George Will has the right idea but I think he’s using the wrong word:

Today, Little Sisters of the Poor Home for the Aged v. Sebelius may be the second-most serendipitously named court case in U.S. history, second to Loving v. Virginia (wherein Richard Loving, who was white, and his wife Mildred, who was black, in 1967 overturned Virginia’s law against interracial marriages). The Little Sisters are challenging the Obamacare mandate that makes them complicit in providing, through their health insurance, contraception, something that offends their faith.

This mandate illustrates Gesture Liberalism: It is unimportant to the structure of Obamacare. It has nothing to do with real insurance, which protects against unexpected developments — car insurance does not pay for oil changes. The mandate covers a minor expense: Target sells a month of birth control pills for $9 . The mandate is, however, a gesture affirming liberalism’s belief that any institution of civil society can be properly broken to the saddle of the state.

I think the word he’s actually looking for, rather than “gesture”, is “signal”. Increasing the minimum wage won’t do a lot if anything about income inequality or to ameliorate the circumstances of the poor since the number of workers that would receive a pay increase is actually quite small and many of them aren’t poor. As a means towards either end an increase in the minimum wage is inadequately targeted. However, support for an increase in the minimum wage is a signal of your concern for the poor.

Similarly, under the best of circumstances the Chevy Volt of itself won’t do much about anthropogenic climate change. For one thing GM can’t seem to produce enough of them to do so and even if it did the end-to-end production cycle is environmentally suspect. However, support for the production of the Volt signals your concern about the environment.

Support for the PPACA signals your support for the poor and sick. Threatening the Assad regime with attack over its alleged use of chemical weapons signals your support for the innocents being killed or left homeless in Syria. Backing the ARRA signals your support for those left jobless by the recession.

Sending signals is ever so much easier than actual reform.

21 comments… add one
  • Modulo Myself Link

    Most people who support the PPACA seem to believe that it will actually help the poor and sick and not just send ‘signals’.

    And the idea that birth-control is only $9/month is bogus:

    For some women, finding the right contraceptive is a matter of finding the right pill. For others, it’s a matter of finding a whole other birth control method – like implants, inter-uterine devices, or surgical sterilization. Most of these alternatives cost more than $9 a month and some of them cost a lot more than $9 a month.

  • Belief is not enough to effect the objective.

  • Modulo Myself Link

    Also, please name one person who believes the Chevy Volt is in any way a real solution to halting the increase of CO2 in the atmosphere.

  • jan Link

    Using the word gesture, indicates a more gratuitous implication in addressing a problem. It invokes a conclusion that such liberal pursuits are less legitimate in effecting an actual remedy than they are in being more symbolic, or superficial tokens, to effect the attitudes and feelings of others — in this case for political purposes. I think that’s why George Will used this word, rather than one like signal, to denote a more spurious connotation associated with the piece he wrote regarding the actions taken by the government towards the Little Sisters.

    Just my take on it……

  • Modulo Myself Link

    Belief is not enough to effect the objective.

    Sure. But are you big on respect of one’s opponents, or some such nonsense? To me, trying to claim that the PPACA is just a ‘gesture’ for its proponents rather than an actual solution is just cheap.

  • Modulo Myself Link

    Sorry–‘aren’t you big on respect for your opponents…’

  • Modulo Myself Link

    See? Jan gets it. Liberals are total fakes. Nothing they do is real; so many mysteries upon mysteries. And they’re always trying to get inside the minds of voters, polluting them with their wily state signals. Ice cream, Mandrake. Children’s ice cream…

  • PD Shaw Link

    George Will is probably wrong with this particular example since the contraception mandate doesn’t do anything to encourage women to buy generic birth control from Target, as opposed to more expensive birth control elsewhere (and I’m not sure what’s to keep Target from doubling or tripling its price at this point).

    He would be more correct to point to the requirement that the Sisters designate their third-party administrator to provide contraception coverage for their employees, which the Administration argues poses no harm to the Sisters because the government has no authority to require the third-party provider provide contraception coverage.

