Why Do Republicans Hate the Affordable Care Act So Much? And What IS Health Insurance, Anyway?

The only kind of Darwinist Republicans like is a social one.

William Graham Sumner -- the intellectual father of today's GOP

Over at TNR, Jonathan Bernstein is having a terrible time figuring out why Republicans have such incredible hatred for the Affordable Care Act.  Is it wonky worries about Medicare costs?  No — if that were the care, they would embrace the ACA’s attempts to hold down those costs.  Is it fears for private insurers?  No — private insurers are not only protected by the ACA, but given literally millions of new customers.  Then what is it?

It’s really quite simple, although you can spin it two ways.  They are outraged that the government is helping working people who cannot afford health insurance purchase it.  The more charitable spin concerns how Republicans (and conservatives generally) think about health insurance.  For them, it’s a commodity.  If you can afford a widget, you buy a widget; if you don’t, you don’t.  If you can afford a car, you buy one.  If you don’t, you don’t.  If you can afford health insurance, you buy it; if you don’t, you don’t.  That’s the way the market works.

Democrats and progressives disagree, although we don’t have a good way of talking about it.  Some have used the language of “rights,” as in a “right to health care.”  But as with all positive rights, this obscures the issue: many states have the “right to education,” but that doesn’t mean that everyone gets the education they want.  They get something minimal, and have a claim on the public fisc to get it, although as states all over the country are showing, that claim is quite tenuous during a recession and when Congress seems devoted to avoiding its responsibilities to assist the states.  But whatever health care is, it’s not a commodity.

The less charitable spin — which (as I’m sure will come as a shock to all) is what I agree with — comes from Bernstein’s TNR colleague Jonathan Chait.  The core of Republican belief, he explains, is that

all success is earned success. They do not believe that luck or life circumstance play an important part in economic success. They believe that wealth and poverty are essentially moral categories, interchangeable with “hard work” and “sloth.” They decry government, but they don’t really oppose government per se. They oppose those government functions that transfer resources from the rich to the non-rich.

What Chait could have said but didn’t is that this is essentially Social Darwinism 101, or Scrooge, or Rand.  Ironically enough, this is the only Darwinism in which Republicans believe.  So instead of the man himself, I would suggest replacing the elephant as the GOP’s symbol with William Graham Sumner, the late 19th social Darwinist.  Although Sumner’s academic bona fides would no doubt offend most in the party, his insistence on the futility and downright immorality of doing anything to assist workers and the poor would be quite congenial.

Author: Jonathan Zasloff

Jonathan Zasloff teaches Torts, Land Use, Environmental Law, Comparative Urban Planning Law, Legal History, and Public Policy Clinic - Land Use, the Environment and Local Government. He grew up and still lives in the San Fernando Valley, about which he remains immensely proud (to the mystification of his friends and colleagues). After graduating from Yale Law School, and while clerking for a federal appeals court judge in Boston, he decided to return to Los Angeles shortly after the January 1994 Northridge earthquake, reasoning that he would gladly risk tremors in order to avoid the average New England wind chill temperature of negative 55 degrees. Professor Zasloff has a keen interest in world politics; he holds a PhD in the history of American foreign policy from Harvard and an M.Phil. in International Relations from Cambridge University. Much of his recent work concerns the influence of lawyers and legalism in US external relations, and has published articles on these subjects in the New York University Law Review and the Yale Law Journal. More generally, his recent interests focus on the response of public institutions to social problems, and the role of ideology in framing policy responses. Professor Zasloff has long been active in state and local politics and policy. He recently co-authored an article discussing the relationship of Proposition 13 (California's landmark tax limitation initiative) and school finance reform, and served for several years as a senior policy advisor to the Speaker of California Assembly. His practice background reflects these interests: for two years, he represented welfare recipients attempting to obtain child care benefits and microbusinesses in low income areas. He then practiced for two more years at one of Los Angeles' leading public interest environmental and land use firms, challenging poorly planned development and working to expand the network of the city's urban park system. He currently serves as a member of the boards of the Santa Monica Mountains Conservancy (a state agency charged with purchasing and protecting open space), the Los Angeles Center for Law and Justice (the leading legal service firm for low-income clients in east Los Angeles), and Friends of Israel's Environment. Professor Zasloff's other major activity consists in explaining the Triangle Offense to his very patient wife, Kathy.

72 thoughts on “Why Do Republicans Hate the Affordable Care Act So Much? And What IS Health Insurance, Anyway?”

  1. If people don’t believe the assertion that Chait makes about success and morality, I suggest making a trip to the fever swamps of any newspaper comment board when a story about health care is printed. It won’t take long to change your mind.

  2. Whenever “Social Darwinism” is mentioned, it’s worth pointing out that this particularly heartless and greedy bit of social theory may have taken Darwin’s name, but it was never proposed or embraced by the man himself. I only make this point because those same people who reject Evolution and endorse Social Darwinism have a tendency, and perhaps a rhetorical reason, to demonize Charles Darwin.

  3. The sitcom “Parks & Recreation” has a great character named Ron Swanson who embodies the social darwinist / objectivist / Republican [is there a difference?] attitude. He gave a presentation recently on the topic of “Capitalism: God’s way of deciding who is smart and who is poor”.

  4. And you would never accept a subsidy for your own health care needs . . . okay, well maybe you would, after all . . . and if you can’t afford a bridge you don’t build one, and if you can’t make money farming, then you don’t farm . . . oh, wait a minute, no, actually, you ask the government for a hand out and often enough you get one.

    Please stop pretending that Republican positioning on health care is part of an intellectually coherent set of principles.

  5. Eh. I think there’s a much simpler reason. When was the last time either party’s base enthusiastically supported a major legislative effort launched by the other party? ACA is associated with Obama/Reid/Pelosi, therefore it must be bad.

    Plus, in this case, there’s the lesson from 1993-1994 — demagoguery on health care reform is perceived as winning the Republicans’ votes. It worked for them before, why not try it again?

    You’re trying to come up with a causal explanation when the causality runs the opposite direction.

