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A health care debate

My good friend Jody Tompson and I agree on football (we’re both Cowboys fans) and beer (we both like it), but not usually on politics. We started this debate on Facebook, with Jody’s post about wait times…

Jody waiting at the DMV….will the doctors’ offices be like this someday soon?

Ted

Now seriously, Jody, how long did you ever wait in a doctor’s office in New Zealand?

Jody

I never went to the doc in NZ. But Abby’s birth was botched and I know ppl who were on waiting lists to have urgent care conducted…like a hernia surgery.
Ted
Okay, we both know we’ll never agree on this! But here goes… I’ve been to the doc at least twice a year for 14 years and have never waited more than about 20 minutes. I can get an appointment the same day, no one asks about my insurance, and it costs 35-45 NZ dollars for a typical visit–about 25-35 US$. Most prescriptions cost $3. And NZ is far from the best example of universal health care, according to international studies. Unfortunately, doctors botch operations occasionally in every country. And of course, what’s rarely said in this debate is that having a public system doesn’t rule out also having private insurance, which we (and about 30% of NZers) have, and which takes care of the wait list problem for those who are worried about it (and costs me about 110 NZ$ per month for a family of 3–one fifth of what it costs me in 1996 in the US). No system is perfect, but the wait list issue is not really that hard to deal with. Ultimately the US pays more than any other country for health care and gets less than stellar health outcomes, especially if you happen to be poor in the richest country in the world. There’s got to be a better way. Your turn… ;-)
Jody
We can think of failures and successes in any system. And the waiting is often a symptom of the individual practice, not the whole system. I agree with your last sentence…there probably is a better way. For me, the main issue is this: it’s not the govt’s job to intervene here. It’s not the govt’s job, and the govt is not any good at these things. Schools? not so good. Post office? Nope. DMV? Hardly. Medicare? More fraudulent than ever.If I buy 6 new TVs and fancy cars and a house I can’t really afford…then can’t pay my mortgage, will you bail me out? The govt is insisting that you should.

And will you subsidize my medical care after I neglect my own health?

The better way is how Whole Foods Market is doing it now.

Ted

I liked the Whole Foods article. I’d be happy to see some of those ideas enacted. Some of them would certainly help, but they won’t solve the problem on their own.  It’s great what Whole Foods is doing. But do you think Walmart might follow suit? I doubt it.

The thrust of Mackey’s argument is pretty standard neo-liberal economics: cut taxes, deregulate, and trust the market to solve the problem. How’d that work out in the banking and finance sector? Or the energy sector (ask Enron’s stakeholders). The market already has more freedom to operate in health care in the US than it does anywhere else in the world and what are the results? Systematic practices to deny claims, deny coverage to those who need it most, the most per capita costs for health care in the world with mediocre results.

I understand your skepticism of government-run programs. But you and I both study organizations, so I hope you’re not going to argue that only government organizations are guilty of inefficiency and fraud. Dilbert wouldn’t be funny if that were true!

Ultimately you want to trust the private sector and not government.  But it doesn’t have to be an either-or choice. I like having the choice between the post office and the private alternatives and use them both. I’ve sent my daughter to both public and private schools and both have been excellent. (I went to only public schools and have few complaints). And, people in Medicare are more satisfied on the whole than those in private plans. The market has its place, but it’s not a panacea, as numerous studies comparing private and public sector service industries show.

Not the government’s job to intervene? When the biggest cause of bankruptcy is medical debt? When 15% of the population have no health care insurance? What’s the government’s job if not to address systemic problems like these?

To paraphrase Michelle Obama….

For the first time in what seems a very long time, I’m very proud of my country. This is not the time to gloat or criticise. It’s a great day. I hope even McCain’s supporters will appreciate that–if not now, then eventually. As a child of the South, the election of Barack Obama is especially gratifying for me to see. We’ve truly come a long way.