    The N.Y. federal district court:

    “the Government’s belated revelation that the regulations do not even require plaintiffs’ TPAs to provide contraceptive coverage fatally undermines any claim that imposing the Mandate on these plaintiffs serves a compelling governmental interest. To demonstrate a compelling interest in remedying an identified harm, defendants must show “that the regulation will in fact alleviate these harms in a direct and material way.” [citation omitted] Here, the
    Government implicitly acknowledges that applying the Mandate to plaintiffs may in fact do nothing at all to expand contraceptive coverage, because plaintiffs’ TPAs aren’t actually required to do anything after receiving the self-certification. In other words, the Mandate forces plaintiffs to fill out a form which, though it violates their religious beliefs, may ultimately serve no purpose whatsoever. A law that is totally ineffective cannot serve a compelling interest.”

    There is another federal district court decision, which went the other way, and the Attorney General’s positions do not appear to be consistent across the cases either.

  • I have no idea what you’re talking about.

    The PPACA is only a solution to the problems facing us if the healthcare system has substantial excess capacity. I know of no evidence that’s the case. If anything, the evidence is that our system is overstressed.

    What does insurance in the absence of the capacity to treat accomplish?

  • Modulo Myself Link

    Having insurance is an absolute necessity in America for good medical care. The PPACA kind of sucks, but it does increase access to halfway-decent insurance, while providing a substantial credit for this insurance to people who need it. This is not nothing.

  • michael reynolds Link

    I think if you’re a single mother with a sick kid Obamacare/Medicaid expansion is a hell of a lot more than a gesture or a signal. I mean, come on, Modulo is right, that’s so transparently wrong that it borders on being cheap link-bait. Actual human beings are getting actual medical care they weren’t getting before.

    As for signaling generally, yes, it’s frustrating when people confuse nice thoughts with concrete action. But it’s equally frustrating to have such signaling dismissed as completely irrelevant. We live in a world where a celebrity wearing a certain type of shirt can set off a real-world buying spree worth millions. Of course signaling has impact, and of course it’s important in everything from logo design up to presidential speeches. Our entire culture is signaling of one type or another. When Seth Rogan can go on Letterman and talk quite openly about getting high, for example, you bet it has real world significance.

    As for the minimum wage, I love the shifting of emphasis. We’ve been told repeatedly from the Right that raising minimum wage sets off a domino effect of rising wages, and now suddenly it will do nothing, nothing at all. And yet, it’s being opposed by business interests. So it won’t shift money from profits to wages, except when it will, which is whenever conservatives think they need it to. It’s the same mental jujitsu as trying to claim that raising taxes on the rich will simultaneously not cause the rich to pay an extra penny and yet cause the rich to leave the country.

  • I think if you’re a single mother with a sick kid Obamacare/Medicaid expansion is a hell of a lot more than a gesture or a signal.

    Lay it out for me a little more. You’re a single mother with a sick kid on Medicaid. There’s no physician in town who accepts Medicaid or the physicians in town who do take Medicaid aren’t accepting new Medicaid patients. Explain to me how the PPACA helps you.

    The problem with our healthcare system, as Uwe Reinhart put it so succinctly: it’s the prices, stupid. There is no non-disruptive reform that’s going to change that.

  • jan Link

    “Liberals are total fakes. Nothing they do is real; so many mysteries upon mysteries. And they’re always trying to get inside the minds of voters, polluting them with their wily state signals. Ice cream, Mandrake. Children’s ice cream…”


    My post addressed the word usage of gesture and/or signal, as I interpreted being applied in George Will’s piece. I don’t view dems as fakes or any other kind of ‘evil’ beings, as is the invariable characterization the social progressives seem to plant on their nemesis counterparts — the republicans. Slinging one’s criticisms is one thing. Slinging nothing but mud, though, just antagonizes and accomplishes nothing.

    The Washinton Examiner wrote an interesting comparison/contrast story on Walmart’s HC coverage versus what Obamacare has to offer.

