A Socratic Dialogue on Health Care

You might be interested in reading this interview at Vox. In it Sean Illing, playing the role Alcibiades without the self-awareness, discusses health care with economist Craig Garthwaite taking the role of Socrates in the dialogue. Armed only with the sword of self-righteousness and the impenetrable armor of ignorance, Mr. Illing opens the conversation with the confrontational and argumentative statement “I think health care is a right. Tell me why I’m wrong.” Dr. Garthwaite responds patiently and temperately. Read the whole thing.

As a matter of public policy health care presents many challenges. I agree with Dr. Garthwaite in that I believe that it is better to treat health care as a benefit rather than a right. I disagree with him in that I believe that while the matter should be approached in full recognition of the implications of eschewing a market-based solution, no market-based solution is acceptable for the simple reason that none of the stakeholders, by which I mean patients, physicians, hospitals, insurance companies, pharmaceutical companies, taxpayers, and politicians (just to name a few), would find an actually free market in health care tolerable. Free markets are like the old joke about “a little bit pregnant”. Either a market is free or it isn’t. When it isn’t a free market some participants gain advantages while others incur penalties.

Unlike negative rights like, say, freedom of speech, when health care is construed as a right, in this case a positive right, you must dilute the notion of right itself out of any real meaning. There are just too many conflicting interests. These include

  • Health care as a right.
  • Physician autonomy.
  • Access to health care.
  • The right to property.
  • The corpus of common law.

If health care is a right that belongs to the patient, how can physicians be allowed to prescribe courses of treatment? How can taxpayers be protected from excessive demands? How can physicians be assured of earning a living? The list of such questions is nearly endless.

Under the Affordable Care Act a carefully balance but risky solution to the problem of health care was chosen. Unsurprisingly, it has met with substantial resistance and without additional subsidies may collapse of its own weight. Under the Republicans’ version of health care reform yet another strategy would be implemented, no less tenuous or risky and also, unsurprisingly, meeting with substantial resistance.

I think that the preferred strategy should be to treat health care as a benefit and to exert substantial efforts to decreasing the cost of health care. The provision of the vast array of subsidies that we apply to health care should be tied directly to cost reduction. My strategy would have the advantages of being sustainable and as effective practically by definition as possible. I’m accustomed to disappointment.

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Civil War Then and Now

Contrary to my general policy of conforming quite closely with the copyright laws, I think that the interview in the WSJ with historian Allen Guelzo on the similarities and dissimilarities of the present with the Civil War era is important enough that I’m going to quote it in full.

If there’s one thing Americans of all political stripes can agree on, it’s that the country is divided—bitterly, dangerously, perhaps irreconcilably riven. “It shows up in very cinematic fashion, in things like the Scalise shooting,” says historian Allen Guelzo. “So we jump to the conclusion: Oh my goodness, does it mean we’re on the brink of civil war?”

No, answers Mr. Guelzo, director of the Civil War Era Studies Program at Gettysburg College. The Civil War was singular and is almost certain to remain so. But he does see continuities, some of them surprising, between then and now. And he thinks today’s divisions are worse than those of any time in American history except the 1850s and ’60s.

Today “there are a lot of unhappy personalities, and there are divisions of cultural values,” Mr. Guelzo tells me over dinner at the Union League of Philadelphia, where he’s been a member since 1983. That was also true when the country was young, “between Jefferson and Adams, and between Jefferson and Hamilton,” and later with “all kinds of acidulous political and cultural divisions—over Masons, Catholics, John Calhoun, nullification, tariffs, Andrew Jackson. You go down the list, and it’s one thing after another. But it didn’t drive us to civil war.”

What did was the combination of slavery and secession, “and the two of them are really bound together.” Both are “very absolute questions,” Mr. Guelzo says. Lincoln’s observation in 1858 that “this government cannot endure, permanently, half slave and half free” was born of the failure of repeated efforts at compromise—most recently the Supreme Court decision that made Chief Justice Roger Taney infamous.

“When Taney wrote Dred Scott in 1857, it wasn’t because Taney was the most vile pro-slavery ideologue in the country,” Mr. Guelzo says. “He wasn’t—I mean, the man had actually emancipated his own slaves. And while he certainly wasn’t friendly to abolitionists, that’s not why he wrote Dred Scott the way he did. He did it because the situation in 1857 seemed to have demonstrated that neither the legislative branch nor the executive branch was capable of arriving at a solution for the slavery question. So who steps up into the batter’s box? The judiciary—we will settle this.”