  6. This post is the left-wing equivalent of Dinesh D’Souza’s attacks on President Obama.

    You can think all that about those on the right who oppose the ACA, or you could ask some of them, and listen charitably to their explanations. Of course that would require believing that people of good will can disagree with you in good faith.

    JHA

  7. Aye Jonathan…

    But it is a socio-cultural darwinism; to be practiced with a bit more vengeance against blacks and hispanics first…
    Let me remind you of a very famous Krugman quote:

    “But the AMA didn’t defeat Truman’s health plan alone. There was also crucial opposition to national health insurance from Southern Democrats, despite the fact that the impoverished South, where many people couldn’t afford adequate medical care, would have gained a financial windfall. But Southern politicians believed that a national health insurance system would force the region to racially integrate its hospitals. (They were probably right. Medicare, a program for seniors equivalent in many ways to the system Truman wanted for everyone, was introduced in 1966–and one of the results was desegregation of hospitals across the United States.) Keeping black people out of white hospitals was more important to Southern politicians than providing poor whites with the means to get medical treatment.”

    Krugman is right. But he doesn’t flesh out the deeper meaning. Namely, that all that historical chatter about how “The Great Frontier” has shaped the American character to this day, is the right idea applied to the wrong force. What shapes our character to this day is the brutal institution of slavery. Without the remnants of slavery afloat in whitey-righty’s mind today, we’d have single payer. Instead we have shrewd sociocultural darwinists dividing us and conquering. It has been what…. six generations since the Civil War? But whitey-righty still can’t get over his resentment for blacks, the loss of his plantations, and the fact that he has a Kenyan as president.

    The moral degradation of America’s South, the original evil empire, haunts us to this day.
    They are our anchor, holding us back, and despoiling our future.

  8. The Jons are greatly oversimplifying a subtle and closely reasoned Republican position. Much apparent success, for example the electoral victory of any Democrat, and the wealth of George Soros, is theft and crime. Conversely, much wealth, like Paris Hilton’s, is its own justification and its self-legitimating power would only be diminished if Ms. Hilton had sullied it by her own labor.

  9. You are overthinking the ideology involved here. There is no actual ideology here- only considerations of POWER. They are still working on the basis of the Krystol memo of 1994, where he recommends all-out opposition, not compromise on this issue.

  10. Jonathan,

    Of course that would require believing that people of good will can disagree with you in good faith.

    It would also require finding some of those people of good will who disagree. I suppose they exist, but the overall impression is that most opponents either:

    1. Are simply against it because it is Obama’s program.

    or

    2. Are wildly misinformed – wonder who did that? – about the Act and generally hysterical about “the government taking over 18% of the economy” or whatever.

    The fact is that the opposition has offered little in the way of serious criticism and commentary and that while it might be unfair to dismiss all opponents of the Act that way, it’s hardly inaccurate to say it describes the large majority.

    And what good, exactly, would it do to have conversation with the serious opponents? No serious modification is going to pass. It’s this or nothing.

  11. I generally hear that opposition to Government run health care is based on the belief that the government is taking on things beyond its mandate. Generally this is attached to the article of faith that the free market does everything better than the government can. I find this (often inconsistent) approach exasperating, as there never is much proof offered that this bold thesis is true; rather, it is supposed to be self-evident. Admittedly, there often is an underlying theme that people deserve what they get.

  12. Yup, social Darwinism. That and, it must be said, the intolerable affront of an African American president with a (just barely) progressive agenda sticking it to the traditional white ruling class. Turned the Republicans into lemmings, it has — triggered a mad stampede to the loony bin right wing of the party. We should be thankful for a president able to turn a blind eye to stupidity, & keep extending the olive branch.

  13. @Jonathan H. Adler

    There’s no symmetry involved. People of good will can disagree, but there’s no good will on one side of this particular dispute.

    As Barbara points out, and Michael O’Hare illustrates, there isn’t even a genuine philosophical argument on both sides. The conservative position comes down to a selfish expression of vested interest and resentment; whatever “philosophical” talk from the conservatives is tendentitious rationalization and opportunistic and glib gambits. Coherence in argument, on the right, can be completely subordinated to tactical convenience. And, since, in a popular democracy, an honest exposition of desiderata would doom advocacy of the conservative desire for a privileged and oppressive aristocracy, honesty is pretty much replaced by paranoid rantings and foul-mouthed slanders.

  14. Any benefit for someone who isn’t me must come at cost to me. Republicans don’t think in terms of systems or positive sum interactions or ‘what is good for society.’ Protecting youself and your blood from other people improving their lives is identical to morality.

  15. The basic difficulty with this conversation is that most of the participants seem to be confusing opposition to one particular solution to a problem with opposition to solving the problem altogether. This difficulty is further aggravated by a lack of knowledge about and how insurance works.

    For example, removing the lifetime cap on cost of treatment, which is already quite high, sounds like an easy, humanitarian gesture, which it is, especially as hardly anyone ever approaches that limit anyway. By removing it, we remove a source of anxiety over what is a remote possibility, right? Right. Anybody who opposes removing it must be a social Darwinian savage, right? Right. Except…

    By removing the cap, medical insurance companies are being exposed to a horrendous risk, even if the chance is remote. Why? Because in the event of a new treatment that is wildly expensive, the insurance companies have to pay. Of course, the truth is that, as previously mentioned, such treatments are extremely rare. However, there’s no assurance that in the future, they won’t appear, especially as by removing the cap there is tremendous incentive for them to be developed,or even for current treatments to be expanded greatly, no doubt with the strong urging of the Trial Lawyers Association. The rating agencies are going to have to take this into account, and it’s going to force a rise in premuims and put tremendous pressure on the insurance companies’ investments.

    Well then, the ACA supporters are probably thinking at this point that this proves making the government the single-payer is the way to go, but it isn’t, because it’s as unaffordable for the public sector as it is for the private. An unlimited cap is not workable for more than a few years, but all the ACA supporters hear is that anybody against removing the cap is a cruel social darwinist putting profits before people etc.

