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August 19, 2009

Comments

It's like these people really think we're out to destroy the country.

yes, they actually think that - at least that's what we have to believe if we take their word for it. i don't know if the GOP pols think that, and i think it's obvious that a lot of pundits are just demagoging. but the GOP rank and file, the people who have pushed Glenn Beck's ratings through the roof, all of my wife's older relatives, the guy down the road who paints huge anti-Obama signs and sticks them in his front lawn, the people who show up at town halls and cry that their country is being destroyed ? yeah, i think they believe it. and they're terrified of it. they're insane, but terrified.

Yeah, let's keep some perspective. I totally respect people like GoodOleBoy and the like; I don't think they're ultimately correct, but they argue honestly and with integrity, and they bring a lot of good arguments to the table (they make you WORK with your arguments)...and who knows? They might actually be right and convince you.

But I don't respect a lot of the arguments. They're ill-informed and refuse to look at additional sources of information. We don't need that kind of willful ignorance.

yup, and there's a whole industry of becks and limbaughs and now grassleys whose aim it is to keep them terrified and keep them in line through imposing a reign of terror.

hmmmm. people who try to impose their political will by constantly terrorizing the civilian population of a nation. seems like there used to be a word for them.

But the sheer intensity of the hysterical ideological opposition is completely disproportionate to the actual goals.

I do like the idea that these people believe, after painting the Democratic party as the party of tax and spend and government waste and nanny-statism, that the Democrats are going to pull the plug on Grandma to save the government money!!!

That's what's so insane about the hysteria. Do people really think that Obama and the Dems are laughing hysterically about evil government takeovers, etc.? What do these people think the Dems' actual motivations are? I can tell you the real motivation is -- it's simply to help people get affordable health care. That's what motivates me, anyway. It sounds quaint, but it's the whole "make the world a better place" thing.

Not to defend this particular weirdo (who's a follower of LaRouch, by the bye, not a Republican -- not that Republicans and Democrats don't have their own crazies), but:

1. A certain percentage of the Democratic party would like a single-payer, wholly government run system and that they are using the current health care reform effort as part of a "camel's nose" effort .... hence the general distrust of even reasonable reform efforts.

2. A lot of what I find objectionable about the current health reform effort is precisely that it is being done by people with the best of intentions, who simply can't fathom the other side of the debate. But good intentions, particularly clueless ones, aren't results.

3. A lot of the reform efforts being batted around -- e.g., efforts that tie health care ever more strongly to employment, which are wonderful for certain well-placed unions but neutral to pernicious for everyone else -- are not real reform and will have negative consequences.

4. President Obama (specifically) and the Democrats (generally) have done a horrible, horrible job of framing the health care debate. This further lowers the trust factor, and creates fertile soil for all kinds of craxy theories. As a random aside, when someone worries about "rationing" under a proposed system, it is utterly stupid to respond "we're already rationing." It implicitly concedes that there will be rationing under the new system without responding to the question (which was about the proposal, not what's happening today). The listener is left with the impression that there will be rationing under the system, but no one knows/will tell what such rationing will entail.

4. Now, put items #1-#3 together: Should anyone really be surprised that 60+% are coming to prefer the devil that they know?

I think there are a fair number of people who are genuinely (though I think profoundly mistakenly) concerned that a public health system will literally cause the destruction of healthcare provision in the US.

It's not a completely irrational fear if you don't know much about what makes healthcare different to other goods or services, or if you don't know that universal healthcare has been proven to work in dozens of other developed countries through the latter half of the 20th century.

It is actually possible to completely screw up the market for providing some good or service in a well-meaning attempt to provide or expand access. For instance, if you tried to provide universal access to food by giving everyone in the country tokens that could be used to buy any meal, anywhere, paying a fixed reimbursement, you would instantly destroy the market for restaurants that provided anything other than the cheapest possible food, and cause all kinds of repercussions down the food supply chain. Of course that's a ridiculous example, but I think that's exactly what opponents of a public healthcare system think Congress might be trying to institute.

Now for two main reasons the healthcare reforms will not have those effects, but knowing those reasons requires a certain amount of sophistication in understanding the specifics of healthcare markets and the planned reforms. The first main reason is that healthcare is not like other goods, and as a result even the existing insurance system is not like the market for other goods. I think we all here know the difference. The second is that the proposed reforms are quite carefully designed not to destroy the existing systems of provision of healthcare, and in fact will keep the same market-based systems for doctors, medical services, medical equipment, etc etc.

But I don't think it's completely crazy to have that worry if you are not well-informed. Or watch too much Fox News. Which might define you as completely crazy in itself, but you know what I mean.

My wife recently rented Sophie's Choice from Netflix. The DVD extras included interviews with holocaust survivors and some documentary footage of concentration camps with expert commentary, not to mention the most gut-wrenching clips from the film itself. People should watch that or similar material just before deciding to casually cast about Nazi comparisons at public meetings. They might, just might, think twice about it.

I think its fine for the GOP talkers and their pols to keep their 25-30% bitter-enders worried and afraid. I don't have a problem with that unless and until the secret service or the police miss the one nut with a gun or a bomb and we get another Ok City or another JFK (and yes, I'm old enough to remember that - I was a college freshman). Like the GOP's stances on Sotomayor and immigration, anything that drives substantial numbers of voters to the Dems is overall a good thing.

The problem we're seeing now, nationally, is the one Massachusetts has had locally for years. Despite electing some governors, there is no effective opposition party, so its the liberal Dems vs. the conservative (not crazy, just conservative) Dems. We're seeing that in Congress right now with the blue doggies.

I don't have a solution. As a bleeding heart process liberal I'm generally against the old model of doing whatever the speaker or Senate president tells you to do. And in any case, we don't have any Lyndon Johnsons or Sam Rayburns hanging around right now to twist arms and threaten the caucus.

Ultimately (as I've said in another thread) the thing that will work is for some skilled people to get the digital splicers out and make some creative 30-second spots to run as paid media in the districts where it matters. People don't always watch the news, but if you stick the crazies with appropriate scary commentary in between scenes of CSI or Jeopardy or whatever, like any other political ads, you'll push more people over to the left side.

von, there are a certain percentage of Republicans that think all liberals are traitors and should be exiled or executed and are using this uproar to provide cover for that policy. And in fact created the Patriot Act to start us on that path.

