Tag Archives: health care

Health Care Basics

Posted on by

So, the health care debate.

But first, a really long tangent. Feel free to skip this part, but it does kind of relate.

* * *

One day when I was a boy, I was reading some old Jewish folktale that took place in a shtetl. There were some robbers, and they were stealing from a family’s home. My dad was shaving in the bathroom, and I went in and asked him, “Is there such thing as robbers?”

It seemed so weird to me that there could be a group of people who snuck into someone’s house and stole their stuff. It… just didn’t make sense. It was too scary and unsettling. It was… wrong. Why would people do something that was wrong?

I tend to be idealistic about humanity — or naïve, depending on how you look at it. I like to throw away the assumptions and ask the questions a child would ask. Why do dogs have four legs? Why is the sky blue? Why are people mean? Why can’t they just not be mean? Grow the hell up, someone might say. People are just mean. What? Come on! I can’t even ask why?

I believe, or I want to believe, that every human being wants to be good, that human beings care about their fellow human beings, and that if you just try to communicate with someone who is ill-informed — if you calmly lay out your reasoning, clearly and logically — the other person can’t help but come around; perhaps not right away, but eventually. Even if the person protests, I believe (or, again, I want to believe) that your words will seep into the person’s subconscious, take root, and flower when the time is right.

I believe deeply, almost religiously, in the power of logical argument. That doesn’t mean an argument divorced from emotion or morality; ultimately, arguments for the preservation of humanity or for the idea that we should treat each other well are moral ones, not logical ones. But the process by which you get from a moral premise to a moral conclusion, that involves logic.

As for the substantive part, the moral part: I do think everyone wants to do good. We can be selfish, fearful creatures, but we are also capable of great empathy and generosity. That empathy and generosity just needs to be teased out sometimes, and it has to be done in the right way. I don’t always know what that way is, but I believe it’s possible. I just refuse to believe that there isn’t a person who can’t ultimately be convinced.

Again, call me idealistic or naïve. I don’t care.

* * *

Okay, that’s the end of the tangent. You really should have read it.

But back to the health care debate.

All the craziness is making people forget what this is all about:

Either you care about what happens to strangers, or you don’t.

Either (1) you believe your fellow citizens deserve health insurance, or (2) you don’t believe your fellow citizens deserve health insurance.

Either (1) you see other human beings — most of whom you will never meet and who may have life circumstances or cultures that are completely different from your own — as actual, living, breathing people, or (2) you see your fellow human beings as subhuman.

Why do I say subhuman? Because if you don’t ascribe to other people the same three-dimensionality that you ascribe to yourself and your own family members, if you don’t think their lives matter as much, then you’re not treating them as human beings. You’re treating them as less than human. As subhuman. (This is why good fiction writers are probably better people than the rest of us: because they take the time to imagine fully real, fleshed-out characters. Because they appreciate that every human being has value.)

It’s weird. For most of 2008, and most of the years before that, I thought that the health care debate was about the fact that millions of Americans don’t have health insurance. Either they can’t afford it or they’re denied coverage, but for whatever reason, they don’t have health insurance. So they get sick and die because they can’t afford to see a doctor for minor issues that become major issues or even for preventive care. Or they have an accident or develop a catastrophic illness and then they go into bankruptcy because they have to pay for everything themselves.

So health care reform is about insuring all of our citizens, like every other modern nation tries to do.

But then suddenly it’s 2009, and people are saying, “Health care reform, as we’ve long said, is primarily about reducing costs.” What? When did this happen? I thought health care reform was about insuring all of our citizens. When did it become about cost? Cost is an issue, but it is a secondary issue. The primary issue is that there are millions of Americans who lack health insurance.

The cost isn’t really a big deal. Why are people so selfish that they’re not willing to pay higher taxes to help out millions of other people? Our taxes are already so low compared to other countries. Back in the ’50s and ’60s, taxes were way higher than they are now — the top rate was 91 percent — and the economy thrived.

The response is, “Are you kidding? I’m struggling as it is.” Well, guess what? There are millions of Americans who are much worse off than you.

“But this is my money. I should be rewarded for my hard work.” Yes, but you have a moral obligation to the rest of human society.

“But if these other people just worked harder, they’d be doing as well as me.” Tell that to the woman working two minimum-wage jobs to feed her family.

“It’s not my fault she’s worse off than I am.” No. But again, you are part of human society, and therefore you should care about her.

You should care about her.

“Why can’t we all just give to charity?” If that worked, we wouldn’t be in the mess we were in. Besides, mandatory payment — taxes — takes the social pressure off you. We care about how we’re doing in relation to other people, and if you know that everyone else has to give money for the common good, you won’t feel like a chump for being the only one doing it.

I don’t understand why more preachers and pastors and other religious leaders aren’t pleading with their congregants to support universal health care and the higher taxes that are necessary to achieve it.

I can be selfish and irritable and scared and suspicious just like anyone else can. But that’s why I need to be made to contribute, just like everyone else. We can’t rely on charity. Charity relies on our moods and our moods are inconsistent. We need to be made to pay higher taxes.

I don’t understand why citizens have to carry guns to rallies and why politicians have to spread blatant lies. (Chuck Grassley.)

Either you care about what happens to strangers or you don’t.

I guess I’m just naïve.

* * *

[Update: I don’t mean to suggest that health care costs are not important at all. There’s no need for our taxes to go toward inefficiencies or for us to pay more taxes than are necessary. But reduced health care costs are a means to an end — health insurance for as many people as possible — and not the end in itself.]