    This just one of the most obvious, clear-cut problems with the bill. The ACA is a disaster because it is extremely inefficient, wildly overpriced, forces a crude, simplistic, yet absurdly complicated insurance structure onto a market that really needs a plethora of different products, and will ultimately aggravates the problem it purports to solve instead of just solving it.

  16. “I generally hear that opposition to Government run health care is based on the belief that the government is taking on things beyond its mandate. Generally this is attached to the article of faith that the free market does everything better than the government can.”

    My ‘article of faith’, if you really must insist on my not having reasoned my way into the position, is that said mandate is the law. The ‘highest law of the land’, in fact. It’s built right into the structure of Article 1, which by ‘enumerating’ powers, excludes what was not listed. It’s reenforced by the 10th amendment, which gives to the states or the people those powers not delegated to the federal government. Which implies that, if they’re not delegated to the federal government, it doesn’t have them. Which means that, when the government, (And we’re talking the federal government here, it does matter. “takes on things beyond it’s mandate”, it is acting lawlessly.

    I think lawless government is a bad thing. I think that the habit of lawless government is scarcely going to be restricted to matters where arguably the action is better than compliance. I think that the mechanisms which are in place to permit the lawlessness, while pretending to be a nation of laws, are corrupt.

    I think, for this reason, that Obamacare is bad, even if it would have been a good idea in an alternate universe where the Constitution actually permitted it.

  17. Satan Mayo hints at another reason.
    There are a lot of people who believe that all things occur according to God’s will.
    If you are wealthy it is a sign that God views you favorably. If you are poor obviously God doesn’t like you.

    This may come from Calvinism and the idea that you are predestined as to whether or not you get into heaven.
    Alternately, you could think of it as “The divine right of the wealthy.”

    Advocating something like the Affordable Health Care Act is going against God’s will. It is evil.

  18. (Jonathan): “whatever health care is, it’s not a commodity.
    Splitting hairs. Is a music concert a commodity? How ’bout a ticket to a concert? Medical treatment is a service which uses commodities (consumable goods, like antibiotics and bandages). There’s no feature of the medical care industry which exempts the medical care industry from standard economic reasoning.
    (Jonathan): “I agree with…Jonathan Chait. The core of Republican belief, he explains, is that

    all success is earned success. They do not believe that luck or life circumstance play an important part in economic success. They believe that wealth and poverty are essentially moral categories, interchangeable with “hard work” and “sloth.” They decry government, but they don’t really oppose government per se. They oppose those government functions that transfer resources from the rich to the non-rich.

    What Chait could have said but didn’t is that this is essentially Social Darwinism 101, or Scrooge, or Rand. Ironically enough, this is the only Darwinism in which Republicans believe.” As to Creationism and politics, William Jennings Bryan assisted the Scopes prosecution and ran for President as a Democrat on a progressive (anti-capitalist) platform, remember. It’s progressives who insist that regional varieties of humans cannot differ systematically in brain function or other valuable traits. It’s socialists (i.e., “progressives” or “Democrats”) who believe in Intelligent Design, in economics, while free marketeers believe that “What works?” is an empirical question that only a market can answer.

    For a trainer of legal advocates, Professor Zasloff exhibits surprising confidence in his uninformed assessment of the views of his opposition. Milton Friedman, Friedrich Hayek, and Adam Smith do not hold the views that Professor Zasloff attributes to advocates of the market order. There’s a lot of luck and unearned favor in anyone’s social position on this Earth. Parents roll dice when they put their kids together, and some kids come up snake-eyes. Some talented people are born to poor families and fall in whih a bad crowd. Some people are born to wealth (90% of Americans, compared to the world average).

  19. Typo. Please delete my previous comment.
    (Jonathan): “whatever health care is, it’s not a commodity.”
    Splitting hairs. Is a music concert a commodity? How ’bout a ticket to a concert? Medical treatment is a service which uses commodities (consumable goods, like antibiotics and bandages). There’s no feature of the medical care industry which exempts the medical care industry from standard economic reasoning.
    (Jonathan): “I agree with…Jonathan Chait. The core of Republican belief, he explains, is that

    all success is earned success. They do not believe that luck or life circumstance play an important part in economic success. They believe that wealth and poverty are essentially moral categories, interchangeable with ‘hard work’ and ‘sloth.’ They decry government, but they don’t really oppose government per se. They oppose those government functions that transfer resources from the rich to the non-rich.

    What Chait could have said but didn’t is that this is essentially Social Darwinism 101, or Scrooge, or Rand. Ironically enough, this is the only Darwinism in which Republicans believe.”

    William Jennings Bryan assisted the Scopes prosecution and ran for President as a Democrat on a progressive (anti-capitalist) platform, remember. It’s progressives who insist that regional varieties of humans cannot differ systematically in brain function or other valuable traits. It’s socialists (i.e., “progressives” or “Democrats”) who believe in Intelligent Design, in economics, while free marketeers believe that “What works?” is an empirical question that only a market can answer.

    For a trainer of legal advocates, Professor Zasloff exhibits surprising confidence in his uninformed assessment of the views of his opposition. Milton Friedman, Friedrich Hayek, and Adam Smith do not hold the views that Professor Zasloff attributes to advocates of the market order. There’s a lot of luck and unearned favor in anyone’s social position on this Earth. Parents roll dice when they put their kids together, and some kids come up snake-eyes. Some talented people are born to poor families and fall in whih a bad crowd. Some people are born to wealth (90% of Americans, compared to the world average).

  20. Republicans most certainly worship wealth, but it gives them far too much credit to grant any connection with respect for hard work. If that were the case, Republicans would worship slothful heirs and heiresses less than up-from-poverty success stories. Ever seen any evidence of that? Have you? The only actual Republican principles in this day and age are favoring the haves and opposing whatever Democrats are for. That is hard on would-be pundits and analysts; too bad.

