure paid for by anyone else, and I'm sure your sense of self-reliance would achieve a comfortable living all by yourself, with no need to help anyone else.

"One is tempted to blame Reagan because he existed at the same time and was instrumental in changing the tax regime."

"I'm from the government and I'm here to help".

I blame Reagan for that, and he owns and deserves every ounce of that blame.

At the end of WW2 the US had on of the few industrial bases that was untouched by war. It was essentially the workshop of the world in those early years after the war. This brought great prosperity to the middle class. Over time other countries reestablished their industrial bases and began competing with the United States.

Some have argued from that that it was a grave mistake to rebuild the rest of the world (or at least their industry) instead of keeping them permanently dependent on the US. Some still argue that this is a valid justification to start new global wars (and the Iraq war was sold in parts on the promise that rebuilding the country would bring in more in profits than the war would cost).
---
Agreed that it was not all Reagan's fault. And we haven't yet reached the Platonian idea of health care: "More than 3 sick days? Here's your suicide pill. Nobody will force you to take it but it would highly immoral for you not to."

Correct typo, 690 should be 590

No, it should be $711 billion dollars - when you add in Iraq and Afghanistan supplementals.

The human resources part of the budget has grown from 1 trillion in 1998 to 2.6 trillion in 2010 (before healthcare reform)

Human resources? I'm not sure that's the term you're looking for.

In other news, the number of Americans lacking an adequate sense of self-reliance is expected to top 10% this year.

"The human resources part of the budget has grown from 1 trillion in 1998 to 2.6 trillion in 2010 (before healthcare reform)

Human resources? I'm not sure that's the term you're looking for."

It is the budget line item for most of what we are talking about. But it doesn't include "other".

Source cited above.

"Some have argued from that that it was a grave mistake to rebuild the rest of the world (or at least their industry) instead of keeping them permanently dependent on the US."

Who would some of those people be, specifically?

I see Marty, I stand corrected. Thanks.

Gary, if you want actual names, you'll have to wait a bit for me to look them up (Sorry!).
In order not to be misunderstood, I do not claim that this was anyway near an offical government position (unlike the expected profits from the Iraq war). It was clearly fringe even then*.
To get a bit farther into the past: a similar case could be made about the rise of Japan after the forced opening by way of Perry's fleet. Although I can again not give actual names off the cuff I think I read about loudly aired regrets along the lines of "How could we, for mere short-term profit, allow these [insert racist anti-Japanese term] to grow up to become a rival!".

*I am not referring to the Morgenthau plan. That was something completely different.

So the 18000/yr number is basically an extrapolation from a single study covering a single year. it is very telling that one year's data is being tossed around like it's gospel for multiple years following when that is an incredibly unsound assumption.

'estimate of people who died from lack of health insurance' can mean any number of things, including assumptions that peeled away turn out to not involve health insurance at all.

some honesty would be really nice in these discussions of health care reform.

"I am not referring to the Morgenthau plan. That was something completely different."

Yes, that was a very specific idea about Germany, not about "the rest of the world," or even the rest of Europe. Just Germany.

"Gary, if you want actual names, you'll have to wait a bit for me to look them up (Sorry!)."

That would be interesting, but even in general I really don't have much of a clue as to whom you have in mind. Not a big deal, to be sure; you mentioned it, and it didn't ring a particular bell with my memory, and thus it aroused my curiosity.

To be sure, the U.S. being a large country, I'm sure someone somewhere in it at the time must have held such an opinion, and they probably could have even formed at least a bowling league. I'm just curious if you mean anyone of the least significance in any way, or even, I dunno, some faction of America First, or one of those isolationist/semi-fascist organizations that were popular in the Thirties, and which one might easily argue that the John Birch Society and similar organizations of the Fifties were descendents. And we didn't lack for isolationist members of Congress before the war, nor during it; they just had to pretty much stfu during the war.

Frustratingly, the printed sources I could check on the quick are not big in names but give a general view of criticism. Googling (e.g.) "Criticism of Marshall Plan", "dependency" on the other hand yielded such a variety (not to say cacophony) of voices that it will take some time to wade through (and several links led only to front pages of books with the full text not available. Looks like the plan got parts of both the left and right foaming at the mouth that it was all a devious plot to benefit the other side (and there was a mirror image debate in Europe). Interestingly on the European side there seems to have been a widespread suspicion that the very purpose of the plan was to create the dependency on the US.
I'll dig further but now I have to go (local book shop closing in an hour).

Although I will not retract my statement that criticism of the type I mentioned did exist (unless my memory is completely faulty), my google-fu defeats me in obtaining linkable proof.
The claims have therefore to be treated as (at least yet) unproven.

The Marshall Plan seems to have worked (and still does) like a Rohrschach test. The criticism says much more about the critics than about the plan itself.

The comments to this entry are closed.

Blog powered by Typepad