Therefore it was understandable that a large percentage of Democrats were in the streets demonstarting against it and yelling abuse at their representatives and promoting major lies in the national media about it... oh wait.

The biggest point you make, regarding insurance tied to employers is a legitimate one, but that is actually rationale and would lead to a legitaimate discussion, which is something the Republican Party doesn't wnat to have.

I agree the sell job hasn't been the best, but there are signs that is going to change. And the rationing arguement (there already is rationing you just pay a lot more for it) is a legitimate one. Of course, the largest government run plans, Medicare and the VA do next to no rationing.

"Progressives are seeking healthcare coverage reform because we want to help people."

Ah well, see Publius, you've fallen directly into the trap set for all progressives ;) We want to help people.

That's exactly how Nazi Germany got started.

The Hitler brownshirts wanted people to walk with better posture (easier on the spine and frankly, funnier). They wanted, for the good of the populace, Jewish storeowners to have the benefit of natural air conditioning and so they celebrated Krystallnacht. They wanted to introduce high-tech furnace technology to the freezing 6 million, for their own good.

And look what happened. Good intentions turned into unintended consequences.

Just like healthcare reform by progressives in this great country of ours.

The Bolshevicks just wanted to help people too. Healthy weight reduction programs in the Ukraine, for example. Special literature retreats and workshops in Siberia for fledgling writers like Solzynitsen. Neighbors looking after their neighbor's business and reporting unhealthful practices to the proper authorities.

Again, all well-founded policy from good-hearted people. But ..........

I could go on -- Pol Pot's humanitarian efforts to improve the population's mean eyesight by encouraging urban intellectuals to move to the country and give up eyeglasses so they could wear contact lenses.

Let us continue reasonable debate and honest discussion in this country and appeal to the good faith of our fellow countrymen until they are convinced we really want to help them.

i agree with von's points, mostly.

but in the end, there is no way this could be framed or structured so that the GOP would get on board. they are fighting this firstly to defeat Obama, and secondly to keep the Dems from creating something that will give them a boost in public opinion. the GOP is fighting a political battle, not a policy battle. the actual policies in question would be totally irrelevant, except that they can be used as raw material for slanderous lies against Obama and the Dems.

just like it didn't matter who the Dem nominee was - the GOP was still going to call him or her a traitorous, terrorist-appeasing, proto-communist - it doesn't matter what the policies are or how Obama sells them, the GOP was still going to cover the debate in feces and bile.

A certain percentage of the Democratic party would like a single-payer, wholly government run system and that they are using the current health care reform effort as part of a "camel's nose" effort .... hence the general distrust of even reasonable reform efforts.

But what is that percentage? Is it 1%? 90%? And the Democratic party members matter a lot less than the Democratic party leadership. So what is the percentage among the Democratic party leadership?

My point here is that you've constructed an argument that is impossible to refute. You're accusing the leadership of acting with hidden intentions. There's just no way to disprove that assertion, which makes it pointless to argue over. Now, if you presented some evidence showing that a substantial fraction of the Democratic party leadership actually planned to use the current health care reform proposals to sneak in a single payer system, then we could either refute your evidence or be convinced, but since you present zero evidence, all we're left with is your religious faith.

Also, I'm really confused: if Dems were really desperately pushing for single-payer, shouldn't they vote for Wyden's bill? I mean, isn't that a much easier way to get to single payer nirvana?

But the sheer intensity of the hysterical ideological opposition is completely disproportionate to the actual goals.

Not at all. What the ideological opponents are fueled by is the awful thought that American health insurance companies are so rotten they might go bankrupt if they have to compete with a half-decent public option, let alone with an American NHS.

So the corporate lobbyists and the mass media talk to their shills about how awful Obama's plans are going to be, and the shills work up a real nasty campaign, and the net result is you have the gullible victims of this corporate campaign standing up and trying to tell Barney Frank that Obama's like a Nazi because he wants to extend health care to the 40M uninsured. Because what's at stake is all that beautiful profit: her outrage defends their profits.

I mean, we saw this kind of mass campaign by the right against the Clintons for the same kind of reason, back in the 1990s, those of us who are old enough to remember, rendering Hillary Clinton the kind of hate-object that made it seem rational for Hilzoy to join the right-wing campaign against her when she was running in the primaries. In twenty years Barack Obama will be that kind of hate-object, and a Hilzoy from the generation to come will take for granted that it's only rational to hate him.

But the sheer intensity of the hysterical ideological opposition is completely disproportionate to the actual goals.

One, are you sure you want to use "hysterical" as a pejorative here? I mean, some of those men are plenty upset too.

Two, the best part about the woman's complaint is that it's factually backward. She talks about the T-4, but

the T-4 initiative was prohibitively expensive. Its predecessor, the Gesetz zur Verhütung erbkranken Nachwuchses, or “Law for the Prevention of Genetically Diseased Offspring,” which mandated the sterilization of the physically and mentally disabled, had been scaled back because it was too expensive. That is, they stopped, not started, the ideologically-based murders of those they considered defective because it would save Germany a few million Reichsmarks.

This should go without saying: the Nazis wanted to kill these people, they simply couldn’t afford to. In fact, it was only in 1939, after they’d planted a war on both horizons, that Hitler could justify the expense required to expand the T-4 initiative into the concentration camps.

In short, whatever Obama’s policy will be, if it is, as this protester claims, designed to reduce the national deficit, it won’t resemble Aktion T-4 one whit.

I pretty much agree with von's points.

Turbulence: "But what is that percentage? Is it 1%? 90%? And the Democratic party members matter a lot less than the Democratic party leadership. So what is the percentage among the Democratic party leadership?"

Single payer or even more government control than that has been the dominant Democratic story on health care for decades. Now that included a lot of time where they weren't going to be getting their way, so they were free to spout off any way they wanted I suppose, but that was still the dominant Democratic Party storyline on what they wanted for quite some time.

Now you are free to assert that they didn't really mean it. You are free to suggest that more nuanced views have come to the fore. You are free to suggest that those Democrats who say that this is merely the first step (say eric martin so I'm not accused of strawmanning) don't really count.

But they do exist, and it isn't crazy to notice them.

It is crazy to call them Nazis however. I'll give you that.

von, there are a certain percentage of Republicans that think all liberals are traitors and should be exiled or executed and are using this uproar to provide cover for that policy.

