Tuesday, August 26, 2008

The Human Toll of Republicanism

Ezra Klein writes about the real-world ramifications of a McCain victory:
It's almost inarguable that a McCain presidency will push policies leading to an increase in illness and homelessness. Last year, McCain voted against expanding S-CHIP, which would have extended pubic health insurance to millions of currently uninsured children. Many of those children will become sicker than they would have if they'd been able to access a doctor early in their illness. Some may well die. In 1995, McCain voted for a GOP plan to balance the budget by cutting Medicaid by $182 billion over 10 years. Many adults would have been tossed off the rolls, been incapable of accessing a doctor, and fallen ill, or even died as unchecked hypertension led to cardiac arrest or a small lump grew into a full-body cancer. You can find similar examples of McCain trying to chop apart the safety net in almost every year of voting since.

...

There's a tendency to want to sugarcoat the outcomes of elections. You can say you disagree with McCain's policies because universal health care is important and humane and social programs are just and decent and upper-crust tax cuts are regressive and shameful and he's on the other side of all those opinions. What you're not supposed to say is that if John McCain is elected, the policies he has signaled he will pursue will harm the country's health, defund its safety net, lead to untreated illnesses, reduce mitigation of the ravages of poverty, and, in many cases, the outcome will be sickness and death and homelessness and, for those cut off from health coverage and help, probably hopelessness, too. McCain, for his part, would argue that even so, tax cuts are a matter of fairness and it's more important that health insurance is primarily private than that health insurance is actually accessible. And fair enough. But no reason we should ignore the implications of that philosophy.

It's easy to forget the real human cost of the right's political philosophies. They have a rationalization for everything -- progressive taxation is a priori immoral, higher taxes will kill the economy, universal health care will kill the economy, etc. -- but when you put their rationalizations on one side of the scale and the reality of those who will suffer as a direct and inevitable result of their policies, you've got to be awfully confident in the rationalizations for it to balance out.

When they make predictions that fly in the face of experience -- such as the claim that returning the tax code to Clinton's levels will kill the economy -- you really have to question their calculus.

23 comments:

Holy Hyrax said...

>When they make predictions that fly in the face of experience -- such as the claim that returning the tax code to Clinton's levels will kill the economy -- you really have to question their calculus.

I think this is more based on experience than a prediction. So for example, when Obama said he would raise the capital gains tax, Charlie Gibson mentioned to him that it has been the experience (and economists) from every other president in the last 40 years or so to always lower it, helping the economy.

Orthoprax said...

JA,

I don't think Republicans favor not helping children or people in need - they just don't think it's the government's place to do so, for various reasons. Number one on the list today is probably because the current policies are bankrupting the country.

Medicare/Medicaid plus welfare and social security cost the federal government more than everything else combined. And there's only every indication that the populations those programs serve will only grow while there's no expectation for the taxable population to even remotely keep pace. It's simply unsustainable for America to keep trying to live outside of its means.

Comrade Kevin said...

I heard an interview with an economic weighing the pros and cons of McCain and Obama's health care plans.

I favor Obama's, of course, but I wonder where we'll get the money to pay for it.

Anonymous said...

perhaps we can add another 5-10% tax hike to pay for it? I mean, you do like helping people right? You surely can afford it.

CyberKitten said...

We normally get the government we deserve. Do you deserve another 4 years of Republican rule? Does the world deserve that?

G said...

2 Q's-

a)do you really think if the outcomes would be that horrible the public would sit by and let it happen?

b)are there any policies on the left that would have negative outcomes?

Jewish Atheist said...

a)do you really think if the outcomes would be that horrible the public would sit by and let it happen?

Yes.

b)are there any policies on the left that would have negative outcomes?

Yes.

David said...

Sure, nationalized healthcare will be great! We're already benefitting from Canada's nationalized healthcare-- a large number of their physicians have moved to the United States!

Naturally, the shortage of physicians which results from socialized medicine feeds into the little business of patients having to wait a few years for medically necessary procedures, or not being able to get the rationed drugs they need... all benefits of the wonderful socialism you're preaching.

Think about it-- it's a given that we can't afford endless treatment for all people, right? In this country, right now, you get what you pay for. Once the socialists take over, you will get what the government decides you're entitled to, and not a bit more (Hillary's old plan would have made it a crime to obtain private medical care).