  21. Hayek, Road to Serfdom:

    “Nor is there any reason why the state should not assist individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance, where, in short, we deal with genuinely insurable risks, the case for the state helping to organise a comprehensive system of social insurance is very strong. There are many points of detail where those wishing to preserve the competitive system and those wishing to supersede it by something different will disagree on the details of such schemes; and it is possible under the name of social insurance to introduce measures which tend to make competition more or less ineffective. But there is no incompatibility in principle between the state providing greater security in this way and the preservation of individual freedom.”

    Woops Malcolm completely wrong again. Who could have guessed?

    And JoeYnot appears to have definitively proved that the perhaps 20+ countries providing roughly equivalent health outcomes for around half the cost don’t actually exist. Well done.

    I’d say this was ample evidence for either stupidity or bad faith reasoning. Brett OTOH seems reasonable, just wrong.

  22. Why do I bother? And yet…

    “JoeYnot appears to have definitively proved that the perhaps 20+ countries providing roughly equivalent health outcomes for around half the cost don’t actually exist.” Of course, I said no such thing. I said that ACA is overpriced, inefficient, etc. Is ACA modeled after any of the countries RL Carter is referring to? Of course not. Canadian? French? German? No, no, & no.

    ‘“JoeYnot says: ” So your issue with the ACA is not enough death panels?’ No, my issue in the example I referred to is that ACA is overpriced, inefficient, etc.

    Finally, as I look at the reasons why Republicans, conservatives, libertarians, et al are wrong to oppose ACA I see precious little in the way of any actual reasons why Republicans, conservatives, libertarians, et al are wrong to oppose ACA. I see a lot of reasons why the Republicans, conservatives, libertarians, et al are horrible people, since only horrible people would oppose ACA. And since only horrible people oppose ACA, all the really good people must be for ACA, QED.

    Why do we oppose ACA? Because we’re horrible people. Why are we horrrible people? Because we oppose ACA.

    As a thought experiment, why doesn’t someone come up with an actual reason why–of, forget it.

  23. @JoeYnot

    ‘“JoeYnot says: ” So your issue with the ACA is not enough death panels?’ No, my issue in the example I referred to is that ACA is overpriced, inefficient, etc.

    No. You asserted this, very briefly, at the end of your comment (“The ACA is a disaster because it is extremely inefficient, wildly overpriced, forces a crude, simplistic, yet absurdly complicated insurance structure onto a market that really needs a plethora of different products“), but the vast bulk of your comment was about how it is necessary that insurance companies be able to cap lifetime benefits. In other words, “death panels”

    And as to the questioning of Republican motives in opposing the ACA so vehemently, maybe it has something to do with the striking similarity between the ACA and plans created by Bob Dole in the 90s and Republican think-tankers in the 00’s and enacted by Mitt Romney in Massachusetts. Maybe it has something to do with the Republicans who say that they want to fix the ACA by preserving the ACA’s ban on rescission, preserving the ACA’s ban on pre-existing conditions, but getting rid of mandates. Or Rep. Paul Ryan, who wants to replace Medicare with a medical-inflation-eroded voucher with a fixed value rising only at non-medical inflation for private insurance, but criticizes the ACA’s assertion that it hopes to achieve similar reductions in Medicare growth rates.

  24. Sure, why not.

    Forgive me, Warren Terra. I made the mistake of assuming that everyone realizes that resources are not infinite and so have to be rationally utilized with maximum efficiency; that even with the best of intentions–and should you read my post, you’ll notice that I have no problem in recognizing that you and the others disagreeing with me are acting with the best of intentions–actions must be carefully thought out and evaluated to make sure that they do not aggravate a problem (“First do no harm,” etc).

    My intent was to demonstrate a common example of the best of intentions going awry. Of course there are death panels; there are death panels in everything. In energy use for example: lightening cars for fuel efficiency vs. increasing their bulk for safety; mandating ethanol use vs. rising corn and food prices; Speed limits; red light and stop sign placements; school bus safety requirements; etc. In the medical field, obviously, there is the most immediate and obvious situations, but it always comes down to the same problem of finite resources. Forgive my assumption.

    As far as the rest of what you had to say, it’s the same old thing: You disagree with me, so I’m evil. I’m open to persuasion, believe me. I come from a liberal/left background and only began moving right when the right began to persuade me to. The progressive left seems to have given up on intellectual discourse. What else could Chait’s idiotic aritcle be about? And I use the term “iditotic” advisedly. It’s not as if it’s any big secret why conservatives oppose ACA, or for that matter why leftists do. If Chait has solid reasons why they’re wrong and he’s right, by all means let’s hear them. And if Chait admits to being honestly unable to comprehend intellectual oppostion to ACA, then he should have the intellectual integrity to say so and not call his opponents doody heads.

  25. Warren Terra: Forgive me again. I didn’t fully grasp your last sentence: “Paul Ryan, who wants to replace Medicare with a medical-inflation-eroded voucher with a fixed value rising only at non-medical inflation for private insurance, but criticizes the ACA’s assertion that it hopes to achieve similar reductions in Medicare growth rates.” Okay, that’s interesting. What are the plans for reducing Medicare growth rates? The only two I’m familiar with are 1) capping Medicare rates in the ACA, but increasing them in separate legislation, precisely as they did this year, which is of course meaningless; and 2)(I think) Moving seniors into Medicaid, also a non-savings. What else are they planning to do?

  26. You state “For them, it’s a commodity. If you can afford a widget, you buy a widget; if you don’t, you don’t. If you can afford a car, you buy one. If you don’t, you don’t. If you can afford health insurance, you buy it; if you don’t, you don’t. That’s the way the market works.”, but I think this is not consistent with the world we actually see. These folks do not hold that if your business requires that you be guaranteed to receive any income earned off of your published works, that you pay for it. Rather copyright should be provided, to them at least, for free, or very nearly so. They don’t believe that they should have to pay the full market value for having a guarantee of the sole use of a radio frequency, nor to pay the full market value of the protection against investment loss provided by incorporation. They are perfectly willing to have these services provided to them for free, indeed even to express the greatest moral outrage if they are charged anything at all for these services. These are people who already know that they are “better” than others and therefore they ought to be wealthier. Therefore any policy which increases their prosperity must be justified. Also, the nature of paying for things is always one directional. They should be the beneficiaries of government action, others should pay for it.

