The Supreme Court's health care decision

There are a lot of subtleties in the Supreme Courts' health care decision yesterday. After the initial euphoria/disappointment (depending on your view of the health care plan) passed, it has become clear that while liberals won a near-term victory, conservatives probably won a far more important long-term victory in their drive to restrain the power of the federal government, and in particular to restrain ever broader interpretations of the interstate commerce clause of the Constitution.

But I thought the most important line came in Chief Justice Robert's opinion: “It is not our job to protect the people from the consequences of their political choices."  In the end, if members of Congress impose on us truly dysfunctional legislation, it is our own fault as voters for electing and re-electing those members in the first place.

Recommended: You Don't Have to Support Universal Health Coverage to Support Caring for the Needy

The Reason.com site has a good posting today entitled You Don't Have to Support Universal Health Coverage to Support Caring for the Needy. It talks about what a better government health care system might look like. I agree with the ideas.In particular, the distortion of the price signals that the current system imposes is probably the single biggest thing forcing up health care costs.  Innovative programs in India are delivering top quality eye surgery at less than $100 per operation, while the same operation in the US costs in excess of $10,000.  Clearly there is lots of room for price reduction, if only the incentives were there.

Hans Klammer

I still remember watching Hans Klammer win the downhill ski race in the 1976 Winter Olympics in Innsbruck, Austria. (if you have never seen it, you can see it here). He skied last among the top seeds, and one of his predecessors that day had already set an unbelievably fast time for the course. So Hans threw caution to the winds and went all out, skiing the whole course so fast and with such abandon that he was on the knife edge of disaster the whole way, and winning gold by a fraction of a second.  It was a heart-stopping performance and I have never forgotten it, and the lesson I learned from it, which is that there are times in life to go all out, commit fully and damn the consequences.

I think of that as I watch European and America politicians try to find politically safe ways to deal with all the current crises, and consequently fail repeatedly. If there was ever a time to go all out politically, bite the bullet and push through the drastic policies that we can all see (if we are honest with ourselves) are required, it is now.

Where is Hans Klammer when we need him?

Recommended: What Republicans Think

David Brooks has once again written an outstanding piece in the New York Times: What Republicans Think. He argues that the real divide in the upcoming election between Republicans and Democrats is that the Republicans think the old big government welfare state model is no longer workable (and Europe's current crises seem to highlight that) and needs to be rethought from the ground up, while Democrats think it is still a workable model and just needs more tinkering (and more money) to keep it functioning.

He makes no judgment himself (in this piece, at least) as to which side has the better argument, but since the current model has the federal government borrowing almost half of the entire budget each year, it seems pretty clear to me that the current system is badly broken, and probably not repairable with minor tinkering, especially as there is little prospect of making more money available.

The health care issue

Now that we are all waiting for the Supreme Court decision on “Obamacare” there is a lot of (mostly predictably partisan) argument about where things go from here in the health care field.  What no one on either side seems to be aware of, or willing to grapple with, is the simple fact that it is impossible to offer the best health care to every single American. There simply aren’t enough doctors or nurses or hospitals, let alone enough money in the federal budget, to give everyone the kind of health care that a wealthy CEO can buy.

Nor is it clear that society “owes” everyone the very best, most expensive health care available.  We certainly don’t feel that society “owes” everyone the most expensive meals, the most opulent houses, admission to the most expensive colleges, or the most expensive luxury cars.  Why is health care any different?  

But more to the point, since it will be impossible to give every American top of the line health care, how do we decide who gets what?  Right now the market decides – if people can afford it (or the insurance that covers it), they get it. If they can’t afford it, they don’t get it. It isn’t an ideal system, but it does allow people to make personal choices about how to spend their money.

Would a government bureaucrat’s decision be any more fair?  On what basis would a government bureaucrat decide who gets a new kidney and who doesn’t, who gets a replacement knee and who doesn’t? On what basis would a government bureaucrat decide if and when to withdraw all but palliative medication to a terminally ill patient? Would we all be more content if those decisions were being made for us by someone we don’t know and didn’t elect?

This is the crucial health care issue that no one seems willing to grapple with. If there isn’t enough health care to go around (and there isn’t, by a long shot), what is the best way to allocate what is available?  Despite the problems with free market forces -- and there certainly are some-- I don’t see any better way.  