And at one point, more than a third of Democrats believed that President Bush knew of the 9-11 attacks in advance. (http://www.rasmussenreports.com/public_content/politics/current_events/bush_administration/22_believe_bush_knew_about_9_11_attacks_in_advance). People are going to believe crazy things about their opponents.

The Democrats are not losing the health care debate, however, because of the crazies. They are losing the health care debate for one primary reason: Why should I accept the devil I don't know instead of the devil I know? The original answer was, bend the cost curve, which had two defects: (a) The CBO analysis didn't support the claim; (b) the claim implies greater rationing than today. It's not clear that there is time or room for a new answer. (In general, you only get one shot with framing a new policy proposal of this size.)

But what is that percentage? Is it 1%? 90%? And the Democratic party members matter a lot less than the Democratic party leadership. So what is the percentage among the Democratic party leadership?

My point here is that you've constructed an argument that is impossible to refute. You're accusing the leadership of acting with hidden intentions.

No: This wouldn't be a problem for the Democrats if the intentions were truly hidden. But support for single-payer is out in the open (see, e.g., http://www.democrats.com/single-payer-petition). That's not to say it captures majority Democratic support (though it might). There is a perception -- and probably a fair one -- that enacting any D-sponsered health care package is going to set up a slippery slope to nationalized health care, which is the stated goal of a good number of Democrats.

What von said. Especially point 4:

4. President Obama (specifically) and the Democrats (generally) have done a horrible, horrible job of framing the health care debate.

And it started with trying to forward a bill not many in Congress were familiar with (as in hadn't read the pertinent provisions).

A debate is fine, but this is getting ugly both ways. I say come up with a bill that facilitates different state plans and try them out for a while and see what works, if anything. Get it local. One national plan is stupid before we try something else.

And what's with wiping out ERISA plans after 5 years? Dont' hear much about that.

And I have to admit Frank actually sounding convincing. I usually can't help but laugh (I know, that's bad, I'm working on it).

A certain percentage of the Democratic party would like a single-payer, wholly government run system and that they are using the current health care reform effort as part of a "camel's nose" effort

Look, just to make this same point for the 5,289th time:

Single-payer is not the same as a wholly government run system.

It's not even the same as a wholly government run health insurance system. Because there's always a private market for what the public plan doesn't cover.

And there is nothing like a consensus, among Democrats or anyone else, that single-payer is the way to go. I doubt there's anything resembling a majority.

President Obama (specifically) and the Democrats (generally) have done a horrible, horrible job of framing the health care debate.

The opposition "argument" on health care is more or less the equivalent of "Obama f**ks goats".

Think that's an exaggeration?

How do you "frame the debate" with someone whose argument is that you are a crypto-fascist reincarnation of Hitler who wants to euthanize their granny?

Von, since "knowing about the 9/11 attacks in advance" could for some people include having seen the August 2001 presidential daily briefing titled "Bin Laden Determined to Strike in U.S.", I don't accept that those poll results are an equivalent level of crazy.

Also, are you saying that any plan that claims to control the rise of health care costs "implies greater rationing than today"? All those countries that spend less than we do have greater rationing, despite their better health outcomes? But it does make it possible to dismiss every plan as unacceptable because it either doesn't control costs or increases rationing.

"yup, and there's a whole industry of becks and limbaughs and now grassleys whose aim it is to keep them terrified and keep them in line through imposing a reign of terror."

I'd have to google for links, but my understanding is that talk radio numbers are dropping, so Limbaugh, Beck, etc., have to up their voltage to keep viewers/listeners riveted. As a result, the Republican politicians rush to the head of the crowd to "lead" their base.

Result: ever-further moves by the R leadership to ever-loonier and more extreme positions. Which loses them more voters, overall.

It's not entirely a bad thing.

Among other results, it enables Barney Frank to make matters clear. As it should other Democrats.

But everyone likes to be irate: it's built into our nervous system. And to be irate, we have to have someone to fear.

So everyone likes some of that, too. The extreme Republicans, when painted as The Entirety Of The Other Side, serve usefully to keep Democrats and liberals fearful that the Becks, Limbaughs, Malkins, and fellows, are The Entirety Of The Other Side, just as the Republicans somehow ramp up Jeremiah Wright and Bill Ayers as Typical Democrats coming to bomb your neighbor's home and beat you up to get back at you for slavery having existed.

Fear and anger are something we're all prone to. I like to think that the Democrats are currently channelling it more usefully, and less insanely, but I think part of that should involve not exaggerating notions that Rush Limbaugh and Glenn Beck are going to be leading a beer hall putsch that is actually successful in taking over the government, any time soon.

Noise and numbers are two different "n" words.

I kind of suspect that the extreme crazies are propelled by the "God's Chosen President" narrative from the Bush years. From that point of view, it's simply impossible for the opposite team's guy to be genuinely good, and thus, the more he appears to be doing good things, the more sneaky and underhanded he must really be. (This narrative also neatly explains the "brither" nonsense: no one could defeat God's party legitimately, so Obama must not have been a legitimate candidate.)

Of course, there's been messianism on the part of Obama supporters as well, but that's been disappearing into disillusionment of late.

von: "3. A lot of the reform efforts being batted around -- e.g., efforts that tie health care ever more strongly to employment, which are wonderful for certain well-placed unions but neutral to pernicious for everyone else -- are not real reform and will have negative consequences."

Italics mine: how about insurance companies? Is it or is it not wonderful for them, as well?

Query: which has more lobbying and political power? Unions lobbying for employer-tied health insurance, or insurance companies?

cleek: "but in the end, there is no way this could be framed or structured so that the GOP would get on board. they are fighting this firstly to defeat Obama, and secondly to keep the Dems from creating something that will give them a boost in public opinion. "

It's not just public opinion: Republicans both philosophically, and more importantly, as a practical political matter, deathly fear another Democratic program that's as successful and popular as Social Security and Medicare have been, both because they oppose it in philosophical theory, but more importantly, they know Democrats will benefit politically if it happens for decades to come.

William Kristol and others were entirely explicit about all this back during the Clinton health care reform effort.

[...] But the Clinton proposal is also a serious political threat to the Republican Party. Republicans must therefore clearly understand the political strategy implicit in the Clinton plan--and then adopt an aggressive and uncompromising counterstrategy designed to delegitimize the proposal and defeat its partisan purpose.