  27. “I come from a liberal/left background and only began moving right when the right began to persuade me to. The progressive left seems to have given up on intellectual discourse.”

    Given our previous 11 years of context in which your intellectual growth necessarily must have occurred, that rationalization is a magnificent work of genius. I am in awe, Sir.

  28. You’re conflating two things. (1) There’s the so-called “doc fix”, whereby every year the Congress vote to increase Medicare reimbursement rates above an unrealistically low baseline that was set in some smoke-and-mirrors legislation several years back. I don’t actually remember how this ended up; at one point, the ACA included a change to the previous unrealistic legislation to make it more realistic so that it would not be necessary to pass a “doc fix” every year (this was of course denounced as a budget-busting move by people who every year voted for the “doc fix”). I don’t remember whether that made it through to the final version. (2) The ACA creates a bunch of programs that it is hoped may effect some savings or reduce the growth of Medicare costs. The CBO score assumes that these or other programs will result in a slower growth of Medicare premiums than has recently been the case. This aspect of the CBO score has been criticized by Republicans, including by Paul Ryan – despite the fact that his own plan makes exactly the same prediction, without even proposing any ideas of how it might be achieved; he just does it by providing ever-less-valuable private health insurance vouchers.

    It’s worth remembering that we tried voucherizing Medicare fifteen years ago, with Newt Gingrich’s Medicare Advantage program, and it was an absolute fiasco. The program was created to introduce competition, and Medicare recipients were given the option of obtaining private insurance; the insurers were to receive the per-recipient average of Medicare spending as their premium, and in theory they weren’t allowed to say no to any Medicare-eligible applicant. In practice, of course, they were able to cherrypick the least costly Medicare recipients (in part by offering benefits such as health club subsidies that were missing from Medicare and more attractive to healthier applicants; in part just by the simple fact that the most expensive Medicare recipients are the sick and the dying, they’ve likely been using Medicare successfully for years or even decades, and they lack the energy to seek out different insurance). Even this didn’t work beyond the first couple of years, and soon with help from their friends in Congress Medicare Advantage was receiving a significant subsidy (the insurers threatened to cancel entire programs if the subsidy wasn’t granted, because they weren’t allowed to rescind individual expensive patients’ policies), such that the per-patient reimbursement to the private insurers was (iirc) 13% higher last year than the overall per-patient spending of Medicare. The ACA gets rid of this subsidy, a policy that Republicans denounced as “cutting Medicare”.

    Now, the Medicare Advantage story may have a frightening prediction to offer for the ACA: it may be that, as with Medicare, we spend ever more to subsidize the private insurers. This is one reason that a lot of us liberals preferred at least a public option, to keep the private insurers honest (if it weren’t for that 13% difference, could we see so clearly how the private insurers are gouging Medicare?). But that’s a separate issue from the criticism the Republicans make, because it’s one whose logic drives one towards publicly funded healthcare, at least as an alternative option.

  29. During the debate over universal health insurance under the Clinton administration, I had a conversation with a very nice guy who lived across the street from me. I told him I felt we owed an obligation to our fellow citizens to guarantee them health coverage. He disagreed, on the grounds that these people were responsible for themselves. I then said, ok, but what about children? By definition, they’re not responsible for themselves, so surely we owe them an obligation to provide guaranteed health coverage. He reflected for a minute, and then said, no, he didn’t think so.

    I realized then that he simply couldn’t imagine that this could happen to him — that these might be his kids we were talking about.

    Motivated belief is truly powerful. It doesn’t matter whether these people believe everything they have is due to their own hard work and nothing else (per Jonathan); or whether they believe it’s due to G-d’s will (per Mayo and Douglas). They believe it because it makes mere self-interest seem like a positive good.

  30. Russell: “Woops Malcolm completely wrong again. Who could have guessed?
    Your quote does not rebut my assertion that Smith, Hayek, and Friedman emphasized evolutionary processes in economics, not from any equation of success with moral worth but simply because “What works?” is an empirical question which only an experiment can answer. As far as I can tell, Milton Friedman, Freidrich Hayek and Adam Smith were philosophical materialists.

  31. For what it’s worth, I want to give kudos to JoeYnot for referring to the act as the “ACA”, instead of Obamacare. Because whatever privilege one thinks one is allowing oneself, the term is essentially ad hominem and has no place in reasonable public discourse. This liberal appreciates the gesture.

    Now, carry on! 🙂

  32. Who would Jesus cherry pick?

    It astounds me that Christian fundamentalists fail to recognize Republicans as the Party of Mammon. It disturbs me that (too many of) my fellow Democrats lack sufficient knowledge of scripture to argue that point.

  33. “Your quote does not rebut my assertion that Smith, Hayek, and Friedman emphasized evolutionary processes in economics, not from any equation of success with moral worth but simply because “What works?” is an empirical question which only an experiment can answer.”

    Malcolm, look. You did not assert this, in either of your previous comments.

    I actually think that evolutionary processes in economics are important; I would be surprised if you actually did. Conservative philosophy these days boils down to mandating economic stasis in the pursuit of incumbent protectionism, same as it ever was. Note that the ideal conservative approach to health care is, no change!

    This is true, even though our, by “libertarian” judgement, “world’s best healthcare system” costs roughly twice as much for somewhat similar outcomes as do perhaps 20+ countries, all using different, economically evolving systems.

    So. I am still having a hard time here justifying the notion that conservatives/libertarians/Republicans argue in good faith.

  34. I think it’s perfectly reasonable to state that conservatives generally oppose the ACA because it seems a reward for people who don’t deserve it. A “redistribution”. This is stated over and over. The oddest version of which was Glenn Becks CPAC speech in which he sung the glories of “allowing people to fail”, because that is the only way they’ll really learn. As if his own AA sob-story has much to do with people who are uninsurable, or are too broke to afford insurance.

