I have a dog named Bingo

by von

Matt Yglesias writes perceptively on why Democratic health care reform is failing, but --  perhaps understandably -- doesn't see his own role: 

A disheartened Ezra Klein looks at a WSJ/NBC poll showing that people have lots of false beliefs about the president’s health care agenda and offers the following chart:

My first thought is “reform opponents are lying like crazy and it’s working.” My second thought is that three out of these four things would actually be a good idea.

.....

.... Obama gets accused of wanting a single-payer system. Then I have to say “no! no! he doesn’t! that’s a slander . . . not there’s anything wrong with single-payer.” It’s a damn dirty lie to say that the government will fund abortion services, but really the government should fund abortion services.

Yglesias concludes, in part:  "I think this double-talk makes it hard to convince people that the process isn’t just being driven by people who secretly do want a government takeover of health insurance."  This is true, but kinda misses Yglesias' own point a few paragraphs above.  In fact, the Democratic Party's health care plans are being driven by people who want a government takeover of health care.  For instance, Yglesias himself. 

Yglesias, and a considerable number of others, hope that the Democrat's reform package will be the first step towards a nationalized health case system.  It's the camel's nose under the tent approach; the so-called "incrementalist approach".  And there's nothing wrong with letting the camel's nose into the tent if you indeed favor letting the entire camel in the tent: The sum of all the increments, after all, is government-run health care.  But the "camel's nose" approach to health care reform makes it pretty much impossible to convince folks who don't much like government-run health care that the Democratic plan won't lead to government-run health care.  For a considerable number of Democratic supporters, the Democratic plan absolutely does include government-run health care .... just not at this moment. 

It's also crazy for Yglesias to blame "lies" for the fact that most voters have reasoned, correctly, that some of the louder folks pushing Democratic health care want "coverage for illegals," a "government  takeover" of health care, and "tax-payer funded abortions,"* and to fear to some or all of these proposals are coming -- if not this year, then soon.  Yglesias himself wants all of those things.  So do a considerable number of (although not all) liberal Democrats.**  Voters aren't stupid:  they see this and think that the current Democratic proposal -- whatever its contents -- is a just ploy to set up a future reform. 

One can go on regarding all the other deficiencies in the Democratic sales job on health care reform -- which are legion, and include the fact that Democratic proposals contain some stupid ideas and Democrats have largely ignored the well-reasoned, bipartisan Wyden-Bennett plan (in part because of union pressure).  And I'm not typically in the job of advising the other side regarding how it can improve its arguments.  Still, a significant (tho' not sole) reason for the Democratic mis-fires is that a lot of smart Democrats*** can't seem to see their own, counterproductive role in the sales job.  Yglesias' post is Exhibit A in that regard.

*I should note that I support coverage for all persons, documented or not, like Yglesias.  Of course, the current Democratic plans do not offer such coverage -- another reason why I oppose them.

**Yglesias writes, with apparent surprise:  "Interestingly, the one thing that doesn’t get a majority is the thing that’s actually a bad idea—killing grandma."  I don't know why Yglesias should be surprised by this.  A majority of voters correctly perceive that proponents of Democratic reform (e.g., Yglesias) don't actually want "death squads," even in their end game of a government-run health care system.   

***E.g., Yglesias, whom I very much enjoy reading.

Comments

[Eric Martin]

In fact, the Democratic Party's health care plans are being driven by people who want a government takeover of health care.

Noooooo!!!!!!

Single payer INSURANCE. Not "health care." Not, not, not, not...etc

Also, not government "take over." Private insurance is still available!!!!

Yglesias, and a considerable number of others, hope that the Democrat's reform package will be the first step towards a nationalized health case system.

Noooooo!!!!!!

Single payer INSURANCE. Not "health care." Not, not, not, not...etc

Also, not government "take over." Private insurance is still available!!!!

The sum of all the increments, after all, is government-run health care.

Noooooo!!!!!!

Single payer INSURANCE. Not "health care." Not, not, not, not...etc

Also, not government "take over." Private insurance is still available!!!!

It's also crazy for Yglesias to blame "lies" for the fact that most voters have reasoned, correctly, that some of the louder folks pushing Democratic health care want "coverage for illegals," a "government takeover" of health care, and "tax-payer funded abortions,"* and to fear to some or all of these proposals are coming -- if not this year, then soon. Yglesias himself wants all of those things.

See above.

This is terrible von. You really need to do better.

[Eric Martin]

I mean, in a post chiding someone for being to blame for the misinformation in the political discourse, you...spread that misinformation!

Jeez.

[Audrey]

I agree that there's a lack of clarity around what a desired "steady state" would be - and how we would get there over what time frame. Without that, opponents have more leeway to conflate the terms "single payer" (nationalized/socialized health insurance) and the (deliberately) ill defined terms "socialized medicine" and "government takeover"

[von]

Eric, re-read the post. I think you missed my point.

[JanglerNPL]

I don't get it. Even if some Democrats want the whole schlemiel...funding for abortions, coverage for illegal immigrants, etc., it still doesn't change the fact that none of these things are in this particular bill. I don't think it takes great cognitive ability to reconcile these two facts: (1) some Democrats support policy x and (2) some Democrats will vote for bill y even though it doesn't deal with policy x. The "camel" metaphor seems odd too...it's not like if this bill is passed and the camel's nose is let in, the other policies will just wander in of their own volition--there would have to be another bill and another vote. If people are confused about this, it seems silly to blame it on Democrats instead of people like Beck and Palin who are actively doing the confusing.

[cleek]

In fact, the Democratic Party's health care plans are being driven by people who want a government takeover of health care. For instance, Yglesias himself.

Yglesias does not drive anything in the US government.

[gwangung]

Eric, re-read the post. I think you missed my point.

Might be helpful to point out the point he missed.

[SomeCallMeTim]

Good post, von. What's funny is that Yglesias is sort of an instinctive neo-lib, so he's going to be fine with any compromises.

[John Miller]

I agreee with Eric and gwangung. You made a declarative statement which is not backed up by any sort of facts. Yglesias' post does not supprt government takeover of health care.

You make many valid points elsewhere, but then throw this in there and do everything but use the word "socialist."

Provide actual Democrats with power that support what you are alleging, please.

[von]

JanglerNPL, first, I'm not excusing the misinformation that's being spread by Democratic opponents.

Second:

The "camel" metaphor seems odd too...it's not like if this bill is passed and the camel's nose is let in, the other policies will just wander in of their own volition--there would have to be another bill and another vote.

And of course that's right. The point, however, is that a non-trivial number of health-care reform proponents see the current proposal as the first step towards something larger: that's why the current plan is described as an "incrementalist approach" -- i.e., the camel's nose approach. (People who support the camel's nose like the phrase "incrementalist approach" because "camel's nose" generally sounds sneaky .... which is kinda is.) You're right it's not certain that the rest of the camel will enter. But a lot of voters will reason that, if I oppose the camel, I have to oppose the nose as well.

It's very similar to a common Democratic response to the Republican's attempt to reform social security. Many Democrats reasoned that Republicans ultimately wanted to destroy social security and, therefore, the current reform efforts should be resisted, whatever their merits.