An interesting excerpt

I found this interesting excerpt from David Frum's review of Thomans Edsall's 2012 book The Age of Austerity: How Scarcity Will Remake American Politics. You can read the whole review here:

Edsall excoriates the cost of the Afghanistan and Iraq wars. Yet the mesmerizing fact in US fiscal policy is not the cost of defense, but the wastefulness of US health spending. The US spends 17 points of GDP on healthcare. Runner-up Switzerland spends 13. Four points! That’s the whole defense budget right there! Given that US health spending breaks down 50-50 between public sector and private sector, the elimination of healthcare waste could add 2 points worth of GDP to the spending power of both the public and private sectors.
To put that in perspective: the public sector’s 2 points of GDP would have sufficed nearly to eliminate the federal budget deficit in the Bush years.

For the private sector, 2 additional points of GDP would have qualified as a 4% pay increase for the average worker.

These are serious sums of money that ramify through every economic calculation.

Recommended: The Politics of Loss

Another very good, very long, thoughtful article worth reading is Jay Cost's The Politics of Loss on the National Affairs website. Cost argues that we have had decades of robust growth, when politicians of both parties had enough revenue to parcel out goodies to the favorite issues of both the left and the right, so that compromise was possible, and regularly occurred.

Now, he argues, we no longer have enough for both guns and butter, to fund the favorite issues of both the left and the right, and so now, he predicts, politics will get much nastier and compromise much more rare.  It is no longer a case of dividing up the federal largess, but rather now fights over who will have their benefits and entitlements cut first and most, and both sides will fight to the death to preserve as much as possible of the federal goodies flowing to their own voting bases.

This is a good article.

Recommended: The "People United" Goes Down in Flames

Walter Russel Mead, who as a British observer often gives a refreshingly new look at America affairs,  has written a piece "The "People United" Goes Down in Flames. He argues, convincingly, that the result in the Wisconsin recall election was not that the Republicans outspent the Democrats, but rather that the left no longer is able to convince the public of their positions.  This follows from his earlier pieces about the new Blue social model -- the left is still enamored of old policies that once worked but are no longer valid in today's world, but the public is ready, he argues, to move on and find new solutions better suited to our new conditions.

It is a long and thoughtful article, and well worth reading.

Recommended: Culture Still Matters

Victor David Hanson has another of his insightful commentaries posted, this one called Culture Still Matters. It is indeed culture, not religion nor race nor geographic location, that determines a society's success or failure, prosperity or poverty. And cultural habits are very hard to change. And when they do change they generally take generations to change or evolve. Worth remembering when Washington naively proposes to spend billions of our money to "nation build" in some remote part of the world.

Is the tide turning?

Gov Walker's 53%-46% victory yesterday in the Wisconsin recall election, and the 2-1 ratio by which Californians passed the public pension reforms propositions in San Diago and San Jose suggest that voters are FINALLY getting it, and getting realistic about our state and federal fiscal crises.  That is good news if it continues.

Who is really on trial?

From the daily news about the presidential election, or the Wisconsin recall election, one might think it is right-wing vs left-wing politics that is on trial, or Republican vs Democratic ideologies.  But it isn’t. It is we, the American voters, who are on trial these days.

In the end, it is we, the American voters, who have voted in politicians of both parties who swelled the state and federal deficits, buying our votes and handing out goodies to us funded by our own children’s inheritances.  It is we, the American voters, who have made it political suicide for a politician to propose balanced budgets or sensible fiscal restraint.

In the end, it is we, the American voters, who have allowed, with almost no complaint, a massive reduction of our own civil liberties, so that torture, execution without trial, warrantless searches, tapping of telephones and email, etc, etc are not only legal for the federal government, but now widely practiced.

In the end, it is we, the America voters, who have allowed, with almost no complaint, the growth of unlimited political influence by both corporations and unions, so that we now truly have “the best government money can buy”.

In the end it is we, the American voters, who have allowed successive administrations of both parties to (a) get us into wars without Congressional debate or approval, and (b) to finance those wars with borrowed money, to the serious detriment of our nation’s finances.

If we, the American voters, can’t grow up and behave like responsible adults, and insist that the politicians we elect behave like responsible adults, we deserve the (very, very unpleasant) consequences we will inevitably get, and probably sooner rather than later.

