Socialism: Converting Hysterical Misery into Ordinary Unhappiness for a Hundred Years

by Corey Robin on December 10, 2013

In yesterday’s New York Times, Robert Pear reports on a little known fact about Obamacare: the insurance packages available on the federal exchange have very high deductibles. Enticed by the low premiums, people find out that they’re screwed on the deductibles, and the co-pays, the out-of-network charges, and all the different words and ways the insurance companies have come up with to hide the fact that you’re paying through the nose.

For policies offered in the federal exchange, as in many states, the annual deductible often tops $5,000 for an individual and $10,000 for a couple.


Insurers devised the new policies on the assumption that consumers would pick a plan based mainly on price, as reflected in the premium. But insurance plans with lower premiums generally have higher deductibles.


In El Paso, Tex., for example, for a husband and wife both age 35, one of the cheapest plans on the federal exchange, offered by Blue Cross and Blue Shield, has a premium less than $300 a month, but the annual deductible is more than $12,000. For a 45-year-old couple seeking insurance on the federal exchange in Saginaw, Mich., a policy with a premium of $515 a month has a deductible of $10,000.


In Santa Cruz, Calif., where the exchange is run by the state, Robert Aaron, a self-employed 56-year-old engineer, said he was looking for a low-cost plan. The best one he could find had a premium of $488 a month. But the annual deductible was $5,000, and that, he said, “sounds really high.”


By contrast, according to the Kaiser Family Foundation, the average deductible in employer-sponsored health plans is $1,135.


It’s true that if you’re a family of three, making up to $48,825 (or, if you’re an individual, making up to $28,725), you’ll be eligible for the subsidies. Those can be quite substantive at the lower ends of the income ladder. But as you start nearing those upper limits (which really aren’t that high; below the median family income, in fact), the subsidies start dwindling. Leaving individuals and families with quite a bill, as even this post, which is generally bullish on Obamacare, acknowledges.


Aside from the numbers, what I’m always struck by in these discussions is just how complicated Obamacare is. Even if we accept all the premises of its defenders, the number of steps, details, caveats, and qualifications that are required to defend it, is in itself a massive political problem. As we’re now seeing.


More important than the politics, that byzantine complexity is a symptom of what the ordinary citizen has to confront when she tries to get health insurance for herself or her family. As anyone who has even good insurance knows, navigating that world of numbers and forms and phone calls can be a daunting proposition. It requires inordinate time, doggedness, savvy, intelligence, and manipulative charm (lest you find yourself on the wrong end of a disgruntled telephone operator). Obamacare fits right in with that world and multiplies it.


I’m not interested in arguing here over what was possible with health care reform and what wasn’t; we’ve had that debate a thousand times. But I thought it might be useful to re-up part of this post I did, when I first started blogging, on how much time and energy our capitalist world requires us to waste, and what a left approach to the economy might have to say about all that. It is this world of everyday experience—what it’s like to try and get basic goods for yourself and/or your family—that I wish the left (both liberals and leftists) was more in touch with.


The post is in keeping with an idea I’ve had about socialism and the welfare state for several years now. Cribbing from Freud, and drawing from my own anti-utopian utopianism, I think the point of socialism is to convert hysterical misery into ordinary unhappiness. God, that would be so great.


• • • • • •


There is a deeper, more substantive, case to be made for a left approach to the economy. In the neoliberal utopia, all of us are forced to spend an inordinate amount of time keeping track of each and every facet of our economic lives. That, in fact, is the openly declared goal: once we are made more cognizant of our money, where it comes from and where it goes, neoliberals believe we’ll be more responsible in spending and investing it. Of course, rich people have accountants, lawyers, personal assistants, and others to do this for them, so the argument doesn’t apply to them, but that’s another story for another day.


The dream is that we’d all have our gazillion individual accounts—one for retirement, one for sickness, one for unemployment, one for the kids, and so on, each connected to our employment, so that we understand that everything good in life depends upon our boss (and not the government)—and every day we’d check in to see how they’re doing, what needs attending to, what can be better invested elsewhere. It’s as if, in the neoliberal dream, we’re all retirees in Boca, with nothing better to do than to check in with our broker, except of course that we’re not. Indeed, if Republicans (and some Democrats) had their way, we’d never retire at all.

 

In real (or at least our preferred) life, we do have other, better things to do. We have books to read, children to raise, friends to meet, loved ones to care for, amusements to enjoy, drinks to drink, walks to take, webs to surf, couches to lie on, games to play, movies to see, protests to make, movements to build, marches to march, and more. Most days, we don’t have time to do any of that. We’re working way too many hours for too little pay, and in the remaining few hours (minutes) we have, after the kids are asleep, the dishes are washed, and the laundry is done, we have to haggle with insurance companies about doctor’s bills, deal with school officials needing forms signed, and more.


What’s so astounding about Romney’s proposal—and the neoliberal worldview more generally—is that it would just add to this immense, and incredibly shitty, hassle of everyday life. One more account to keep track of, one more bell to answer. Why would anyone want to live like that? I sure as hell don’t know, but I think that’s the goal of the neoliberals: not just so that we’re more responsible with our money, but also so that we’re more consumed by it: so that we don’t have time for anything else. Especially anything, like politics, that would upset the social order as it is.

…We saw a version of it during the debate on Obama’s healthcare plan. I distinctly remember, though now I can’t find it, one of those healthcare whiz kids—maybe it was Ezra Klein—tittering on about the nifty economics and cool visuals of Obama’s plan: how you could go to the web, check out the exchange, compare this little interstice of one plan with that little interstice of another, and how great it all was because it was just so fucking complicated.

I thought to myself: you’re either very young or an academic. And since I’m an academic, and could only experience vertigo upon looking at all those blasted graphs and charts, I decided whoever it was, was very young. Only someone in their 20s—whipsmart enough to master an inordinately complicated law without having to make real use of it—could look up at that Everest of words and numbers and say: Yes! There’s freedom!

That’s what the neoliberal view reduces us to: men and women so confronted by the hassle of everyday life that we’re either forced to master it, like the wunderkinder of the blogosphere, or become its slaves. We’re either athletes of the market or the support staff who tend to the race.

That’s not what the left wants. We want to give people the chance to do something else with their lives, something besides merely tending to it, without having to take a 30-year detour on Wall Street to get there. The way to do that is not to immerse people even more in the ways and means of the market, but to give them time and space to get out of it. That’s what a good welfare state, real social democracy, does: rather than being consumed by life, it allows you to make your life. Freely. One less bell to answer, not one more.

{ 186 comments }

1

Shelley 12.10.13 at 3:16 pm

As Howard Dean said with a smile, he just enrolled in Medicare. Took ten minutes.

Single. Payer. System.

2

Steve LaBonne 12.10.13 at 3:25 pm

I’m with you, Shelley, as are many others. So how do we get there politically?

3

Rob in CT 12.10.13 at 3:25 pm

Ack. A long post just got eaten.

Short version: yes, yes, single payer > ACA. Granted.

A large % of the population (~70% I think) is insured via employer-provided insurance. There tends not to be a ton of choice there. For instance, my company has you pick between 3 plans (Blue Cross Blue Shield PPO, United Healthcare, High-Deductible Plan). You can select a healthcare spending account or not. You can select a healthcare savings account (new option, woohoo) if you pick the HD plan. Dental or not. Vision or not.

That’s reality for many of us, and it’s a big reason why we got the ACA and not single-payer. Suboptimal? Fer sure. I still think it’s an improvement.

4

Rob in CT 12.10.13 at 3:33 pm

Hmm. Maybe I shouldn’t have done the short version. To add on:

Many people, like me, support the ACA while preferring a simple single-payer system. Getting there from here is the problem. If we’d gone SP back in 1945… ah, the path not taken. Instead, we went down the employer-provided private insurance route (except for seniors, the military & the very poor). Now it’s entrenched. You’ve got a large industry and a lot of money tied up in it. Of course they’ll fight to stay alive. And it’s not just the insurers. The hospitals and, frankly, doctors, are enriched by the current system. When people talk about getting people affordable care, at some point you can’t ignore that it means hospitals & docs and pharma companies taking a haircut.

Also, people resist change, right? The ACA is a change, but much less so than junking the the whole shebang and going with Medicare for All. I happen to think the change would be largely good, and therefore desirable, but convincing others of that while the entrenched interests are doing everything they can to scare them is not a small task. Thus the political decision to basically co-opt the interests instead.

5

geo s 12.10.13 at 3:51 pm

More important than the politics…

I think you are trying to posit that it’s possible to make a popular argument against an ideology: “neoliberalism,” by saying that it makes life annoying and difficult. But, you are really making an argument here about rhetoric rather than ideas: do you really think the left “wins” arguments in this day and age by reframing politics as an argument about ideology?

The problem with the ACA has always been that it split the left along “pragmatists” vs. “radicals” lines… it’s that “Groundhog Day” which never seems to end. And the thing about that is that, the Massachusetts model (from which the ACA draws a lot) was very much a product of the politics in MA, at the time, which had a strong “single-payer” constituency that needed sandbagging. If you look at the way the ACA is built, through basic constituency politics you see that much of the complexity results from the imperative to maintain wedges between groups of people: self-funding upper middle classes, employees, working poor and “charity cases”… which is not accidental.

The argument which needed to be countered was not that the ACA would be annoying and difficult, but the mistaken belief of left-pragmatists that it would lead to something better, when in fact it was built as a firewall against deeper reform (or replacement) of the health-care markets.

(and I say this as someone who think a true single-payer system would be a policy disaster in the US… we actually desperately need to build a parallel system more like the NHS: primary medical care is collapsing as an economically viable activity in the US right now and trying to mess with price controls systemwide (ala Medicare) is setting the left up for failure, given the size, complexity and various opposition groups within the US health care industry)

6

Corey Robin 12.10.13 at 3:56 pm

“you are really making an argument here about rhetoric rather than ideas”

I have no idea what that means.

7

David J. Littleboy 12.10.13 at 3:57 pm

But enrolling in ACA insurance is, in one big way, easier than it used to be for pre-ACA insurance: Your medical history/condition is simply not part of the process. (Except for age and smoking; but they can’t turn you down; they have to issue a policy.) That’s a lot of information you had to get right, or you might find you’re not insured. If you get accepted for a policy at all: “preexisting conditions” is something that exists nowhere else in the industrialized world.

Re: High deductibles. Health care cost in the US is a friggin outlier: it’s twice as expensive as anywhere else, three times more so than Japan (which gets better results). So paying for it takes a lot of money, either as premiums or as deductibles. Other countries put price controls on medical services, and keep prices sensible. We don’t, and our prices aren’t sensible. Single payer, if done the way Japan does it (with draconian price controls, YAY!) can bring prices down. I don’t think the doctors would like it though: here in Japan, when a Japanese MD’s doppelganger in the states buys a luxury car, the Japanese MD gets a Yamaha motorbike.

Also, it’s wrong to compare ACA policies with company policies, which tend to be subsidized, heavily, by the company. I’ve not experienced the US pre-ACA heath insurance marketplace, but as a freelance translator, returning to the US would have been largely unthinkable. To the best I can tell, the pre-ACA policies that sound on paper better, were actually far worse if you actually had to use them.

I’ve been following this for a while, and I’m becoming more and more convinced that price controls are absolutely necessary in the US. But the ACA is chock full of all sorts of wonderful goodies; it’s not just insurance…

8

Trader Joe 12.10.13 at 3:58 pm

Interesting post (s).

The diabolical thing about retirement savings is that the World War II generation had actually already figured this all out. Workers in many industries, not just union shops, had pension plans and individual savers used a combination of bank accounts that paid a yield that had a positive spread vs. inflation and/or insurance and annuity contracts. All of these were available to quite ordinary people, were “vanilla” in complexity and while they generated a lot of money for the banks and investment houses that managed them they tended to perform as intended with relatively low volatility.

Starting in the ‘70s the coming of age baby boomers screamed for “choice” and not being “stuck” in pensions and insurance products. Wall Street predictably responded spawning the rapid growth of the mutual fund industry and all its complex derivatives and offshoots, allowing individuals to make their own investment mistakes. The concurrent creation of the IRA/401k plan forced individuals to make all of their own retirement decisions and be responsible for the related investment outcomes.

Bottom line: Risk was shifted to individuals in the service of choice.

The end result being that banks and money managers continued to make tons of money – but now the individual had to do all the work of selecting investments, monitoring them and as CR said otherwise administering their own retirement. This was all viewed as progress when it happened and only crashes in 2000 and 2008 have caused people to severely question (among other things) whether maybe they are all that capable of managing their own money afterall.

The same exact process is in the early stages of unfolding in healthcare. The ACA has definitively improved access to healthcare just as 401ks improved access to investment choices. The cost of access however is the requirement to sift through all that choice for oneself, bear high deductibles and and consistently and repetitively make decisions where errors have big dollar consequences.

Again – Risk shifted to inviduals in exchange for choice/access.

Too soon to say if it ends well or badly – but the sales job focued entirely on the choice and acess and didn’t explain at all how the free lunch was to be paid for.

9

Ben Alpers 12.10.13 at 4:04 pm

I have no doubt that the ACA is a marginal improvement over the status quo ante and that it was the best plan that could have passed Congress in 2009-10.

The problem is that, politically speaking, this may not be good enough. The ACA’s very complexity means that most individuals will experience it only partially and will judge the rest of the plan as much based on rumor and propaganda as on actual experience. For example, most Americans will never go on the insurance exchanges to purchase health insurance. Even if the millions of Americans who do, on the whole, end up having good experiences, most Americans will judge the exchanges based on what they hear about other people’s experiences.

Programs like Social Security and Medicare have become hardwired in part because they are virtually universal. Programs like AFDC and foodstamps that benefit (or benefited) smaller groups of people in need are much more vulnerable. Though the ACA’s aspirations are to provide something like universal coverage, its approach to achieving this goal is anything but universal, and that may well be its political undoing.

10

William Timberman 12.10.13 at 4:11 pm

Off-topic question: does geo s = geo = George Scialabba? As a general rule, I believe that substance/content trumps authorship, but sometimes continuity as a defense against cognitive dissonance seems to demand more, especially when one already has expectations with respect to what a given author is likely to say. (It’s not that I don’t welcome the occasional surprise, you understand, but….)

11

Lee A. Arnold 12.10.13 at 4:17 pm

I think ACA sets the U.S. on a short path to single payer, because it brings some things about the private insurer system out into the open, all at once, for everyone to see (not just people who have been following the issue closely and already understand it). I think the key to political change is actually rhetorical: you need the uniformity of an idea happening to almost everyone in the same moment. That the necessary condition for new agreement.

It is misleading to think single-payer must start at the national level. ACA also provides the ability for states to set up their own public options or single payers starting in 2017, and those states (Vermont has already declared it will do it) will then have a simpler system costing approx. 15-20% less. Most of the rest of the states (at least, the blue states) will follow shortly after that.

12

geo s 12.10.13 at 4:19 pm

you are really making an argument here about rhetoric rather than ideas”

I have no idea what that means.

you are talking about how to talk about the ACA, i.e. the problem is that neoliberal ideology makes life difficult and unhappy by creating policies which force everyone to be an investor managing their various accounts, etc.

on the one hand you are talking about life: is it easy or difficult, does it make you unhappy and happy. but you want to explain the difficulty and unhappiness as being the result of an ideology: neoliberalism. it strikes me that this is still really about shifting the discussion to ideology, rather than talking about everyday concerns.

and either way, it’s about the discusssion… rhetoric

13

Lee A. Arnold 12.10.13 at 4:20 pm

To see how to get to single-payer, consider what happens to blue-state vs. red-state labor costs, after blue states start to take waivers to have public-options or single-payers, as ACA allows any state to do after 2017. (Vermont is already moving on it.)

Labor costs, of course, include the healthcare costs of the labor. If the blue states all go to public-options or single-payers, they may save an additional 20% of healthcare costs, thus, have lower labor costs. (And it becomes big news.)

But if the red states decide instead to continue paying healthcare insurers 20% (for no-value-added, by the way), then red states are going to put themselves out of business: because red-state employers will find that the higher labor costs in red states make their products uncompetitive in the national market and international market.