[anon]

Yglesias's version of "govt takeover" means govt will pay for it, not that the govt will control the doctors/hospitals/etc.

The Republican version of "govt takeover" means the latter.

Two very different things.

[Eric Martin]

Von: help me out. What's your point?

[kid bitzer]

the reason that yglesias is right to refer to lies and is right to decry the false beliefs that the polls reflect is because:

the polls show that a lot of people have false beliefs.

if you actually read the wording of the poll, the people were asked about what is contained in "the proposed health care plan". i.e., the current plan being considered by the obama administration.

they were not asked "what might happen twenty years down the road?" or "what might some of the advocates of the plan like to do if there were no political reality to consider?"

in particular, they were not asked "what does the camel of von's fears look like?"

instead, they were asked to comment on what they thought was contained in the current plan.

and they got it *wrong*. they had a deeply *false* picture.

and that's because of a lot of *lies*.

like eric said, von--you've got to do better than this.

[von]

I agreee with Eric and gwangung. You made a declarative statement which is not backed up by any sort of facts. Yglesias' post does not supprt government takeover of health care.

Did you miss the spot where Yglesias declares "My second thought is that three out of these four things [one of which is government takeover of health care] would actually be a good idea"?

Now, obviously, there are different degrees of government takeover of healthcare, and Yglesias hasn't indicated which degree he wants. But, from the perspective of pushing the health-care bill, that doesn't really matter. What matters is that Yglesias (and others) clearly want greater government control than in the current bill .... which is one of the reasons why he's finding it so difficult to convince opponents that Democrats will stop with this reform effort. He clearly doesn't want them to do so.

(Perhaps you and Eric are getting confused by the fact that I'm making a process rather than a policy criticism, here?)

[Eric Martin]

It's very similar to a common Democratic response to the Republican's attempt to reform social security. Many Democrats reasoned that Republicans ultimately wanted to destroy social security and, therefore, the current reform efforts should be resisted, whatever their merits.

No, the opposite!

The Dems were complaining that the actual bill/legislation being proposed would destroy social security. Not that it wouldn't, but would make people more willing to consider legislation decades later that would destroy social security.

Opposite.

[publius]

Right, the bills not only don't have "takeover" provisions, they bend over backwards to prevent a takeover of any kind.

I went over some of this in my "bad faith" post. There has to be like 100 different low-probability things to happen for this bill to transform into something remotely resembling single-payer.

But I keep hearing this "unions" bit, as if unions are what prevented people from adopting Wyden. What exactly do you think the GOP would say if the Dems came out with a bill that basically ended everyone's employer-based health care? Unions may be part of it, but they are a small part -- one of many.

[argo0]

von, I agree that there are almost certainly some voters who share your belief that incrementalism is at work here, and that is why they oppose the bill. But when 45% of people believe a reform plan will kill grandma and only an additional 10% believe a reform plan will mean coverage for illegal aliens (the response gathering the biggest "yes" response), surely the vast majority of those surveyed are not engaging in the reasoning you suggest (unless incrementalism is actually the reason for concern among the kill-grandma folks, something I don't find likely).

[Sebastian]

Eric. Why do you want single payer so badly? (as opposed to say the government merely paying for insurance for the uninsured or subsidizing it EITC-style)?

Your arguments have seemed to focus on the idea that single payer will allow government to ram cost controls down pharma's throat and force other cost controls down other people's throats. I question that as a good method, but to constantly harp on "It's just insurance" when an enormous part of the goal is to use the government's control of the payment to reshape the system is approaching deceptive.

You want the government to be the single payer for a reason. And it isn't just to cover the uninsured. There are lots of ways to cover the uninsured that don't involve single payer. Furthermore, none of the current Democratic plans cover all of the uninsured (which I find very confusing). And in fact a huge majority of the legislation isn't about the uninsured. This leads to the very reasonable inference that it isn't mostly about the uninsured even though their plight is rightly the focus of the moral argument. It is not at all unreasonable to focus on why you think the government needs the POWER of cutting off most everyone's standard insurance. You want that POWER to do things. It is not unreasonable, nor is it misleading to focus on what you want the government to do with that greatly increased power.

This is doubly true when some of the things you talk about using that power to do strike me as deeply unwise (see especially your repeated suggestion that lots of savings should be squeezed out of the pharmaceutical industry.)

[Eric Martin]

Did you miss the spot where Yglesias declares "My second thought is that three out of these four things [one of which is government takeover of health care] would actually be a good idea"?

Now, obviously, there are different degrees of government takeover of healthcare, and Yglesias hasn't indicated which degree he wants.

But he does! In the same piece! And you quoted him!

"I think this double-talk makes it hard to convince people that the process isn’t just being driven by people who secretly do want a government takeover of health insurance."

What you did was seize on sloppy wording in a Matt Yglesias post (which is a given) and extrapolated way too far. You repeated the canard about government takeover of health care over and over again - even though we're talking about insurance, not health care!!!!

What matters is that Yglesias (and others) clearly want greater government control than in the current bill

Nooooo!!!!

We want greater government participation in providing insurance.

See my original comment.

The confusion stems from the sloppy conflation of health care and health insurance, whether that sloppiness is on the part of Yglesias or you.

Either way = not helpful.

[John Miller]

One of the points is not "government takeover of health care". You are adding the last. Government takeover of paying for healthcare is a totally different thing. Unless you can find somewhere where he is stating the former, you are doing misinformation spreading. And additionally, please find others who are supporting government takeover of health care.

I don't think Eric or I are confused. We both think that the process you are criticizing (or rather what you perceive to be the desired goal of the process) is not accurate.

[JanglerNPL]

Thank you for the response, von. I feel that the reasoning of your hypothetical "lot of voters" is flawed, and that each proposal should be evaluated on its merits rather than its potential successors' merits--Republican plans as well as Democratic ones. I only recently started following this stuff in any detail, so I do not know whether the Social Security debate is analogous, but I'll take your word for it.

[Nate]

von: First, as Eric said.

Second, So. What? Even IF the plans were for a government "takeover of health care", that STILL wouldn't be the lies constantly being screamed about grandmas on ice floes with Hitler and a bureaucrat. The rest of the industrialized world has universal, almost always government run health insurance or health care, and have yet to turn into illegal immigrant run death camps for grandma that cost everyone 50% of their taxes.

What is proposed is an attempt to spread health care and/or insurance to more people, and do it better, which is exactly NOT what Bush's Social Security "reform" would have done, that would have just sucked money out of Social Security and stuck it into Wall Street, without providing any real benefits. So your example there is no good either.

[Eric Martin]

Eric. Why do you want single payer so badly? (as opposed to say the government merely paying for insurance for the uninsured or subsidizing it EITC-style)?

Where did I say I want it so badly? Nowhere, actually, because I don't. Every time you've suggested expanding Medicare to cover the uninsured, I've said I agree. We even joke about us co-sponsoring the bill. I'm OK with several alternatives, but think single payer is the best.

see especially your repeated suggestion that lots of savings should be squeezed out of the pharmaceutical industry

Seb, that's ridiculous. We've discussed this topic repeatedly, and I've repeated that I do NOT!!! think "lots of savings" are available. I've said, some, and that some will help. Not sufficient, but something positive.