So these next few years will really be a test to see if we, the American voters, have become so addicted to our “entitlements”, so distanced from our ancestor’s values of prudence and thrift and hard work and self-reliance, and so disconnected from reality, that we are unwilling to change our ways even as we head toward national disaster.

Who is really on trial these days is we, the American voters!

Quotation of the week

“Reason is not automatic. Those who deny it cannot be conquered by it. Do not count on them. Leave them alone.”

 

Ayn Rand

Observations about the world

I have spent the past two days attending the CRN Irish Dance World Championships, in Wexford Ireland. It is awesome to see so many brilliant Irish dancers, some as young as 9 or 10, all of whom have pursued their dance with such dedication and focus that they can qualify for the World Championships. I have a granddaughter among them, and she did well.

Two things occurred to me over the long hours of watching the competitions.  The first was a renewed confidence in the younger generation who are inheriting our planet.  At a time when the daily news is filled with stories of disaffected youth rioting in this or that part of the world, it is comforting to see young people who are dedicated enough to put in the proverbial 10,000 hours to become truly excellent at something very demanding and difficult.

The second observation is simply wonder at the human mind and human body.  A dancer is recalling and executing an intricate sequence of hundreds or thousands of individual high speed steps or movements while keeping time to an auditory signal (music beat) while keeping spatial awareness (position on stage and relative to other dancers on the stage) while maintaining balance in a gravity field while shifting body support rapidly from one foot to the other while remembering a myriad of stylistic requirements (point the foot, keep the arms at the side, etc, etc).  And all this coordinated by a relatively small mass of neural tissue in the brain and along the nerve pathways.

We usually take all this for granted, in our daily life, in sports, in dance, in acrobatics, etc.  But if one stops to really think about it, the amount of high-speed processing going on is absolutely astounding.

The world around us is truly wonderful – truly awe-inspiring – if one only stops occasionally to really look at it.

Creationism and democracy

The latest Gallup poll indicates that 46% of Americans, almost half the population, believe in creationism, including that the world was created only some 6000 to 10,000 years ago. I hardly know what to make of this information. It implies that almost half the population either doesn't understand the methods of science, or is entirely unswayed by evidence that contradicts what they want to believe.

It is hard to see how a democracy can function in the modern world with such a population.  But then, our democracy does not seem to be functioning very well these days, and perhaps it is because a successful democracy requires an intellectual and educational level in the voting population that we simply don't have. Certainly successful politicians, who probably do understand their voters pretty well, have learned to simplify even the most complex issues down to simple sound bites, because (I guess) they have found accurate and realistic explanations to be beyond the comprehension of most of their voters.

People are concerned these days that real power in our nation has flowed increasingly to a powerful and wealthy ruling elite. In light of this statistic about creationism it is not clear to me that if power were returned to the general voting public we would get any better governance; indeed we might well get worse government.

It certainly makes me wonder...........

An Easy Guide To Keeping Political News In Perspective

 A friend e-mailed me this wonderful item:


1. The Wall Street Journal is read by the people who run the country.

2. The Washington Post is read by people who think they run the country.

3. The New York Times is read by people who think they should run the country, and who are very good at crossword puzzles.

4. USA Today is read by people who think they ought to run the country but don't really understand The New York Times. They do, however, like their statistics shown in pie charts.

5. The Los Angeles Times is read by people who wouldn't mind running the country, if they could find the time — and if they didn't have to leave Southern California to do it.

6. The Boston Globe is read by people whose parents used to run the country and did a poor job of it, thank you very much.

7. The New York Daily News is read by people who aren't too sure who's running the country and don't really care as long as they can get a seat on the train.

8. The New York Post is read by people who don't care who is running the country as long as they do something really scandalous, preferably while intoxicated .

9. The Miami Herald is read by people who are running another country, but need the baseball scores.

10. The San Francisco Chronicle is read by people who aren't sure if there is a country or that anyone is running it; but if so, they oppose all that they stand for. There are occasional exceptions if the leaders are handicapped, minority, feminist, atheist dwarfs who also happen to be illegal aliens from any other country or galaxy, provided of course, that they are not Republicans.

11. The National Enquirer is read by people trapped in line at the grocery store.

12. The Key West Citizen is read by people who have recently caught a fish and need something to wrap it in.