Self-interest will get them, where mere altruism could not penetrate…

Perhaps the red-states will collapse even FASTER, if you consider that red states tend to be a little unhealthier (according to Centers for Disease Control, due to e.g. a higher rate of obesity).

So, if blue states chase private insurers out of their markets via public-options or single-payers, the private insurers get stuck with “adverse selection” of the red states as a whole.

The next question is: Will the federal taxpayers consent to bailing-out the private healthcare insurers for being stuck with the red-state lemons?

14

Corey Robin 12.10.13 at 4:26 pm

“and either way, it’s about the discusssion… rhetoric”

No, it’s about reality. The problems I’m describing are quite real, and they need to be confronted. I’d like the left to confront them.

Ironically, I find your comment to be more about rhetoric than anything else. Inasmuch as I can even understand it, which is not that much.

15

Nine 12.10.13 at 4:34 pm

Trader Joe@8 – “Starting in the ‘70s the coming of age baby boomers screamed for “choice” and not being “stuck” in pensions and insurance products. Wall Street predictably responded”

Was this really the direction of cause and effect ? I wasn’t alive back then but if contemporary affairs are any guide then i’m skeptical that Wall Street “just responds”.

16

Barry 12.10.13 at 4:36 pm

Trader Joe: “Starting in the ‘70s the coming of age baby boomers screamed for “choice” and not being “stuck” in pensions and insurance products. Wall Street predictably responded spawning the rapid growth of the mutual fund industry and all its complex derivatives and offshoots, allowing individuals to make their own investment mistakes. The concurrent creation of the IRA/401k plan forced individuals to make all of their own retirement decisions and be responsible for the related investment outcomes.”

Bull fucking shit. We were ‘given’ ‘choice’ by the elites and their propagandist whores (case in point – the title of Friedman’s most popular book).

17

Asteele 12.10.13 at 4:38 pm

The think about Obamacare that might move us to single payer, is that below a certain level you qualify for medicaid, and your heathcare is essentially free, whereas if you make slightly more money, you start having to negotiate with private insurers.

18

Asteele 12.10.13 at 4:39 pm

It’s really hard to see the 401K as anything other than a massive transfer of money from individuals to the financial industry. You too, can spend hours of unpaid labor managing you pension.

19

Barry 12.10.13 at 4:41 pm

Corey: “…We saw a version of it during the debate on Obama’s healthcare plan. I distinctly remember, though now I can’t find it, one of those healthcare whiz kids—maybe it was Ezra Klein—tittering on about the nifty economics and cool visuals of Obama’s plan: how you could go to the web, check out the exchange, compare this little interstice of one plan with that little interstice of another, and how great it all was because it was just so fucking complicated.”

First, as you said, he has no children. He’s also young, and unmarried (and probably has no existing issues to plan around). This makes his time/energy: complexity ratio way higher. In addition, he’s *paid to do this*.

20

JW Mason 12.10.13 at 4:41 pm

I have no doubt that the ACA is a marginal improvement over the status quo ante and that it was the best plan that could have passed Congress in 2009-10.

How could you have no doubts about the possible outcomes of a complex political process? Did God tell you?

21

Barry 12.10.13 at 4:44 pm

His only redeeming feature is that he’s – I don’t want to say ‘paid for being factually correct’, because this is the WaPo we’re talking about, but at least paid for having a good truth:lies ratio.

22

Barry 12.10.13 at 4:45 pm

Asteele 12.10.13 at 4:39 pm

” It’s really hard to see the 401K as anything other than a massive transfer of money from individuals to the financial industry. You too, can spend hours of unpaid labor managing you pension.”

But on the good side, you bear all of the risk! :(

23

Trader Joe 12.10.13 at 4:46 pm

@15 – nine
The law that allowed creation of 401ks was passed in 1978. Mutual funds existed prior to 1978, but they weren’t a mass market investment to anything like the degree they are today. They were mainly accessed through brokerage houses. It was the passage of the law that caused the industry to flourish and caused fund companies to actively market direct to individuals.

The act was passed to provide tax benefits to savers and portability. Whether the industry would have developed the same way in the absence of the creation of 401k plans is hard to know.

24

geo s 12.10.13 at 4:55 pm

No, it’s about reality. The problems I’m describing are quite real, and they need to be confronted. I’d like the left to confront them.

Ironically, I find your comment to be more about rhetoric than anything else. Inasmuch as I can even understand it, which is not that much.

I’m sorry. I guess I misunderstood where you were heading.

Anyway, Michael Olenick does a run-down at nakedcapitalism of what insurance policies the ACA is actually spitting out much along your lines…

I think the problem is that what the ACA means on a practical level depends very much on who you are (again, by design): are you on employer health care, are you self-employed and wealthy, are you self-employed and poor, are you working at Quik-E-Mart, are you unemployed, etc. The law already splits people up into different factions with different basic outcomes under the law.

In particular, you can look at the difference between the quasi-indigent and the working poor (or “lower middle class”) in that washington post article on the ACA Kentucky a few weeks back. It contrasted toothless alcoholics without children who were finally going to get on medicaid with a working mother who felt like the ACA plan was too expensive. When you argue that the ACA leaves people paying too much for too little, the law has already given them someone to blame.

25

Mao Cheng Ji 12.10.13 at 4:58 pm

“A large % of the population (~70% I think) is insured via employer-provided insurance.”

That’s what makes me think that the ACA is just a patch designed to keep the current system intact. IOW, it makes a SP or NHS-style system less likely.

26

JWB 12.10.13 at 5:04 pm

You raise an interesting contradiction in conservative and neoliberal thought. They rail against the complexity of government regulation and the effort of complying with it. Think of the Paperwork Reduction Act or the spurious flat tax crusade. Yet they are indifferent to the complexity and effort required to prevent suppliers of goods and services from taking advantage of consumers’ ignorance. Presumably they like it when businesses take advantage of consumers. Or perhaps it’s because regulation requires obedience to an authority, whereas preventing workers and vendors from cheating provides opportunities to exercise petty authority over others.

27

Bruce Wilder 12.10.13 at 5:10 pm

ACA is just a patch

Or a highway out of employer-provided insurance, in the same sense the 401K was a path away from corporate / union pensions.

28

Mao Cheng Ji 12.10.13 at 5:18 pm

“Or a highway out of employer-provided insurance”

Could be. But employer-provided insurance is a part of the ACA, isn’t it. It’d take a decade to transfer it into the highway out of employer-provided insurance. And only then, realistically, you could start transforming those exchanges into something else, because before that 70% of us won’t really give a fuck. We get our insurance at work as always, the uninsured are now insured, so everything is fine.

29

Lee A. Arnold 12.10.13 at 5:20 pm

Corey on your more basic point, I think it is the heart of the matter, and I am glad to see someone else finally get onto the issue, too. In general, the system is becoming so complicated that there can be too much information to handle.

The solutions are three: 1. more brainpower developed in humans (unlikely); 2. more markets, to take care of the information problems automatically (i.e. the Hayekian information- mysticism); and 3. non-market or quasi-market institutions, such as retirement security (e.g. U.S. Social Security), to obviate the information problem by taking care of a standard need on an automatic and “thoughtless” basis : i.e. “reduce transaction costs”.

“Information problems” are shunted away in economic thinking to the categories of “asymmetric information”, “transaction costs”, and “cognitive biases”. Because you need certain pieces of information to make a correct decision on a purchase or sale.

But in additions our individual cognition-budgets are limited. Isn’t this a more basic problem for economic theory? Especially in an era when the largest threats to economic well-being are being posed from areas that require enormous intellectual study (e.g., climate)?

I think that increasing complexity is the real economic problem of our times. It is one of the two main reasons why government will be getting a little bigger in the future (the other reason is increasing inequality).

The Hayekian notion is that markets work best: i.e. if you come across a problem, create another market for it. This avoids any consideration of the fact that an individual’s attention-budget is limited.

How do you know that the can of tuna you buy at the grocery store did not come from a fishing fleet that killed dolphins? You do not. You rely upon laws and enforcement of government.

Look at the enormous proliferation of financial instruments in Wall Street, all presumed to allow greater risk-bearing — “Why would financiers create them, if they were not useful?” asks a neoliberal. But, even if they were markets with public price discovery — and some of them are not!: the great lie is that Wall Street is free-market capitalism at its finest; but it is not, it is a limited-access oligarchy — even if there were public price discovery, there may be too much information for humans to judge whether the whole system is stable, or about to crash.

Intellectual budgets are limited, too. When I was a kid growing up in New Jersey with friends, we saw the wild forests falling to farms, and then the farms developed into suburbs. We said, “This isn’t going to work. There won’t be any wild plants and animals left, ” and we were told, “It is necessary for economic growth, and they will be saved elsewhere, or as people want to.” But learning exactly where the illogic comes in, what are the two things in thought that do not comport with each other, took me decades more study of both economics and ecology. It is a huge intellectual task.

We saw a brief return to this thinking in the debate over President Bush’s proposal to privatize Social Security in 2006. The idiocy expressed tat that time? “Let people have their own money and manage it.” Quite aside from the fact that this is mostly financial industry propaganda to get their hands on trillions more dollars (and just before the financial system was set to crash, wouldn’t that have been marvelous!), the flip side of the question is: We should go with”people managing their money” (to create the “ownership economy”, an entire propaganda effort to invoke a phony virtue) instead of providing a universal safety-net that requires LESS thought and calculation? What happened to efficiency?

Non-market institutions can be efficient, in formally the exact same way that marketed innovations, like better clothes-washing machines, can be efficient: they save attention-time.

Giving more time to the rest of life is a form of freedom. Increasing the number of transactions, by marketizing everything, can reduce freedom.

30

Metatone 12.10.13 at 5:25 pm

Stepping away from the ACA details (I’m in the UK and there’s plenty of evidence than an NHS would serve you better, but all the evidence in the world isn’t preventing the right-wing here from propelling the destruction of our NHS…)

Anyway, stepping aside from the ACA to the meta-post/meta-argument, I think this is exactly right and at the same time really hard to get people to understand. Despite the damage done to the NHS so far, it’s largely still the case that the normal medical incidents of life mostly inconvenience me just in the arranging of a doctor’s appointment. I don’t have to think much… But it seems few in the USA can conceive of what that reduced cognitive overhead might be worth…

31

Ben Alpers 12.10.13 at 5:26 pm

The think about Obamacare that might move us to single payer, is that below a certain level you qualify for medicaid, and your heathcare is essentially free….

Except, thanks in part to the SCOTUS, half the states have refused to expand Medicaid, so this simply isn’t true for millions of Americans.

How could you have no doubts about the possible outcomes of a complex political process? Did God tell you?

The political process was, of course, complicated, but by the middle of 2009 (and please note that that’s what I’m talking about), the possibilities had become significantly narrowed. There is simply no evidence that there were even fifty votes in the Senate–let alone sixty votes–to pass anything better in the fall of 2009 or the winter of 2009-10. What told me this wasn’t God, but rather the actual political behavior of the actual people empowered to make the law.

32

Barry 12.10.13 at 5:37 pm

Trader Joe: “The law that allowed creation of 401ks was passed in 1978. Mutual funds existed prior to 1978, but they weren’t a mass market investment to anything like the degree they are today. They were mainly accessed through brokerage houses. It was the passage of the law that caused the industry to flourish and caused fund companies to actively market direct to individuals.

The act was passed to provide tax benefits to savers and portability. Whether the industry would have developed the same way in the absence of the creation of 401k plans is hard to know.”

Yes, they existed, and yes, some people took advantage of them, either to supplement a pension, or because they had no pension.

That’s not the issue, of course – the issue is how many people *wanted* to get rid of their pensions to get 401(k)’s?

33

ezra abrams 12.10.13 at 5:58 pm

fact fail
The Times article compared obamacare plans (individual market) to employer group plans
Apples to bazookas

But, your general thesis is correct (the Romney view of the world where we can manage our healthcare and IRAs is not only crazy, but hypocritical: Romney has experts to help him, but ,imo, irrelevant: healthcare costs have to do with technology.
Back when congress was debating ACA, J Califano, Sec HEW under LBJ, was on one of the talk shows.
And he said, iirc, you know, when we put in medicaid, there was no technology…we didn’t dream of a world of 500,000 dollar MRI machines….

As long as we have new technology that *adds* cost, we won’t be able to pay for healthcare.
imo, only when robots start taking over a lot of functions (like surgery) will costs drop

34

ezra abrams 12.10.13 at 6:00 pm

Bruce @ 27
path out of employer insurance
yeah, u got that right.

Bottom line: ACA better then the past, but still need socialized medicine
Don’t whine, organize (with apologies to J Hill)

35

actio 12.10.13 at 6:07 pm

“The problem with (micromanagement) capitalism is that it takes too many evenings.”

36

MPAVictoria 12.10.13 at 6:19 pm

“How could you have no doubts about the possible outcomes of a complex political process? Did God tell you?”

To be fair this has been covered extensively, and I would also say convincingly, over at LGM. There was no way single payer was going to get by Joe Lieberman.

37

geo 12.10.13 at 6:28 pm

WT@10: does geo s = geo = George Scialabba?

No.

38

Bruce Baugh 12.10.13 at 6:33 pm

I’m old enough to have followed some of the discussion between Mom and Dad in the era when 401Ks and such arrived at Jet Propulsion Labs, where Dad worked. They were sold with a really serious push of slickly packaged lies and distortions. Dad grew up in the Great Depression and fought in World War II, and had seen this kind of thing before and wanted none of it. But the rhetoric of “Don’t trust the old fuddy-duddies and their fear of everything! You’re the brightest of the bright, in tune with our glorious modern era, and you can spot opportunities they’re scared of!” was persuasive to a bunch of people in aerospace.

Of course the pitch went from to bullying and then to resentment of those who still had stability, and here we are. The thing is that it took years of hard sell to get even that audience to regard dependable predictability in their retirement fund as a bad idea.

39

Lasker 12.10.13 at 6:35 pm

I don’t get this. As a young person who has always been on the individual insurance market, and who has also watched as their parents and friends on the individual market struggled to pay for or even find insurance that will accept their pre-existing conditions at all, I look a the health plans you quote and think they sound like pretty decent deals.

Pre-ACA, My mother was paying over 1k a month for herself alone in Minnesota. My father was paying a similar amount before he became eligible for medicare. This was well over a third of their income. And in addition, I don’t think you have quoted the correct numbers for who gets subsidies. At least in NYC, single people are eligible for some subsidy up to about 42k/year.

People have always had to balance premiums vs deductibles. For people who were already on the in individual market, I don’t see how this is any more complicated than what existed previously, and it massively increases accessibility.

That said, US healthcare remains in a shameful state. In the context of what ought to possible, the plans described above are still terrible. We still have to fight for something better. I guess pointing out the flaws of the ACA (“is this really the best we can do?” etc. ) can be a useful part of that.

But I guess my objection is that I think pointing out how far the ACA falls short compared the ideal without also describing how much improvement it has made over a status quo that – don’t forget – could easily have been continued utterly undisturbed – tells an incomplete story.

40

Mao Cheng Ji 12.10.13 at 6:46 pm

Can’t something be an improvement of the status quo and at the same time unacceptable as a solution? If your roof is leaking, catching the drips in a bucket will improve your life, but it’s not a solution.

41

William Timberman 12.10.13 at 6:47 pm

geo @ 37

Thought not — and thanks.

42

Lasker 12.10.13 at 7:02 pm

Mao:

Of course. I thought I said as much in my own post. And I do agree with what I take to be Corey’s larger point about the false attraction of “choice” in matters like this.

I just find this example to be odd one. The choices faced by the people in the article he quoted between seems to me to be clearly less cognitively draining than the choices they might have faced pre-ACA, say between much more expensive insurance or no insurance at all. As regrettable or daunting as being faced with these choices may be, these are not new, and I would argue that they are in fact made slightly less bad by the ACA, since much less can be hidden in the fine print now, so the penalties for not completely understanding what you are getting into are less severe.

43

Bruce Wilder 12.10.13 at 7:20 pm

metatone: it seems few in the USA can conceive of what that reduced cognitive overhead might be worth…

There are a few people, who can calculate quite well what imposing that cognitive load might be worth, and they work for predatory insurance companies.

