Health and the Market

Well, I see that the Congressional GOP is threatening to shut down the government in October if the Democrats block repeal of the Affordable Care Act, aka Obamacare, and the partisan rhetoric is predictably flying.

A Democratic friend sent me an email listing the multiple sins of the Bush Administration, from wars of choice to decimation of the economy to the massive increase in the national debt; the message was something like “You didn’t get mad about any of these things, but now a black guy wants to provide healthcare to Americans who don’t have it, and that makes you mad!?” A Republican friend sent me a similarly incendiary message insisting that Obama is a “socialist” who hates capitalism and wants to destroy the market “that made American health care the best in the world.”

Let’s stipulate that not everyone who opposes Obamacare is a racist, and that American healthcare before the ACA was not only not the best in the world, but actually ranks around 37th. Other than that, my purpose is not to engage these arguments, but to point to a perfect example of the way “the market” works in areas like healthcare, where buyers and sellers are not on equal footing, and do not possess the sort of equivalent information that is necessary for markets to work.

I have previously referred to a book written my cousin, Morton Tavel, in which he takes on the “snake oil” aspects of the healthcare industry. He has now created a blog devoted to the subject, and his first post is a perfect example of “the market” in medicine–a discussion of all the ads about “low T”–testosterone deficiency. I encourage you to click through and read the whole post, but the bottom line is that  “low T” is extremely rare. The numbers the manufacturers are hyping are misleading at best and fraudulent at worst, and the “remedy” they are promoting is expensive, unnecessary and unlikely to restore the virility of the aging men who miss their morning erections.

Markets are wonderful where they work. And they work more often than they don’t. But in those areas where they don’t work, they enable the snake oil salesmen who prey on the unwary and drive up costs for everyone.

As with so many policy debates, this isn’t an “either-or” debate between all market all the time and socializing every aspect of the economy. We “socialize” functions that markets cannot efficiently provide–police and fire protection, infrastructure provision, national defense, public education. We leave to the market those economic areas where markets have proven their effectiveness.

The decision whether to leave an activity to the market or provide it through government should be based on evidence, not ideology. And as every other western industrialized country has long recognized, the evidence for government’s role in healthcare is overwhelming, just as the evidence for the market in consumer goods and manufacturing is overwhelming.

The evidence also tells us a lot about elected representatives who–having lost the argument–are willing to shut down the American government in order to protect the profits of health insurers and drug companies.

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The Art of the Dog Whistle

Poor Mitt Romney. He’s wooden and inauthentic on the campaign trail, and yesterday, his attempt at a ‘dog whistle’ to those uncomfortable with Obama’s “otherness” simply betrayed his very curious lack of self-awareness.

A ‘dog whistle,’ for those unfamiliar with the phrase, is use of language and/or allusions that send a message to a targeted constituency without communicating that message to the public at large. George W. Bush was a master at it: he would use biblical phrases that were familiar and meaningful to evangelical Christians but unfamiliar to most of us to send a signal that he was one of them–without alerting anyone who might have a problem with so explicit a declaration of faith.

In an interview with Larry Kudlow yesterday, Mitt “went there” by opining that Obama’s beliefs are “foreign to American experience.”

Mitt, Mitt, Mitt. This might work if you were one of the dramatically declining number of Americans living the life of Opie in Mayberry, but in case you hadn’t noticed, your beliefs and experiences aren’t exactly part and parcel of the “American experience”–whatever that means these days.

Very few Americans are married to someone who drives “a couple of Cadillacs.” Fewer still claim a tax deduction of 77,000 for upkeep of their “dressage” Olympic horse, or install car elevators in one of their multiple homes.

Your devotion to your church probably does reflect American religiosity, but most denominations don’t share a belief that Jesus visited the continental U.S. after he rose from the dead, or that his visit and further instructions were inscribed on gold plates that were subsequently discovered buried in Palmyra, New York.

Let’s face it: neither you nor President Obama are typical Americans. Obama is a member of a racial minority; you are a member of a religious minority. You grew up privileged, he spent a good part of his childhood abroad.  In both cases, your experiences have shaped who you are. In neither case have your atypical backgrounds made you “foreign” to the American experience. Both of you are part of the increasingly diverse fabric of this country.

Dog whistles only work when you are clearly a member of the group you are signaling–and the other guy just as clearly isn’t.

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Incivility and an Inability to Govern

There’s an interesting symposium on political civility in a recent issue of PS: Political  Science and Politics. The articles wrestle with some foundational questions: what is the difference between the sort of argumentation that illuminates differences and is an inevitable part of democratic discourse and rhetoric that “crosses the line”? What do we mean by incivility?

The consensus seemed to be that incivility is rudeness or impoliteness that violates an agreed social standard.

I’m not sure we have agreed social standards in this age of invective, but surely attacks that focus on, and disrespect, persons rather than positions should count as uncivil. An example of civility in political argument might be Dick Lugar’s often-repeated phrase to the effect that “that is a matter about which reasonable people can differ.” (Hard to imagine Mr. Mourdock, who has taken pride in incivility and intransigence, making such a statement.)