Why not compare the survival rate for cancer, or the availability of drugs for an average UK citizen to the same stats for an American? How long do you wait to see a specialist from the time of referral for needed treatement? In Canada, it's now more than 3 months.

Frankly, left-wing nut-jobs who insist that I should not only pay for my health care and that of my family, but that I subsidize it for everybody else (thus ruining it for myself in the process) really irritate me. You have no clue as to the consequences of what you're seeking.

Orthoprax said...

David,

"Frankly, left-wing nut-jobs who insist that I should not only pay for my health care and that of my family, but that I subsidize it for everybody else (thus ruining it for myself in the process) really irritate me."

Newsflash: you do that already! The saving grace of a national health plan would be in obviating Medicare/-caid. And by providing regular care for the uninsured it ends up being less expensive because then they don't as readily get so ill that they need to be admitted to the hospital for an expensive stay.

You're already paying for their medical care. You're just doing it in a wasteful, inefficient, and health-damaging way. Government spending (which you pay for) on medical care is already proportionally the same size or larger than those well known socialized systems in Europe. And then, on top of that, you also pay for your own care. Basically you're paying twice as much for a system that doesn't provide good care to as many people as those socialized systems cover.

For decades, the question in America hasn't been whether to socialize the medical system but really just how to organize it.

G said...

>a)do you really think if the outcomes would be that horrible the public would sit by and let it happen?

>>Yes.

So the left would just sit by and watch it happen?

>b)are there any policies on the left that would have negative outcomes?

>>Yes.

Fair enough, when can we expect to see that post?

Jewish Atheist said...

david:

We're talking about slightly more universal coverage, not switching to socialist medicine.


g:

So the left would just sit by and watch it happen?

Probably. We didn't do much when Bush vetoed SCHIP.

Fair enough, when can we expect to see that post?

Actually, that's a good idea for a post. I'll start thinking.

Ezzie said...

you've got to be awfully confident in the rationalizations for it to balance out.

Doesn't this show that unless one claims that Republicans are the epitome of all that is evil and cruel, they actually believe in what they're saying? More importantly, would they believe in it when it's so much easier to just take the other side and think of one's self as virtuous, if it were NOT true?

When they make predictions that fly in the face of experience -- such as the claim that returning the tax code to Clinton's levels will kill the economy -- you really have to question their calculus.

I'm curious how claiming that returning to Clintonian levels would kill the economy flies in the face of experience, especially when one considers we've never tried returning to such levels before.

I look forward to the post G asked about!

Jewish Atheist said...

Ezzie:

Doesn't this show that unless one claims that Republicans are the epitome of all that is evil and cruel, they actually believe in what they're saying? More importantly, would they believe in it when it's so much easier to just take the other side and think of one's self as virtuous, if it were NOT true?

Oh, I'm sure the rank and file believe in what they're saying. (The Bill Kristols and Rush Limbaughs of the world are knowingly lying/stretching.)

I'm curious how claiming that returning to Clintonian levels would kill the economy flies in the face of experience, especially when one considers we've never tried returning to such levels before.

That's an odd distinction. We've been at that level before, but we haven't returned to it before? Why would returning to it be catastrophic if it worked great the first time we were there.

I look forward to the post G asked about!

Yeah, yeah, I'm thinking about it. Maybe you could inspire me by doing the same in reverse. :-)

David said...

"Newsflash: you do that already!"

Newsflash back at you: no, I don't. I have to pay for healthcare for a percentage of the population, like those on Medicare, etc. Try multiplying those benefits out for everybody in the country. It doesn't work-- at least, not on my salary. And, especially not with the "wasteful, inefficient, and health-damaging way" that it's being managed. Of course, it's safe to assume that, once the government takes over the rest of our health care system, they'll do a really great job, right?

Seriously, do you really believe this stuff you're pushing?

Orthoprax said...

David,

"Newsflash back at you: no, I don't. I have to pay for healthcare for a percentage of the population, like those on Medicare, etc."