Socialism needs a sales pitch, an appealing vision, a theory, but I think it also needs, as I’ve said before, a devil. I don’t see how you can make the politics work, if you are approaching this as an Obama-style apologist for the plutocracy.

I’m not saying that anyone in present company is particularly taking up the role of apologist for the plutocracy, but it does seem to me that, collectively, our rhetoric is turning around the pivots put in place by the frameworks of neoliberalism, to serve the interests of the plutocracy. Sure, the freedom to choose of the conservative-libertarian / neoliberal dialectic, with its reliance on paternalistic nudges and privatization and metaphorical “markets” papering over domination by administrative hierarchies, imposes a cognitive load. But, shouldn’t we notice that cognitive load is just a magician’s trick to distract from the main business of harvesting the soylent? Shouldn’t we notice that the ACA is designed to benefit insurance companies, at the expense of the insured? The cognitive load is a means to cheat people.

Is the ACA, on net, an improvement? It sure is an improvement on certain, highly salient points of “market failure” in the status quo ante: pre-existing conditions being a prime example. But, the insurance companies only have to pay out 80% of premiums on health services. Paying even a subsidized $1 for 80 cents of health care doesn’t seem like such a great deal, especially in a country where 80 cents buys 40 cents worth of health care.

Getting bogged down in arcane discussions of “what was possible with health care reform and what wasn’t” or “pointing out how far the ACA falls short compared the ideal without also describing how much improvement it has made over a status quo that – don’t forget – could easily have been continued utterly undisturbed” just seems to me like ways to transfer the same debilitating cognitive load into political rhetoric, and to the same effect: to wit, covering for the plutocracy’s predation.

44

William Timberman 12.10.13 at 7:20 pm

Random thoughts:

1. I worked for 30+ years for the University of California. The pay wasn’t great by private industry standards, but the benefits and the working conditions were outstanding — at least by comparison with what the rest of the US work force in those days had to endure.

2. I’ve been retired for ten years on the proceeds of UC’s defined benefit plan, which were just there at the end of my career. It’s a comfortable living, with decent medical care, even though I’m ancient enough not to have been enrolled in Medicare.

3. If UC could do it then, Google and Walmart can do it now. In other words, the 401K flimflam has less to do with can’t than with you can’t make us.

4. For the past ten years or so, my daughter has been making twice what I ever made. When she tells me how much is in her 401K account, which she hasn’t ever raided, I cringe.

5. If capitalism’s total victory proves as Pyrrhic in the end as I believe likely, there won’t be enough tumbrils in all of Christendom to ferry the smug to their reward.

45

Erik 12.10.13 at 7:21 pm

Thanks, Corey. I’m glad that somebody is talking about this. I think it’s actually really important.

I just signed up for a Health Flexible Savings Account at my work. This is money that is deducted from your paycheck tax-free. You get a debit card, and $50 (or whatever you like) is deducted from your paycheck each month before taxes and put in the account. Now you can spend that money; but only on certain health care items. Prescription drugs are OK, over-the-counter drugs are not. And you must spend it by the end of the year, or you lose the money.

What is the purpose of this system? Besides being a huge pain in the neck? As far as I can tell, it’s only purpose is to give a little extra boost to those who have a stable job. And all for a little bit of tax savings!

Shopping for a cell phone plan is similar. This one is cheap, but has crazy extra fees if you go over; this one is expensive, but no fees. It’s simple! just average out your monthly usage (data, text, and voice) and choose the plan that’s right for you from all your choices; it’s a simple linear programming problem, any schoolchild can solve it.

There is no purpose to this: it’s not like the plan you choose will effect the cell phone company’s capacity planning. The only purpose is to get a little extra money from those who can’t or won’t spend the time to figure out the “right plan” for them.

If the left could explain this kind of thing better, I think it could work to our advantage.

46

matt 12.10.13 at 7:36 pm

The law doesn’t merely make defined contribution plans possible, as I understand it. It virtually prohibits defined benefit plans, by barring employers (profit or non) from paying retirees as they go, year to year. Retirement benefit costs or medical insurance costs for retirees might be rather small each year, but the employer is no longer allowed to carry an ‘unfunded liability’, reckoned as the total amount of benefits that might ever be due all current employees. No other operating or personnel cost is subject to this requirement to pre-fund all future costs, because that would be crazy.

47

Martin Bento 12.10.13 at 8:21 pm

Trader Joe wrote:

“Starting in the ‘70s the coming of age baby boomers screamed for “choice” and not being “stuck” in pensions and insurance products. Wall Street predictably responded spawning the rapid growth of the mutual fund industry and all its complex derivatives and offshoots, allowing individuals to make their own investment mistakes.”

I think you’ve got backwards who was screaming for this change and who had it imposed. I’ve never heard of any hippy demonstrations demanding the end of fixed-benefit pensions and twisting wall street’s arm.

On the post generally, the welfare state can be at least as Byzantine and difficult as the private market, and is more humiliating, as you must constantly prove how abject you are in the face of implicit suspicion of fraud. It is one of the reasons I favor moving from need-based systems to straight entitlements (like SS and Medicare) that are much more efficient and less fraught, as well as easier to defend politically.

48

SoU 12.10.13 at 8:30 pm

no one was screaming for choice. there was/is a concerted effort on behalf of wall street to get the money out of defined benefits and into defined contribution plans. the latter meant so much more money to play with for the investor types. we are talking massive quantities of savings that they can now take a cut from. and these changes accompanied and dovetailed with a number of other similar changes in corporate structures at the time, carried out by a similar group of executive and shareholder types. it was a swindle, not a response to bottom up pressures by employees.

49

Barry 12.10.13 at 8:34 pm

matt, from what I understand, that’s how the GOP is strangling the Post Office (which is required by the Constitution, so every GOP Senator and congressscum is in violation of their oaths of office). They require the USPS to *pre-fund* all employees – if you are hired today, then the USPS has to pay *now* *all* funds necessary to fund your retirement, 30 years from now. Not fund year by year so that there’ll be enough, but deposit a huge lump sum now.

Now, any business required to do anything like that would fold immediately (e.g., if you want a storefront, pay five years’ rent today).

50

Barry 12.10.13 at 8:38 pm

Bruce Baugh 12.10.13 at 6:33 pm

“Of course the pitch went from to bullying and then to resentment of those who still had stability, and here we are. The thing is that it took years of hard sell to get even that audience to regard dependable predictability in their retirement fund as a bad idea.”

Two good points – first, it took a looooooooooooooooong time of massive pressure by the elites (and all of their servants in the MSM and academia) to get people to go along, and second, the ‘crabs in a bucket’ mentality of all too many in the USA helped a lot.

.

51

Bruce Wilder 12.10.13 at 8:42 pm

Erik, re: Health Flexible Savings Account: This is money that is deducted from your paycheck tax-free. . . . you must spend it by the end of the year, or you lose the money.

Lose the money to whom? ’cause I want to sign up to be on the winning end of that game.

Probably you just explained it badly, but this seems like outright theft on its face.

52

Collin Street 12.10.13 at 8:54 pm

3. If UC could do it then, Google and Walmart can do it now. In other words, the 401K flimflam has less to do with can’t than with you can’t make us.

Not… really. The problem is, a defined-benefits plan is dependent on the continued existence of the defined-benefits-plan-issuing-entity going forward, which is a risk. Well, as it stands — with the current unwillingness to impose costs on hollowing out a corporate shell and letting it collapse — it’s not a risk, it’s a certainty, but even assuming that that former could be fixed there’s always the possibility of a firm genuinely shrinking and unable to pay its defined-benefits.

Specific 401k details/problems/issues/corruption are no doubt real [others know them better than I do; I only know australian super], but there are genuine economic/structural problems with defined-benefit pensions through the employer.

[but equally the same argument can be -- but isn't -- made for abolishing limited liability and replacing it with an insurance scheme...]

53

Cranky Observer 12.10.13 at 9:05 pm

http://www.shrm.org/hrdisciplines/benefits/Articles/Pages/FSA-Lose-It-Rule-Modified.aspx :
“FSAs are voluntary account-based plans that enable millions of Americans to use pretax dollars to pay for eligible out-of-pocket health care expenses like prescription drugs, co-pays, and vision and dental costs. FSAs are often funded by employees, although companies can also make contributions. However, for nearly 30 years, employees eligible for health FSAs have been subject to the use-or-lose rule, meaning that any account balances left at the end of the year were forfeited, usually to the employer.”

54

Cranky Observer 12.10.13 at 9:09 pm

Colin Street @ 8:54,
Noting that in the 1975-1995 time frame there were also people such as Mitt Romney running around “cracking open” defined-benefit plans and “releasing” (I.e. stealing) the funds. That wasn’t accidental.

Cranky

55

clark 12.10.13 at 9:13 pm

“One more account to keep track of, one more bell to answer. Why would anyone want to live like that?”

This.

Most people, if I may generalize from myself, want to spend as little time as possible bringing economic analyses to bear on our choices, even economic ones. It’s math, and we don’t like it. Where do we want to live?: weather and family are issues. What kind of work?: job satisfaction and hours are issues. If money math is an issue, it is complicating and corrupting.

What insurance?, retirement planning?, investment options?, cell plan?… My head hurts.

That said, i think we need slogans. Here’s one:

If it must be capitalism, then let it be capitalism with a human face.

Here’s another:

Healthcare for all isn’t communism, it’s civilization.

56

Collin Street 12.10.13 at 9:21 pm

For sure. And you could get the money out of the control of the original company through some sort of third-party annuity scheme, or something

… but you’d still have the possibility of the issuing institution going down the tube. Only way to actually eliminate the risk in defined-benefit is by having the government either run them or backstop them, and… I don’t think either are good ideas, tbh. Better with guaranteed old-age income supplemented with private savings/investment vehicles, and all you’re quibbling about is the details of the vehicles.

[of course, I'm sure it's just a coincidence that the scheme I like is the scheme I live under...]

57

Adam Bradley 12.10.13 at 9:21 pm

Bruce Wilder Re: Flexible Savings Accounts:

Lose the money to whom? ’cause I want to sign up to be on the winning end of that game.

I’ve had an FSA for a few years now. Erik explained it pretty well, though he simplified it quite a bit (for which I don’t blame him–I don’t think you could pay me to explain this crap in detail). Benefit Strategies, the company that runs my FSA, gets to keep any money in my account that I don’t spend by the end of 2013. I’m not clear whether that’s their only source of revenue for this product, or just a bonus on top of what my employer pays them.

58

Rob in CT 12.10.13 at 9:31 pm

FSAs are garbage. I got screwed out of my money in one of them once (leave of absence, didn’t realize it got shut off automatically when I went out and therefore failed to *immediately* reinstate it upon my return, too bad so sad, we’re keeping your $200). Even if you don’t get screwed that way, the fact is that you’re guessing your out of pocket healthcare costs for the next year and if you guess too high you find yourself in a pharmacy in December buying a pile of stuff you don’t really need ’cause it’s use or lose. Blech.

59

bob mcmanus 12.10.13 at 9:34 pm

Backroom Deal that could have given us single-payer;Jacobin

36:To be fair this has been covered extensively, and I would also say convincingly, over at LGM. There was no way single payer was going to get by Joe Lieberman.

Frankly Lemieux is a terr…nevermind. He lacks imagination and only sees a process he wants to see. Also has a habit of blaming the people for the bad governance.

Rule #1 of American politics: Senators can be bought. You wouldn’t believe what Dirkson got.

So in January 2009

1) End the filibuster
2) In order to get ready cash, end the Bush tax cuts and raise taxes on everybody. In a depression? FDR did it big time in 1933; and also borrow, deficit spend like crazy
3) Pass out pork infrastructure like there is no tomorrow;2-3 trillion
4) Buy the insurance companies as described at the top, making sure Lieberman Baucus Bayh get headquarters in their states and nice positions for their kids. Maybe 5 billion a Senator. Whatever it takes, however legally.
5) Voila! American NHS.

or plan b: declare martial law and nationalize everything. Or just threaten it.

60

bob mcmanus 12.10.13 at 9:45 pm

What do you think, we got Hoover Dam and Tennessee Valley Authority and the Golden Gate Bridge because they were good ideas and efficient ways to create jobs?

Problem is, all solutions, all good policies, all smart politics, were always gonna die in the White House.

A very bad President.

61

Matt 12.10.13 at 10:02 pm

@33:
Back when congress was debating ACA, J Califano, Sec HEW under LBJ, was on one of the talk shows.

And he said, iirc, you know, when we put in medicaid, there was no technology…we didn’t dream of a world of 500,000 dollar MRI machines….

As long as we have new technology that *adds* cost, we won’t be able to pay for healthcare. imo, only when robots start taking over a lot of functions (like surgery) will costs drop

This is not a very satisfying explanation. It might explain year-over-year differences but not international differences. Japan has no MRI machines? Japan spends less money on medical care but trades it for reduced lifespans? No and no.

Also, if it’s expensive new technologies accounting for high costs, why does a nurse’s injection of pethidine show up as a $300 item on an ER bill? The drug is cheap. It’s been generic since before my parents were born. It took 2 minutes of hands-on time. I never touched an MRI machine or an on-patent drug.

According to a recent NY Times article, prices for basic procedures are soaring for no better reason than “because we can.” A 300% markup here, a 4000% markup there, pretty soon you’re talking real money. As Hospital Prices Soar, a Stitch Tops $500

62

Nine 12.10.13 at 10:10 pm

Trader Joe@23 – “The law that allowed creation of 401ks was passed in 1978. Mutual funds existed prior to 1978,”

Ah, I see. But my query was more along the lines of those raised and answered by Martin Bento & several others viz was there really a popular clamour for choice in pension investment vehicles and was Wall Street merely “responding” to those demands ?

63

William Timberman 12.10.13 at 10:12 pm

No matter how pissed off I am at the sheer inventiveness, not to mention the rabbit-like proliferation of our modern rentiers, Collin Street makes a point that undoubtedly has to be made. Even though Walmart is the largest private employer in the US, it might not be around for another 30 years, and I suppose that however shiny they are at the moment, Googles come and go as the technology waxes and wanes. Even the semi-permanent University of California is nowhere near as generous to new employees as it was to those, like myself, who started there in 1970. The self-employed and the itinerant can’t be left out of our calculations either.

So okay, government-administered social insurance, but way more comprehensive than Social Security, and a much larger percentage of it funded as a sort of deferred compensation by all employers. Surely it can’t be rocket science to come up with something that doesn’t leave a significant percentage of the aged population scraping at the inside of discarded cat-food tins with their chilblained fingers. If labor is a commodity, and traditional social structures and their support mechanisms — family, parish, etc. — had to be destroyed in order to provide it in sufficient quantity to those marvelously productive machines, surely we have a right to ask that the true price of that commodity be paid. If we want a decent society, that is.

As for secular stagnation, saying goodbye to full employment forever and ever because a) Chinese, or b) robots, then maybe it’ll have to be tumbrils after all. If saying socialism is all but impossible in the US today, making it actually happen might very well mean Armageddon, who really knows? At least the free-market swine lecturing us today should be offered the chance at a peaceful outcome.

64

Trader Joe 12.10.13 at 10:12 pm

Re: prior comments on 401ks vs. pension plans

The regulatory sequence was that ERISA was passed in 1974 which for the first time ever put a backstop behind pension plans so that when companies failed, big or small, the pension plan (which was probably underfunded anyway) wasn’t given to creditors essentially rendering the pension plan worthless. Prior to 1974 pension plans were truly an empty promise. It was the UAW that pushed for this legislation as they were worried about the failure of the automakers and their mammoth unfunded plans.

While its true no one was protesting in the streets demanding 401k plans, there was plenty of interest in having ownership of ones own retirement plans. The 1978 Revenue Act was established to keep companies from raiding pension plans, which 1974 ERISA didn’t prevent and to legislate what benefits qualified for favorable tax treatment. Even with that 401ks didn’t catch on until the mid-1980s.

It should surprise no one that at many companies the ‘fat cats’ had large fully funded pensions while average workers had small ones that sometimes weren’t funded. The initial use of 401ks was to award senior management benefits not available to the rank and file. Once again it was unions that led the effort to change that.