[...]

But the long-term political effects of a successful Clinton health care bill will be even worse--much worse. It will relegitimize middle-class dependence for "security" on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.

Italics by Kristol.

Read the whole thing; it's the memo the Republicans are still exactly working off.

von:
Why should I accept the devil I don't know instead of the devil I know?

For the reason publius gives: because the current system is reprehensibly bad for many people other than yourself. The devil you know kills people for profit.

If you're afraid of a new massive government bureaucracy, remember that we've *already* got massive bureaucracy -- we'd be shifting it, not expanding the total supply. Your choice is *not* between government bureaucracy and no bureaucracy -- your choice is between Big Government or Big Corporation. If you say you're "opposed to big government", then you are *automatically* in favor of big corporations getting their way. "No large bureaucracies" is not one of the available options.

KCinDC: "Von, since "knowing about the 9/11 attacks in advance" could for some people include having seen the August 2001 presidential daily briefing titled "Bin Laden Determined to Strike in U.S.", I don't accept that those poll results are an equivalent level of crazy."

You appear to be wrong

Question:
There are also accusations being made following the 9/11 terrorist attack. One of these is: People in the federal government either assisted in the 9/11 attacks or took no action to stop the attacks because they wanted to United States to go to war in the Middle East.

Answers:
Very likely 16%
Somewhat likely 20%
Not likely 59%
Don't know 5%

The very likely 16% are batSH!& insane and the somewhat likely 20% are loons.

There's no nefarious plot.

That's what you say when there is a nefarious plot.

Which bill is the bill that Obama's doing a lousy job selling? The House Ways & Means bill, the substantially similar but not quite identical Energy & Commerce Committee bill, the Education & Labor version, which pretty much matches the other two, but not exactly, or the Senate HELP committee version, or the Senate Finance version that no one has even seen yet?

"Also, are you saying that any plan that claims to control the rise of health care costs "implies greater rationing than today"? All those countries that spend less than we do have greater rationing, despite their better health outcomes?"

For whatever reason, we aren't those other countries. If we were, we would already have 100% coverage over everyone, because the US government already spends enough per capita to pay for Canadian level care and more than enough for UK level care. And I raise this only for the limited point of suggesting that the comparison isn't helpful without figuring that problem out (which I don't believe any of the current proposals do).

President Obama (specifically) and the Democrats (generally) have done a horrible, horrible job of framing the health care debate. This further lowers the trust factor, and creates fertile soil for all kinds of craxy theories.

Um, examples? Because seems to me they've mostly said things like, hey, let's save money and cover more people by regulating better and expanding government health insurance. That's a reasonable frame. I can't think of a way to frame it that would have preempted insane claims about "death panels" and "Nazis."

Or was the following meant to be your example? Because this isn't a 'frame,' it's a response, and not by Obama or Congressional Dems.

As a random aside, when someone worries about "rationing" under a proposed system, it is utterly stupid to respond "we're already rationing." It implicitly concedes that there will be rationing under the new system without responding to the question (which was about the proposal, not what's happening today). The listener is left with the impression that there will be rationing under the system, but no one knows/will tell what such rationing will entail.

Maybe the questioner is "utterly stupid" for not saying what kind of rationing he is afraid of. After all, it's his concern, so he has some responsibility to state it clearly. Maybe he's utterly stupid for jumping to the conclusion that it will be worse than the current rationing. Maybe there is just no way to answer utterly stupid people without upsetting them.

But granting that it would be pretty stupid for a paid spokesperson for reform to literally say "We're already rationing. Next question?" -- has this ever happened? Every time I have seen even an unpaid pundit say it, they add that we would now ration in a fairer way.

Sebastian: "You appear to be wrong"

Your link appears to be broken; at any rate, it points back at this thread, even via "show source."

von: "A certain percentage of the Democratic party would like a single-payer, wholly government run system and that they are using the current health care reform effort as part of a "camel's nose" effort .... hence the general distrust of even reasonable reform efforts."

The camel's nose is already inside the tent: it's called "Medicare".

My wife and I are both 55. I fully expect that without reform, at some point in the ten years while we wait to reach the magic threshold of 65, we will either (a) be denied coverage completely by the private insurance system or (b) allowed to buy restricted coverage at a price tag around 25% of household income -- more than taxes, more than housing, more than food. It happened to my father and I really expect it to happen to one or both of us.

Give me the option; let me sign up for Medicare when the time comes that the private companies "kick me out" and I'll pay 100% of the premiums until I'm 65. Just guarantee me access to a program where I can't be denied coverage and the premiums are community rated.

Single payer or even more government control than that has been the dominant Democratic story on health care for decades.

I don't know how to tell if this sentence is true. Judging by the fact that you cite zero evidence, I don't think you do either. How do you know what has been the dominant Democratic story?

I mean, this statement seems a lot like saying "killing Arabs has been the dominant Republican story regarding middle east policy for decades". There certainly are some Republicans that would love to kill Arabs. But there hasn't been a consensus on this point and there are other Republicans that kiss up to various Arab regimes (see Bush, George W making out with the king of Saudi Arabia).

Now you are free to assert that they didn't really mean it.

Your statements are too incoherent to refute. Who didn't mean what? All Democrats? Dem party leaders? Dem party activists? Dems who care about health care?

You are free to suggest that more nuanced views have come to the fore. You are free to suggest that those Democrats who say that this is merely the first step (say eric martin so I'm not accused of strawmanning) don't really count.

Well, Eric Martin does not count. He's not a Senator or a Congressman or the President. He's not a party leader. He's got no power in the Dem party.

But they do exist, and it isn't crazy to notice them.

Dems who advocate single payer certainly exist; no question about it. Some of them are even in Congress. But what's not clear is that they dominate the health care debate or that they constitute a majority of Dem leaders. When I talk with single payer advocates, they often complain (at great length, on and on and on) about how the Dem leadership refuses to take them seriously or listen to their ideas.

But support for single-payer is out in the open (see, e.g., http://www.democrats.com/single-payer-petition).

Why do you think a single petition tells us anything about how popular single payer is with the Dem leadership?