    Or maybe it does: maybe the poor are really to blame for their poverty. Maybe they are too lazy. This too is a stated claim of many conservatives, even if usually spoken of in a round-about way by all but the most brave. The logic is sound. The wealthy created their own wealth, so the poor must *not* have created it, right? Further, wealth is a prime motivator. If we “give it away”, people won’t have anything to work for. Just look at communism.

    Have conservatives not been listening to their own rhetoric these last few decades? Is there something about liberals saying the words that bothers them?

    I think one last note to hang on this: the question of contra-causal free will plays a role here. Conservatives generally believe people are responsible for their own choices, and thus social privilege doesn’t really compute. They worship stories of men who succeeded “despite the odds”, as if to prove that privilege means nothing. And yet this magical fortitude, this mystical agency is neither a socially learned function, nor a genetic advantage. Because either (or both – as most liberals believe), would imply *causality*.

    Yet if you have causality, you suddenly lose responsibility. Better genes or learning places agency’s origin in events beyond human control (we don’t pick our genes, we can only learn how to learn, how to learn (etc.). This of course is all the logic behind liberal social programs – we call this “social responsibility”. And without it, you have conservatism. Or at least to the degree you have less of it, you have more conservatism.

    I personally have never heard a conservative argue around the vast data that supports this basic liberal equation. You generally get the question changed from “should we?”, to “how can we?”, with the answer usually being “it’s too expensive”, or “it’s hopeless”, or “you’ll do more harm than good”. But conservatives never have any helpful solutions aside from vague and hopelessly inadequate gestures towards charity. So then the issue is dropped. Until once again you hear conservatives complaining, “we shouldn’t… we shouldn’t”. And you then explain why, and the liberal policy is criticized (even though, like with the ACA, it has been so weakened by conservative compromises that most liberals in many ways will agree).

    Yet, like Sisyphus, we keep trying, fighting for our little old “social justice”, calling for “social responsibility”, pushing that ball a little up the hill. A little more health care for the needy. A little more money for poor kids. A little more regulations on businesses destroying the environment. This will all sound like creeping serfdom to some. But to those of us just looking to give every one a fair shot at success (or just dialysis, for crying out loud), it is a better, slightly more just and ultimately moral world.

  35. Joel Horowitz taught me first and foremost as a freshman in Sociology 105 this precept: Never generalize from your own necessarily limited personal experience. I’m going to violate his principle anyway. Chait is right, as are those here who agree with him. I work with several college-trained (educated would be too charitable) technicians, and they were and are universal in their revulsion at ACA or any similar proposal for one reason and one reason only: This health care may become available to the homeys of all colors, but mostly of the darker shades, standing on the corner instead of working. And they do not deserve it! Not with their money! Period. It goes without saying that none of these people can imagine being without a job or without the prospect of a job that comes with “health insurance,” however lousy it really is, because they are above all worthy. And those other people? Unworthy, now and forever more. Simple as that. Alas.

  36. (Jonathan Z): “What Chait could have said but didn’t is that this is essentially Social Darwinism 101, or Scrooge, or Rand. Ironically enough, this is the only Darwinism in which Republicans believe.”
    (Malcolm): “William Jennings Bryan assisted the Scopes prosecution and ran for President as a Democrat on a progressive (anti-capitalist) platform, remember. It’s progressives who insist that regional varieties of humans cannot differ systematically in brain function or other valuable traits. It’s socialists (i.e., ‘progressives’ or ‘Democrats’) who believe in Intelligent Design, in economics, while free marketeers believe that ‘What works?’ is an empirical question that only a market can answer.
    (Russell): “Hayek, Road to Serfdom:…

    (deteled)

    Woops Malcolm completely wrong again. Who could have guessed?

    (Malcolm): “Your quote does not rebut my assertion that Smith, Hayek, and Friedman emphasized evolutionary processes in economics, not from any equation of success with moral worth but simply because “What works?” is an empirical question which only an experiment can answer. As far as I can tell, Milton Friedman, Freidrich Hayek and Adam Smith were philosophical materialists.
    (Russell): “Malcolm, look. You did not assert this, in either of your previous comments.

    Okay, I substituted free marketeers for Professor Zasloff’s “Republicans”, but it’s not Democrats (usually) citing Adam Smith, Freidrich Hayek, and Milton Friedman. Glen Beck has promoted __The Road to Serfdom__. Republican enough for you?

    (Russell): “I actually think that evolutionary processes in economics are important;…
    You could demonstrate that by acknowledge the value of competitive markets in goods and services, including health care.
    (Russell): “Conservative philosophy these days boils down to mandating economic stasis in the pursuit of incumbent protectionism, same as it ever was. Note that the ideal conservative approach to health care is, no change!
    First, abandon this switching of labels. Who said “conservative”? We were discussing partisan lines on support for market processes versus State mandates in provision of health care. Democrats versus Republicans. Second, if we put the issue on a free-market to socialist continuum, with Republicans more inclined to markets, it is not at all the case that free marketeers would protect incumbents. For example, Milton Frienman opposed occupational licensure, even for physicians. He called the AMA a cartel. Generally, free marketeers attribute high costs of medical care to third-party payments (leading to over consumption and moral hazard).

    (Russell): “This is true, even though our, by “libertarian” judgement, “world’s best healthcare system” costs roughly twice as much for somewhat similar outcomes as do perhaps 20+ countries, all using different, economically evolving systems
    All social systems evolve. The degree of industrial concentration determines the pace of evolution.

    I am still having a hard time here justifying the notion that socialists/progressives/Democrats argue in good faith.

  37. “They decry government, but they don’t really oppose government per se. They oppose those government functions that transfer resources from the rich to the non-rich.”

    Close, but not quite right. Conservatives love big government. Just look at how they love government spending on the DoD and wars overseas. But they also like big government for old people.

    http://yglesias.thinkprogress.org/2010/03/ethnocentrism-and-small-government-hypocrisy/

    Conservatives would love the ACA too but they can’t love it because they think it will disproportionately help Black and Latinos.