Also: cost savings come in vastly streamlining the recordkeeping/paperwork administrative costs.

There are lots of ways to cover the uninsured that don't involve single payer. Furthermore, none of the current Democratic plans cover all of the uninsured (which I find very confusing). And in fact a huge majority of the legislation isn't about the uninsured.

Right. Which makes it particularly odd to demagogue the Dem plans as "government takeovers" or even "single payer" camel noses. They are not even close. As you point out.

[Sebastian]

"The Dems were complaining that the actual bill/legislation being proposed would destroy social security. Not that it wouldn't, but would make people more willing to consider legislation decades later that would destroy social security."

No, the largest complaints I heard was that opt-out would undermine support for Social Security by those who opted out.

Same thing with means-testing. Whenever we go through the "It's a pension, no it's anti-poverty protection for old people" merry-go-round the argument goes in the following circle:

1. It is a pension

Response: It is a crappy pension

2. You can't really judge it on that because it is really about protecting the elderly from poverty.

Response: The vast majority of the benefits don't go to the poor or near poor. So maybe we should sliding-scale means-test.

3. *SHOCK HORROR* That would undermine the program because in the long run the middle class wouldn't support it unless they were getting money out of it.

[Eric Martin]

No, the largest complaints I heard was that opt-out would undermine support for Social Security by those who opted out.

No, the largest complaints I heard was that it would ciphon money out of Social Security, and due to the payment structure of current workers and current retirees, this would be unsustainable.

[elm]

von's failure to distinguish health care from health insurance weakens this entire post. Furthermore, the gap between the wishes of some proponents to "Likely to mean" is awfully wide.

I've never read Matt Yglesias previously and can't see any reason to read him again. His noncommital and rambling piece would have been better left unwritten. I'd much rather read someone who advocated something -- even if I didn't agree with it.

If anything, this topic is the very opposite of a slippery slope. It's among the stickiest slope imaginable. All the monied interests stand on one side and the public good on the other. The elderly would rather maintain the status quo. The bulk of the Democratic Party is ambivalent on a publicly-run insurance option, and the conservative Blue Dog caucus has disproportionate influence.

It's easier to imagine the opposite. A future congress and President could easily kill or cripple the type of watered-down public option that the President may or may not support.

[Sebastian]

Whoops forgot the end of the merry-go-round.

4. So it is a pension.

[russell]

In fact, the Democratic Party's health care plans are being driven by people who want a government takeover of health care. For instance, Yglesias himself.

In the link Yglesias says:

And ultimately I think health insurance should be directly provided by the government.

Health insurance is not health care.

A single-payer health insurance plan does not exclude private insurance.

A publicly provided health insurance plan does not, remotely, on this or any other planet, constitute a government take over of the health care.

Weak tea, dude.

[russell]

Response: It is a crappy pension

Compared to what?

My 401k is worth about 60% of what it was two years ago. I believe it's worth less than what I put into it.

It'd be hard to compare SS to private pension plans because there aren't many left. And most of those are hurting.

So, compared to what?

[SomeCallMeTim]

Does anything in von's argument turn on the distinction between healthcare and health insurance? It doesn't look like it to me.

[Ben Alpers]

I think the notion of interpreting legislation not on the basis of what's in that legislation, but on the basis of what some of its supporters might like to do is bizarre. To begin with, it eliminates the possibility of any kind of compromise or negotiations. So long as the ultimate desires don't change (and why should they?), it simply doesn't matter what's in the legislation.

Two other thoughts about all this...

First, as publius (and others) have pointed out, most of the versions of the public option that are being seriously discussed are specifically designed not to be the first step to single payer. The bad faith argument coming from proponents is not their denial that this is an incrementalist "government take over" (it isn't), but rather some proponents' continuing attempts to suggest to potential progressive supporters that it might be.

Second, as our national "debate" about healthcare indicates, any reform worthy of the name will get labelled "government takeover," which is one of the many reasons that we should have tried for single payer. If you're gonna win an argument over "government takeover," you should at least get a "government takeover." And the reason we're not having an argument over single payer is not that it is particularly political impossible (I actually think it's no more nor less politically possible than any other comprehensive and effective healthcare reform package) but that the leadership of the Democratic Party doesn't want single payer.

[Sebastian]

"My 401k is worth about 60% of what it was two years ago. I believe it's worth less than what I put into it."

The second sentence is not likely to be true unless you have been putting money into it only in the last 3-4 years or unless you were in a very unusual 401k investment plan.

If the economy stays low enough that your 401k never comes back, I hope you don't believe that the government will be paying out Social Security at levels comparable to the last decade (at least not post-inflation, I suppose they could just print enough money to make it appear that benefits didn't go down).

Compared to any normal retirement plan that you would have put any similar amount of money into, Social Security is a bad deal.

[russell]

Does anything in von's argument turn on the distinction between healthcare and health insurance? It doesn't look like it to me.

Yeah, it does.

In one case von's claim is what we call "true". In the other case it's what we call "not true".

Find all the places where von says "government-run health care". Substitute the phrase "publicly provided health insurance".

See if the argument has anything like the same weight.

Let us know what you discover.

[Turbulence]

von, I think you fail to distinguish between mere desire and actively striving for acquisition. I mean, I want to stop working and move to a beautiful tropical island where I live a life of leisure but I know that's not going to happen. I'm not doing anything that could plausibly lead to the tropical island scenario. If you refused to do business with me for fear that I'd disappear one day for the island, you'd be an idiot.

There are lots of things that we want, things that we believe are "best" in some sense that we do not believe are feasible. I think the NHS is pretty awesome. I don't plan on working to get an NHS system built in the US because I think it is completely infeasible. But that doesn't change the fact that I think the NHS is really awesome, just like my insistence that the my tropical island plan is totally awesome remains even though I have no intention of bringing it about.

[Sebastian]

"No, the largest complaints I heard was that it would ciphon money out of Social Security, and due to the payment structure of current workers and current retirees, this would be unsustainable."

It is already unsustainable, that is why we were having the conversation in the first place. And the whole syphoning money thing is an interesting way of framing it considering that Social Security has always been sold to the public under the blatant lie of it being like a retirement savings program. (Remember the "lock box" garbage?)

[ericblair]

Again, I can't see why conservatives would worry about the public option being a camel's nose. After all, if they're right, the public option will turn out to be an expensive, bureaucratic nightmare with crappy care that will be obvious to everyone, right? And so, you'd never get widespread support for extending it to single payer, right, since it would be political suicide?

Or are conservatives worried that it might, you know, work?

[Marty]

Should be "I have a bridge to sell you". AllCaps and repeated no's aside, there is a large number of people speaking for the progressive side of this debate who characterize every concession as a means to the ultimate single payer end. Single payer creates control, once you have control of the payment all the rest is semantics.

Asking for "people in charge" that are saying it is like saying we can discuss the debate but you can't quote Rush or Beck (or Gingrich for that matter).

Silly stuff. At least debate the merits of the central point which is very effectively stated so I won't repeat a word of it.

[Carleton Wu]

No, the largest complaints I heard was that opt-out would undermine support for Social Security by those who opted out.