The Tax Reform Act ( TRA) 1984 included tax amendments that put in fairness rules to basically make 401ks available to all employees if they were made available to any (it was much more complicated than this, but this is the essence). Since Senior managements liked the benefits they had, they opened the plans up to all.

To be blunt, Wall Street didn’t give a crap whether the money was in pensions or 401k plans…if the pension plan was ACTUALLY FUNDED they were managing the money and earning fees on that anyway. The #1 difference between the Pension and 401k plans is that 401ks get funded, in cash, every month, all the time….its real money and a nice steady drip that can be planned for. Few pensions at the time were anywhere near that well funded so Wall Street’s interest was the opportunity to manage actual money, not promised money. The steady flow was entirely condusive to mutual funds which are sold in fractional share increments rather than pensions which are managed in whole.

Sure Wall Street was more than happy that these Revenue acts were passed (1978 and 1984) but the legislative goal was labor driven in each case and wanted 1) actual funding of benefits and 2) actual ownership of assets. I have no doubt Wall Street lobbied hard for these laws, but the genesis was labor driven.

The consequences are open to interpretation but for some a 401k with actual deposits in it that was portable was more valuable than a pension they’d never vest to (7 year full time employment before vesting being common) and couldn’t touch for >30 years. I’m not disputing the negatives some have mentioned, but as mobile as workforces have become – this is a far more flexible tool for retirement savings and the benefits shouldn’t be discounted.

65

Ben Alpers 12.10.13 at 11:45 pm

1) End the filibuster

Stop right there. What makes you think there were fifty votes to end the filibuster in 2009? Or is your principle that the Senate can be bought so universal that you’re just suggesting that that Obama could have called someone to bribe the dozen (or more) Democrats necessary to do this?

2) In order to get ready cash, end the Bush tax cuts and raise taxes on everybody. In a depression? FDR did it big time in 1933; and also borrow, deficit spend like crazy.

The Democratic majorities in the both the House and the Senate refused to even allow these tax cuts to expire. What makes you think there were the votes to do it in 2009? Oh yeah…you can pay them to do anything and the President has access to infinite cash!

And so forth.

This is all just fantasy. I agree that Scott Lemieux often has too inflexible an understanding of political life, assuming that the way things happened to turn out was the only way that things could have turned out.

But just assuming that our political system is so entirely corrupt that the President can simply bribe Congress to do whatever he wants them to do is even more obviously falsifiable. It’s just a cynical version of Green Lanternism. And it’s disproven by the fact that every single U.S. Presidents has had things that they’d like Congress to have passed but have been unable to get through Congress.

66

bob mcmanus 12.11.13 at 12:03 am

What makes you think there were the votes to do it in 2009?

Pelosi wanted to do it, so she thought she had the votes in the House?

But we had a President who promised and delivered a half billion dollar tax cut as the key part of the Recovery Act, and then in 2010 said the gov’t is out of money. Congresspersons usually don’t like going out on such obvious limbs. I don’t count votes before the bills start moving. You call that Green Lanternism; I call it realism.

Oh, there are a lot of moving parts, like Howard Dean’s organization that was disbanded.

But I am so tired of liberals who claim that it can’t be helped as a way of avoiding action.

67

StevenAttewell 12.11.13 at 12:04 am

1. Half of those covered under the ACA are being covered by Medicaid. (I just applied for it myself.) Indeed, had it not been for John Roberts, the income entitlement in the ACA would be binding on all 50 states. I think this is important to note; single-payer for half is different from single-payer for none.

2. “often tops” is not particularly good statistics – I think we need a better sense of what the statistical distribution of deductibles, co-pays, etc. are than this article gives us. For example, in California, if you’re at 138% of poverty or below, you get Medi-Cal! If you’re between 138-150% of poverty, you get a 94% Silver Plan; that Silver Plan comes with a $35/month premium, a $0 deductible, and co-pays below $6 for everything but emergency room visits which clock in at $25. However, if you’re between 150%-200%, you get an 87% Silver Plan; that Silver Plan comes with an $85/month premium, and a $500 deductible/$1000 family, and slightly higher co-pays. Likewise, if you’re between 200-250%, you get a 73% Silver Plan that has a $1,500 deductible – however, as your income goes up, you also get access to more expensive Gold Plans that don’t have deductibles but cost about $60 a month in premiums.

So it really, really depends on the distribution of incomes. The people who are in that sweet spot of 138-150% don’t have to worry about deductibles; people who are above 200% have more significant deductibles, but can choose plans without them.

68

Substance McGravitas 12.11.13 at 12:09 am

Pelosi wanted to do it, so she thought she had the votes in the House?

Not possible in a variety of ways. No doubt Pelosi would like it, but she doesn’t get to change Senate rules.

69

Martin Bento 12.11.13 at 12:19 am

Trader Joe, but what you said was that “boomers” clamored for these plans, and what you have argued, at most, is that unions in the 70s did. Since the world’s oldest boomer turned 30 in 1975, the bulk of 70s union membership and almost the entirety of the leadership in the 70s were not boomers.

The generational issue is important because vilification of boomers is an important element of Republican plans to dismantle entitlements. Although initial plans exempt those at or nearing retirement, to get the savings they want, the Petersenites need to screw the boomers. First exclude the younger generations, then let their upset at that give you political cover to screw the boomers. That’s the plan.

Creating a narrative that boomers somehow deserve it is essential to this, and long-standing and mostly ill-founded boomer-bashing from gen x is harnessed to this purpose.

70

Bruce Wilder 12.11.13 at 12:35 am

StevenAttewell @ 67

Ah, but then there are the network restrictions, eh?

71

Lawrence Stuart 12.11.13 at 12:44 am

“We’re either athletes of the market or the support staff who tend to the race.”

There is something about the athletic metaphor that works very well — It is not just wealth that is the purpose of the competition, but virtue. Or rather making money becomes a measure (for many, not all) of a particular kind of virtue. Romney himself is a case in point. Certainly I see this sensibility in my own father, and catch it in myself as well (my Presbyterian roots run deep, I’m afraid).

For the very wealthy, this association between wealth and virtue is nothing new. Noblesse oblige and all that. But the gentry never felt the need to justify the accumulation of wealth as a virtue in itself (they didn’t have to, of course).

This mutilates the metaphor, but maybe the layers of Kafkaesque crap become a self fulfilling prophecy of suffering: a kind of bourgeois Inferno where the virtue of wealth accumulation lifts one higher. With enough money to afford help, a personal assistant, a good legal and accounting team, etc., purgatory, if not paradise itself, become at least an aspirational possibility.

But it’s not just the athletes. All we who toil in the service of such acquisitive virtue, not being complete dolts, seek some sort of escape ourselves. But we have become the agents of our own misery, devilish little cogs in the machinery of hell. It’s a zero sum game, or race, or whatever. Even for those who might accept that what’s good for capital is some ultimate sense good for all, it gets harder and harder to see how that translates into an individual’s possibilities of escape from the inferno. When there seems to be a reciprocal movement toward the bureaucratic complication of life commensurate with every increase in social wealth, the aspirational myth of escape through individual virtue should start to fall apart.

But the myth is fiendishly resilient. Why do we tend to identify our tormentor as the collective machinery of our own making? Logically speaking, shouldn’t we turn on the ultimate source, the notion of individual escape? Why do we stick to this notion of wealth as virtue?

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CaptFamous 12.11.13 at 12:48 am

Just wanted to add a comment about the idea of “carrying liability”, with regards to pension plans. A company with a pension plan is not required to carry every dollar that they will theoretically owe their employees in the future. They are required to carry the actuarial present value of all of their current vested obligations.

It’s the same as managing the combined sum of all of your employees’ 401Ks. For young employees who are only, say 50% vested and only have 5-10 years of services, you need to have maybe 5,000-10,000. For employees about to retire, if you’ve been regularly contributing in the manner as a 401K, you should have everything you owe them. For any employees short of 3 years (or whatever), who wouldn’t be vested at all, you needn’t carry anything.

Essentially, all it’s saying is that, if a company goes belly-up, the pension fund should have enough money that everyone gets what they’ve vested, based on current service, when they hit 65, same as if every single employee up and quit on the same day. It’s hardly financially prohibitive, it’s just pooling of risk, with the company held responsible for managing the investments.

Allowing companies to carry unfunded liability makes pensions into Ponzi schemes, and guarantees that someone, sometime will get screwed when the music stops.

73

Lee A. Arnold 12.11.13 at 1:34 am

Standard economics appears to be untrained to think of the situation where a subsystem does not have enough information to deal with systemic risk from a larger external system — whether that larger shock might cause financial panic or climatic agricultural failure. It is categorized and dealt with variously, as negative externalities, information asymmetry, transaction costs, cognitive biases. For yet another way to deal with it, naive free-marketeers think that property rights and less regulation will allow proper and timely price discovery, thus providing all the real information you need. (And often they instantly disprove their own theory by being among the least informed.)

But all of these explanatory categories about “information” are somewhat premised on the idea that the information is correctable, and that the cognitive and intellectual budgets of participants are available to correct it.

But what if they are not? What if cognitive budgets are limited and intellectual budgets are limited? Then with growth, we would be increasingly unable to estimate the real risks to the whole system.

We could surely be entering into such an era, insofar as the growing population increases the size of the network, the network connections are a power of that, and all the connections that come with negative externalities, both negative environmental and negative social externalities, would grow right along with them.

Economics has almost no language to deal with business and government as the same KIND of institution. There may be more of it in sociology. There are smatterings of it in Ostrom.

74

Ben Alpers 12.11.13 at 1:49 am

I don’t count votes before the bills start moving. You call that Green Lanternism; I call it realism.

No. I call Green Lanternism your general contention that the Senate can be bribed to do anything whatsoever and your specific contention that, with a wave of his presidential hand, Obama could have eliminated the filibuster in January 2009.

75

JW Mason 12.11.13 at 2:24 am

There is simply no evidence that there were even fifty votes in the Senate–let alone sixty votes–to pass anything better in the fall of 2009 or the winter of 2009-10.

The Sanders-Wyden amendment, which became Section 1332 of the ACA, allows states to opt out of most of the provisions of the bill and use the funding they would otherwise receive as a block grant to establish their own single-payer program. In my opinion, this is an important positive element of the bill, and a major positive achievement of single-payer advocates. It was only approved in January of 2010, indicating there was still space for significant improvement at that point.

More generally, “there weren’t votes for it” is one of those phrases people use to avoid the discomfort of thinking. Proposals that have already gotten support of the necessary legislative majorities and the executive? We call those laws. The whole point of politics is to find ways to build the necessary support for ideas that don’t currently have it.

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StevenAttewell 12.11.13 at 2:54 am

Bruce Wilder @70 – sure. But Corey Robin explicitly fingered the deductibles and copays, and I’ve shown that those can be quite reasonable, depending on the state and your income.

As for the PPO networks, here in SoCal you get your choice between Blue Shield and Anthem/Blue Cross, which both get between 2-3 stars on the CA Department of Insurance PPO ratings website.

77

StevenAttewell 12.11.13 at 2:55 am

Oh, and like I said, I myself just applied for Medi-Cal. So there’s that too.

JW Mason @ 75 – more important than the Medicaid expansion?

78

Ben Alpers 12.11.13 at 4:06 am

More generally, “there weren’t votes for it” is one of those phrases people use to avoid the discomfort of thinking. Proposals that have already gotten support of the necessary legislative majorities and the executive? We call those laws. The whole point of politics is to find ways to build the necessary support for ideas that don’t currently have it.

Yes. But p, at any given time, some things are possible to pass, others not. If you think something better could have passed, given the lay of the political land in Obama’s forst thirteen months on office, please suggest a reasonable scenario for something better passing. Instead, all you’ve offered is:

A) the assertion that anyone can bribe the Senate into passing anything
B) a scenario that begins with the filibuster being eliminated in January 2009

79

bob mcmanus 12.11.13 at 4:41 am

78: And what is your position, Alpers, that Birch Bayh and Joe Lieberman are men of unbending principle and unassailable loyalty?

The LGM narrative usually starts and ends with:”Joe Lieberman wasn’t going to vote for single-payer” and never takes the next step of asking why not? Because Lieberman’s campaign money comes from the insurance companies? Can we make a better offer, or a better offer to Bayh’s wife, who makes seven figures for Wellpoint?

Senators are big deals representing millions to tens of millions of people. Yeah they are hard to move and very very expensive. “Bribe” is a strong word, I prefer pork and favors and incentives.

Maybe make Lieberman Secretary of State.

Dirkson was moved not only with pork. He had a wing of the Republican Party who were socially liberal, fiscally moderate, but beat off primary challengers with fervent anti-communism. LBJ had to pay a huge price to get the CRA and Great Society.

Maybe a bombing run on Iran would have gotten Lieberman’s vote.

Presidents and parties should always be doing terrible and terrifying stuff, and if the narrative is “well best we could get” rather than “Jesus, was anything worth going that far” they are squandering their opportunities.

80

derrida derider 12.11.13 at 5:18 am

Collin Street (great pen-name, BTW, presuming you’re from the business end of town in Melbourne), problems with unfinded DBs are AND WERE easily managed through funding via trust funds – the problem is the prefunding, not the benefit.

Like 401k’s, the selling of Australian DC superannuation in their place represents a transfer of risk to individuals through a loss of pooling, and was similarly done for the benefit of sundry scammers keen to get their hands into workers’ pockets.

81

ezra abrams 12.11.13 at 6:46 am

Matt @ 61
if you go to these urls
you will see that healthcare costs are rising in a lot of countries; I think the urls below provide data on a representative sample.
It is just that we are more advanced (=screwed) then other countries.

I would add that spending more on healthcare is normal and what should happen in a healthy economy:
consider your familys spending, by %: you spend so much on clothing, housing, etc
If clothing becomes cheaper, you may spend less (% of family income) on clothing; by definition, if you spend less on clothing (%) then some other catagory has to go up

technology(and “free trade”) is lowering the cost of a lot of things – cars (last longer) clothing, etc, so healthcare costs should be a larger % of family budgets

http://en.wikipedia.org/wiki/File:Total_health_expenditure_per_capita,_US_Dollars_PPP.png

http://kff.org/health-costs/issue-brief/snapshots-health-care-spending-in-the-united-states-selected-oecd-countries/
(see fig 3)

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Collin Street 12.11.13 at 11:14 am

(great pen-name, BTW, presuming you’re from the business end of town in Melbourne)

After a roleplaying character. Naval chap, rank of lieutenant.

[I do actually work in an appropriately-located prestigious melbourne office building, but in one of the ancillary retail/services businesses rather than corporate.]

83

Ben Alpers 12.11.13 at 2:00 pm

And what is your position, Alpers, that Birch Bayh and Joe Lieberman are men of unbending principle and unassailable loyalty?

I assume you mean Evan Bayh. And, yes, my position is that there is a profound difference between Evan Bayh and Birch Bayh. Your view seems to be that the only difference between Ted Cruz and Bernie Sanders is that Cruz is more expensive. Your “evidence” for this view is that LBJ was able to make a deal with Everett Dirksen. My evidence that Senators are not infinitely bribable is that every single President in modern US history has things that he cannot get Congress to pass, from Bush’s attempt to privatize Social Security to Clinton’s health care reform, fron LBJ’s attempt to make Abe Fortas Chief Justice toReagan’s attempt to put Robert Bork on the Supreme Court. Why was Clinton impeached and Nixon about to be impeached when they could have simply paid the House not to impeach them? What explains the fact that Congress often doesn’t do what Presidents want? Do Presidents run out of cash or favors? Or are you just more ruthlessly Machiavellian than the pathetic milk-toasts we keep installing in the White House?

I agree with you that Scott Lemieux can see politics as more rigid and inflexible than it often is. But the opposite view–that politicians believe nothing and are constantly, infinitely up for sale–is even more ridiculous and fits the facts of our political life even less well.

The ACA in the Senate passed with not a single vote to sparein the Senate. Nobody voted against it from the left. Could things have worked out differently? Of course. But if we restrict ourselves to considering where things stood in August or January 2009, my contention is that they could not have turned out substantially better. You’ve offered no concrete story about what could have been offered to whom to make things turn out better in that political short-run. But since your alternate scenario has a concrete starting point — eliminating the filibuster in January 2009 — let’s start there.