  38. Oh, hey, I missed it the first time when Malcolm dug up ol’ William Jennings Bryan. Because I guess the “Jefferson Davis Was A Democrat” script was too far out of reach or something? “Strom Thrumond Was A Democrat” had gotten a little too threadbare? There is a party that is strongly identified with the refusal to acknowledge science and evidence – in terms of evolution, in terms of anthropogenic global warming, in terms of “Supply-side economics”, etcetera – but it’s not the Democrats. However flawed our standard bearer of a century ago may have been. Heck, within the last generation the Republican standard bearers have included Nixon and Dubya – and you’re picking on the post-political activities of a Democrat who never became President?

    PS if it may convenience you in any way, you are free to point out that Harry Truman’s wife was an antisemite and a bigot, that JFK lied about the missile gap, and that both JFK and Clinton were adulterers.

  39. “Or maybe it does: maybe the poor are really to blame for their poverty. “

    I think that is objectively not true in many cases, but still reflects a powerful statistical fact: While there are certainly people who are poor through no fault of their own, most poor people, if you examine their situations, you find they’re poor because they made bad choices. Do your homework, don’t have a baby until you’re married, if you’re living someplace where there aren’t any jobs, move… There are a whole series of simple rules like these, which close to uniformly you’ll find the middle class follow, and the poor don’t. Most of the poor are not poor by accident. They’re poor by their own bad choices.

    Now, it’s quite likely they don’t understand that they’re making bad choices which will haunt them for the rest of their lives. Poverty is a culture in this country, it’s learned and passed on from generation to generation. Not all cultures are equal, after all. Some of them lead to prosperity, some of them lead to poverty.

    Maybe they ought to teach these rules in school? Have a required class in “How not to screw up and stay poor.”? Whatever we do about it, we’re not going to solve the problem of poverty by giving money to people making bad choices, who then go on to teach their children to make the same bad choices. That’s like running a pump 24/7 in a sinking boat, instead of patching the hole.

  40. Anyway, can I comment that it’s rather appalling the extent to which this thread displays the liberal belief that people disagree with you out of sheer evil, knowing that you’re right, and deliberately choosing to be wrong? Catch a clue, your arguments aren’t THAT persuasive…

    Hell, even the title of the post betrays this incredible moral arrogance.

  41. JoeYnot says:

    “The basic difficulty with this conversation is that most of the participants seem to be confusing opposition to one particular solution to a problem with opposition to solving the problem altogether. ”

    No, we are not. As has been pointed out, the ACA drew very heavily from the Heritage Foundation proposals, and many GOP politicians reversed their stands when it came time to support their earlier talk with actual votes.

    The GOP talked big sh*t during the early 90’s about it’s own proposal as an alternative to the Democratic proposal, and then did nothing for healthcare reform for the next 15 years, which included times when the GOP could ram through darn near anything.

  42. Warren Terra: Thanks for taking the time to reply; Unfortunately, I won’t have time to seriously evaluate your points until this weekend, by which time this thread will no doubt be cold, but I have confidence another will pop up here soon enough. I realy want you to be right, since ACA is the law of the land. Any progress in reducing Medicare costs would be wonderful.

    Russel L Carter: “Given our previous 11 years of context in which your intellectual growth necessarily must have occurred, that rationalization is a magnificent work of genius. I am in awe, Sir.” “Necessarily have occured” in the “previous 11 years?” I’ve read a little bit about the young earth creationists, and you put them to shame… No, actually it occurred in the early 1980’s…unless I was living in the matrix and only thought it was happening…

  43. “No, actually it occurred in the early 1980′s…unless I was living in the matrix and only thought it was happening…”

    Then your beliefs are impervious to data, which of course is completely consistent with being a Republican. You chose well. But the rest of us need not share your delusions. Odd that your beloved Republicans were correct on health care in the 90s, and are also correct during the last decade, even though their positions during those two intervals are exactly contradictory.

    And Brett whines:

    “Anyway, can I comment that it’s rather appalling the extent to which this thread displays the liberal belief that people disagree with you out of sheer evil, knowing that you’re right, and deliberately choosing to be wrong? Catch a clue, your arguments aren’t THAT persuasive…”

    Poor Brett doesn’t have any arguments anymore, just lugubrious feelings. Spare us. You’re all Palin now.

  44. (Warren): “There is a party that is strongly identified with the refusal to acknowledge science and evidence – in terms of evolution, in terms of anthropogenic global warming, in terms of “Supply-side economics”, etcetera – but it’s not the Democrats.
    We disagree, here.
    The point about Bryan remains: capitalism undermines traditional institutions. Bryan knew this. The “religious right” has often been progressive (socialist) in economic policy (Huckabee, for example). When opponents of the Vietnam war and radical activists for various social causes gained control of the Democratic Party, the traditionalists bailed. These were the “Reagan Democrats”. This is a relatively recent phenomenon.
    AGW: What evidence do you assert skeptics of the AGW hypothesis deny? “Evidence” mean “from what is seen” I directly observe a 24 hour warming/cooling cycle where I live, and a cycle of of approximately 365 days. I have lived through five Pacific Decadal Oscilations, which I have to take on faith, since I was not keeping track. I have been told that the Earth’s climate responds to cycles of around 20,000 to 100,000 years generated by changes in the eccentricity of its orbit and the tilt of its axis relative to the plane of the ecliptic. Like any non-astronomer, I have to take this on faith, just as I have to take the existence of Antarctica on faith (I’ve never seen the place). Add the noise of volcanism, mountain-building and related redirection of atmospheric currents and changes in atmospheric chemistry as new crust meets the air, the opening and closing of sea passages, etc. and I expect that the extraction of a anthropogenic signal from very noisey proxy temperature data would be difficult. Do you have a PhD in statistics? Me neither. Much science depends on trust. Even experts have to trust other experts. With their refusal to share data and their manipulation of the peer-review process, Mann, Jones, Briffa, and the rest of the Hockey team have forefitted that trust.
    “Supply-side economics”: As opposed to what? Charles Schultz, a Kennedy-Johnson era economic advisor, called the Laffer curve a straightforeward consequence of standard economic analysis. Alfred Kahn was a Carter appointee.
    (Warren): “However flawed our standard bearer of a century ago may have been.
    What? This is not a sentence.
    (Warren): “Heck, within the last generation the Republican standard bearers have included Nixon and Dubya…
    And? Did either deny the evidence for biological evolution? What point do you make here?