Nonwithstanding that this is not what I recall (ie I recall that the proposals were a not-very-subtle attempt to destroy the system directly by diverting funds from it), this still doesn't make it a good analogy. Von's argument is that later legislation is likely to do something he doesn't like even if the current legislation is unobjectionable. The SS example is of people objecting to legislation that they objected to on its own merits (or, as you say, because of the anticipated effects).

Objecting to legislation because you anticipate bad effects makes sense. Objecting to legislation because you believe that the same people will propose other legislation that you might not like in the future does not. If the first part looks good, and doesn't create the necessity for the second part, then vote for the first part and not for the second part.

[Sebastian]

I think the distinction between health insurance/health care isn't nearly as helpful nor as clear as Eric is asserting--especially not in the case of single payer reform.

Single payer may have some administrative advantages (possibly overstated by the fact that other government departments pay for things that can't be hidden in a non-government's balance sheet--i.e. tax collection and anti-fraud enforcement). But they aren't anywhere near large enough to answer the complaint that the US spends too much on health care.

Single payer's main theoretical advantage comes from monopoly power over providers. Using that power is an attempt to control how health care is provided for the majority of people. Proponents of single payer of course believe that such power will only be used for good. I'm more skeptical. An institution with monopoly power over providers tends to exhibit the negative characteristics of monopolies--slow responsiveness to change, active attempts to stifle competition, the propensity to get caught in dead-end ideas out of inertia.

Single payer reform wants near-monopoly power. It wants it for the purpose of doing something. That something is intended to strongly affect health care.

[hairshirthedonist]

Yeah, I don't quite get the connection between "here's stuff that's not in the proposed legislation, but that people believe is" and "I would favor some of this stuff if it were." What are the special mind powers of Yglesias that inject his wishes into legislation, future or current or past? How should his personal preferences affect what people (who probably have never read a word he's written) believe is in a written document containing specific proposals that Yglesias had no role in writing? Yeah, it's Yglesias enabling Palin and Limbaugh. (I'd like a giant titanium iguana that eats old people. Now that my wishes are on the internet, will this show up in the polls as a suspected health-care reform proposal?)

[Eric Martin]

And the whole syphoning money thing is an interesting way of framing it considering that Social Security has always been sold to the public under the blatant lie of it being like a retirement savings program

But the plan did siphon money out of the system, regardless of how it was sold. So, whatever.

Also, what carleton wu said.

Single payer's main theoretical advantage comes from monopoly power over providers. Using that power is an attempt to control how health care is provided for the majority of people. Proponents of single payer of course believe that such power will only be used for good. I'm more skeptical. An institution with monopoly power over providers tends to exhibit the negative characteristics of monopolies--slow responsiveness to change, active attempts to stifle competition, the propensity to get caught in dead-end ideas out of inertia.

But it's not monopoly power. Anyone can pay for treatments out of pocket. Anyone can buy supplemental insurance, or alternative private insurance. And, for the record, there are plenty of single payer systems in place, and yet none have succumbed to the fate you fear.

[russell]

At least debate the merits of the central point

Fine.

I make this out to be the central point:

Yglesias, and a considerable number of others, hope that the Democrat's reform package will be the first step towards a nationalized health case system.

In fact, that statement is untrue. Yglesias has said that he would favor a single-payer public health insurance plan.

Public health insurance IS NOT synonymous with government takeover of health care.

Period.

So, in a nutshell, the central and motivating claim of von's argument is false.

Not true. False.

If we want to have a debate about whether there are some Democrats who favor single-payer health insurance, where "single-payer health insurance" means universally available publicly provided insurance for basic health care and nothing more or less than that, that's fine with me.

It'll just be a very short discussion. It'll go like this:

"Some Democrats would like to see universally available public health insurance".

"Yes, that's correct".

[Carleton Wu]

von,
But a lot of voters will reason that, if I oppose the camel, I have to oppose the nose as well.

First, I just don't see the rationale here. If the GOP proposes a tax cut I think is good, I would support it. I wouldn't think "they probably want other tax cuts that I don't like, so I should oppose this as well." The nose argument implies that the second bill has some inevitability as soon as the first bill becomes law, but I don't see a causal force that makes single payer easier once this bill is passed. In fact, I see this as very likely reducing the possibility of single payer in the immediate future.

Second, it's been pointed out that there is a different between what you assert- that voters anticipate future legislation- and the facts Matt cites- that voters believe that these features are in the existing proposals.
So, this isn't about the nose at all- this is about lying about the legislative proposals currently on the table. It seems to me that you're offering a subtle defense of the lies that have been fed to the electorate here, by misrepresenting the concerns represented by the polls as being about hypothetical future proposals. I don't see any evidence out there to support the "nose" argument itself, nor evidence that it has any followers in the general public.

[Turbulence]

As I pointed out before (here, here, and here), there is no evidence that a substantial fraction of the Dem party leadership even wants a single payer system. Yglesias, like Eric Martin, is irrelevant. He has no power. He is not the Speaker of the House or the President or a major party bigwig. I've asked for evidence before and so far have gotten...nothing. I suppose von really has no evidence to support his beliefs.

[Bernard Yomtov]

I think ericblair's point, also made by Dr. Science in the previous thread, is pretty compelling.

Whether people want single-payer or not, they're not getting it with these bills. What anyone wants five or ten years from now will be heavily influenced by what happens between now and then. If the public option is an expensive flop single-payer wil be dead. If it's successful, maybe the public will want to expand government's role.

If you oppose that as a matter of principle, fine, but if you just think it's a bad idea from a practical point of view then the camel's nose argument doesn't hold. Maybe what you think is a camel is really a dog, and it's going to come in and be a loyal watchdog, and help you guard your sheep, and so forth.

[kth]

It is only a camel's nose politically. Nothing in the current bill would lead inexorably to single-payer, except that people might like the new arrangement sufficiently that the phrase "socialized medicine" might no longer scare them. Hardly a cogent argument on the merits against the current proposal.

[Bernard Yomtov]

This leads to the very reasonable inference that it isn't mostly about the uninsured even though their plight is rightly the focus of the moral argument.

I think a wider-angle lens is called for, There is also the problem faced by those who face a significant probability of becoming uninsured for various reasons. There are also the cost issues in general, which after all drive some of the insurance problems.

[kth]

It's very similar to a common Democratic response to the Republican's attempt to reform social security.

Not in the slightest. Total comparison fail. The supposed problem with Social Security was that it was underfunded. Bush's proposal took more funds out of the system (by allowing contributors to take out 1/6 of their contribution and place it in a private account). It made no sense in terms of its stated intention, and only thusly was it necessary to try to infer the real intention of the proposal.

[John Thullen]

"A majority perceive that proponents of Democratic reform don't actually want "death squads" .........."

Well, we want "death squads", but first the "death panels" need to meet and determine grandma's relative productivity and then the "death squads" will be dispatched to carry out the "death panel's" judgement.

It's a little over-bureaucratic and duplicative for my taste buthe unionshave their work-rules and featherbedding -- job creation, we call it over here in Nazi Stalinist Hillarycare land.

I would think the death panels could just push a button under their death panel table and dispense with Grandma right then and there, but government tends to fall behind in the latest technology.