That's not to say it captures majority Democratic support (though it might). There is a perception -- and probably a fair one -- that enacting any D-sponsered health care package is going to set up a slippery slope to nationalized health care, which is the stated goal of a good number of Democrats.

What fraction is a good number? And what fraction of the Dem party leadership are counted amongst this number?

I mean, do Obama or Reid or Pelosi have long histories of strongly advocating for single payer?

But everyone likes to be irate

I resemble that remark.

Seb and von, another way of approaching the issue: can you point me to a version of the Dem party platform that calls for single payer health care? I mean, if single payer really is the dominant narrative among Democrats, surely they'd include it as a plank in their platform, right?

Sebastian, your cite of the actual poll question is useful, as it does appear to demonstrate high levels of Crazy among the Democrats. Still, it seems to me that people discussing these recent poll results seem to overlook the percentage of people who just want to tweak the pollster, or the express in the most overstated terms their revulsion for one side of the argument. Case in point: apparently the most recent poll to find huge numbers of "birthers" found that a quarter of them (6% of the total respondents) don't believe Hawai'i is a state. Now, you can take that as being accurate, or you can consider that a fair proportion of the people just wanted to wind up the pollster, and some or all of them said Hawai'i wasn't a state. Or, of course, some combination of the Crazy and the pollster-haters.

And, of course, in comparing 9/11 conspiracy theories' popularity among the Democratic base to Birfers and Deathers among the Republicans, it's always worth comparing the involvement of elected officials and prominent spokespeople on each side; the difference is quite striking. Also, the Bush administration played dirty, evil politics with 9/11 in a way I'd never seen before, for example when Bush said in 2002 that Senators concerned about evisceration of the public sector unions didn't want to defend America. The level of political exploitation of heightened fears in 2002 and 2004 was greater than anything since the Red-bashing of the McCarthyites or (regionally) the racism of the Dixiecrats, if not before. Given all that, overstated and hyperbolical sentiments about malign Republican political use of 9/11 may be more understandable, if no less defensible.

Von, you may well be right that the bills being devised are lousy. Since the Republicans in Congress are on record saying that given the chance they wouldn't vote for a bill they wrote every part of, I don't much care. Given the stance they've so obviously taken, this is no longer a public debate to which Republican spokespeople can contribute in any meaningful way, and their manifest and widespread dishonesty (death panels, anyone?) coupled with their refusal to engage in any sort of constructive debate means that any criticism they may have, even were it in fact to be insightful, cannot be taken seriously. Boy who cried wolf, and all that. Now, I'd love to see some carefully considered, detailed criticism from thoughtful Conservatives such as yourself - but you should be aware that the behavior of your theoretical standard-bearers means that no Republican of national or Congressional significance can inject ideas such as you might have into the debate.

the US government already spends enough per capita to pay for Canadian level care and more than enough for UK level care.
This is true, and important.

Moreover, I believe that it understates the scale of current federal spending on health care, because in addition to what it spends the US government also foregos a lot of tax revenue by making employment health benefits (and any remaining nonprofit hospitals) tax-exempt.

The British NHS is underfunded, and is genuinely socialist in a way that we could never manage to transition to in this country without massive upheaval if there were even the remotest chance of doing so (and while there are a few in Congress who like single-payer, I'm not aware of anyone in Congress backing single-provider like the NHS). So maybe comparison to it is a little futile. Still, it's pretty astounding that its outcomes are on the whole no worse than ours, for 40% of the cost.

I think you meant to link, perhaps, to this, Sebastian?

This was a July 6th, 2006 poll, btw.

I have to say that I don't think the notion that there were "[some p]eople in the federal government" who [...] took no action to stop the attacks because they wanted to United States to go to war in the Middle East" "are batSH!& insane"; I think it's very likely untrue, but it's still a very general assertion to debate, and doesn't require one to believe that, say, Dick Cheney personally plotted to have the WTC struck, or, indeed, that anyone at all knew anything at all about a specific strike at the WTC.

All it requires is that some person or persons at some unspecified level of government (maybe down to some low-level analyst) intentionally did some unspecified undefined thing, such as by ommission, in hopes of increasing the odds of a terrorist attack, in hopes of seeing American retaliation against some country.

That's a pretty darned generalized thing to think possible.

As such, similarly, thinking that the above is only "Somewhat likely" merely, in my mind, marks someone as a person highly skeptical about the lengths to which people in government will sometimes go to obtain their goals. It hardly need be to the point of being "a loon."

Given the actual lies and deceptions surrounding the Iraq War, or, if you prefer something less recent, the Vietnam War, or, say, innumerable direct lies during the Cold War, such as Eisenhower claiming in public, at first, that the Gary Powers U2 flight was a stray weather balloon, I don't think that people have to be loons to be generally skeptical of governmental claims.

It was my impression that conservatives, as a matter of course, were supposed to be skeptical of governmental claims.

As it happens, conservatives are skeptical when the issue is something in line with their philosophical predilections, such as suspecting that one health reform program is a Trojan Horse for another, but less so when it's not so in line, such as that someone, anyone, somewhere in a conservative Republican government would possibly not, out of patriotic motivations, do something that might involve some temporary, with unspecifically known results, harm to the U.S. to further the greater good.

But even governments led by Democrats have been known to fake up stuff like the Gulf Of Tonkin incident, or lie/convince themselves about the effectiveness of our war in Vietnam, and even former CIA officers have been known to say that:

[...] Scheuer: The only chance we have as a country right now is for Osama bin Laden to deploy and detonate a major weapon in the United States. Because it's going to take a grass-roots, bottom-up pressure. Because these politicians prize their office, prize the praise of the media and the Europeans. It's an absurd situation again. Only Osama can execute an attack which will force Americans to demand that their government protect them effectively, consistently, and with as much violence as necessary.

Beck: Which is why, I was thinking this weekend, if I were him, that would be the last thing I would do right now.

For example.

Why is it unreasonable to think that, say, a senior CIA official who now thinks this could have thought it a decade or so ago?

Sebastian: "For whatever reason, we aren't those other countries. If we were, we would already have 100% coverage over everyone, because the US government already spends enough per capita to pay for Canadian level care and more than enough for UK level care. And I raise this only for the limited point of suggesting that the comparison isn't helpful without figuring that problem out (which I don't believe any of the current proposals do)."