Please give me a realistic, concrete account of how Barack Obama could have made the Senate eliminate the filibuster in January 2009.

84

JW Mason 12.11.13 at 2:08 pm

Yes. But p, at any given time, some things are possible to pass, others not. If you think something better could have passed, given the lay of the political land in Obama’s forst thirteen months on office, please suggest a reasonable scenario for something better passing. Instead, all you’ve offered is: A) the assertion that anyone can bribe the Senate into passing anything; B) a scenario that begins with the filibuster being eliminated in January 2009

Ben, you are quoting me, but I have not mentioned the filibuster, or bribes. What I did mention was a specific instance of the bill being improved late in the process as a result of outside pressure. This is the evidence that you requested, that there were still meaningful political choices about the content of the bill as late as early 2010.

85

JW Mason 12.11.13 at 2:10 pm

JW Mason @ 75 – more important than the Medicaid expansion?

No, of course not. I’ve said all along that Medicaid expansion is the most important part of the bill.

Some valuable things were achieved. With different choices at different points of political agency, more could have been.

86

Mao Cheng Ji 12.11.13 at 2:21 pm

Bribes are problematic, because industries have a much better ability to bribe than the president. Check out the Billy Tauzin’s story.

Blackmail would be a more realistic approach: surely every one of them has a few skeletons in the closet. But that would invite a retaliation in the next cycle, and no one there wants that.

Politics is a devious business, and it seems very difficult to suggest a hypothetical realistic scenario. Like no one probably could predict Roosevelt’s court packing move before it was made. Nevertheless, it was made.

87

Ben Alpers 12.11.13 at 2:27 pm

What I did mention was a specific instance of the bill being improved late in the process as a result of outside pressure. This is the evidence that you requested, that there were still meaningful political choices about the content of the bill as late as early 2010.

I’ve never argued that things couldn’t have turned out differently in 2009-10. I’ve argued that they could not have turned out substantially better than they did given where things stood in January 2009. I base that conclusion on such factors as they razor thin margin by which the ACA passed the Senate, as well as the work of people like Bernie Sanders to assure that the outcome was better than it otherwise would have been. I agree Sanders did a marvelous job marginally improving the ACA. Unlike you, I don’t think there was a lot more he could have done.

88

JW Mason 12.11.13 at 2:39 pm

Ben-

Let me offer an alternative: Medicare expansion. Rather than pursue the route they did, the framers of the proposal (we can leave aside for now how much we are talking about the administration and how much about the leadership in Congress) could have chosen to reduce the Medicare age to some age X, on its current non-means-tested basis, and/or to create a new Medicare-like program for children, again without means-testing, up to age Y.

I think we can agree that there is some combination of X and Y for which the required political capital would have been the same as for the bill that actually did pass.

Assuming Y less than X, Medicare expansion could not be called universal coverage. (Of course the ACA is not really universal either.) But it would have avoided the administrative complexity that is the subject of Corey’s original post; of avoiding the new veto points and implementation challenges created by the ACA’s many moving parts and its reliance on state governments. And by extending the current successful model of universal coverage, it would have been a direct incremental step toward a rational universal system.

Now, we can debate both what values of X and Y would represent a comparable political lift to the bill that was passed. And we can also debate how much each additional year of Medicare coverage is worth, relative to what was achieved. The latter is obviously going to depend on how costly we think a system of complex means-tested subsidies is, compared with a simple universal system. And it will depend on how much we value the longer-term political benefits of strengthening the principle that health insurance is a public good. These are difficult questions! But clearly, some tradeoff was possible.

I think it’s not hard to imagine scenarios where the actual Medicaid expansion was passed, but instead of the rest of the bill, Medicare eligibility was extended to children up to age 18. I think that would have ben a significantly better bill, even though fewer people would have gained health coverage from it in the short run.

89

JW Mason 12.11.13 at 2:46 pm

I don’t think there was a lot more he could have done.

What’s your basis for this belief? To me, the fact that significant improvements were happening right to the end of the process, is clear evidence that there were other potential improvements that did not happen.

Also, note again, the only reason Sanders was effective is because he was (rightly) seen as representing a significant constituency on the left of the Democratic party that unhappy with the bill and wanted something much better. Note that part of Sanders’ “marvelous job” was halting the whole process at the 11th hour to demand a vote on a single-payer alternative, which people like you at the time saw as a wildly irresponsible threat to wreck everything.

90

JW Mason 12.11.13 at 2:49 pm

Also, it would be nice if you acknowledged you were wrong to say I claimed the filibuster could have been eliminated in 2009, since I never mentioned the filibuster.

(But speaking of that — crazy, never happen, right?)

91

Ben Alpers 12.11.13 at 2:59 pm

What’s your basis for this belief? To me, the fact that significant improvements were happening right to the end of the process, is clear evidence that there were other potential improvements that did not happen.

My evidence is that the bill passed by the absolute thinnest of margins. And I believe that Bernie Sanders does his job well and achieved what he could have. What’s your basis for believing that Sanders left a lot of potential gains on the floor?

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Ben Alpers 12.11.13 at 3:00 pm

The filibuster suggestion came from bib mcmanus, who still hasn’t explained how Obama could have eliminated the filibuster in Jan 2009 (and, incidentally, the filibuster for legislation is still very much in place today).

93

Alex 12.11.13 at 3:14 pm

Maybe make Lieberman Secretary of State.

Radical Bob strikes again.

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JW Mason 12.11.13 at 3:33 pm

My evidence is that the bill passed by the absolute thinnest of margins. And I believe that Bernie Sanders does his job well and achieved what he could have. What’s your basis for believing that Sanders left a lot of potential gains on the floor?

There are two points here. First, it is not obvious ex ante what there is 60 votes for, and what there isn’t. That’s why it took so many months of negotiations — people did not know what they could agree to until they tried to reach agreement. ANYTHING that passed would have gotten 60 votes, because that’s how many Dems there were. That doesn’t tell us what exactly the marginal Dem would accept.

Second, among the universe of things that could get 60 votes, it is not obvious what the relative merits are. For instance, how do you trade off a simple, principled bill which reaches fewer people but gives good reliable coverage to those it does reach, vs. a more complex bill that reaches a larger universe but has greater administrative costs and which more eligible people will fail to successfully navigate?

This is not the sort of question that can be answered a priori. It depends on practical questions of how much exactly is being won and lost in each case, and also on a difficult question of long term strategy versus immediate gain.

But while we should not pretend to have any confident knowledge on this question, we can still reason about it in a sensible Bayseian way. Whatever our priors were about the tradeoff we saw between extent of coverage and the principle of universality, new observations of high costs of adminstrative complexity should make us revise them in favor of a narrower universal program. I believe that is the point of the OP.

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JW Mason 12.11.13 at 3:34 pm

The filibuster suggestion came from bib mcmanus

Right. See, Bob and I are different people. If you’re responding to him, you shouldn’t be quoting me.

96

StevenAttewell 12.11.13 at 3:34 pm

JW Mason at 88 – actually, I think Medicare expansion goes against your argument, and points out a major flaw in bob mcmanus’ as well. Because Medicare expansion was put on the table as a compromise alternative to the public option…and Lieberman vetoed it, despite having literally come up with the idea. Which suggests that Medicare expansion would have come up short, vote-wise.

Why did Lieberman veto the idea? Because he was motivated, not by money, but by ideology and a personal vendetta against the left. He torpedoed his own idea because by 2009 Lieberman wanted to revenge himself against the left and had completely abandoned his pre-2004 DLC position that modest expansions in the welfare state (combined with unshaking allegiance to financial capital) were the way to achieve capitalism with a human face. He put in Medicare expansion to block the public option, and then yanked that when progressives didn’t publicly hate it enough.

97

William Timberman 12.11.13 at 3:45 pm

On Lieberman: it’s never wise to leave assholes out of your calculus of probabilities — and we have such a lot of them these days.

98

JW Mason 12.11.13 at 3:46 pm

By the way.

Ben, Steve: I wonder if you’ve ever helped write a health care bill that was successfully passed through a legislature, despite business opposition? I have.

99

Lee A. Arnold 12.11.13 at 3:48 pm

The evidence that Sec. 1332 passed is NOT evidence that other improvements would have passed, if only enough pressure were applied.

But such a “states’ rights” section is all that will be required to end-up at a nation-wide public option or single-payer system, due to the difference it will make in businesses’ labor costs, as outlined in #13 above.

100

Ben Alpers 12.11.13 at 4:04 pm

Right. See, Bob and I are different people. If you’re responding to him, you shouldn’t be quoting me.

I’m sorry, JWM. I confused your argument and bob’s argument. As I’ve already acknowledged, you did not argue that the filibuster could have been eliminated in 2009.

Is that good enough?

101

Ben Alpers 12.11.13 at 4:12 pm

Second, among the universe of things that could get 60 votes, it is not obvious what the relative merits are. For instance, how do you trade off a simple, principled bill which reaches fewer people but gives good reliable coverage to those it does reach, vs. a more complex bill that reaches a larger universe but has greater administrative costs and which more eligible people will fail to successfully navigate?

It’s worth remembering that the President had run on proposing the latter, more complex and wider sort of bill. The lay of the political land as of January 2009 was, in part, set by what had occurred during the Democratic primary, in which single-payer advocates (most notably Edwards) did poorly and the two leading candidates (Clinton and Obama) had supported the sort of plan that ended up being signed into law. All of which is _not_ to say that what Obama supported in 2008 was simply destined to become law. For example, Obama opposed an individual mandate during the primaries (Clinton supported one).

102

JW Mason 12.11.13 at 4:24 pm

What was Lane Pryce’s line? “If we wanted to end up where we are, I suppose we did everything right.”

103

Ronan(rf) 12.11.13 at 4:27 pm

“Right. See, Bob and I are different people. If you’re responding to him, you shouldn’t be quoting me.”

Yeah, must be frustrating to have words put in your mouth.

104

StevenAttewell 12.11.13 at 4:36 pm

JW Mason – good for you. But I’m guessing the Suffolk County legislature doesn’t have a supermajority requirement. And none of that answers my point about the fact that the author of the Medicare expansion provision vetoed that provision on ideological grounds.

105

MPAVictoria 12.11.13 at 4:44 pm

“But I’m guessing the Suffolk County legislature doesn’t have a supermajority requirement. And none of that answers my point about the fact that the author of the Medicare expansion provision vetoed that provision on ideological grounds.”

Exactly. Lieberman was NEVER going to allow anything better to pass and they needed his vote.

106

temp 12.11.13 at 4:45 pm

The PPACA is complex because it is a negotiated compromise between different factions and individuals in the Democratic party with different interests (many influenced by the insurance and healthcare industry), and due to structural factors in US government (i.e., our federal system). Its complexity is not a result of ideology; particularly not neoliberalism. The major US political party more favorable towards neoliberalism gave zero votes to the PPACA.

107

Corey Robin 12.11.13 at 5:04 pm

People should note that Josh Mason wasn’t proposing that Obama and the Dems push for Medicare for all, but entertaining a much narrower move: perhaps lowering Medicare eligibility to, say, 55, and extending it to children. That’s all. No universal coverage, just a smaller incremental move. He’s not saying it would have worked, but asking us to consider whether a much less ambitious and more incremental program might not have been worth the tradeoff of what we got. I have no idea about Lieberman — folks here might be right — but the narrower incremental moves are harder to oppose, on ideological grounds, than something more expansive.

108

MPAVictoria 12.11.13 at 5:10 pm

Since October, 1.2 million have gained Obamacare coverage.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/12/11/since-october-1-2-million-have-gained-obamacare-coverage/

The number would have been higher if not for the political hacks currently calling themselves Supreme Court Judges. This is a huge win. Is it everything I would want? No of course not. Was it the best, or at least close to the best, that could have been gotten out of the Senate at that time? Probably. Again I encourage anyone here with an interest in the matter to read Scott Lemieux’s work at LGM on the issue.

109

Corey Robin 12.11.13 at 5:15 pm

Again, I think Josh’s point, in keeping with my OP, is that a small expansion of Medicare would NOT have been as good as universal coverage, and would certainly have required some tradeoffs from the good things that Obamacare does do, but it would also have had other benefits that might have get us further down the road over the long haul. And again, helped us avoid the problems I was trying to get at with the OP. We can accept Scott’s work at LGM as a given. But given all that, there was a small, more incremental path to pursue that might, in the end, take us further. That’s all he’s suggesting.

110

Ben Alpers 12.11.13 at 5:20 pm

Though I disagree with him or her about neoliberalism and the Democratic Party, as temp notes @106, the PPACA was a negotiated compromise that reflected a lot of effort by a lot of people inside and outside of government. Other outcomes would, presumably, have required that at least some, and probably many, of the people who brought us the ACA to have behaved very differently. The people who created the ACA, in and out of government, wanted a broad plan. Many of them didn’t want to expand Medicare. And, if we assume (reasonably, I think), that, as of January 2009, not a single Republican in the Senate would support any plan that the Democrats supported, every single Senator would have to be brought on board any alternate scenario in which universality was ditched in favor of a modest expansion of Medicare. It is not at all clear to me that this was a reasonable possibility in 2009.

Now would we be better off today if, instead of the ACA, we had somehow achieved a modest, but not universal, expansion of Medicare? I’m not convinced, but that’s at least an interesting argument.

111

JW Mason 12.11.13 at 5:20 pm

Obviously, if we start from the assumption that everyone involved must behave exactly as they did behave historically, the outcome could only be what it was. So we have to start from the assumption that somebody might have behaved differently.

Now lets assume that someone is not Lueberman — him, we will take as an objective constraint. Ok. Then if we rank all proposals by Lieberman’s view if them, there will be some he likes better than ACA as passed, and some he likes worse. If we compare Lieberman’s list to yours or mine, many we like better, he would like worse. But there are lots of possible proposals. Some we like better than what passed, he would probably like better too. What if it were a smaller Medicare proposal, combined with something else that made insurance companies happier? Well, who knows. The point is that you make choices about part of policy space to explore without knowing in advance where all the compromises are hiding.

Second, Liberman didn’t care only about the ACA. There is some universe of proposals that he would, on their own, have opposed, but which a plausible offer could have been made on something else, to persuade him. Ask yourself: Why did he vote for the bill at all? Do you think he really supported it? Or had it reached a point where he saw the costs and benefits of opposition had moved to where he felt he had no choice? So then, adjust those costs and benefits a bit, and the limits of the possible will move too.

It’s silly to say “nothing better was possible.” There are many, many dimensions along which this bill could have been better or worse, and no one has evaluated the political capital required to move forward on each or how they could or should have been traded off.

What we can say is, given what we have learned since then, are there things which we wish had been a higher priority in 2009? Corey is suggesting that one such thing is administrative simplicity. I agree.

112

mds 12.11.13 at 5:30 pm

I have no idea about Lieberman — folks here might be right

Yeah, such things are basically unknowable. Meanwhile, apropos of nothing, I will label the following link to CNN from December of 2009 with the title of the article: Lieberman opposes Medicare at 55. The narrower, incremental move being “proposed” as if it had not been the very thing brought up as a possibility for the PPACA was in fact what Lieberman rejected. (Lieberman even followed up his repudiation of his own prior “lower the Medicare age” idea by co-sponsoring a bill in 2011 to raise the Medicare eligibility age.) Thank goodness the US Senate works exactly like a New York county legislature, or his opposition might have mattered somehow.

113

Mao Cheng Ji 12.11.13 at 5:31 pm

Bomb Iran, get a free MRI.

114

Corey Robin 12.11.13 at 5:38 pm

Yeah, but see, if you go beyond the title of the article — in the same way that you might go beyond the surface and slogan of your own and other people’s arguments — you see this very first sentence: ” Sen. Joseph Lieberman signaled he would oppose a health care bill that INCLUDES a proposal to expand Medicare to people as young as 55.” See, Josh’s whole point was that rather than going for universality as a whole, or a big comprehensive overhaul, we start much smaller, extending eligibility. And that’s about it. What Lieberman was responding to was a much more ambitious proposal that would have –again — INCLUDED Medicare expansion. And a public option and a lot of other stuff.