Spreading fear, ignorance, and racism: Response to a fellow redneck

Like everyone else in this election season, I’ve received lots of e-mails about the election, supporting one candidate or the other. Following is one I received recently. I usually read and delete messages along these lines, but this one prompted a response, mainly because it was from my hometown and from someone I know, which probably makes me think–and cringe–a bit more. Here’s the message I received:

If You Agree, Will You Send This To Your Paper’s Editor? Send it to everyone you know around the nation, please. I have submitted this to the Post & Courier

Regards,
Kyle
————————————————————————
I do not believe in spreading my wealth.  I do not believe that relatively wealthy people should pay higher taxes than people with less wealth as the Democratic party believes and apparently the Republican party as well.  We already live in a society that has changed dramatically in my lifetime due to higher and higher taxes.  If not already, we are on the very verge of becoming a socialist nation. Very clearly Obama stated that he wants to spread the wealth. To each according to his needs, and from each according to his abilities certainly defines “spreading the wealth.”   Scarier still, is that most American voters are not aware that “To each according to his needs….” was a communist policy and was first personally declared by Joseph Stalin. I believe that the requirements for a president of the United States, as specified in our Constitution should be followed. The DNC and RNC should certainly and precisely identify and declare that the simple requirements to be the president of United States have been met by their candidate. Barack Obama’s proof that he is a naturalized citizen of the United States is still outstanding. As some of you may know, a lawsuit in Pennsylvania (started by a lifelong Democrat and NAACP supporter) to discount Obama’s qualification to be a president of the United States, because he cannot prove that he is a naturalized citizen,  was ruled against by a federal judge this past Saturday. Of course, the DNC lobbied heavily to have the lawsuit thrown out. I suspect Obama was born in Indonesia or Kenya, and not Hawaii. Where is the rage by the RNC to have this charade exposed?  Where is your rage?  Contact your representatives now. I do not believe that any political party should endorse any candidate who spent two decades  listening to and agreeing with his pastor who damned America. I do not believe that anyone should support a presidential candidate, whose wife openly declared that she was not proud of America (until her husband became a presidential candidate). The allowances, perks backbreaking efforts, etc. of the American people and the United States government to help blacks in this country over the last 40 years that surely helped the Obama’s amass their one- half million income per year, is another subject for discussion.  I do not believe that an unborn child should be killed if “my daughter makes a mistake” as explained by Obama. I do not believe that a person should be elected to be president of the United States after his own vice presidential pick earlier declared that he was not qualified to be a president, as stated by Joe Biden (his vice presidential pick). I do not believe that a person should be elected to be our president who refuses to produce documents regarding his past, who has basically zero executive experience, who has had and has ties with people who have backgrounds of national terrorism, who initially refused to wear or an American flag on his lapel, is a Marxist, whose national and foreign policies were conceived on the campaign trail and whose presidential candidacy is supported by Iran.  People, if you are considering voting for Barack Obama because of his race (half black and half white) or his “change” mantra, please reconsider. You may not believe this now, but our democracy, what’s left of it, is at stake.

———————————————————————

My response:

Hi Kyle,

When my brother forwarded this message to me, I was going to just file it away, since I’ve read most of what you said in one form or another, looked into the issues you raise, and made up my mind. But since I just figured out that we actually know each other, and your message contains a number of common attacks on Obama, I thought I would write back.

You ask in your message “Where is your rage?” I’ve tried as best I can not to let rage rule my views on this election process, although that’s been difficult. However, the source of my anger is different from yours. Mine comes from the spread of misinformation, fear-mongering, and racism on the part of many, a process to which I believe you contribute in your message. It’s a process that has become a popular tool in politics, and is mostly responsible for giving us the worst presidency in our lifetime and a country that is in tatters at the moment. If I thought that Obama would actually make things worse, I might be more sympathetic to your message. But I have a hard time believing that’s possible.