But even slavery was not a sufficient condition for war. “If slavery had been legal in, let’s say, Minnesota, Maine, Florida and Louisiana, there would never have been a Civil War,” Mr. Guelzo says. What gave the question “political mass” was geography: Slavery had been outlawed throughout the North by the early 19th century, leaving 15 states where it was legal. “Because these slave states were all contiguous, they could look at a map and see themselves as a political unit.” Eleven did in 1860-61.

“Do we have that today?” Mr. Guelzo asks. “No. I mean, you have California talking about seceding. But then again, California talks about all kinds of crazy things.”

Americans on both sides look across the political divide and see crazy people espousing destructive ideas. From his historian’s vantage point, Mr. Guelzo sees something deeply durable. “If you look at Democrats and Republicans since the middle of the 19th century,” he says, “the political culture of the parties has not changed all that much.” Their policies may be drastically different, but “that’s the tip of the iceberg. What you want to look at, as far as historical continuity, is the seven-eighths of the iceberg below the water.”

He pulls out a small notebook in which he has drawn a comparative chart listing seven “cultural components” of each 19th-century party. Democrats’ orientation, he says, has changed in only two of them: They used to tend toward “agrarian” occupations and “patriarchal” families, both anachronisms now. Republicans, though, still favor “commercial” work and “companionate” marriage.

The other components pairs do seem continuous for both parties, as Mr. Guelzo says. Morals: Democrats, “individual”; Republicans, “collective.” Economic system: Democrats, “static”; Republicans, “dynamic.” Philosophy: Democrats, “Romantic”; Republicans, “Enlightenment.”

This cultural taxonomy predates the GOP’s founding in 1854. Mr. Guelzo credits fellow historian Daniel Walker Howe with inspiring the chart by observing, in “The Political Culture of the American Whigs” (1979), that “the Whigs proposed a society that would be economically diverse but culturally uniform; the Democrats preferred the economic uniformity of a society of small farmers and artisans but were more tolerant of cultural and moral diversity.”

Two of Mr. Guelzo’s components seem especially salient today. The first is political style, a cousin of philosophy: “Democrats love passion, Republicans love reason.” He cites Lincoln’s debates with Stephen Douglas : “With Douglas, it was always a big show, and if you listened to Douglas for five minutes, you were captured by him.” By contrast, “Lincoln is as reasonable as a Vulcan with Asperger’s,” Mr. Guelzo says. “If you listened to him for five minutes, you weren’t impressed. If you listened to him for 25 minutes, he had you, because you couldn’t argue. He had done all the work.”

When I observe that President Trump doesn’t quite fit this mold, Mr. Guelzo acknowledges the point. “Then again,” he says, “he’s not been a Republican all of his life, now has he?” Mr. Guelzo’s theory would explain why many conservative Republicans found it harder to stomach Mr. Trump than Mitt Romney, notwithstanding Mr. Romney’s ideological heterodoxies, and why Mr. Trump had crossover appeal to traditionally Democratic voters.

The second salient component is what Mr. Guelzo calls a party’s “political center.” For Democrats, it is “local”; for Republicans, “national.” At first glance, this seems like a discontinuity: In recent decades the GOP has been the party of states’ rights, while the Democrats have sought to centralize power in Washington.

But Mr. Guelzo isn’t talking about policy. His argument is that Republicans think of themselves as Americans first, whereas today Democratic localism takes the form of subnational identity politics. “A sense of belonging to an American nation is much more attenuated,” he says. “Do you identify yourself as being a woman, transgender, black, Latino—you go down the list—or do you identify yourself as an American? That has actually now become an issue. This would have been unthinkable two generations ago.”

It is in this regard that Mr. Guelzo thinks the divisions of the current era are the second-worst in American history: “The Civil War is really the only other time I can find where people are willing to sacrifice—completely sacrifice—national identity for local.”

As an example of the decline in national solidarity, Mr. Guelzo cites Nancy Pelosi’s and Harry Reid’s public assertions—as leaders of congressional majorities during the later Bush administration—that the Iraq war was a failure. No political leader would have said such a thing during World War II. Even in World War I, which was much more contentious, “the United States wasn’t the issue. The question was: Are we looking at a casus belli being provided by Germany?” he says. “For Pelosi and Reid, who said that while the war was in progress—to announce while things are still going on, while they’re still shooting—that is simply unimaginable, and yet there they were. And they were doing it not because they really had a lot of military expertise. They were doing it to score political points.”