[russell]

I would think the death panels could just push a button under their death panel table and dispense with Grandma right then and there, but government tends to fall behind in the latest technology.

That's OK, we'll hire Blackwater. They'll get it done.

[Sebastian]

"Bush's proposal took more funds out of the system (by allowing contributors to take out 1/6 of their contribution and place it in a private account). It made no sense in terms of its stated intention, and only thusly was it necessary to try to infer the real intention of the proposal."

No that isn't the case, because the idea was that they also wouldn't be able to drawn down on Social Security itself for that portion. (Which would be a greater pay out than pay in.)

"But it's not monopoly power. Anyone can pay for treatments out of pocket. Anyone can buy supplemental insurance, or alternative private insurance."

You mean it isn't 100% monopoly power. Standard Oil was never a real monopoly. Microsoft has definitely never been a real monopoly. Yet the first was a target of initial anti-trust laws, and the second is often a target of anti-trust laws.

Do you deny that one of the major 'advantages' you see in single payer is the immense 'market' power it will have to cram down prices or make other changes? I'm pretty sure that in previous discussions you've talked about the need for government pricing power in that way (especially on drug prices). Am I confusing you with someone else?

[stonetools]

I think that it is important to follow Dave Krugman's lead and clearly distinguish the three health care reform options on the table.

The first option is socialized medicine, where the government runs and pays for everything. Examples are the British NHS and the military/VA system. That option has its advantages, but is impossible in the USA at this time. NOBODY is suggesting that, not even Mr. Yglesias.

The second is the single payer option (Canada, Australia, Medicare). Yglesias and most liberals (including Mr. Yglesias and yours truly ) like this. Indeed, I think that if Obama had led strongly from the beginning with a single payer proposal, under the slogan "Its like Medicare for all", we would have gotten it this year. Unfortunately, Obama simply didn't have the cojones for this approach.

The third option is the highly regulated private health insurance approach ( Germany, Switzerland, Netherlands). This is the approach being tried in the reform bills. Unfortunately, its complicated, difficult to understand and explain, and easy to demagogue, although its the furtherest from a "government takeover". Indeed, that's the tragedy. Despite the legislators bending over backward to avoid the "government takeover" smear, they are getting hit with that anyway, as in "take your government hands off my Medicare".
I agree with Mr. Alpers. We should have gone ahead with single payer and given the demagogues some actual "government takeover".We didn't try that route, however. What will pass is a modified Swiss approach, with maybe a limited public option. Now if von thinks that is "government takeover", well everyone is entitled to their own opinion, not to their own facts.

[Gary Farber]

I would think the death panels could just push a button under their death panel table and dispense with Grandma right then and there, but government tends to fall behind in the latest technology.

That's OK, we'll hire Blackwater. They'll get it done.

No, killer robots are definitely the way to go.

[von]

In one case von's claim is what we call "true". In the other case it's what we call "not true".

Find all the places where von says "government-run health care". Substitute the phrase "publicly provided health insurance".

This is kinda silly.

For the vast majority of folks and the vast majority of procedures, government-run* health insurance and government-run health care are functionally identical. That's because the vast majority of folks are unable to afford the vast majority of procedures, and the presence of government-run health insurance will drive most (all?)supplementary private health insurers out of the market (assuming private insurance is even allowed).

So, please, continue to make these kinds of arguments .... and continue to be surprised why you continue to lose support for health care reform.

*Government-provided implies government-run, although, of course, one could theoretically have government-run health care/health insurance without government provided insurance.

[Marty]

"I think a wider-angle lens is called for, There is also the problem faced by those who face a significant probability of becoming uninsured for various reasons."

Do you imagine that a bill covering the uninsured would be limited to the currently uninsured? If so, please let me know what the effective date is so I can be be certain to be uninsured on that date.

[KCinDC]

Asking for "people in charge" that are saying it is like saying we can discuss the debate but you can't quote Rush or Beck (or Gingrich for that matter).

Eric Martin and Matt Yglesias are the liberal equivalent of Limbaugh, Beck, and Gingrich? I had no idea they had such an audience or influence!

[gwangung]

This is kinda silly.

For the vast majority of folks and the vast majority of procedures, government-run* health insurance and government-run health care are functionally identical. That's because the vast majority of folks are unable to afford the vast majority of procedures, and the presence of government-run health insurance will drive most (all?)supplementary private health insurers out of the market (assuming private insurance is even allowed).

Excuse me????????

WOULD YOU STOP DOING THAT!!!!!

"assuming private insurance is even allowed" indeed. That comment is dishonest, no two ways about it.

[Turbulence]

It is funny, von keeps writing comments but he never manages to provide any evidence showing that a substantial fraction of Democratic leaders want a single payer system. How strange.

[von]

Comparisons to the Republican-proposed overhaul of social security are, in fact, quite apt. Contra Eric, the Republican plan would not have destroyed Social Security. Social security, including a substantial government-funded safety net, would have continued to exist. The Grow accounts were purely opt in. Given the current misinformation about health care reform, however, I suppose that it shouldn't surprise me that many Democrats believed the (false) Democratic hype regarding SS reform efforts and did not actually read the bill.

OTOH, to the extent that Democrats were legitimately concerned about "camel's nose" type arguments .... well, that's my point, innit?

As I pointed out before (here, here, and here), there is no evidence that a substantial fraction of the Dem party leadership even wants a single payer system. .....

I suppose von really has no evidence to support his beliefs.

Turbulence, when it was pointed out to you that substantial numbers of Democrats want some variation on a government-run system, you revised the issue to the Democratic leadership. And, you're right, many (most?) of/in Democratic leadership is not, at this time, advocating anything like some in the grass roots are advocating. Now, why is that relevant to my point?

[Uncle Kvetch]

the presence of government-run health insurance will drive most (all?)supplementary private health insurers out of the market

Von, you were asked upthread to provide something to back this prediction up. There are functioning single-payer systems in a number of countries. Where has one of them driven all supplementary private insurers out of the market?

[Gary Farber]

"For the vast majority of folks and the vast majority of procedures, government-run* health insurance and government-run health care are functionally identical."

I don't know what this means: "for the vast majority of folks," etc. At the least, I'm unclear how you're getting this information: mass mind-reading? Election to the Senate? But if it's true, than, hey, let's set up a government service that hires almost all of the doctors, and pays their salaries directly; it sounds more efficient than letting them engage in private practices. After all, you claim that the single payer proposals, which you say most Democrats approve of, "are functionally identical" to this, and Democrats are the majority, so therefore, apparently, we might as well go ahead and set up a National Health Service.

Ok.

[von]

Eric Martin and Matt Yglesias are the liberal equivalent of Limbaugh, Beck, and Gingrich? I had no idea they had such an audience or influence!

Martin and Yglesias, however, do reflect opinions held by many others.

Excuse me????????

WOULD YOU STOP DOING THAT!!!!!

"assuming private insurance is even allowed" indeed. That comment is dishonest, no two ways about it.

There are many variations on a government-run health insurance programs, and not every variation freely allows private insurance. So, no, the comment is not dishonest.

[lowellfield]

As "crazy" as it may be for Yglesias to blame Republican dishonesty for the poll results in question, it's far, far crazier to say that "voters aren't stupid."