Yes you do! There is a federal law on the books that if a person walks into any emergency room requesting medical care he is given care no matter what his insurance status. And when people are using the ER as their primary source of care and/or wait until they're sick enough that they need to be admitted - that is hugely expensive. Who do you think pays for it? Here's an example: an untreated UTI which costs pennies to treat as an outpatient can turn into a (no kidding) $30,000 admission if the patient is untreated and turns septic.

It's much cheaper if people can see a regular doctor before they get that sick. Better for their health and better economically.

"Of course, it's safe to assume that, once the government takes over the rest of our health care system, they'll do a really great job, right?"

Heh, no. Probably not. But it will likely be better than the current system. The way it is now is just stupid.

tommy said...

I'm curious if Jewish Atheist believes taxation ever hits immoral levels? 100% taxation on an individual is de facto slavery to the voting majority (not to mention a serious disincentive to work). Is there any moral limit to taxation?

Of course, Klein and JA cannot be bothered to factor in the human costs of taking 30% of a working family's income once or twice a month -- some of that to be distributed to people who don't feel like working for a living. But hey, that's just an abstraction to people from non-prole backgrounds. They also seem dismissive of the idea that taxation might act as a disincentive in job creation. It's unthinkable to them that a government not providing any assistance when a business loses money, but effectively punishing a business by seizing profits might actually impact the availability of jobs and, ultimately, the prevailing wages for those jobs.

tommy said...

Yes you do! There is a federal law on the books that if a person walks into any emergency room requesting medical care he is given care no matter what his insurance status. And when people are using the ER as their primary source of care and/or wait until they're sick enough that they need to be admitted - that is hugely expensive. Who do you think pays for it? Here's an example: an untreated UTI which costs pennies to treat as an outpatient can turn into a (no kidding) $30,000 admission if the patient is untreated and turns septic.

Do you have any actual statistics to back up the claim that the current system is more expensive than the alternative? You can point to an extreme example, but unless you can demonstrate the prevalence of such examples in the current system versus an alternative one, then your example remains meaningless.

Have you considered the reality that free health care means that people will be free to visit their doctors far more often than they did previously over ailments that aren't at all serious? Even minor visits to the doctor tend to be rather expensive.

Orthoprax said...

Tommy,

"Do you have any actual statistics to back up the claim that the current system is more expensive than the alternative?"

Would you like to compare different national systems? Let's take France - the US government *already* pays more per capita towards healthcare than does the French government. Altogether, public + private spending in the US is double per capita that of France. And France's system covers everybody while the US still leaves tens of millions out of the loop.

The tuth is that the American health system is very procedure emphasized. Another example: we have the highest rates of coronary revascularizations, by a very wide margin, but among the lowest doctor visits per capita. Instead of treating people when they're young and their blood pressure and/or cholesterol can be controlled for minor cost, we seem to prefer waiting until they need stenting or bypass surgery at huge cost.

Naturally the health system is very complicated and there are other things that drive up costs in the US - like administrative overhead (something else that could be minimized through a national system), the fact that we subsidize medications for the rest of the world, and that our overly litigious society promotes wasteful defensive medicine. But it bothers me to no end that we spend twice as much as countries like France and Canada and Britain and we can't provide good care to everyone whom they provide care.

"Have you considered the reality that free health care means that people will be free to visit their doctors far more often than they did previously over ailments that aren't at all serious?"

Yes, and it's largely a bogus argument. As long as people aren't paying significantly out of pocket per visit (which is the case for the overwhelming number of plans) then no matter what insurance plan you have it encourages more frequent visits because people want to get their money's worth.

tommy said...

Would you like to compare different national systems? Let's take France - the US government *already* pays more per capita towards healthcare than does the French government. Altogether, public + private spending in the US is double per capita that of France. And France's system covers everybody while the US still leaves tens of millions out of the loop.

OK. Let us compare different health care systems. Just so we are on the same footing, I would recommend this article first.

tommy said...

Yes, and it's largely a bogus argument. As long as people aren't paying significantly out of pocket per visit (which is the case for the overwhelming number of plans) then no matter what insurance plan you have it encourages more frequent visits because people want to get their money's worth.

You're assuming that everyone deserves to have insurance. Most of the people who will be receiving subsidized health care are precisely those people who cannot afford insurance and, thus, will not be paying into the system what they take out. In other words, the onus is on the rest of us to pay for these people -- including a rapidly growing underclass of Hispanics who are already a net burden on the taxpayers and, due to low IQs, will remain so generation after generation.