Wasn’t there a precedent in the Vietnam era? No, Mr. Guelzo says, at least not in Congress: “You didn’t see Mike Mansfield ”—the Senate majority leader and a critic of the war—“do that kind of thing during Vietnam.”

But the Civil War era was far worse. In the 1850s, “you had brawls on the floor of the House of Representatives. One of the most precious ones was when William Barksdale from Mississippi got into a flying fistfight with a Northern representative, and one of them reached out to grab him by the hair and pulled off his wig.” That was in 1858.

The story reminds me of this year’s riot at Middlebury College, and that’s what Mr. Guelzo has in mind. Colleges, he says, “have become the stages on which violence has been acted out.” He describes today’s social-justice warriors as “ideological lynch mobs” and pointedly compares them to the real thing. “The people who always wanted to silence others, always wanted to have the lynchings, were the pro-slavery people,” he says. “It surprises my students, as it should, that Southern postmasters were given free rein to censor the mails coming into Southern post offices. They could take material that might be suspected of being abolitionist in nature; they were allowed to destroy it—because you didn’t want a slave who might turn out to be literate to read any of that, now did you?”

But the comparison goes only so far. The violence “doesn’t make things happy for us in the universities, believe me,” Mr. Guelzo says. Still, “it’s better than happening in Congress.” Further, campus mobs are a far cry from an army, and their selection of enemies betrays a certain incoherence—one day a libertarian conservative like Charles Murray, another a leftist like Evergreen State College’s Bret Weinstein.

Which brings us back to the central premise of Mr. Guelzo’s assurance that America is nowhere near a civil war. “There is a lot of contention about culture; there’s a lot of contention about politicians and individuals. But there’s no flaming, absolute issue that draws people out of themselves—which is to say, draws them out of responsibility to each other—and pits them at each other’s throats.”

In the 1980s, he says, he wondered “whether abortion was going to constitute an issue like that, because there’s no way you can be mildly for or mildly against—you’re either for it or against it.” But he concluded it probably wouldn’t happen, because abortion lacked the “sectional identity” of slavery circa 1860.

Thus another counterfactual: “If you had, let’s say, 21 contiguous states in the union where abortion was legal and 29 where it is illegal, then suddenly you have created a political standoff, and people will start to think in terms of us versus them, rather than the nation,” he says. “You just do not have that in the atmosphere right now.”

Abortion laws did vary by state before 1973, when the Supreme Court imposed a nationwide regime of legalization. But pro- and antiabortion states “hadn’t begun to conceptualize themselves that way,” Mr. Guelzo notes, before Roe v. Wade elevated the question into a national one. Today it’s not hard to imagine what Mr. Guelzo’s scenario of a country divided over abortion might look like—see the 2004 or 2016 election map.

When the high court effectively upheld Roe 25 years ago, in Planned Parenthood v. Casey, a three-justice plurality proclaimed that the 1973 ruling carries “rare precedential force” because it “calls the contending sides of a national controversy to end their national division by accepting a common mandate rooted in the Constitution.” The three justices claimed this was something the court had done only once before “in our lifetime,” in Brown v. Board of Education.

But it sounds very much like what Mr. Guelzo thinks Chief Justice Taney was attempting in Dred Scott. The question arises: Did Justices Sandra Day O’Connor, Anthony Kennedy and David Souter succeed where Taney had failed—if not in uniting the country, at least in keeping the peace?

Maybe so, Mr. Guelzo answers with a hint of reluctance: “By getting it out of the states, it’s removed an opportunity for it to become that kind of sectional issue. I’m not saying that as a fan of Roe v. Wade, but at least we haven’t gone to war over it. And given the absolutism of the issue, it had plenty of combustibility for that. Still does.”

I think that Dr. Guelzo is underestimating the dangers of the present for several reasons, the most important that wars today are different than they were 150 years ago.

For one thing he places far too much weight on the fact that no fistfights have taken place on the floor of the House. There’s a reason for that:

The members of Congress are a lot older today than they were 150 years ago. Sadly, it doesn’t mean that they have grown wiser, merely that they are less predisposed to physical altercations. Nonetheless feelings are running very high.

IMO how divided the two political parties are is much more significant. Today the most conservative Democrat in the Senate is more liberal than the least conservative Republican. That is a new development. We have never experienced anything like it in our history.

Today we are a networked society and, consequently, it makes sense that our wars are different, too. Just because today wars are not fought by lines of men firing at each other from 150 feet doesn’t mean that they aren’t wars. If calling a civil war an insurgency makes you feel better, go ahead.