Now there are a lot of costs associated with Josh’s approach. It would have given up a lot. That might not have been worth the trade-off. But that’s what he’s suggesting. And to act as if that is exactly what was on offer in 2009 and turned down by Lieberman is, indeed, a propos of nothing.

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Ben Alpers 12.11.13 at 5:57 pm

Obviously, if we start from the assumption that everyone involved must behave exactly as they did behave historically, the outcome could only be what it was. So we have to start from the assumption that somebody might have behaved differently.

Naturally. But arguments about how things could have turned out differently have to take into account people’s propensity for behaving the way they actually did. They certainly didn’t have to behave that way. But the fact that they did indicates the likelihood of their doing so.

Alternative scenarios need to understand why political actors behaved as they did and suggest why they might have behaved differently. What could have made them behave differently? How would they have behaved differently? And what would have been the result of those different behaviors?

In this case, suggestions that radically different proposals were a possible outcome need to take into account not simply the possibility of convincing the marginal votes (e.g. Lieberman…though even in this very specific case, all we get are vague suggestions that there must have been some way to buy him off), but moving the many players who were, by January 2009, deeply committed to something that looked like the ACA eventually looked. Barack Obama made a plan like this the centerpiece of his successful 2008 presidential campaign. That doesn’t mean that such a plan was inevitable. And, indeed, the ACA includes an individual mandate that Obama did not initially support. But all of the political capital invested in an ACA-like plan prior to 2009 gave much momentum to such a plan and made alternatives less politically likely. Politics does not take place in a vacuum.

116

Bruce Wilder 12.11.13 at 5:59 pm

The convoluted argument from political possibility is meant to hide just how evil Obama is. Lieberman, the filibuster, etc. are just the excuses Obama’s PR machine uses to reconcile the image he projects with the policies he pursues. In the hands of its most dedicated practitioners — ex. Scott Lemieux — it becomes a vehicle for the passionate denunciation of anyone and anything to his left, with a long, breathless, “Shut up, shut up, shut up!”

It is possible to have mixed feelings about Obamacare, and grave doubts that it will prove politically sustainable or popular — sentiments that I would think would be normal in the reality-based community — without feeling passionately angry in response to every reminder that we could do much, much better than this, as every other economically advanced country in the world does, in fact, manage.

Yes, Americans would have to overcome the inverted totalitarianism of our politics, giving up the mass passivity of the television audience criticizing the plot line of the reality show already aired.

117

MPAVictoria 12.11.13 at 6:01 pm

“Obviously, if we start from the assumption that everyone involved must behave exactly as they did behave historically, the outcome could only be what it was. So we have to start from the assumption that somebody might have behaved differently. “

Isn’t that a better approach than assuming that they would have behaved in a way that is completely contrary to what we know about their character?

118

StevenAttewell 12.11.13 at 6:03 pm

I’m sorry, Corey, I just don’t buy it. Lieberman was initially in favor of the Medicare provision’s inclusion (which, btw, was a substitute for the public option at the time, not in addition) up until the Left started liking the idea, then pulled his support.

And this is where I think temp at 106 is wrong – ideology was also at play here. Not exclusively (witness Ben Nelson and the “cornhusker kickback”), but significantly. Lieberman was against the Left, and if Medicare expansion was the only thing on the table, that would have been the Left’s position, and he would have been against it.

119

MPAVictoria 12.11.13 at 6:03 pm

“The convoluted argument from political possibility is meant to hide just how evil Obama is. Lieberman, the filibuster, etc. are just the excuses Obama’s PR machine uses to reconcile the image he projects with the policies he pursues. In the hands of its most dedicated practitioners — ex. Scott Lemieux — it becomes a vehicle for the passionate denunciation of anyone and anything to his left, with a long, breathless, “Shut up, shut up, shut up!””

This is just an evil variation of the Green Lanternism that has been plaguing the left for years. I think I will call it Dr. Doomism.

120

MPAVictoria 12.11.13 at 6:19 pm

121

Corey Robin 12.11.13 at 6:27 pm

Having made my own little contribution to precisely the conversation I was trying to avoid — were there alternatives to Obamacare, did the White House fight hard enough, blah blah blah — I beg of us not to repeat this debate. It really has been done to death. Let’s move on and talk about other things.

122

MPAVictoria 12.11.13 at 6:41 pm

” It really has been done to death.”
Point taken.

To get back to the post, I think Corey makes a good point. I, as a Canadian with a (almost) middle class job, have never once thought about medical expenses or wasted anytime worrying about medical insurance and why should I have to? I am not a doctor or an insurance policy expert. I am not equipped to judge what sort of insurance would be the best investment for me. It just makes sense to leave it to the experts.

123

Chatham 12.11.13 at 6:59 pm

Again I encourage anyone here with an interest in the matter to read Scott Lemieux’s work at LGM on the issue.

Scott Lemieux:

Is it even true Reconciliation was available? I thought it was limited to spending issues in a way that made it inapplicable to the Public Option.

It might have been had the leadership been really determined do it. But. obviously, Reid wasn’t going to double-cross the conservative Dems he made a deal with and could make his life miserable.

124

Watson Ladd 12.11.13 at 7:02 pm

@MPAVictoria: Why do the experts know better than you do the amount you want to bear in the form of a deductible? The same problem applies to fixed benefit pensions: I might want to adjust my income in response to investment trends so as to spend less on insurance costs. Why should that decision be made for me?

125

MPAVictoria 12.11.13 at 7:18 pm

“Why should that decision be made for me?”

Why should there be ?

Because it works better and because people democratically decided that that is how they want the system to work.

126

Lee A. Arnold 12.11.13 at 7:28 pm

Well I know Corey says to stop but if you will forgive me, I will shut up after this. I do want to ask you guys one thing. I don’t understand your underlying point about the Senate on Obamacare. Is it a belief that Medicare expansion is the only way to single-payer? Or do you believe that larger steps to “socialism” always count more than smaller steps, as if it were a unilineal progression? Or is this an argument about your knowledge of politics?

The thing is, Corey #109, an expansion of Medicare wouldn’t necessarily get us “further down the road,” any faster.

Speaking of info to be coordinated? There are problems with: the disparities in pricing; providers complaining for decades about payments; and now, Medicare to be infringed upon: it looks like the Republicans via Paul Ryan, at this very moment, are forcing future Medicare reductions, simply to make the numbers match-up better now, it is all nonsense. And the Democrats are stupidly going to sign the bill, because really, everybody knows it can be reversed later. So this, too, is a long fight.

Why not counteract neoliberalism, using its own methods? One thing Obamacare does, at least, is to rectify (in the sense of align) the healthcare system across all states, thus allowing a few years of price discovery for the whole system, after which an individual state can then decide to take a waiver, in order to challenge the middleperson (i.e. the private insurers) with a publlic option, or else to reduce the middleperson at once to a small, concierge coverage market, with a state single-payer. This saves the 20% of the healthcare dollar lost to insurers (for no value added on their part, by the way), –while (and this is very important) still retaining knowledge of what the supply-side (doctors, nurses) requires, pricewise, from the gov’t monopsony. That price expectation of providers is important to know, because it makes a state-level single-payer possible. That price expectation of providers is important to know, for psychological reasons all the way around.

Indeed the doctors should be very happy to finally jettison the private insurers: they have been nuisances on the phone, and because doctors are likely to pick up a few more pennies out of the new arrangement.

As I argued above, single-payers in a few blue states virtually ensure a national move to single-payer, because of evident cost-savings. 20% of healthcare costs is a nice chunk to add to consumer demand. Thus, single-payer can come through state innovation. Then it may go national if enough states deem it expedient.

The thing is, a smaller expansion of Medicare wouldn’t necessarily get us “further down the road”. It could merely be the same speed as other routes, or maybe slower. You don’t get to know this, beforehand.

Stop trying to engineer it, in one fell swoop. Because then it will be foul indeed. If Marx was correct that the way out of capitalism will be an evolution, (a thesis which so far has not been disproven), then it could be true, that smaller steps can create the later preference for the bigger one.

So I know that Corey says to stop this, but I need to know: What is the root of this argument about influencing the boobs in the Senate? Is the basic argument that Medicare the only route, or is it that only the biggest step to socialism is the allowable, durable step? Or is it your knowledge of how to purchase Senators? I cannot find the method under this interminable argument.

127

temp 12.11.13 at 7:35 pm

StevenAtewell @ 118, my claim isn’t that ideology played no role, but that the final result is so complex largely because it’s a compromise between different factions with different ideologies and interests, and therefore the PPACA cannot be said to be an expression of any single ideology. Any given faction could have designed a system that was a purer expression of their ideology that would also be simpler for people to use.

Corey presents the complexity of the PPACA as inherent to the “neoliberal” ideology, comparing it to Romney’s proposal to replace unemployment benefits with unemployment savings accounts. But it seems very relevant that Romney’s party gave zero votes to the PPACA and Romney himself ran against it in his presidential campaign. The major conflict in US politics is not between a neoliberal vs. leftist social welfare model, but between people who want to expand the welfare state and people who want to contract it. In this context, we often see proposals like PPACA and unemployment savings accounts not because anyone has an ideological belief that these are optimal solutions, but because they are seen as reasonable compromises or intermediate positions between free markets and more direct social programs. Obama can’t get the votes for single payer, so PPACA is a way of expanding healthcare while minimizing the threat to vested interests. Romney would like to eliminate unemployment benefits, but cannot run on doing so because it will make people think him an extremist. It is a mistake to think the end result is a reflection of some dominant “neoliberal” ideology held by both men. Obama and Romney want to move the country in opposite directions on the main axis of conflict.

128

Lee A. Arnold 12.11.13 at 7:45 pm

Watson Ladd #124: “Why should that decision be made for me?”

Because, if the rest of us deem it most efficient to have a system that denies everyone the right to determine deductibles by having them determined automatically and at lowest system-cost, (insofar as to most of us, it is a costly bother to do otherwise), then YOU sir are out of luck. Think of it as a “density-dependent population effect”, a well-known result in community biology, and an inexorable biological determinism. Should the rest of us be compelled to keep horses or burn wood in fireplaces, just because you want to be a goddamn blacksmith or a chimney sweep?

129

Chatham 12.11.13 at 7:46 pm

I’m sorry, Corey, I just don’t buy it. Lieberman was initially in favor of the Medicare provision’s inclusion (which, btw, was a substitute for the public option at the time, not in addition) up until the Left started liking the idea, then pulled his support.

Well, there certainly seems to be a number of blue dogs that believe that the Left needs to compromise, no matter what’s being discussed. This was also the case with, for example, the stimulus – some believed that whatever Obama ended up proposing, he should compromise on something. The implication of this, however, is that the Left should ask for more.

130

Mao Cheng Ji 12.11.13 at 7:47 pm

” It is a mistake to think the end result is a reflection of some dominant “neoliberal” ideology held by both men.”

Maybe they want different things, but both want a ‘market solution’ to achieve them. Both say that’s what they want.

131

Rob in CT 12.11.13 at 8:55 pm

“Make Lieberman SecState”
“Bomb Iran for single-payer”

Comedy gold.

132

geo 12.11.13 at 10:20 pm

Lee @99: The evidence that Sec. 1332 passed is NOT evidence that other improvements would have passed, if only enough pressure were applied.

and @126: What is the root of this argument about influencing the boobs in the Senate?

At least some of those who are unhappy with the whole way the Obama administration played the ACA legislative process are not merely saying that he could have gotten a better result if he’d “applied pressure” more skillfully or determinedly to “influence the boobs in the Senate.” That’s just the kind of Beltway-insider, horse-racing debate we’re not interested in. We’re unhappy that Obama didn’t treat the citizenry as adults and citizens, fully capable of understanding what was at stake and of mobilizing to demand it of their representatives — just what he talked about doing in his campaign and in The Audacity of Hope. The country is suffering from a colossal democracy deficit, and one obvious way of beginning to address it would have been to take the debate over ACA to the people (instead of leaving it to the media, who were of course only interested in legislative tactics and PR strategies). Obama failed to do this, or even to see the opportunity. It’s true, as Bruce said @116, that in order for this to have any effect, “Americans would have to overcome the inverted totalitarianism of our politics, giving up the mass passivity of the television audience criticizing the plot line of the reality show already aired.” But a lot of us thought the Man from Hope might have helped accomplish just that. He hasn’t even tried.

133

Sev 12.12.13 at 12:11 am

geo #132 I think a lot of us agree with this, and was the source of disillusionment with Obama, resulting in the fiasco of 2010 elections when so many stayed home, with appalling consequences which we see daily, as well as the bone we have to pick with Scott Lemieux.

Bruce Wilder 12.10.13 at 8:42 pm
“Erik, re: Health Flexible Savings Account: This is money that is deducted from your paycheck tax-free. . . . you must spend it by the end of the year, or you lose the money.

Lose the money to whom? ’cause I want to sign up to be on the winning end of that game.”

Interesting question. Googling, I see that these funds can be used for the plan’s reasonable administrative expenses, which sounds peachy for those reasonable administrators.

134

Lee A. Arnold 12.12.13 at 1:08 am

Geo #132 — Welllll being treated like adults would be in order, only if the critics understood a few things. I question whether it is realistic to assume that the citizenry is “fully capable of understanding what was at stake and of mobilizing to demand it of their representatives.” Further, the critics here don’t get it right, even now: they insist that chances at the single payer are over, when it is just beginning. So I ask again, what is this about? “If you don’t listen to me, I am taking my marbles and going home”? Yes I agree that the Obama Administration’s public representation of healthcare reform, telling people what the options are, and what is at stake, has been abysmal — and I started complaining about it in 2009, as a political problem which might have a dire outcome, such as the 2010 election proved to be. But I also realized then as now that this was a legislative initiative, and Presidents are not well-positioned to micromanage the legislative process. I would imagine they would be resented by Congress, were they so foolish as to attempt it. The White House got the AMA and Big Pharma temporarily out of the way, and then palmed it off to Congress. I have also remarked that “The Audacity of Hope” appears to translate directly as, “the ballsiness of wishful thinking.” But what I don’t understand here is that, since ACA allows states to start public options or single payers in 2017, why do we keep re-running this ridiculous debate? To prove lefty credentials? Or because there are critics somewhere who are just waking up to the fact that any President of the United States is going to be a card-carrying neoliberal member of the U.S. foreign policy establishment? Yet they think they should be treated like adults?

135

Collin Street 12.12.13 at 1:08 am

Why do the experts know better than you do the amount you want to bear in the form of a deductible?

Well, they’re the experts, aren’t they. They might not know your exact preferences, but they can make a guess — possibly they can know you better than you know yourself — and certainly they can evaluate the consequences of your choices better than you can because, hey, they’re the experts and that’s what expertise means.

I intensely dislike rhetorical-question as a rhetorical strategy because rhetorical questions conceal their assumptions. It’s fairly easy to draw attention to false assumptions if something’s expressed as a statement, much much harder if the same thought is expressed as “but why not!?”.

Of course, if you’ve got a dubious case rhetorical questions are advantageous, for the same reasons. Good ideas don’t need bad rhetoric, after all.

136

StevenAttewell 12.12.13 at 4:02 am

temp @ 127: Ah, I see. Sorry for misconstruing your point. Yes, I’d agree – no one ideology. Certainly, I think we can agree that the ideologies of say, Jacob Hacker and SEIU differ significantly from those of Senator Reid or those of Senator Ben Nelson or Senator Joe Lieberman.

geo @ 132: see, I’m skeptical of that argument, because I think you need to explain how popular mobilization would have shifted which votes, especially in a Senate where only a third of the body is up for election and where rural states that Obama didn’t win in 2008 were the difficult gets.

137

geo 12.12.13 at 4:56 am

Lee @134: Presidents are not well-positioned to micromanage the legislative process. I would imagine they would be resented by Congress, were they so foolish as to attempt it

I criticized Obama for not “taking the debate over ACA to the people” (in something resembling the way FDR did with the New Deal). You reply that it would not have been prudent to try to “micromanage the legislative process.” Did I seem to be suggesting that he try to micromanage the legislative process?

The White House got the AMA and Big Pharma temporarily out of the way, and then palmed it off to Congress.

Got them out of the way, did he? What would it have looked like if he’d given away the game to them beforehand?

why do we keep re-running this ridiculous debate?