I think you’re entitled to your opinion, and even though I support Obama enthusiastically, there are some legitimate concerns raised in your message. Like you, many people will disagree with Obama’s stance on Roe v. Wade and he certainly has less experience than McCain.  However, I think that most of the other points you raise are seriously misguided. Just to addess the most egregious:

  • First, a bit of history: “To each according to his needs….” was not “first personally declared by Joseph Stalin”. It was popularized by Karl Marx (who borrowed it from someone even earlier) and then adopted by the Soviet communist leaders Lenin and Stalin.
  • You imply that Obama has endorsed the Marx quote and you later call him a Marxist.  I seriously doubt he’s ever endorsed that statement, but if so I’d be interested to know your source. If you mean that his “spreading the wealth” comment suggests that he supports Marxism, that’s a pretty big leap. I know his comment has been used by the McCain campaign to suggest that Obama endorses socialism, but if you read the whole conversation in which he used that phrase, he was simply arguing for progressive taxation. To call Obama a Marxist is either not to understand Marxism, or just to be name-calling and fear-mongering. He would not be getting the endorsement of so many conservative newspapers and Republicans if they thought for a moment that he’s a Marxist.
  • You obviously don’t agree with progressive taxation, and that’s fine. But we’ve had progressive taxation in the US for 150 years. The only difference has been a matter of degree. Even under Reagan, Nixon, Bush and every other conservative president, we’ve had progressive taxation.
  • You say  that society “has changed dramatically in my lifetime due to higher and higher taxes. Since you’re focusing on the presidential race, I assume you’re mostly interested in Federal taxes. I don’t know how old you are or what your income is, but if you just consider the income tax rates for the wealthiest citizens–those that Obama wants to raise–if you’re older than 20, then taxes have certainly not increased in your lifetime. In my lifetime (I was born in ’55), the top tax rate has gone from 91% to its present 35%. So, just the opposite of what you claim has happened. In fact, income inequality is at its highest point since the 1920s. I hardly think we’re on the road to socialism.
  • Regarding the lawsuit in Pennsylvania challenging Obama’s citizenship, the guy who filed the suit, Philip Berg, is a bit of a conspiracy theorist. Don’t believe me? He’s also got a<!–[if gte mso 9]> Normal 0 false false false EN-NZ X-NONE X-NONE MicrosoftInternetExplorer4 <![endif]–><!–[if gte mso 9]> <![endif]–> <!–[endif]–> court case against Bush and Cheney saying that they were co-conspirators in the 9-11 attacks. Maybe he’s right about that, too, but as much as I distrust the two of them, I doubt this is a credible claim. And Obama does not refuse to turn over his birth certificate. If he did, he would not be eligible to run for president. This is one of the many smear attempts that is making the rounds. His birth certificate is published on his Fight the Smears website. It’s been authenticated not only by Factcheck.org, as Mr. Berg says, but also by  Politifact, a non-partisan service of the St. Petersburg Times. It’s also possible that the so-called “liberal media” is ignoring the story. But 46 newspapers that supported Bush in 2004 are now endorsing Obama and can hardly be considered liberal.
  • You mention that “presidential candidacy is supported by Iran”. I’m sure if you asked the KKK or any white supremacist group, they’d support McCain, but that’s not McCain’s fault, is it? I don’t think we can hold candidates accountable for who supports them, but for who and what they support. And here’s a news flash: If the rest of the world got to vote in the election–including Iran, but also including every English-speaking country–it wouldn’t be a close race.
  • Now, we come to the really nasty stuff. Do you seriously think the Obamas get “their one- half million income per year” because of some affirmative action program? Let’s put aside that whatever fortune the Obamas have pales in comparison to the McCains. If you take even the smallest amount of time to investigate Obama’s biography–rather than relying on racist stereotypes–you will know that he graduated magna cum laude from Harvard Law School along with being president and editor of the Harvard Law Review. I think it’s fair to say that he succeeded on his own merits. Compare that to Bush and McCain, who got into their respective universities and were helped in their careers because of rich and/or powerful fathers, and performed somewhere between average and pitiful at university: McCain graduated 894 out of a class of 899 and Bush was a C student.
  • Finally, your comment that “if you are considering voting for Barack Obama because of his race” placed, as it is, at the end of your message, is very telling. Race is obviously very much in your thoughts. I don’t doubt that there are many people who will vote for Obama because of his race–and many others, like you, who will vote against him because of race.