There is already a low level insurgency taking place, visible in inner cities and on college campuses. It is a literal insurgency, not a figurative one and it is organized via the Internet.

Dr. Guelzo also places considerable weight behind the lack of a single, galvanizing issue. There are 1,000 galvanizing issues. All that is actually needed is hatred, and that is obvious.

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Happy Birthday to Me, Ryan, Love, Olivia

If you didn’t watch FX’s miniseries, “Feud: Bette and Joan”, by some reckonings the hit of the season, when it was broadcast you may never get a chance to do so. Today is Academy Award-winning actress Olivia de Havilland’s 101st birthday. Yesterday she gave herself an early birthday present by filing suit against Ryan Murphy, producer of the pseudo-documentary, and FX for for infringement of common law right of publicity, invasion of privacy and unjust enrichment, is asking for damages and any profits gained from the use of her likeness, and an injunction against FX to prevent the network from using her name and likeness. Hollywood Reporter reports:

In a complaint filed Friday in L.A. County Superior Court, de Havilland claims she has built a reputation for integrity and dignity by refraining from gossip and other unkind, ill-mannered behavior — but the series opens with Zeta-Jones doing an interview as de Havilland and creates the impression that she was a hypocrite who sold gossip to promote herself.

“[A]ll statements made by Zeta-Jones as Olivia de Havilland in this fake interview are completely false, some inherently so; others false because they were never said,” writes attorney Suzelle Smith. “FX defendants did not engage in protected First Amendment speech in putting false words into the mouth of Olivia de Havilland in a fake interview that did not occur and would not have occurred.”

The entire complaint is included in HR’s report and is well worth reading. Here’s a snippet:

A key reason for the public’s deep respect for OLIVIA DE HAVILLAND is that, in an 80-year plus career, she has steadfastly refused to engage in typical Hollywood gossip about the relationships of other actors. Even in her own case, where the press reported unkind and critical remarks allegedly made about her by her sister, actor Joan Fontaine, who also wrote an autobiography painting an unflattering picture of OLIVIA DE HAVILLAND, she used remarkable restraint. She went so far as to publicly state that she “doesn’t look back in anger [at any conflict in their relationship], only affection” and stated “I loved her so much as a child.”

Miss De Havilland has asked for a jury trial.

She is no stranger to the courtroom. On August 23, 1943 she filed suit against Warner Bros. claiming that under California law her contract with them had ended and ultimately prevailed. The “De Havilland Law” is frequently cited by performers seeking release from contracts with their employers.

Picture it for a moment. The 101 year old actress with enormous dignity makes her way painfully through the courtroom, reaches the witness box, is sworn in, and without script or apparent preparation testifies to the injury that FX and Mr. Murphy have done her. I don’t have the competence to comment on the jurisprudence but I’m qualified to remark on the dramatics. If it gets that far, they don’t have a chance.

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Trending at the Watcher’s Council Site

Watcher of Weasels

Tennessee bitchslaps Marxifornia 

 A Haunting Video From The UK – “Stiff Upper Lip” 
 

 
 
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Conflicted

I am greatly puzzled by this report in the Washington Post:

The United States is in the midst of what some worry is a baby crisis. The number of women giving birth has been declining for years and just hit a historic low. If the trend continues — and experts disagree on whether it will — the country could face economic and cultural turmoil.

According to provisional 2016 population data released by the Centers for Disease Control and Prevention on Friday, the number of births fell 1 percent from a year earlier, bringing the general fertility rate to 62.0 births per 1,000 women ages 15 to 44. The trend is being driven by a decline in birthrates for teens and 20-somethings. The birthrate for women in their 30s and 40s increased — but not enough to make up for the lower numbers in their younger peers.

To appropriate a recurring theme in some blogs I’m so old that I remember when teen pregnancy was a bad thing.

I simply have no idea how the following issues can be reconciled:

  • Too low a rate of teen pregnancy.
  • Low family incomes, especially for single parent households headed by women.
  • Enough research to believe that in general it’s better for children if they live with both of their biological parents.
  • Everyone should get a college education.
  • Robots are taking all the jobs.
  • Our experience with AFDC.
  • Hiring and pay should be based on merit (including experience, education, and seniority as merit).
  • Equal work—equal pay.

If anyone can cut that Gordian knot, I’m all ears.

It certainly sounds to me as though we have seriously conflicting objectives.