If you want European-style health care, you would be well advised to first have European-style demographics. As this country lurches toward a majority Third Worlder population, your scheme will become increasingly unaffordable.

Orthoprax said...

Tommy,

I fail to see how that article responded to my basic argument that making regular healthcare available to all would serve to decrease costs through cheaper, early interventions. It talks about wait lists in Canada, but in America there are classes of people who would simply never be able to get the care they need.

I have no problem with a two-tiered system. I'm not arguing for socialized medicine. I just want to see people have the basic coverage they need.

"You're assuming that everyone deserves to have insurance."

I don't think I'm assuming anything. I do think people should be able to access the care they need.

"Most of the people who will be receiving subsidized health care are precisely those people who cannot afford insurance and, thus, will not be paying into the system what they take out."

That's true, but that wasn't your earlier point. Frivolous doctor visits are a minor concern through the whole insurance-based payment system and would not be especially problematic with widespread public assistance.

"In other words, the onus is on the rest of us to pay for these people -- including a rapidly growing underclass of Hispanics who are already a net burden on the taxpayers and, due to low IQs, will remain so generation after generation."

Oh, I didn't realize you were a racist. I guess you figure those Hispanics just deserve to die, huh?

tommy said...

I fail to see how that article responded to my basic argument that making regular healthcare available to all would serve to decrease costs through cheaper, early interventions.

Your argument was that health care was better in other countries than it is here. The article makes a few points worth considering: (1) longevity rates between countries differ for reasons other than health care availability and when those variables are taken into account, the differences aren't as significant as might be assumed; (2) Americans have a higher GDP and, therefore, more money to spend on more expensive medicines and electoral procedures than other countries; (3) the availability of certain drugs and, consequently, the survival rates for certain serious illnesses is reduced in those countries with socialized medicine; (4) those other countries do not spend nearly as much on research and development as the United States does.

Oh, I didn't realize you were a racist. I guess you figure those Hispanics just deserve to die, huh?

If, by racist, you mean that I believe there are real and important cognitive differences between races that result in different educational and socioeconomic outcomes, then, yes, I am a racist.

I'm saying we cannot afford government-run health care over the long term. A nation that is minority white by 2050 is not going to be able to afford a lot of things short of massive and debilitating tax hikes. (Unless, of course, we find practical ways to enhance intelligence by that point. That's very possible, but I wouldn't gamble our nation's future on it.) Worse, the white population is going to become increasingly geriatric. You choose to ignore racial differences in IQ at your descendants' peril.

Orthoprax said...

Tommy,

"Your argument was that health care was better in other countries than it is here."

No, my argument was that the healthcare was of comparable quality for half the price. My argument was for half the price they manage to cover all of their people with similar care.

"longevity rates between countries differ for reasons other than health care availability.."

True, but I'm not sure how you can explain away infant mortality rates which place America at number 26 in the industrialized world. There are serious shortcomings in the American system.

"Americans have a higher GDP and, therefore, more money to spend on more expensive medicines and electoral procedures than other countries"

Marginal impact.

"the availability of certain drugs and, consequently, the survival rates for certain serious illnesses is reduced in those countries with socialized medicine"

You're referring to cancer, right? If you actually read the Concord study you'd see that the US is only at the top of half of the four studied cancers and only then by a tiny margin, except for prostate cancer which America does show a solid lead.

"those other countries do not spend nearly as much on research and development as the United States does."

True. But all the same, I want to see more bang for our buck. I'm ok with paying twice as much as a nation if the people of this nation actually get that significant a return.

"I'm saying we cannot afford government-run health care over the long term."

That's nice, but I haven't been talking about government-run healthcare. I've been talking about publically subsidized basic medical care for those who cannot otherwise afford it. This is a compensation issue, not a health management issue.

We're already paying for their care - but in the form of inefficient and expensive ER visits and inpatient stays which raise medical costs and taxes. I think something like 55% of emergency services in this country are uncompensated. You are already paying the difference.

"A nation that is minority white by 2050 is not going to be able to afford a lot of things short of massive and debilitating tax hikes."

I guess we should increase our proportion of Asian immigrants to this country. They're smarter than white folks are, right?