[John Miller]

"For the vast majority of folks and the vast majority of procedures, government-run* health insurance and government-run health care are functionally identical."

von, this statement is ridiculous. As is your later statement about supplementary isnurance be driven out of the market.

Is Medicare government run health insurance? Yes. Is it functionally the same as government run health care? Not even close. Medicare rcepients have far more choice of physicians and procedures that people covered by private insurance.

Additionally, the private insurance thrives on providing supplemental isnurance to people on Medicare to cover what Medicare doesn't such as deductibles, co-pays, etc.

This argument is going nowhere unless people actually try to represent things factually.

[Turbulence]

Turbulence, when it was pointed out to you that substantial numbers of Democrats want some variation on a government-run system,

I must have missed it. Where exactly did you point that out?

you revised the issue to the Democratic leadership. And, you're right, many (most?) of/in Democratic leadership is not, at this time, advocating anything like some in the grass roots are advocating. Now, why is that relevant to my point?

If there is zero evidence that a substantial fraction of Dem party leaders want a single payer system, then it is not rational to believe that Dem leaders are using the current proposals as a gateway to single payer. I'm not just talking about what Dem leaders are publicly advocating right at this instant: I'm talking about party platforms, books they've written, interviews they've given in the past, speeches they've made, etc. Just about any evidence that rises above the group mind reading you're relying on.

[John Thullen]

Also, Sebastian, upthread:

"The second sentence is not likely to be true unless you have been putting money into it only in the last 3-4 years or unless you were in a very unusual 401K investment plan."

The Fidelity Spartan S&P 500 Index Mutual Fund has returned an annual average MINUS 1.19 percent over the past ten years.

Compound that and we'll see how far ahead everyone is.

There are infinite variables to put this into context: age, prospective retirement date, etc, etc, but the investment strategies (very few people have a 401K Strategy, and the fad strategy of being fully invested in the stock market over the past decade has infinite variables as well, diversification among asset classes, etc.)

I'm willing to bet very, very few people know jacks--t about their 401K returns over the past however many years.

Also, Social Security was designed to be a "pension" with crappy returns, as opposed to the private pensions of various sorts which have had "crappy returns" during the last decade.

[Sebastian]

""assuming private insurance is even allowed" indeed. That comment is dishonest, no two ways about it."

I'm assuming he means private insurance for the things that the government covers. Which most likely would not be allowed under single payer.

And top-off insurance is highly controversial in some of the comparison countries, so the 'assuming' makes sense from that point of view too.

Also, are we positing

A) that politicians never say one thing and mean another;

and

B) that substantial numbers of Democrats definitionally have no influence on Democratic leadership?

[Eric Martin]

Eric Martin and Matt Yglesias are the liberal equivalent of Limbaugh, Beck, and Gingrich?

I don't even think Eric Martin is the equivalent of Matt Yglesias in terms of readership/notoriety/influence. Let alone either of us being in the Limbaugh/Beck/Gingrich echelon.

But color me flattered.

For the vast majority of folks and the vast majority of procedures, government-run* health insurance and government-run health care are functionally identical. That's because the vast majority of folks are unable to afford the vast majority of procedures, and the presence of government-run health insurance will drive most (all?)supplementary private health insurers out of the market (assuming private insurance is even allowed).

What on earth does that mean? If you can't afford health insurance, and the government steps in to provide health insurance, that is still not the government taking over your health care because...you had no health care to begin with!!!!

And on what basis do you substantiate the out of business claim? Why have other nations been able to avoid that fate? What is it about a public option that would be so irresistible.

And really, it's not the actual elements of the proposals that are turning people off. Actually, overwhelming majorities prefer SINGLE PAYER in poll after poll!!! It's the misinformation and propaganda catapulted by a multi-hundred billion dollar industry cross-section.

Do you deny that one of the major 'advantages' you see in single payer is the immense 'market' power it will have to cram down prices or make other changes? I'm pretty sure that in previous discussions you've talked about the need for government pricing power in that way (especially on drug prices). Am I confusing you with someone else?

No, it's not a cram down. There are some pricing advantages, also advantages of paperwork (administrative costs are huge, so don't discount the effect of large savings in these areas). Those are the advantages, but I'm open to public option alternatives.

And other cost cutting measures are a separate issue, as you like to point out. But there are two tracks: insuring everyone/controlling costs.

[Nate]

von: Again, NO. Bush's plan was to get money out of Social Security and give it to Wall Street. If that had happened, our current woes would be EVEN WORSE. Even leaving aside the blatant payoff to Wall Street, it was a Bad Idea that wouldn't have worked out well for anybody. Trying to use it to destroy Social Security was just a side benefit.

But that's a side point. The main point is that a) government run health insurance is NOT government run health care b) Why can other countries manage it without death squads and we can't, c) NONE of those are in the damn bill being considered anyway, and d) There's nothing wrong with government run universal insurance anyway (This chain was was the point of MattY's original post)

[Gary Farber]

"There are many variations on a government-run health insurance programs, and not every variation freely allows private insurance. So, no, the comment is not dishonest."

No, it's just discussing imaginary health care plans that are on the table in Airy Fairy Fantasy Land, rather than anything actually being negotiated in the Congress today.

So it's really really relevevant.

To repeat the same question I still haven't gotten an answer from from Sebastian when I asked him this when we had the exact same conversation in yesterday's thread: please read this comment, this comment, and let me repeat: Let me ask a question in an attempt to clarify: Sebastian Von, how long, in your worst case, would you expect a single-payer-plan bill to pass Congress, following passage of whatever it is we will or won't pass in this session?

and: In any case, Sebastian, von, I think that if you want to strengthen your case that passage of a bill this session -- whatever it may wind up being -- will inevitably lead to a single-payer system, that you'd do best to firm up that case with more specifics, rather than vague assertions that some politicians have at one time said they'd like to see it someday happen, or that a lot of ordinary Democrats say they favor it.

[von]

Von, you were asked upthread to provide something to back this prediction up. There are functioning single-payer systems in a number of countries. Where has one of them driven all supplementary private insurers out of the market?

To be clear, it's absolutely correct that many single-payer systems include private (supplemental) insurance. The UK single-payer system, for instance, has a robust (but, as a relative matter, very small) private insurance market ... although it's noteworthy that there are certain conditions where no private insurance is offered because public health insurance effectively preempts it. For example, AIDS/HIV treatment.

And this, I think, answers Gary's complaint about my mindreading abilities. When you have a government program that effectively preempts the field, you end up with very small (or nonexistent) private insurers. It's true that the examples of a no-private-insurer system is rare.* But it's equally true that some elected Democratic proponents of health care reform have suggested that private insurance should be outlawed. For instance, Rep. Anthony Weiner (D-NY).

*Cuba is one, but I'm not relying on it -- Rep Weiner's quote is more relevant.

[Gary Farber]

I'm assuming he means private insurance for the things that the government covers. Which most likely would not be allowed under single payer.

And top-off insurance is highly controversial in some of the comparison countries, so the 'assuming' makes sense from that point of view too.

Also, are we positing

A) that politicians never say one thing and mean another;

and

B) that substantial numbers of Democrats definitionally have no influence on Democratic leadership?