Actually, I don’t think we’ve even begun the debate I’m suggesting: viz, shouldn’t Obama have tried harder to rally popular support rather than either “palming off” the ACA to Congress or lobbying Congress harder or more skillfully? We haven’t begun it because practically nobody with any influence in academia or the media, much less in politics, seems to believe (or even comprehend the notion) that genuine democracy requires a vast amount more in the way of popular participation and expression than voting (or abstaining) bi-annually for one of two corrupt parties, answering pollsters asking which of the two corrupt parties the respondent supports, and passively imbibing the mindless drivel that passes for “political commentary” on television. Making the US government responsive to an informed and demanding citizenry is admittedly a very long-term project, like forcing the US foreign policy establishment to abide by international law or persuading our fellow citizens to reduce our collective carbon footprint. But the consequences of not doing these things will eventually get very ugly, so we’d better begin.

Stephen @136: you need to explain how popular mobilization would have shifted which votes

See above. The question isn’t only “how could or should Obama have shifted a few votes in the Senate,” but also “what does the whole ACA legislative process say about the degradation of American democracy, and what should be done about it?”

138

Chris Mealy 12.12.13 at 5:23 am

Alright, I haven’t quite finished signing up for Obamacare yet (Washington state exchange). So far it’s like doing my taxes. For example:

Do you or someone in your household have any of the following
expenses: spousal maintenance, student loan interest, educator
expenses, moving costs since January of the current year, domestic
production activities, penalty on early withdrawal of savings, pre-tax
retirement account payments (excluding Roth IRA contributions),or
certain claimable business expenses of reservists, performing artists,
or fee-basis government officials? For each of these categories,
please provide the amount that the IRS would allow you to subtract
from total income to calculate your adjusted gross income.

Just like with taxes, it’s mostly asking me questions about stuff the government knows more about than I do. It’s like a parent making a misbehaving kid say what they did wrong. You tell me, dad, you’re the one with all the answers.

139

Manta 12.12.13 at 2:20 pm

What’s wrong with low premiums and high deductible?

It’s an insurance against unforeseen or unlikely events.
For foreseeable or likely events you don’t need insurance: you should pay with your own money (you pay with that in any case; if you take insurance the difference is that you also have to pay the insurance company).

140

Chatham 12.12.13 at 3:36 pm

@geo
We haven’t begun it because practically nobody with any influence in academia or the media, much less in politics, seems to believe (or even comprehend the notion) that genuine democracy requires a vast amount more in the way of popular participation and expression than voting (or abstaining) bi-annually for one of two corrupt parties, answering pollsters asking which of the two corrupt parties the respondent supports, and passively imbibing the mindless drivel that passes for “political commentary” on television. Making the US government responsive to an informed and demanding citizenry is admittedly a very long-term project, like forcing the US foreign policy establishment to abide by international law or persuading our fellow citizens to reduce our collective carbon footprint. But the consequences of not doing these things will eventually get very ugly, so we’d better begin.

Yes. This, 100%. We should be having a larger conversation about what we should be doing, not just viewing politics as a spectator sport. Or for those of using who are doing things, perhaps using the internet as a form of organizing rather than a debate club.
I will say that the continuation of the OFA seems like a good idea (though I haven’t checked out what they’re actually doing), and the DFA has done a decent job (even though it’s relatively small).

@Lee
But what I don’t understand here is that, since ACA allows states to start public options or single payers in 2017, why do we keep re-running this ridiculous debate? To prove lefty credentials?

For a number of reasons. For example, if Steve’s right above about centrists needing the Left to give up something (and I agree with this, mostly), it makes sense to push for our leaders to ask for much more in their opening offer. Likewise, looking at how everything played out, we may want to push harder for leaders who are willing to press for clear progressive goals next time (and not just looking through the lens of “would this one action have caused the legislation to be different,” comparable to “would my one vote have made a difference?”).

I agree that we should be focusing on single-payer at the state level. But that was true before the ACA as well, so any discussion regarding the ACA (as opposed to how we should move forward with health care in general) is going to diverge from this a bit.

141

joe from Lowell 12.12.13 at 4:53 pm

Excuse me for being late to the party, but since Joe Lieberman originally proposed Medicare buy-in, doesn’t that make it a Lieberdem idea, and those who support it Liberdems, no matter how strenuously and effectively he later worked to kill it?

I’m pretty sure this is how one is supposed to analyze health care reform policy.

142

Scott Lemieux 12.12.13 at 5:40 pm

Anything to his left

The basis for this assertion is mysterious. It’s not based on policy merits, because there’s no disagreement here that any European model of health care would be preferable to the ACA. In terms of our analysis of American politics, my focus on structural limitations and the extent to which American political institutions has traditionally been considered the “left” position. Your contrary apparent assumption that presidents can get any legislation enacted if they just want to badly enough, conversely, is the most complacent middlebrow assessment of American politics imaginable, however radical the tone.

143

Hogan 12.12.13 at 5:44 pm

Blackmail would be a more realistic approach: surely every one of them has a few skeletons in the closet.

Mister, we could use a man like J. Edgar Hoover again.

144

rea 12.12.13 at 5:56 pm

So far it’s like doing my taxes.

Enforcement of the indvidual mandate and the subsidies are tied to your taxes, so of course it’s like doing your taxes.

145

StevenAttewell 12.12.13 at 5:57 pm

geo @137 – I’m not sure what you mean by degradation of democracy, though. The House elected in 2008 passed a bill that was pretty damn close to what Obama had put in his platform. Democracy seems to have worked there.

The Senate is a trickier beast – the filibuster is absolutely an anti-majoritarian system (and if you’re referring to that, I absolutely agree), but it’s very difficult to get mass mobilization about an arcane procedural rule. Even back in the 60s at the height of mobilization on civil rights, it was much easier to get pressure to pass a civil rights bill than to get pressure on reforming the Rules Committee or Rule 22 reform. If the issue is pressure on wavering Senators, that’s where things get tricky: Max Baucus won re-election with 73% of the vote in 2008 in a state that Obama lost with 47% of the vote; Snowe had been elected with 74% of the vote in a New England state during the middle of a Democratic surge; Joe Lieberman had been re-elected in spite of the Democratic Party with Republican support, and a bolt was quite possible; Ben Nelson won with 64% of the vote in 2006 in a state that Obama only got 41% of the vote in.

It’s not clear that mass pressure of mobilized Obama voters would move every senator, just given the reality of where Obama voters are located.

146

StevenAttewell 12.12.13 at 6:02 pm

Chatham @ 140:

“if Steve’s right above about centrists needing the Left to give up something (and I agree with this, mostly), it makes sense to push for our leaders to ask for much more in their opening offer.”

I absolutely agree about this. If there’s one legitimate criticism to be made of most of the major bills of Obama’s first term – the stimulus, Dodd-Frank, and the ACA, it’s that rather than starting at 200% of what he wanted to get to 100%, Obama tended to start at 100% and get knocked down to 50-75%.

147

Rob in CT 12.12.13 at 7:43 pm

[146] That I think most of us can agree with. Democrats in general (not just Obama) tend to put their opening “ask” too low, believing that they must look reasonable to hold the center. But the center is squishy and easily swayed, and the GOP has figured out that asking for the moon (and howling when you get 90% of the moon) works. They should absolutely have asked for well over $1T for the stimulus, with less of it coming in tax cuts, fer instance. The ACA version of asking for a lot was in theory the public option, and it was surrendered early (this seems to be the core of He. Didn’t. Even. Try.). I view that as a tactical negotiation error rather than some sort of horrid betrayal.

148

geo 12.12.13 at 8:08 pm

Steven, this is a much larger subject than reforming Senate rules or comparing voting percentages in senatorial and presidential races. The rhetoric of democracy is full of glowing references to popular sovereignty, civic equality, free and open debate, official accountability, and other ideals. In practice, all nation-states have always fallen far short of nearly all their pr0fessed ideals, but there was a time when the United States was less plutocratic than it is now. There were unions, which could exert some pressure on legislators and employers. There was a judiciary chosen with some correspondence to merit rather than purely on ideological criteria. There was a competent, professional civil service not yet devastated by budgetary assaults and partisan hackery. There was a wider range of mass media, not yet consolidated and absorbed into half a dozen conglomerates. There was a modicum of ideological diversity in the two major parties. Above all, there was not yet a well-organized, well-financed, longstanding, and by now overwhelmingly successful campaign by the business class to marginalize dissent, render the population atomized and economically insecure, and in all ways dominate the electoral, legislative, and regulatory processes. As a result, governments barely go through the motions any longer of soliciting the participation of the 99 (or 90) percent in formulating or refining policy. Freedom of information is not free but too expensive all but a few civic professionals. Official accountability, between electoral charades, is a joke. Even voting, the ground zero of democratic participation, is a minority activity, thanks in part to Republican obstructionism (and irrelevant in any case, thanks to Republican and Democratic gerrymandering). Just to descend to earth for a moment from all this rhetorical high-flying, I suspect that no more than a third of all Americans not covered by health insurance voted in the last three national elections.

I know you know all this. I’m just trying to get you to pay as much attention to it as you lavish on voting percentages.

149

Bruce Baugh 12.12.13 at 9:20 pm

I’m willing to say that on the merits, setting all difficulties of enactment aside, a modest Medicare expansion and a few trimmings instead of the ACA would be a terrible deal. The problem is a simple one and I’m certainly not being original here: when you expand a service to a select group, lots of them become very resistant to every further expansion of it, and a significant number of them will regard it as trying to take it away from them.

We can see plenty examples of this in very recent American history, starting with the “keep the government out of my Medicare” crowd and ranging widely from there. I’d be very comfortable staking money, if there were some way to view across the timeways, that a major consequence of such a move would be greater resistance to future expansions.

I’m open to an argument that it wouldn’t happen in such a case. New things happen, I’ve noticed. But I’d need to actually see the argument and some reason to believe it likely.

150

liberal 12.12.13 at 11:08 pm

geo,
Not so sure about the media part. AFAICT, most smaller newspapers were, for example, extremely reactionary.

151

geo 12.12.13 at 11:25 pm

Yes, but there was a chance for a civic-minded non-billionaire non-mega-corporation to dabble in the news biz, with unpredictable results. Now, Fox, Clear Channel, Murdoch, GE, Time-Warner, and a few other soulless, stifling, homogenizing, infantilizing behemoths.

152

Lee A. Arnold 12.13.13 at 1:09 am

Geo #137: “I criticized Obama for not “taking the debate over ACA to the people” (in something resembling the way FDR did with the New Deal). You reply that it would not have been prudent to try to “micromanage the legislative process.” Did I seem to be suggesting that he try to micromanage the legislative process?”

It would be tantamount to it. Obama took it to the people: he held a 7-hour healthcare summit with all the main Congressional players. Nobody watched it. Should he have added fireside chats? Chats, about a bill which was already in the process of horse-trading? I don’t see why any President would muck around any further with it, until the bill is ready to sign.

153

Lee A. Arnold 12.13.13 at 1:22 am

Chatham #140: “it makes sense to push for our leaders to ask for much more in their opening offer.”

I don’t trust that tactic. The GOP has been doing the same, and it leads to a lot of self-inflicted wounds.

“I agree that we should be focusing on single-payer at the state level. But that was true before the ACA as well, so any discussion regarding the ACA (as opposed to how we should move forward with health care in general) is going to diverge from this a bit.”

ACA makes single-payers at the state level about 100x easier to do.

154

Chatham 12.13.13 at 2:47 pm

The GOP has been doing the same, and it leads to a lot of self-inflicted wounds.

The self-inflicted wounds have been caused by an inability to compromise at all, not by asking for too much in the beginning. Nobody here is proposing that he stop negotiating.

ACA makes single-payers at the state level about 100x easier to do.

Well, we have Vermont, who was going forward with single-payer before the ACA passed and has stated whenever the ACA seems threatened that their plans are independent of it. We have California, where a major push for single-payer was being planned if the courts struck down the ACA (and going by their history, there’s a good chance it would have been successful), but the movement has pulled back as the focus has moved towards the implementation of the ACA. The evidence at the moment doesn’t point to the ACA making single-payer more likely.

155

Lee A. Arnold 12.13.13 at 3:24 pm

ACA makes going to single-payer pretty much like flipping a light switch, compared to the situation before.

Single-payer needs prior price discovery, so we know what the gov’t monopsony should pay the suppliers (i.e. doctors, hospitals). It is even better to know this beforehand across the country, so doctors don’t leave one state to go to another. That means, before single-payer: 1. get everybody into the system, via mandates and Medicaid, etc. 2. Standardize the coverages, gold-silver-bronze, etc. 3. Prevent recissions and denial through pre-existing conditions, etc.

Done, nationwide.

How would a state going to single-payer on its own prevent the loss of doctors to other states? How would a state going to single-payer on its own withstand the onslaught of deliberately-confusing insurance-industry propaganda hitting its statehouse?

Not only is single-payer (actually, a two-tier system,with private concierge service on top) much more likely now, it is almost a done deal, nationwide. (See my business labor cost reasoning above, #13.) ACA’s real message to the insurance companies is, “Get into another line of work. You have only a few years remaining to ride this.” I don’t imagine there is anyone in Congress, at least in the Senate, who doesn’t already understand this.

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Chatham 12.13.13 at 4:16 pm

How would a state going to single-payer on its own prevent the loss of doctors to other states? How would a state going to single-payer on its own withstand the onslaught of deliberately-confusing insurance-industry propaganda hitting its statehouse?

So you would have opposed SB 840 in California?

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Suzanne 12.13.13 at 7:46 pm

@149: My personal experience, for what that’s worth suggests that’s not true. I know several Medicare recipients who think expanding the program is a fine idea (and simple, easy to explain and understand). Yes, there are Americans who are fearful of losing what they have for health insurance, and given the noises coming out of Washington they’re not wrong to be fearful. But I see no reason for assuming that those currently enjoying Medicare would be hostile to the idea of expansion, as long as it didn’t hurt them in any major way – which is only human and part of politics.

@146: Max Baucus observed that taking single-payer out of the discussion at the outset was a mistake – a pre-emptive surrender that shifted the debate to the right and made the public option the most progressive choice, thus pretty much ensuring its doom.

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Lee A. Arnold 12.13.13 at 10:30 pm

Chatham #156: “So you would have opposed SB 840 in California?”

No, I was in favor of it. You can read the insurance industry propaganda expressed in Schwarzenegger’s veto.

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Ed Herdman 12.13.13 at 10:49 pm

@ Lee A. Arnold:

I don’t have any major problem with your comments, but I think you’re somewhat oversimplifying the process of determining healthcare costs.

I am quite sure Arthur Kaplan has said somewhere or other that the ACA simply doesn’t do enough to hold back costs. But I agree that the new structure is definitely simplifying, and healthcare providers are struggling to predict costs ahead of billing, where before the ACA they simply declined to try to get that kind of fine analysis.

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Lee A. Arnold 12.14.13 at 12:52 am

I have to ask you to define your terms, because I thought “cost” is different from “price”. To me, determining the price of healthcare insurance has little to do with determining healthcare costs. It is already a fact that on the ACA exchanges, prices are being quoted, then compared. This alignment of prices is all you need to cause a single-payer to come into consciousness. Why? Because (and the following logic and psychology are important:) if everybody is paying the same price to different private insurers, for the same coverages, then the next question is: what is the purpose of the insurers, and why are they still allowed to take 20%? Because they give no “value-added”; under ACA, they are simply collecting and disbursing moneys. Nobody should get 20% for that! You only get to keep some of the money if you add value; if you give value-added. They give no value-added. Before ACA their “value-added” was keeping “costs” down by 1. avoiding risky patients 2. recissions and 3. keeping your doctor on the phone.

To me, the word “costs” should be used instead for the supply chains of healthcare supplies, equipment, medicines, doctors and hospital overheads, etc, etc, etc. I am not writing about that in the stuff above, on rectifying prices as a precondition to a single-payer. I imagine, though, that afterward a single-payer can certainly get a better deal on these real cost issues.

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Bruce Baugh 12.14.13 at 1:11 am

Suzanne: I know a bunch of fine Medicare recipients who’d be happy to see it expanded, including to cover everybody. I didn’t say every beneficiary of an expansion turns into a kick-the-ladder-down type, just that some do, and that this is a real problem for incremental improvement.