Excellent point. I'm willing to go out on a limb and say that the experience of the developed countries as a group suggests that there are two things you can do to slow costs: eliminate the administrative overhead inherent in a lightly regulated private insurer system, and restrict access to specialists. The overhead I'm talking about is all the staffing at both insurers and care providers whose jobs are basically to negotiate whether the plan actually covered that treatment or not, that has been estimated consistently at about 15% of total health care costs. And honestly, there are a limited number of really expensive things that a GP can do.

The US does neither of these and has the highest costs in the world. The Swiss take care of the first through regulation but not the second, and have the second highest costs. The rest of the world does both in one fashion or another and has costs another step down from Switzerland. Some countries push you to a GP first (outside of life-threatening conditions). IIRC, Germany restricts the number of specialists and where they can practice.

Your link appears to be broken; at any rate, it points back at this thread, even via "show source."
I can't believe that I get to be the one to tell Gary Farber that he could always find it for himself by Google.

In any case, when I searched for a chunk of the blockquoted text, this was the first result, and contained this link to the 2006 Scripps Howard/Ohio University poll

Sigh. Gary posted a link to the poll while I was commenting. And here I was so proud.

Some countries push you to a GP first

Isn't this already true for most Americans who are fortunate enough to have health insurance? Certainly I've never been in a plan where I could go to a specialist on my own initiative without getting my regular doctor's approval (and of course lately for me that referral is mysteriously defective about half the time, resulting in a bill and endless arguing with the insurance company bureaucracy, on one occasion to the point that I gave up and paid for something that should have been covered -- but that's what those insurance company employees are for, right?).

Isn't this already true for most Americans who are fortunate enough to have health insurance?

I've got a PPO and my wife has managed to go straight to a specialist without seeing a primary care physician. On the other hand, when I was told to see a neurologist, even though my insurance would cover it, the local neuro group refused to deal with anyone unless they were referred by another physician. The other local neuro group had a three month wait time. It sure is good that we don't have health care rationing.

I thought the ability to see a specialist without a primary care referral was one of the main selling points for PPOs. Admittedly, PPOs are not cheap and I'm sure most people are not in them.

Your mistake was in asking, "What do these people think?" They don't. Sycophancy is not about thinking, it's about spouting prepackaged nonsense to agitate and irritate. I would like someone to simply ask one of these clowns to define socialism and watch them squirm. Frank's dining room table comment was priceless.

Some countries push you to a GP first (outside of life-threatening conditions).

I participate in a household name HMO. I absolutely *am not* covered for specialist medical care without prior authorization by my GP.

Anecdota:

My wife had to reschedule a routine mammogram originally booked for the first week of August. The next time they could fit her in was late October, about 10 weeks later.

In the spring I was in my GP's office for an "emergency" (stepped on a rusty nail while tearing out some fence) and while there, booked my physical.

If I was willing to see the nurse practicioner, I could get an appointment for July.

If I wanted to see the GP, it would be November, i.e., six months later. For a physical.

It sure is good we don't have health care rationing.

You are free to suggest that those Democrats who say that this is merely the first step (say eric martin so I'm not accused of strawmanning)

Wait, I said I support single payer, but never did I say that this legislation is a first step. Not at all.

I would point out, however, that it is entirely illogical to debate the merits of single payer in the context of these bills since these bills do not create...single payer. Or even the nose of the camel.

If someone proposes a bill establishing single payer, by all means, challenge it. Otherwise, it is the definition of strawman attacks.

Further, as russel noted, single payer is an insurance system, not a health care system. So, even then, no government take over of healt care. Further, even under the single payer system, private insurers are an option, so it's something of a misnomer.

"There is a perception -- and probably a fair one -- that enacting any D-sponsered health care package is going to set up a slippery slope to nationalized health care, which is the stated goal of a good number of Democrats."

The Slippery Slope Argument is always about what "tendency" it will lead to.

It's always a question as to how reasonable an SSA is. To quote that Wikipedia entry at present:

[...] In debate or rhetoric, a slippery slope (also the thin edge of the wedge or the camel's nose) is a classical informal fallacy. A slippery slope argument states that a relatively small first step inevitably leads to a chain of related events culminating in some significant impact, much like an object given a small push over the edge of a slope sliding all the way to the bottom.[1] The fallacious sense of "slippery slope" is often used synonymously with continuum fallacy, in that it ignores the possibility of middle ground and assumes a discrete transition from category A to category B.

[...]

The argument takes on one of various semantical forms:

* In the classical form, the arguer suggests that making a move in a particular direction starts something on a path down a "slippery slope". Having started down the metaphorical slope, it will continue to slide in the same direction (the arguer usually sees the direction as a negative direction, hence the "sliding downwards" metaphor).
* Modern usage includes a logically valid form, in which a minor action causes a significant impact through a long chain of logical relationships. Note that establishing this chain of logical implication (or quantifying the relevant probabilities) makes this form logically valid. The slippery slope argument remains a fallacy if such a chain is not established.

There's a bunch more, including a helpful link to Eugene Volokh, and Nizkor.

Naturally, you will maintain that you've established "this chain of logical implication."

Let me ask a question in an attempt to clarify: Sebastian, 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?

I'm also going to throw in a quote from my blog sidebar, because naturally I wouldn't have added all those if I didn't believe they made valuable points:

"We don't live just by ideas. Ideas are part of the mixture of customs and practices, intuitions and instincts that make human life a conscious activity susceptible to improvement or debasement. A radical idea may be healthy as a provocation; a temperate idea may be stultifying. It depends on the circumstances. One of the most tiresome arguments against ideas is that their 'tendency' is to some dire condition -- to totalitarianism, or to moral relativism, or to a war of all against all."
-- Louis Menand
In any case, Sebastian, 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. (If it turns out a majority of Americans favor it, well, then you're just outvoted, of course.)

And speaking of that, it appears most Americans do favor a single-player plan, or at least have prior to the current fear-mongering. (Polls are always just snapshots of single moments in time, of course, so it's helpful to look at trends, but naturally those with preferences will choose to look at whichever supports their preference. :-)

So I'll save you the trouble of finding this one.

WT: "The level of political exploitation of heightened fears in 2002 and 2004 was greater than anything since the Red-bashing of the McCarthyites or (regionally) the racism of the Dixiecrats, if not before."