  45. “Anyway, can I comment that it’s rather appalling the extent to which this thread displays the liberal belief that people disagree with you out of sheer evil, knowing that you’re right, and deliberately choosing to be wrong? ”

    Sheer evil? It seems exactly not that – it is a very concise summary of the philosophical assumptions underpinning conservatism.

    As for poverty being about bad choices – that is entirely in line with the liberal notion of social dysfunction, which relies on a model of social learning and cultural, which takes causality away from the individual and places in with, as you say, larger cultural and social pressures. “Can we solve this” – I made the point that this is the classic conservative dodge. Because – *even if we can’t* – it is our moral duty to provide help to people who can’t help themselves, therefore, redistribution in the form of government safety net services.

    However, many of these things can and do help reduce the drivers of poverty, whether cultural or structural – such as education, health, drug abuse, crime, etc. Heck, just spending more money cleaning the streets of poor neighborhoods will have a positive effect on morale and normative behavior, in turn decreasing dysfunction and despair (“broken windows theory”).

  46. Brett,

    Anyway, can I comment that it’s rather appalling the extent to which this thread displays the liberal belief that people disagree with you out of sheer evil, knowing that you’re right, and deliberately choosing to be wrong?

    You’ve got it wrong. The point is that a very large percentage of the most vocal opponents are not, in fact, motivated by good will. Some, like the Congressional Republicans, act out of purely political motivation. They want to defeat Obama, period. The merits of HCR are irrelevant. They don’t care about that. They’ve said as much. In their efforts they are assisted by widespread ignorance and misrepresentation about the plan, spread by themselves and their top spokespeople – Palin, Limbaugh, Beck, Bachmann, etc. I think you have to agree that whatever motivates this group it is not any sort of grasp of the issues or honest analysis.

    So we are left with the people of good will, as JHA describes them. Where are they? And if they are serious, why do they make common cause and common arguments with those I mention above. The fact is that the Republican Party, the conservative movement in general, has been taken over by an irrational, anti-scientific, know-nothing faction. Taken over. It’s not just fringe elements. It’s the core.

    So there may well be serious people of good will who have arguments against the program. In fact, it’s likely PPACA can be improved. But I’d like to see these SPOGW disassociate themselves from the kooks and cycnics.

  47. (Joe): ““No, actually it occurred in the early 1980′s…unless I was living in the matrix and only thought it was happening…”
    (Russell): “Then your beliefs are impervious to data, which of course is completely consistent with being a Republican.
    This style of argument is completely consistent with the Reality Based Community. What data? Basic arithmetic goes back to the paleolithic. Earlier, actually; crows can count. Geometry goes back to Sumer. Martin Anderson wrote that all the economics you need to write good policy was written down in the 19th century. Perhaps he exaggerated a bit. The arguments for the market economy, as opposed to the command economy, have not changed much in nearly 100 years. We have more examples, that is all.

  48. (Eli): “Because – *even if we can’t* – it is our moral duty to provide help to people who can’t help themselves, therefore, redistribution in the form of government safety net services. However, many of these things can and do help reduce the drivers of poverty, whether cultural or structural – such as education, health, drug abuse, crime, etc. Heck, just spending more money cleaning the streets of poor neighborhoods will have a positive effect on morale and normative behavior, in turn decreasing dysfunction and despair (‘broken windows theory’).
    I’ll agree about crime and cleaning the streets. Drugs? Legalize recreational drugs and let employers discriminate on the basis of urine tests (or by any other method or for any other silly reason).
    We disagree about wealth distribution or other State provision of charity (education, health care).
    Perhaps “we” have a moral duty to “provide help”. This hardly implies that “we” have any duty to support policies which funnel this help through the sticky fingers of the goons with the guns (the State). Arguments for State (government, generally) operation of the education industry and the health care industry are weak. Neither the education industry not the medical care industry qualifies as a natural monopoly.
    Between the definition of “public goods” and the conclusion of State operation of an industry, the argument has a flaw: corporate oversight is a public good and the State itself is a corporation. Oversight of State functions is a public good which the State itself cannot provide. State assumption of responsibility for the provision of public goods transforms the free rider problem at the root of public goods analysis but does not eliminate it.
    The “public goods” argument implies subsidy and regulation, at most, not State operation of an industry. The State cannot subsidize education or health care without a definition of “education” or “health care”. Then the State’s definition binds customers and recipients of the service. So we march kids at a uniform pace through a one-size-fits-all curriculum and give medical treatment decisions to remote bureaucrats.

  49. “Do your homework, don’t have a baby until you’re married, if you’re living someplace where there aren’t any jobs, move…”

    Talk about something that displays moral ignorance. Exactly where do the poor get the funds to move themselves across the country to where the jobs are, if in fact it is the case that moving will produce a job. They’re poor, get it? They barely can put food on the table, if that, get it? They use local public transportation because they can’t afford a car, get it?

    Or do you think “moving” is a cost-free endeavor, Brett?

    And exactly what area of the country is starved for workers – is there in fact any state with a negative unemployment rate?

    I’ll answer for you: no. The lowest is roughly 4% unemployment, which means that moving the poor to anywhere else in the country merely pushes the unemployment rate for that area up – it doesn’t solve the unemployment problem that leads to much poverty, much less the underemployment problem.

    “most poor people, if you examine their situations, you find they’re poor because they made bad choices.”

    And you of course have empirical proof of this? Of course not. Which simply proves you believe it to be true because you want to believe it to be true because it makes you morally superior to the poor.

    Catch a clue, your arguments aren’t THAT persuasive…

    In fact, they are mindless drivel.

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