So if we make four leaps of assumptions, then we have something to worry about.

By this standard, we should all be frightened to death of almost everything, because, after all, if, if, if, if, therefore!

[von]

Von, how long, in your worst case, would you expect a single-payer-plan bill to pass Congress, following passage of whatever it is we will or won't pass in this session?

My reasons for opposing the Democratic bill are based on the way that it further ties health care to employment, rather than any concerns regarding a single payer plan but, in answer to your question: it all depends on the public option. The public option is the nose under the tent, and thus is what's getting all the heat (on both sides). Once you have a public plan -- no matter how small -- it becomes easier to expand the public plan.

[Turbulence]

But it's equally true that some elected Democratic proponents of health care reform have suggested that private insurance should be outlawed. For instance, Rep. Anthony Weiner (D-NY).

von, that's wonderful! You've managed to provide a bit of evidence for a proposition that several people had conceded yesterday, namely that there exist some Democratic congressfolk who want a single payer system. Now, do you think you can up your game and provide evidence that a substantial fraction of Dem congressman or the Dem leadership want single payer?

[Eric Martin]

The UK single-payer system, for instance, has a robust (but, as a relative matter, very small) private insurance market

I would think the UK would be the wrong choice for comparison because it actually has government run health CARE not just government provided health INSURANCE.

Which is, normally, an important and essential distinction. This post notwithstanding of course.

[John Miller]

Sebastian, von specifically used the term "supplemental" which by definition means an add-on to the public insurance. It is not meant to cover the same things the government insurance covers except as a way of covering that part of care the government doesn't pay such as deductibles, etc.

Additionally, supplemental would include items like covering for things the government doesn't cover like coolgen injections into the lips, etc, or private hospital room instead of the standrad.

And there is no rational reason to think that private insurance wouldn't be allowed. To even make that statement as a question is close to irresponsible.-

[von]

von: Again, NO. Bush's plan was to get money out of Social Security and give it to Wall Street. If that had happened, our current woes would be EVEN WORSE.

Sorry, not true. Here was the final (?) Republican proposal regarding GROW Accounts. Note that these were opt-in accounts and that did not divert SS money. Even the original Bush accounts were purely opt-in, although they left a potential shortfall in SS that would need to be filled with greater deficit spending.

[Eric Martin]

How could they not divert SS money? Even if they were opt-in, wouldn't you be opting your SS money into these new accounts and not SS?

[Shygetz]

The UK is not a single-payer system. The NHS is actual government health care. Canada is single-payer, as is France and various others. There is no plan to outlaw private supplemental insurance, and certainly no plan to eliminate out-of-pocket purchases of health care.

But to answer those who ask why people are so adamant about the single-payer system is that it is one system that has been proven to work time and again, both in other countries and in subpopulations of America. So, rather than cobble together something that is "uniquely American" (i.e. untested and quite likely to not work properly), why not go with what is proven to work, and work well? The only answers I've ever gotten to this question (other than the ones that flat-out deny statistics) are very religious in tone--crooning homages to the miraculous wonders of the free market in all places and times.

[Nate]

sebastian: "that substantial numbers of Democrats definitionally have no influence on Democratic leadership? "

I would think the fact that single-payer was never considered by the Democratic leadership, and the way the "leadership" has been dragging their feet and/or getting played by the GOP should show this to be pretty true.

von: What, exactly, is the benefit of having a large private health insurance industry? What do they offer society, besides new and creative ways to deny people treatment and funnel money to execs?

Seriously. You're going all out on how evil single payer is because it would kill this vital segment of industry, so what does the health insurance industry DO that makes it so worth protecting?

[von]

And there is no rational reason to think that private insurance wouldn't be allowed. To even make that statement as a question is close to irresponsible.-

Except that Rep. Anthony Weiner (D-NY) (link above) suggested outlawing private insurance.

Again, I don't think that Weiner's arguments would prevail even among Democrats (indeed, even among liberal Democrats). But I don't think that it's irresponsible or dishonest to note that a certain number of liberal Democrats (including elected officials) are open to outlawing private insurance, so long as you provide the clarifications and caveats that I have.

I would think the UK would be the wrong choice for comparison because it actually has government run health CARE not just government provided health INSURANCE.

Eric, you are going to explain the distinction that you're trying to draw, here. I know something about the NHS, and you can accurately characterize the NHS as either government-run health care or government-run health insurance. (It's true that folks in the UK tend not to use the term health insurance to refer to private health insurance, but that does not mean that the NHS is not a form of health insurance.)

[John Miller]

von, you use one quote to advance the arguments that Dems want to outlaw private insurance, which may or may not accurately reflect his thinking. How many elected Republicans have announced clearly that they want Social Security to no longer exist? I will take some time, in between work projects, to provide some. But I am pretty sure it is more than those Dems who have stated they want to get rid of private insurance.

[von]

Sorry, that should be "folks in the UK tend not to use the term health insurance to refer to private health insurance ..."

[Eric Martin]

I know something about the NHS, and you can accurately characterize the NHS as either government-run health care or government-run health insurance.

As the Brits would say, bollix.

Under the NHS, the government runs the hospitals, pays the salaries of the MDs etc. That might include the provision of insurance, but that is only a facet of the over all health care system that is government run.

Unlike anything that was even remotely proximately related tangentially in an off hand way associated with the Dem proposals.

[Turbulence]

Contra Eric, the Republican plan would not have destroyed Social Security.

On such complex issues, I like to hear what experts like Brad Delong say:

The Bush 2005 Social Security Plan was a proposal to wind up Social Security over the next two generations and replace it with mandatory defined-contribution individual retirement accounts. And I remember that it was very hard for the Bush administration to even claim that the numbers made sense--they were, after all, leaving on the table (a) the benefits from diversification across individual portfolio strategies, (b) the benefits of diversification across time, and (c) the backstop risk-bearing capacity of the government.

Given the choice between some lawyer from the midwest and an econ professor who was a former treasury dept official, I think I'll go with Delong. Plus, Delong also occasionally admits to being wrong. That sort of thing makes it easier to trust people.

[von]

How could they not divert SS money? Even if they were opt-in, wouldn't you be opting your SS money into these new accounts and not SS?

Eric, the original proposal from Bush on SS reform didn't answer this question. The revised proposal from Republicans answered the question by blocking portions of the SS surplus to pay for non-SS matters.

The UK is not a single-payer system. The NHS is actual government health care.

Except that the UK system can be described as a "single payer system". That's one reason why I'm asking Eric to clarify what he means when he draws the distinction between providing health insurance and providing health care.

[243]

2. You can't really judge it on that because it is really about protecting the elderly from poverty.

Response: The vast majority of the benefits don't go to the poor or near poor. So maybe we should sliding-scale means-test.

Stats for Households With Members Age 65 Years Old & Over - 2007 US Census Data The median income for said households not including government transfers was $13,807. Note that the poverty level for a household of 2 in 2007 was $13,690, so a majority of said households would have been likely have been living in poverty or near poverty were it not for the governmental transfers they received which raised the median income to a whopping $31,305. Now it could be that Social Security itself doesn't go in equal amounts to those near poverty as to those who have had higher earnings but it seems unlikely that the roughly 70% of the households in the bottom two quintiles would receive significantly less than the 30% in the top three.