You left out the Nixon-through-Reagan exploitation of Fears Of Dangerous Angry Black Men And Youth, which continued through Willie Horton and still has enough potency to be seen, though not triumphantly, in the most recent election

You left out the Nixon-through-Reagan exploitation of Fears Of Dangerous Angry Black Men And Youth, which continued through Willie Horton and still has enough potency to be seen
I didn't overlook those, I just considered them to be less brazen and less concentrated venality. Your guess is as good as mine why we actually went to war in Iraq, maybe better, but I've never witnessed anything as evil as the open political manipulation and scheduling with reference to the fall 2002 election of Congress's debate and vote regarding war on Iraq, an issue that some might otherwise have thought to be too important for such partisan exploitation. Similarly the rest of the imputations of disloyalty and mau-mau'ing on torture, warantless surveillance, and Habeas.

So, Democrats should like this, and Republicans will also get to complain about Democrats: win-win!

Reid spokesman: Congress will pass health bill 'by any legislative means necessary'

Democrats (generally) have done a horrible, horrible job of framing the health care debate.

I think it would be a good idea for Democratic Representatives to hold open "town hall" meetings with their constituents to explain the plan and answer questions. Would that help?

It is due to racism, in short.

The (white) teabaggers look at the poor folks who are uninsured and see that they are black and brown, African-Americans and Latinos. (The teabaggers assume that all Latinos are illegal immigrants.)

They see "Health care for people not like us. Health care for invaders/bad people/social parasites," etc.

Inglewood is our health care Katrina (and it occurs on a smaller scale every day). The teabaggers are the good folk of Gretna, LA who met the New Orleans refugees with guns.

I might qualify as one of those batSH!& insane Truthers, by Sebastian's standards.

"People in the federal government took no action to stop the attacks"

-- The "Bin Laden Determined to Strike in U.S." memo makes this IMHO a matter of historically record.

"they wanted to United States to go to war in the Middle East."

-- the Project for the New American Century (signatories to whose Statement include Cheney, Rumsfeld, Wolfowitz, and Libby) makes this, also, a matter of historical record.

Does that mean they did it "because"? Not in a planned, strictly-speaking way, *necessarily*, they might just have ignored the Al Quaeda threat because they wanted to go to war in the Middle East -- and Iraq, specifically -- and preventing an Al Quaeda attack did not serve that goal.

So: they failed to protect the country; they wanted war in Iraq. The country was attacked; we went to war in Iraq (though Iraq had not attacked us). Conscious conspiracy? I doubt it. Letting things just sort of happen to get the result they wanted? Not unlikely.

I'm not sure why conservatives would be worried that a public option is the camel's nose for single payer. After all, if what the conservatives say is true, then the public option will be a bureaucratic, expensive disaster that everyone will hate and therefore nobody will dare go on record for a single-payer plan, right? Unless the real threat is that it may succeed, and people may start wondering why we pay a lot of money for a bunch of insurance companies who end up doing nothing except pocketing billions of dollars per year to cut a bunch of checks?

As for 9/11, my opinion is that Bush did nothing because counterterrorism was a Clinton thing, and therefore was stupid and bad and weak and girly. I believe Rice's planned speech for that day was on how Russia was the primary future threat for the US. However, the idea that the administration would let a minor bomb or hijacking happen to cement their political goals wasn't a totally crazy idea either, since it had crossed the DoD's mind before.

It is no coincidence that other Anglo-Protestant nations and Northern European Protestants have healthy Social Welfare States, while South Africa and the United States, used their Protestantism to demonize the Other. (You know, Protestant work ethic and all that.)

The folks at VDARE keep reminding us that it is only “natural” to want to help your own.

">http://vdare.com/macdonald/081125_ethnocentrism.htm"> White Ethnocentrism: Can Americans Really Be Brainwashed? By Kevin MacDonald

Conservatives tend to be on the side of nature:

Race exists as a biological reality; there are race differences in socially important traits like IQ; people’s brains are wired to prefer people like themselves; they are more likely to contribute to public goods like health care and education if the beneficiaries are of the same ethnic group; people trust others more if they live in homogeneous societies.

The left takes the opposite tack:

Race doesn’t exist; the idea that it does exist is a fantasy of moral reprobates. To the extent that differences in traits like IQ are interesting at all, they are the result of capitalism, discrimination, or general evil. If it weren’t for white people behaving badly, we could easily build a strong, racially diverse multicultural society where all people can live happily ever after.

"I can tell you the real motivation is -- it's simply to help people get affordable health care"

Sorry Eric but you can't tell me what the real motivation is beyond yours, which I gladly recognize and agree with. it's mine also.

Everyone who can actually make it happen has much more complex mixed motivations than that.

"A certain percentage of the Democratic party would like a single-payer, wholly government run system and that they are using the current health care reform effort as part of a "camel's nose" effort...."

Even if this were true, how does it get you even remotely close to the fear of Obama becoming another Hitler?

"President Obama (specifically) and the Democrats (generally) have done a horrible, horrible job of framing the health care debate."

You know, it's pretty hard to frame a debate when your opponent is willing to propagate "death panel" level lies, while you're trying to stick to some semblance of truth. It's asymmetric warfare, like trying to fight people who are willing to blow themselves up in a crowded marketplace.

Every time Seb trots out his favorite statistic, I will trot out mine. It's a mutual suicide pact.

Yes, we already spend about twice as much per capita as Canada does. But we already buy 10% more physicians per capita with it.

So there are two separate issues here. The first is, why are we stupid enough to pay twice as much for only 10% more physicians? The second is, why are we stupid enough to leave people without health care (which physicians, not insurance companies, provide) even though we have 10% more physicians per capita to go around?

The US system for financing health care sucks. It's a make-work program for file clerks, CEOs, and actors in boner pill commercials, to name but a few. To "cut spending" we'd have to reduce the incomes of such people. (There's no way to spend money without that money being income to somebody.) I think it would be a good idea to cut the incomes of those people, but I'm a heartless bastard.

Nonetheless, "cutting spending on health care" is only my second priority. My first priority is to save rich and/or well-insured people from needless "health care". Doctors have to eat; they get to prescribe their own services; they prescribe them to people who can pay, rather than to people who need them. Our 2.3 physicians per 800 or so insured people obviously have to find things to do to those 800 people; more things than 2.1 physicians per 1000 Canadians have time to do to Canadians. That's probably why Canadians live longer.

