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

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

Single. Payer. System.

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.

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)

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…

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.

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.

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?

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”.

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.

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*.

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.

@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.

“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.

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.

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.

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.

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

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

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

No.

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.

geo @ 37

Thought not — and thanks.

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.

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.

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.

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).

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.

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.”

“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.

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.

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.

@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

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.

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.

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.

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.

“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?

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.

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.

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: 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.

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)

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.

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.

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.

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.

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?

Maybe make Lieberman Secretary of State.

Radical Bob strikes again.

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.

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.

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.

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).

“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.

“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.

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.

Bomb Iran, get a free MRI.

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.

“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?

“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.

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.

“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.

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.

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.

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

Comedy gold.

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.

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.

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?”

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).

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.

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.

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] 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.

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.

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.

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.

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.

@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.

@ 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.

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.

#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%?”

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.

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.

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.

@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?

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.

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.)

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>

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?

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.

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.

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.

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