    For a monthly premium as low as roughly $40, an individual who is a Walmart HRA plan enrollee can obtain full-service coverage through a Blue Cross Blue Shield preferred provider organization. A family can get coverage for about $160 per month.

    Unlike Obamacare, there are no income eligibility requirements. Age and gender do not alter premium rates. The company plan is the same for all of Walmart’s 1.1 million enrolled employees and their dependents, from its cashiers to its CEO.

    A Journal of the American Medical Association analysis from September showed that unsubsidized Obamacare enrollees will face monthly premiums that are five to nine times higher than Walmart premiums.

    JAMA found the unsubsidized premium for a nonsmoking gouple age 60 can cost $1,365 per month versus the Walmart cost of about $134 for the same couple.

    The fact that there are no exceptions, exemptions, or better plans for upper tier employees is kind of amazing — very different stratification than what is offered by Obamacare for a myriad of friends, businesses and importantly Congress.

  • But it’s equally frustrating to have such signaling dismissed as completely irrelevant.

    Not nearly as frustrating as people repeatedly treating signals as though they were material action. As long as people keep doing that, their elected representatives will continue to put forward symbolic measures rather than pragmatic solutions. Sending signals is a heckuva lot easier than working out the details of and implementing actual workable programs.

  • Cstanley Link

    As long as people keep doing that, their elected representatives will continue to put forward symbolic measures rather than pragmatic solutions. Sending signals is a heckuva lot easier than working out the details of and implementing actual workable programs.

    There’s a tremendous opportunity cost to this as well. Think of how the opportunity to actually implement meaningful reform of the healthcare system has been squandered by PPACA.

    So while Democratic voters don’t like to hear this, it’s as important for them to face up to this shortcoming of progressivism as it is for Republican voters to admit that the GOP’s lip service to small government is worthless.

    In short, if Democrats want to convince skeptical people that government can and should do more things, they ought to realize that the proof will be in the pudding.

  • Zachriel Link
  • steve Link

    Dave- Sorry, you are largely wrong about Medicaid and no doc to accept them. Studies pretty consistently show that while it takes a bit longer to get appointments, they get care. If you survey the patients themselves, these studies are seldom cited, you see that they have problems at rates pretty close to those with private insurance, and much better than no insurance. If you understand the demographics of the Medicaid population, then you can better understand the not taking new patients meme that circulates now and then.


  • Here’s the money quote from the post you cited, Steve:

    Medicaid programs vary by state and provider markets are even more local — and they vary by specialty — so it is nearly a certainty that there are some programs in some areas that offer very poor access. But, by the same token, some probably offer quite good access. Additionally, the GAO report cited above documents some key limitations of the program.

    or, said another way, it’s complicated. That’s my basic point. Merely increasing insurance doesn’t necessarily increase care. Care is a distinct issue and the PPACA’s main issue was coverage.

    Note that Dr. Frakt’s observations also have the possibility of leading one to the conclusion that increased private insurance coverage won’t be particularly helpful, either.

  • steve Link

    Weigh that against the alternative, no insurance. It is clear that access is very poor for those people. But, you are correct. Some states make it difficult for people to get on Medicaid, and some set it up so that it is difficult to use Medicaid. Overall, it still works pretty well. I am betting that if patients have a means to pay, the services will be created.


  • PD Shaw Link

    And some states don’t pay for the Medicaid they authorize.

    My wife’s office (mental health) doesn’t accept Medicaid. When I told her last year that the legislature was talking about lifting the requirement that prevented her office from seeing Medicaid patients in order to improve access to mental health services, her response was “so, we could not get paid for our work, too?”

  • PD Shaw Link

    From a discussion at Marginal Revolution, this appears to be the key table:

    Medicaid-to_Medicare Fee Index

    In general blue states tend to provide broader coverage and eligibility under Medicaid, but lower reimbursement rates to Healthcare Providers:

    California: 0.51 reimbursement rate
    Illinois: 0.62 reimbursement rate
    Mississippi: 0.90 reimbursement rate
    Oklahoma: 0.97 reimbursement rate
    Wyoming: 1.16 reimbursement rate

Leave a Comment