The contributors offer a variety of perspectives on the definitions and causes of today’s nasty politics, but one of the most trenchant observations came from a Professor Maisel of Colby College, who attributes the gridlock in Washington and elsewhere to “partisan one-upmanship expressed in ways that do not show respect for those with differing views.” As he notes (referring to Erik Cantor)

If your will is to prevent legislation from passing, to prevent the president’s agenda from moving forward, to work the system to your political advantage, then lack of civility works.

In other words, if your over-riding motivation is simply to beat the other guy–to keep the President from a second term, as Mitch McConnell famously admitted–and if that motivation outweighs any concern for the public good, governing is impossible.

The reason politicians no longer “respectfully disagree” with each other, Professor Maisel points out, is that they do not in fact respect the views of their opponents. They hardly know them. The days when Congressional families lived in Washington and socialized–when their children went to school together, and their spouses carpooled or otherwise interacted–are long gone. It’s easy to demonize people you don’t know.

Add to that an even more troubling aspect of today’s politics, a disregard for fact and truth, enabled by partisan television, talk radio and the internet. Survey after survey shows that people on the Left and Right alike get their “news” from sources that validate their biases. Worse, we have lost the real news, the mainstream, objective journalism that fact-checks, that confronts us with inconvenient realities. In such an environment, it becomes easier to characterize those with whom we disagree as buffoons or worse, unworthy of our respect.

When political discourse is so nasty, and regard for truth so minimal–when the enterprise of government has more in common with a barroom brawl than a lofty exercise in statesmanship–is it any wonder that so many of our “best and brightest” shun politics?

Government is broken, and we need to fix it. Unfortunately, the symposium contributions didn’t tell us how to do that.

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Southern Electioneering

The other day, I mentioned how few bumper stickers I’ve seen this election season. That observation has held as we have driven south, through Kentucky, Tennessee, and the Carolinas.

As every academic knows, you can’t draw valid conclusions from an inadequate sample. But a couple of the things I have seen are consistent with a theory–espoused by several pundits and even by John Boehner–that this election is all about Obama. (Boehner, you may recall, was asked by a voter for a reason to like Mitt Romney. Boehner basically responded that it wasn’t’ necessary to like Romney–it was enough to loathe Obama.)

On our drive, we’ve seen signs for a Congressional candidate promising to “Stop Obama Now.” And we’ve seen a couple of “NoBama” bumper stickers. That’s it. Not a single pro-Romney sign or sticker, and very few pro-Obama ones.

To some extent, of course, every election featuring an incumbent is a referendum on that incumbent, but in this election, that truism is super-charged by the incumbent’s complexion. I was stunned by the intense hatred of Obama that emerged the day after the election–well before he was inaugurated, before he had done anything. The emergence of the “birthers,” the crazies who insist he was really born in Kenya, that he’s really a Muslim (with a radical Christian pastor!)–all efforts to avoid using the “n” word–are hard to miss. But it isn’t only the obvious racists. There are a lot of people who are simply uncomfortable with a black President.

Is it possible to simply disagree with Obama’s policy choices? Of course. Will many people vote for Romney because they are good Republicans, because they don’t like the direction the President wants to take the country? Of course. To suggest that all or even most opposition to the President is racist would be ridiculous–just as denying the substantial racism that does exist would be ridiculous.

One way or the other, the “referendum effect” will be particularly potent this year, because as John Boehner conceded, it’s hard to actually like Mitt Romney.

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A Walk on the Beach

The two youngest grandchildren, 8 and 10, are with us at the beach (this time, thankfully, with their parents). Both were eager to begin the week with something that has become a ritual–a half-mile walk down the beach to the Inn and across the lobby to the newspaper dispensers, where we buy the local papers before walking back.

The sun was hitting the ocean, the beach was pristine. Other walkers nodded and smiled. The kids ran in and out of the water’s edge. My grandson remarked that his dad had told him that he and his  2 brothers used to sleep in the room he and his sister were now occupying, and that one of them had to sleep on the floor. (Two beds, three boys.)  I laughed and said “I guess I had too many children,” to which he responded, seriously. “That must have been hard on you.”

There is something about family traditions that span generations. And since I am nerd to the core, I looked at my grandchildren and the beach and the ocean, and wondered if vacations like this one will be possible when they have grandchildren.

Will the climate change deniers–the dolts and the economically-motivated and the “we’re going to be Raptured anyway” believers–stop policymakers from taking the steps necessary to protect the planet from further environmental degradation? Is my generation so selfish that we won’t agree to some relatively minor inconveniences now in order to preserve mountains and beaches for the generations to come?

Corny as it is, I couldn’t help remembering a poem my own mother used to recite to me. The stanza I remember: “Lives of great men all remind us we can make our lives sublime, and departing, leave behind us, footprints on the sands of time.”

Footprints, hell. I just hope we leave some sand.

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