With a better health care financing system, our 2.3 physicians per 1000 people would be able to provide people like Gary with needed care -- i.e. get paid for it. I don't really care that our "system" hires lots of non-physicians at great expense just to make free-market fetishists or big-government-bureacracy lovers happy.

Incidentally, the reason why "health care" is not the same kind of commodity as Diet Coke, say, should be obvious to anybody who hates going to the dentist. I don't know about Seb, but I would not feel motivated to visit my doctor more often if he dropped his prices.

--TP

Physicians’ Views On Quality Of Care: Five-Country Comparison

Health Spending In The United States And The Rest Of The Industrialized World

Health care in Canada

Health Care Elsewhere: How Health Care Works in Other Countries

"Yes, we already spend about twice as much per capita as Canada does. But we already buy 10% more physicians per capita with it.'

and each of ours cost about 100k a year (33%) more in real dollars. So physicians cost (struggling with my math) 40% more per capita, which is some percentage of the overall health cost difference. In fact, 1 in 9 doctors that graduate in Canada come to the US because of the higher salaries.

"Incidentally, the reason why "health care" is not the same kind of commodity as Diet Coke, say, should be obvious to anybody who hates going to the dentist. I don't know about Seb, but I would not feel motivated to visit my doctor more often if he dropped his prices."

Actually the statistics say that the better the insurance plan, the more often people go to the doctor, they have more tests etc. With higher deductibles all those numbers go down. (and no I can't provide the report, although I tried to find it in more public stats)

"Actually the statistics say that the better the insurance plan, the more often people go to the doctor, they have more tests etc."

What you neglect to address is if it's primarily the patient pushing this, or the doctor. It's the doctor's job to be the gatekeeper in suggest unnecessary tests not be done, rather than to be eager to suggest more tests be done because the doctor will get a kickback. Again, see Gawande.

Actually the statistics say that the better the insurance plan, the more often people go to the doctor

Two possible interpretations of these "statistics": people with worse insurance plans (or none) don't get to go to the doctor as often as they need to; or, people with better insurance plans go the the doctor the way some people go to the opera: they actually enjoy the experience.

--TP

I know there are people that visit the doctor more often than strictly necessary because of "I have paid, now I want to use the services" or because their doctor gives them the warm and fuzzy feeling that they have someone's full and positive attention*
On the other hand I know people that do not go to the doctor because of the 10€ they have to pay per quarter, if they go (and that was the main reason for the introduction of that fee btw). Given my (completely non-professional) views of US mentality, I'd say that these factors are a good deal stronger in the US than over here making it a valid argument in the debate.
---
Reagan was once the main spokesperson in the fight against the slippery slope to socialism that was Medicare.
I hope http://www.youtube.com/watch?v=6FzNTB1qtFA>this is the right clip (the one about a future when parents try to tell their children how it was when America was still free**)


*there is a certain similarity to people that visit prostitutes primarily to talk not because of the sex.
**i.e. a world where medicare was not introduced in the first place.

I shouldn't let my patriotism get into this debate, but since Sebastian wrote

...the US government already spends enough per capita to pay for Canadian level care...
Expressions such as "Canadian level care" suggest that Canadians actually receive less effective health care than Americans. I can only assume the thinking behind such a phrase goes like this: since a private system must, as a matter of first principles, work better than a public one, and since Americans pay so much more than Canadians, they must get better results. But in fact the data suggest the opposite; Canadians have a lower infant mortality rate and greater life expectancy than Americans. And when it comes to actual care, in the sense of response to needs, both systems have their flaws. I have written in another topic about the time I had a painful problem while living in the US. Although I had one of the best rated insurance plans going, my primary care provider pleaded in vain for a specialist to see me; they just had no appointments. Conversely, in Toronto, I once got an MRI in two days.

Carelessly letting a phrase such as Canadian level care slip by, despite the lack of actual evidence for it, allows inaccuracies to creep into the debate. And, frankly, it annoys me by slandering a highly successful and sustainable medical insurance system.

"What you neglect to address is if it's primarily the patient pushing this, or the doctor. It's the doctor's job to be the gatekeeper in suggest unnecessary tests not be done, rather than to be eager to suggest more tests be done because the doctor will get a kickback. Again, see Gawande."

Good point, I have an opinion that it is a combination of going to the doctor for a cold "just to be sure" and the doctors per Gawande. In both cases having the insurance causes the extra cost. No facts though.

"Carelessly letting a phrase such as Canadian level care slip by, despite the lack of actual evidence for it, allows inaccuracies to creep into the debate"

John,

Having been round this debate several times with Seb, I suspect Canadian level care is a numbers covered reference not a quality one.

John, I think your patriotism is making you oversensitive. Sebastian has for some time been comparing the amount the US spends per capita on health care to what Canada spends. His reference to "Canadian level care" referred to that spending, and I don't believe it implied anything about the quality of the care one way or another.

One point in this whole perspective thingy that can't be denied - it sounds silly and simplistic and all, but here it is: for those who are hand-wringing over health care rationing, well, gosh, we already have it. If you don't have insurance, you won't get any care of any kind, except in an ER, which is only ever a stop-gap.

I'll repeat it one more time: we already ration health care. The difference between us and every developed nation with a comprehensive system of some kind (single-payer, single-provider, or such) is that we do so in the most irrational and inhumane way possible, while they do it...okay, the gurgling is audible...rationally and, relatively speaking, humanely.

Even I take a deep breath at that, but I can't escape the fact that rationing of services and resources is going to be unavoidable at some level. What our system (which, when it comes down to it, really isn't a system as such - it's a market, pure and simple) is having the effect of is postponing the recognition of that fact, and while the end result of it would actually look more like death panels and such given the way the market alternately dictates and strangules services and resources, we don't have to wait around for it because it's happening already and we're pretending not to notice it.

If you look at other countries...can anybody find any evidence whatsoever that someone's nana in the UK is being hovered over by an NHS eugenics committee? Or that frumpy old hausfraus in Germany and Austria are being wheeled out gasping because the oxygen tanks are being prematurely unhooked? Or that obaachans in Japan are being left out in the bamboo forests because the system won't cover them anymore? As preposterous as this sounds, the fact remains that these scenarios are much more likely to happen in the U.S. than anywhere else.

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