Judicial Liberalism Not Happening

Posted on by

If you believe in judicial liberalism — which I sometimes do and, to be honest, sometimes don’t — the current direction of the Court is a little depressing. Tom Goldstein, Supreme Court analyst extraordinaire, points out that the conservatives on the Court are free to move at a measured pace in overturning liberal precedents, at least for a while:

For the moment, there is no reason to rush. Time permits a jurisprudence of not just originalism, or textualism, but actuarialism. The sand running through this hourglass will not expire for eight years.

Later in his term, President Obama will likely replace Justice Stevens with someone else on the left. If he is reelected in 2012, he will replace Justice Ginsburg with someone on the left. Nothing changes.

It isn’t until the election of 2016 at the earliest that there is a real prospect for a significant shift to the left in the Court’s ideology. Actuarially, that election is likely to decide which President appoints the successors to Justices Scalia and Kennedy (both on the right, and both 73 now) and Justice Breyer (on the left, and 70 now). Absent an unfortunate turn of health, between now and the summer of 2017 there is no realistic prospect that the Court will turn back to the left. Over the course of that eight years, it is possible to take enough measured steps to the right to walk a marathon. Again, no need to rush.

Unless something happens to Scalia, Thomas, Roberts, Alito, or Kennedy in the next few years, the Court is on a slow rightward trajectory.

On the issue dearest to my heart — gay rights — it probably doesn’t mean much. Kennedy has been pretty pro-gay (Romer, Lawrence), but I don’t expect the Court to take up same-sex marriage for a while. It didn’t overturn the nation’s sodomy laws until only 13 states were left with such laws; the Court is too cautious to constitutionalize same-sex marriage rights at this point, when only six states allow such marriage.

What else could the Court tackle? Don’t Ask/Don’t Tell will be history in the next few years — I’m pretty sure Obama will get around to it after health care and energy are taken care of. DOMA (full faith and credit clause) is a possibility — which would be a sidelong way to rule on same-sex marriage. But I don’t think the Court will touch that right now. Again, the issue is just too volatile, and the Court generally knows when to stay out of things. (It has learned from abortion; would Roe v. Wade come out the same way today? Who knows; the opinion would at least be less intrusive if it were written today.)

Of course, I could be wrong. Issues have a way of showing up on the Court’s docket unexpectedly, especially since it only takes four Justices to vote to hear a case.

But for now, things seem to be in stasis, at least where gay rights are concerned. As for everything else — drifting right.

Bipartisan

Posted on by

I’m so tired of all the talk about “bipartisanship.”

“If there is any chance we can do a bipartisan bill, it has to be in the Finance Committee,” Harry Reid said yesterday about health care reform.

Currently the Senate has 59 Democrats, 40 Republicans, and a vacancy in Minnesota.

If the Senate had 51 Democrats and 48 Republicans, and 8 Republicans joined 51 Democrats to pass a bill by a vote of 59-40, everyone would gush about how wonderful it was that a bipartisan bill passed.

But the Senate has 59 Democrats and 40 Republicans. If all Democrats vote for a bill today and all Republicans vote against it, it still passes, 59-40. But in that situation, it’s not “bipartisan.” So it’s a very bad thing.

Why is the same vote acceptable in one context but not in another?

If there were 90 Democrats and 10 Republicans, Harry Reid and others would still be fretting about winning over one or two of those Republicans in the name of “bipartisanship.”

Enough with the fetishizing of bipartisanship. If spineless centrists are going to worry about winning over members of the opposition no matter how small that opposition is, then what is the point of having a 59- or 60-member Democratic Senate caucus instead of a 51-member caucus or 54-member caucus? Yes, it’s nice to be able to break filibusters. But Congress recently decided that health reform could pass by a simple majority vote if necessary. So why are Reid and others being so obsessive about “bipartisanship”?

The Senate is an exclusive club divided into two teams. There’s a Democratic caucus and a Republican caucus, a Democratic leader and a Republican leader. Members of each party have their own retreats. Party controls everything. Most Americans aren’t loyal to one party or another — they vote for whoever seems like the better choice in any given year — but senators are obsessed with party. That’s especially true today, when party loyalty is much stronger than it used to be. Only three Republicans broke ranks to vote for Obama’s stimulus bill — and one of them switched parties soon after.

The bipartisanship fetishists in the Senate and the media are making an important mistake: they’re confusing bipartisanship with consensus.

We emerged from the 2008 elections with a Senate containing 59 — and it really should be 60 — Democrats. The Republican Party currently has a 25 percent approval rating. So the consensus of the American people is that the Republicans suck.

The consensus is that the Democrats should use their 60-member caucus to pass health care reform. Nearly three-quarters of Americans think there should be a public health care plan; this is a consensus. But “Democrats in the Senate have considered nixing the proposal in order to win Republican support for the bill,” according to that link.

Politicians do not have to listen blindly to what majorities want — people can be ill-informed and majorities can be wrong — but if they’re going to buck the public, they should do so for substantive reasons, not because they’re worried about upsetting the guy who jogs next to them in the Senate gym or sits next to them in the Senate dining room.

Bipartisanship is meaningless. It’s as antidemocratic as the Senate itself. In the Senate, every state gets two seats, no matter how big the state’s population; likewise, each of the two major parties apparently gets a voice, even if the American people think one of those parties is intellectually bankrupt.

Exactly how big a majority do we need before we can start using it?