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A Step in the Right Direction

In a surprise and rather stealthy move the House Appropriations Committee has snuck a provision to repeal the 2001 Authorization to Use Military Force into the defense appropriations bill, reports Lawfare:

A pretty remarkable development in today’s House Appropriations markup on the Defense Appopriations bill. For many years, Rep. Barbara Lee (D-CA) has been putting forward amendments intended to repeal or sunset the 2001 AUMF. They normally do not go anywhere. This morning she moved one that would terminate the 2001 AUMF in 240 days, and lo-and-behold the majority went along with it. It passed with only Kay Granger (R-TX) opposing.

The next step will be taken by the Senate which has been conducting hearings on this subject for some time.

Then there’s getting a bill through the whole House, another through the whole Senate, and reconciling the two pieces of legislation. Finally, there’s the question of whether Trump would sign a bill containing such a provision.

But it’s a step.

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The Niche

This Reuters story underscores a point I’ve been making for some time: how dependent solar power is on subsidies, in this case Chinese subsidies:

The U.S. solar industry would see two-thirds of expected demand dry up over the next five years if a trade case aimed at propping up the domestic panel manufacturing industry is successful, a new report said on Monday.

The utility-scale solar industry, which accounts for more than half of U.S. installations, would be hit hardest if Washington adopts the hefty remedies sought by bankrupt solar panel maker Suniva. That is because large projects depend on being cost-competitive with natural gas-fired plants to spur buying, research firm GTM Research said in their analysis.

“This is arguably one of the biggest downside risks to the future of U.S. solar,” GTM’s associate director of U.S. solar, Cory Honeyman, said in an interview.

In April, Suniva filed a rare Section 201 petition with the U.S. International Trade Commission nine days after seeking Chapter 11 bankruptcy protection. In the petition, the company asked for new duties on imported solar products to combat a global glut of panels that has depressed prices and made it difficult for American producers to compete.

There’s a glut of solar panels because China, eager to dominate the global manufacture of solar panels, has been subsidizing their production so heavily that they now have enormous over-capacity.

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Post-Christian

The only comment I have on the kerfuffle du jour is that it illustrates how post-Christian we are. My advice is from 1 Peter 3:9:

Do not repay evil with evil or insult with insult. On the contrary, repay evil with blessing, because to this you were called so that you may inherit a blessing.

I guess that’s for suckers.

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The New Inquisition

At Worldcrunch João Pereira Coutinho explains how today’s lack of moderation isn’t solely a quality of American politics:

Today, Tim Farron’s case demonstrates just how modern liberalism has turned into a form of religion. A form of inquisition too: Whoever doesn’t sing from the same hymn sheet is a heretic who deserves to burn in the flames of progressive vanity. Politics is not a place for consensus between distinct views of the common good. It is a courthouse where sinners have to confess their crimes (on their knees) and embrace the Truth (with a capital T).

The problem with this medieval view of things does not lie just in the “intolerance” it reveals. It lies also in the quantity of “empty men” it promotes: creatures devoid of any interior life who defer, like robots, to whatever is in vogue.

Those who destroy individual conscience in the name of the “common good” are destroying the last barrier against arbitrary power. A barrier they might one day need if the pendulum of fanaticism changes direction.

The only disagreement I have with those paragraphs is the use of the word “if” in the last sentence. It should be “when”.

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Whistling Past a Graveyard

Meanwhile, in her Wall Street Journal column Peggy Noonan is whistling past a graveyard:

Franklin D. Roosevelt, in creating Social Security in 1935, knew he had to get Republicans behind it and owning it, or America would see it as a Democratic project, not an American institution. In the end he persuaded 81 Republicans to join 284 Democrats in the House. So too with the creation of Medicare in 1965: Lyndon Johnson wrestled and cajoled Republicans and got a majority of their votes.

Every president until Barack Obama knew this. He bullied through ObamaCare with no Republican support, and he did it devilishly, too, in that he created a bill so deal-laden, so intricate, so embedding-of-its-tentacles into the insurance and health systems, that it would be almost impossible to undo. He was maximalist. His party got a maximal black eye, losing the House and eventually the Senate over the bill, which also contributed to its loss of the presidency.

Is it fair that both parties must fix a problem created by one party? No. But it would be wise and would work.

What she’s missing is that today’s politics isn’t merely about getting what you want it isn’t even mostly about getting what you want. It’s mostly about ensuring that your political opponents lose.

Democrats won’t accept anything that looks like repeal of the Affordable Care Act; a significant minority of Republican senators won’t accept anything less. That’s an impasse; there is no room for compromise there.

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