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Ed Herdman 12.14.13 at 1:50 am

Lee Arnold:

Thanks for that response. I hadn’t thought about that potential to call into question the rationale for insurers – that’s interesting, though I don’t exactly follow.

I’d agree that single payer is preferable to private insurance, so we’re just stuck on this step – the public don’t understand it and most assuredly the millionaires in Congress are opposed to it. We’ll see how far the reforms go towards stripping away the greed at the margins and getting private insurance efficiency closer to what a government program would look like. Also, I wonder (open-mindedly) whether you would advocate the same for private banking – it seems that a lot of the same kinds of issues would apply there.

I’ll agree with your terminology and refer to price here instead of costs, though I still think that the note in my second part about costs is still important (just a bit off the topic) – and it’s right that referring to price doesn’t do much to illuminate this; it’s still a problem.

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Lee A. Arnold 12.14.13 at 2:17 am

#162: “the public don’t understand it”

There you go. And there’s no explaining it, that will help. It is “too much information”. So instead of trying to explain the economic logic, do something different, create the conditions on the ground: Everybody looks at their bills, says “Wait a minute! We are all paying the same. Why are they getting 20%?”

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Ed Herdman 12.14.13 at 2:30 am

I don’t mind admitting not being the best-informed on that – but has the new system really made expenses more transparent? If anything, proponents of the change spent a lot of time talking and dreaming about reducing costs (using the term advisedly now) by getting people to spend more wisely on the care they did receive, and being better informed about it. Questioning the role of private insurance is a little ways down the line – if it is actually transparent, which seems to be in doubt.

Also, don’t you get that same kind of transparency with banks? That wouldn’t go anywhere in this Congress, or (probably) almost any Congress we’ve ever had (besides maybe in the immediate aftermath of the Great Depression – and look at how much fury Jackson expended against central banks in his own time). Banks aren’t going anywhere. I don’t see terribly many reasons, at least ones people are likely to raise, why a similar system couldn’t be applied there. The only positive I see in both cases is that the private insurance and private banks can fail – though we just have the taxpayer on a hook to bail them out when necessary.

If so, not only is it the public that don’t understand it – neither do our hired help in government, either, unfortunately.

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Lee A. Arnold 12.14.13 at 3:39 am

Here is a bank: http://www.youtube.com/watch?v=Byaf9GihXhY&feature=c4-overview-vl&list=PLE3BC3F222D31C78D

I want to animate them from the view point of the core economy — i.e. starting with something small enough to capture the historical savings/investment development function of banks. It seems to me that since then, the financial system has gone conceptually off the rails. As soon as there is more than one bank, and they deal directly with each other, there arises a derivative opportunity, of one type or another, and then, in pursuit of its value, the banks all accumulate liability, and cause a systemic risk. Here are shadow banks:

http://www.youtube.com/watch?v=7tTapPEhOKg&list=PLT-vY3f9uw3ADgyYqUVo2R8kxM4Agc3aw&index=17

They are gambling with our money — or to put it a better way, they are creating credit along certain channels, thus redirecting everybody else’s basic means of exchange.

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Suzanne 12.14.13 at 5:17 am

153: ” The GOP has been doing the same, and it leads to a lot of self-inflicted wounds.”

Lose a few battles, win the larger war. The GOP has succeeded in ensuring that the budget debates take place on grounds of their choosing, e.g., debt reduction. The Democrats “win” when they hold the line on the social safety net, at a time when that same net desperately needs expansion. And even so the food stamp extension has lapsed and it looks as if the federal unemployment benefits extension will do the same.

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Lee A. Arnold 12.14.13 at 9:00 pm

The Dems have changed two things: they changed the terms of the debate, though ever so slightly. And they have taken a decisive step toward the last big part of the safety-net, universal healthcare.

When did the Dems change the terms of the debate? It was when they began, a few years ago, to insist that the Repubs NAME the spending cuts to pay for their tax cuts. This rhetorical change was so big as to make the news media, though memories now are short. Repubs had always said, “Tax cuts pay for themselves,” and the Dems, being dunces, never challenged them on it.

(In reality, 1. tax cuts have never paid for themselves in revenue gains, and further, 2. tax cuts for the wealthiest do not appear to increase long-term growth rates enough to do so, at least in the range of U.S. levels of taxation. This is technically confusing enough, but the confusion about tax-cuts also comes from the fact that 3. tax cuts, yes, may be a valid part of short-term deficit spending to cause an effective, short-term business-cycle stimulation. These confusions appear not only among the hoi polloi, but extend to many in the financial community and in the economics profession. Thus, we have another case of too much intellectual hassle, as per the top post.)

So before this, the Repubs had always got their tax cuts without spending cuts, because the Dems were intellectually incompetent. Of course this increased the deficits, which the Dems at the time were unlikely to care about, being more focused on golf games and happy hour. Then, after the Dems got back in power, the Repubs would blame the Dems for the deficits, and try to force the Dems to do the spending cuts.

The old Republican “Starve the Beast” Strategy.

Stopping this ridiculous sequence was the first step to protecting the safety-net. Why? Because, if the Repubs are compelled to NAME the parts of the safety-net that they want to cut, in order to get tax reductions, then they are going to run out of things to cut without hearing a lot of real yelling, and they will start to lose more elections. This obvious outcome has driven the GOP into a truly ridiculous bipolar stance currently, in which they must cut Medicare (Paul Ryan) at the same time as they run against Obama and the Dems for cutting Medicare (i.e. reducing the porkbarrel aspects of Medicare Part D).

It shows you how stupid U.S. mainstream media is, that it does not carp on this blatant GOP hypocrisy daily. Starting from before the 2010 midterms.

That is why in some respects I am against the current budget deal. The Dems are very, very foolish to stop making the Repubs name the spending cuts.

The budget deal of course is the neolibs reasserting themselves in both parties. Note that this is entirely enabled by the public’s fear of gov’t debt (which usually runs at 60-70% mortal fear in the opinion polls). It would not happen otherwise: the real cause of this is the public’s confusion and stupidity. Both parties, eyeing the election ahead, have decided to shore-up their austerity credentials.

It is a good move by Repubs to support this budget deal, because they may be able to start driving a wedge into the Democratic Party, separating out the left, which correctly knows it is nonsense. Indeed the left may soon begin to sputter even more incoherently than is normal. While I am all in favor of destroying the Democratic Party, I would prefer it did not happen before the GOP is destroyed.

Anyway, all is not lost, and it just means that those who want to find practical steps to a better world must change short-term tactics within the long-term strategy. It will continue to be useful to make the parties play-off against each other, but to do so in a way that ultimately makes both parties accountable for inequality and for environmental destruction, because these issues are just going to get bigger and bigger; there is no avoiding them. Then, maybe both parties can be defeated.

P.S. Getting back to Corey’s top post, I think the answer to reducing the transactional “hassles of everyday life” is not to blindly insist that if only people 1. knew more, 2. were not lied to, and 3. had somebody good to vote for, then afterward, all would be well. I think all the information required to achieve those things, is another form of hassle. It competes for the individual person’s cognitive budget and intellectual budget. In short, the problem is too much information.

If that is the case, the best strategy will be to set the powers that be against each other, and make the individual’s choices to be immediately practical. Because most people don’t follow abstract arguments, indeed they mistrust them as being emotionally faulty. This has been capitalism’s strategy, keep the question simple — do you want this new dishwasher, or not? There is no reason it wouldn’t work for other institutions. We could go a long way by ignoring for now whether the institutions are private (i.e. business) or public (gov’t), and continually return to the questions of whether they are transparent, responsible, and achieve our needs.

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Suzanne 12.15.13 at 12:42 am

@161: Your OP seemed to suggest a potential wall of hostility toward expansion, enough to make dangerous and/or futile any attempt at same. Sorry if I misread it. We’ll probably never know now, but my hunch is a successful Medicare expansion would lead to more people wanting it and thus more political pressure, and the types you mention would not necessarily be able to prevent it. Difficult to explain to younger people that you’re denying them a benefit you enjoy.

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Bruce Baugh 12.15.13 at 12:53 am

Thanks for checking, Suzanne. I’m very much in favor of extensions wherever they can be had, on the ground that relief for real people now is a good thing. The Medicaid expansion in the ACA makes me very happy; I’m up for supporting more.

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Suzanne 12.15.13 at 1:11 am

@167: For the first time, a Democratic administration proposed Social Security cuts and raising the Medicare age of eligibility as part of making a budget deal, and at a time when aging workers have been driven out of the workforce in record numbers, probably permanently. Somehow I think the GOP will be able to work with that.

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Lee A. Arnold 12.15.13 at 2:53 am

@170: It is a really stupid idea, but it is not the first time. The Clinton Administration made noises about cutting Social Security too. The intellectual rot has gone deep. It was only a small group of blog commenters who suggested to the Dems in 2006 when George W. Bush wanted to privatize Social Security that the Dems should not go along with this, but make Social Security into the banner of the Democratic Party. Because the Dems were disposed to go along with it, despite Bush’s growing unpopularity via the Iraq War. Most of the rest of the country would have had their asses handed to them on a silver platter, with only a few years until the financial crash. Think the retirees would have been bailed out, like the banks? Guess again! What I want to know is, why doesn’t the left wing start a bank?

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Suzanne 12.15.13 at 5:39 am

Note that I wrote “as part of a budget deal.” It is true that Clinton’s White House was looking at a degree of Social Security privatization and Clinton himself was said to favor individual accounts, although not everyone in the Administration agreed with him. There was a healthy surplus at a time of general prosperity and Clinton and Gingrich were discussing a deal wherein the age limit was raised and surplus money was earmarked long term for the program. Fortunately the Lewinsky scandal intervened, although it’s not at all clear that any such plans would have succeeded had they become more concrete proposals for debate – there would have been strong resistance from Congress and it would likely have been bipartisan.

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Lee A. Arnold 12.15.13 at 7:32 pm

Note that such a budget deal has not entirely gone through, as yet. I think we should start now, and blame the Repubs for any coming reductions in the social safety-net. This may prevent the Dems from voting for it, too, purely in neoliberal self-interest of getting re-elected. All we have right now is setting their self-interests against each other. But not by not-voting. By voting.

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bob mcmanus 12.15.13 at 7:57 pm

blame the Repubs for any coming reductions in the social safety-net. This may prevent the Dems from voting for it, too

Grass roots 12-dimensional chess!

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Lee A. Arnold 12.15.13 at 8:15 pm

Bob McManus #175: “12-dimensional chess!”

“Guerrilla Rhetoric!”: “All dissent must be of a higher logical type than that to which it is opposed.” (Baudrillard translating Wilden, and back again.)

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john c. halasz 12.15.13 at 9:27 pm

A “higher logical type” means that something is more abstract and therefore more general, but also less specific or differentiated. As in nature being a higher logical type than human society. So what is this standpoint outside the system? (Especially since you’re quoting the line to advocate working within it).

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geo 12.15.13 at 10:10 pm

Lee@167: I think all the information required to achieve those things, is another form of hassle. It competes for the individual person’s cognitive budget and intellectual budget. In short, the problem is too much information. /i>

If by “achieve those things” you mean actually write the necessary legislation, then yes, not all of us can do that. But to understand what’s rotten and why — vast disparities of wealth, tens of millions without adequate health care, millions of mortgages foreclosed, millions of people out of work, millions more with unpayable education debts, and the one percent of the population whom this state of affairs benefits in virtually complete control of both parties and of the electoral process — why would this strain the average American’s “cognitive budget and intellectual budget”? It’s hardly rocket science.

Anyway, who is going to “set the powers that be against each other” and “make the individual’s choices … immediately practical”? Is it really possible to do such things in the absence of a well-informed and self-assertive citizenry able to think halfway straight?

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Hektor Bim 12.15.13 at 10:24 pm

This was a great post. As one gets older and assumes greater responsibilities, one has much less tolerance for people wasting one’s time.

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Ed Herdman 12.15.13 at 10:32 pm

Which seems equivalent to saying that one accepts a deflated view of one’s place in the world – with respect to actual or accepted responsibilities, as opposed to the wider opportunities viewed by youth (supposedly).

“Wasting time” isn’t good, of course, but when we swear off avenues as pie-in-the-sky wishful thinking, we’re also wasting our time, by choosing to pick just the low-hanging fruit.

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Lee A. Arnold 12.15.13 at 11:44 pm

John C. Halasz #176: “So what is this standpoint outside the system? (Especially since you’re quoting the line to advocate working within it).”

That question might be better directed to Bob McManus, who appears to think that setting the two parties fighting within themselves, and against each other, is so complicated as to be 12-dimensional chess.

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Lee A. Arnold 12.15.13 at 11:50 pm

Geo #177: “to understand what’s rotten and why… why would this strain the average American’s ‘cognitive budget and intellectual budget’? It’s hardly rocket science.”

Please explain, then, why 60-70% of the population regularly polls as believing that the federal budget deficit is a big economic danger — (and I would bet that a slight majority also thinks that the federal budget deficit is the reason why the economy is already so bad, though I don’t know that particular poll number). Because Geo, you are right, it isn’t rocket science.

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geo 12.16.13 at 12:10 am

Lee: Please explain, then, why 60-70% of the population regularly polls as believing that the federal budget deficit is a big economic danger

That isn’t rocket science, either. Because they’re told so ceaselessly by the hack commentators on the corporate-controlled media, because graduate students who see through economic orthodoxy are actively discouraged and drop out, and because labor unions, which could once afford to employ and promote economists with a dissenting viewpoint, have been decimated. It’s not a problem with the public’s cognitive or intellectual resources — though indeed those resources are more meager than they would be if public education were better funded and state and local boards of education were less subject to pressure from the business community.

But you know all that. Which is why I was puzzled that you seemed to scoff at the idea that “the answer to reducing the transactional “hassles of everyday life” is … to insist that if only people 1. knew more, 2. were not lied to, and 3. had somebody good to vote for, then afterward, all would be well.” Perhaps not all would be well if people knew more and were not lied to, but wouldn’t it be a hell of a lot easier to make all well if they did?

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Lee A. Arnold 12.16.13 at 1:29 am

Geo: #182: “Because they’re told so ceaselessly”

Yet, you and I are also both told so ceaselessly, and we do NOT believe it.

I think the issue is the amount of individual time that can be given to understanding it. I agree with your statement, “It’s not a problem with the public’s cognitive or intellectual resources.” I take for granted that we all have the same basic mental abilities. But a few of us reason that the federal debt is not a threat, because we developed our intellectual budgets to understand it, and made an allowance in our cognitive budgets, or attention budgets, to have the time to understand it.

Now, I can think of three ways to deal with public nescience. 1. Change everybody’s intellectual and cognitive budgets. Good luck!

2. Change the dominant social narrative which most people follow. You might help to change the dominant social narrative by changing the graduate departments, or putting the mainstream media out of business, or reconstituting the labor unions, or getting teachers more money. I’m all for it.

3. Change an institution that controls the individual choices and preferences, which then makes people think about it. This forces that extra allowance in the cognitive budget, with the intention to (finally) save more of that budget for other tasks. Example? Obamacare.

“Perhaps not all would be well if people knew more and were not lied to, but wouldn’t it be a hell of a lot easier to make all well if they did?”

I was trying to write something pursuant to Corey’s point about hassle-reduction. Since cognitive budgets are limited, if you are doing something like reforming healthcare, it may be more efficient to create a mess like ACA, which then gets sorted-out in the individual doing of it, rather than take a perhaps long detour of first, educating everyone about the details of healthcare policy, and making sure you’ve voted-out all the insurance industry Senators.

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Lee A. Arnold 12.16.13 at 2:10 am

I thought of a fourth way to deal with public nescience: 4. If you animate a flow-chart language and create repeating motions as part of a standard grammar about transactions and grouping, this might harness the new degree-of-freedom given by screen animation, to accelerate comprehension by reducing comprehension-time, even about fairly complicated subjects.

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geo 12.16.13 at 2:23 am

Lee: OK, fair enough. Like your suggestions. Number 4, in particular, is brilliant.

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Lee A. Arnold 12.16.13 at 2:51 pm

Thanks, but so far I can’t claim any success!

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