[Nate]

von: There's no question on the definitions here, but let's make it clear: government run health insurance means the government pays for procedures by independent doctors/hospitals etc, just like (most) insurance companies do now. Government run health care means the government actually employs the doctors/hospitals/etc. Which, yes, usually involves the government paying for procedures too. Can we stop playing word games now?

As for SS (which is a side point, no the main), the article you cite disagrees with you, for first, it was going to be opt-out, NOT opt-in. "Personal accounts, called “GROW” accounts, would be established for all workers under the age of 55, unless they choose not to have an account."

The rest of it looks very...fishy. The money would have been "credited" to the SS Trust Fund (i.e. used to buy the Treasury Bonds in the Trust Fund) and then used to buy Treasury Bonds for the individuals enrolled in it somehow? Or whatever other investments were "recommended". Then the account balances would be used to pay for part of the person's SS benefits, with the Trust Fund making up whatever the difference was. How is that anything other than double accounting? And it doesn't matter, because it was defeated, so we're a few years away from having to deal with that kind of nonsense.

[socratic_me]

Camel's noses sound a lot like slippery slopes, with the exception that we are all aware that slippery slopes are bad reasoning whereas camel's noses are new and, as noted earlier, sound sneakier.

The odd thing about this particular slippery slope is that it has these weird things called "other bills that have to be passed" lining the slope in an interesting configuration that creates something more like a "long wide descending staircase that is fairly easy to stop along or even turn around and walk back up". But then that turn of phrase is kind of bulky and probably doesn't sell von's point very well. Or sticking with von's own camel's nose, I will simply add, as many have above, that the camel in question has an awfully lot of extremely large humps that are going to make it very tricky indeed to sneak it into a tent without anyone noticing.

[von]

von, you use one quote to advance the arguments that Dems want to outlaw private insurance, which may or may not accurately reflect his thinking. How many elected Republicans have announced clearly that they want Social Security to no longer exist? I will take some time, in between work projects, to provide some. But I am pretty sure it is more than those Dems who have stated they want to get rid of private insurance.

You don't need to do that, John: I'll accept that you're right. The point is that a lot of folks don't want even a majority-public system (like, e.g., the UK). The only reason why I provided those quotes was to respond to arguments that I was being irresponsible (or lying) for suggesting that some percentage of Democrats really did want to eliminate all private health insurance.

[Gary Farber]

"My reasons for opposing the Democratic bill are based on the way that it further ties health care to employment, rather than any concerns regarding a single payer plan but, in answer to your question: it all depends on the public option. The public option is the nose under the tent, and thus is what's getting all the heat (on both sides). Once you have a public plan -- no matter how small -- it becomes easier to expand the public plan."

The purpose of my intention is that you -- and Sebastian -- and anyone making this argument -- be specific as to your worst case scenario: do you see, worst case, the single-payer bill being introduced next year? In 2011? 2012? 2014? 2020? 2030? What year, or range of years, specifically?

You're making a Slippery Slope Argument. I want you to make it concrete, rather than -- and I refer you to my previous two comments again -- refer to vague "tendencies" and vague possible unspecified times in the future, in scenarios that depend on multiple sets of "ifs" happening. I'll allow you one if: if the public option" passes, then in what year or range of years do you expect Democrats to begin trying to pass single-payer?

Thanks.

[Marty]

" why not go with what is proven to work, and work well?"

The difference in what works in the US vs Canada vs the UK or France is not limited to the construction of the healthcare system. There are many facets of those societies that are different that could make a particular healthcare solution work better or worse. The fact that all of those countries have different systems is a reason, in itself, not to just implement one here and assume it will work.

American government works differently, society is different, culture is different so why would anyone assume the healthcare system that works somewhere else would work here?

[socratic_me]

On a separate note, I can't speak to what other people think of their social security as providing, but I find it useful to think of as this thing called a "safety net". The idea here is that it is a guaranteed amount of money that I can count on being there when I retire. In good times, it will provide a little safety and security, peace of mind if you will. In a pinch, I can fall back on it entirely. It will be a very uncomfortable fall, because it isn't meant to be a big cushy mattress, just a net. You know, for safety. So I can go ahead and try for bigger things with the rest of my retirement money.

[Eric Martin]

Except that the UK system can be described as a "single payer system". That's one reason why I'm asking Eric to clarify what he means when he draws the distinction between providing health insurance and providing health care.

Oh jeez von, you are much, much, much smarter than this. You don't really need me to do this but I will:

1. Government provides insurance but private hospitals, private doctors, private medical care professionals handle the health care.

Single payer, not government run health care.

2. Government provides insurance (even and especially if single payer), government also provides and runs hospitals, publicly employed doctors, publicly employed med care professionals.

Government run health care.

In the UK, they have single payer AND government run health care.

In other countries, such as Canada, they have single payer but NOT government run health care since the private sector still provides the actual CARE. Not the insurance, but the CARE.

Thus, you can have single payer with either model, but it's only government provided health care where the government provides the health care.

[Nate]

von: You weren't saying that "some percentage" of Democrats wanted to eliminate private health insurance, you implied it was the DIRECT RESULT of any single payer system. Which is FALSE.

[von]

Nate, where does it say that the GROW accounts were (under any version) opt-out? The original Bush plan or the second plan? If it's there, I misread it. Sorry.

Under the NHS, the government runs the hospitals, pays the salaries of the MDs etc. That might include the provision of insurance, but that is only a facet of the over all health care system that is government run.

And how do you think insurance reimbursement works? Granted, the NHS has elements of centrality control that are not found in all single-payer insurance systems, but it's a matter of degree -- not kind.

[von]

von: You weren't saying that "some percentage" of Democrats wanted to eliminate private health insurance, you implied it was the DIRECT RESULT of any single payer system. Which is FALSE.

Provide the quote where you think I said that.

[Nate]

von: The bolded part. Again, "would be established for all workers under the age of 55, unless they choose not to have an account."" That's the DEFINITION of opt-out.

Okay, and now you're just being obtuse deliberately and trying to conflate the NHS with government provided insurance, which is false, and everyone has called you on so far.

[von]

In other countries, such as Canada, they have single payer but NOT government run health care since the private sector still provides the actual CARE. Not the insurance, but the CARE.

OK, so does the US have public health care? Because a large number of US hospitals fit the definition of being run by the government (e.g., New York City Health and Hospitals Corporation, which was created by the New York legislature as a public hospital.)

I really think that you're drawing distinctions that are not particularly meaningful. You're right that no one is seriously proposing a centralized public health care system, a la the NHS. But it's the centralization that's the key distinction between the NHS and the issues at hand, not the "government run" healthcare bit.

[Uncle Kvetch]

The point is that a lot of folks don't want even a majority-public system (like, e.g., the UK).

True, to the extent that Anthony Weiner is "lots of people," and to the extent that he is calling for anything remotely resembling the NHS, which he is not doing, and to the extent that he said that he would outlaw private insurance, which he only sort-of maybe hinted at if you squinch your eyes up just right but that's close enough for Hot Air.

This is pathetic.