There’s lots of negative stuff I could say about McCain in response, but that’s an issue for another blog post. I’ll just end where you did, Kyle: Our democracy is at stake.  But in my mind, the biggest threats are not those you articulate. Rather, they’re fear, hate, ignorance, and racism that lead to hysterical rants and an inability to engage in informed and civil discussion about differences. Whoever wins, I hope that we can find a way to have that sort of discussion.

Guilt by association…or perhaps praise?

With the non-stop attacks on Obama’s association with Ayers and ACORN by McCain/Palin and the right wing pundits, accompanied by charges that he’s un-American, unpatriotic, and maybe a foreigner after all, you’d think Obama must be a scary guy. No sane, well-informed and patriotic person or institution wouldn’t support someone like that, would they?

Well, as it turns out, Obama’s “associations” are pretty impressive. Yesterday came the news that Colin Powell endorsed him. However, despite an eloquent, detailed, and rational explanation as to why he supports Obama, Powell’s endorsement was dismissed as purely racial by the likes of Rush Limbaugh and Pat Buchanan. But Powell is just the latest in a long line of endorsements, many of whom even conservatives would have a hard time dismissing:

  • Christoper Buckley, son of the late William F. Buckley, who many people consider the father of modern conservatism, saying in his endorsement that Obama has, “a first-class temperament and a first-class intellect” and “the potential to be a good, perhaps even great leader.”
  • Lilibet Hagel, wife of Republican senator Chuck Hagel, endorsed him last week, calling Obama “smart, dedicated, steady, and wise” and said of Obama and Biden that “They are good, decent people who always put their country first.”
  • Warren Buffett, the “sage of Omaha” and the worlds’ richest man.
  • Eric Schmidt, CEO of Google.
  • And many other conservatives, who aren’t so well known.

Then there are the endorsements by major newspapers. If Obama was all those horrible things that the wingnuts have claimed, surely the newspapers would investigate these accusations and expose them, right? Well, apparently not, since he leads McCain in newspaper endorsements by a 3-1 margin. But of course, some will say that’s meaningless because of the “liberal media” bias. Well how about this: 26 newspapers that supported Bush over Kerry have endorsed Obama, including the Chicago Tribune, which has never supported a Democrat in its 160 year history. Only 4 that supported Kerry have switched parties to support McCain.

Now, John McCain has some important supporters, too, of course. But few people are trying to make an issue out of his associations, even though they certainly could, with G. Gordon Liddy and Charles Keating being at least 2 highly questionable associations, not to mention Sarah Palin’s association with the Alaskan Indepence Party–an anti-American organisation if there ever was one.

The Ayers and ACORN accusations are pure desperation. Let’s move on.

When nothing else is working, try fear

Things have not been going John McCain’s way recently, so perhaps it’s no surprise that his campaign’s new strategy seems to be “All Ayers, all ACORN, all the time.” Fear is a powerful persuasive weapon, and if they can simply paint Obama as unpatriotic, un-American, unlike “us”, he looks dangerous. Be afraid, they seem to be saying. Be very afraid.

So, Sarah Palin accuses him of “palling around with terrorists”. In the last two days the McCain campaign has used a “robo-call” to scare people into thinking that Obama has terrorist leanings. Fox Noise has focused on little other than Ayers and ACORN in the last week.

Can you really look at these two tickets and think that Obama-Biden is more dangerous than McCain-Palin? Neutral parties have investigated the Ayers and ACORN matters and have concluded they’re non-issues (see also here and here and here). On the other hand, the seething anger McCain has demonstrated in the debates, the impulsive and bizarre choices he has made and Sarah Palin’s idiocy seem much more scary to me.

Fortunately, there are many notable, sensible people and institutions out there that are having none of these scare tactics. It’s noteworthy that many conservatives are supporting him (and here and here and here).  The Chicago Tribune, a conservative publication that has never endorsed a Democrat in its long, proud history, has just endorsed Obama, dealing with the fear-mongering by saying,

Many Americans say they’re uneasy about Obama. He’s pretty new to them. We can provide some assurance. We have known Obama since he entered politics a dozen years ago. We have watched him, worked with him, argued with him as he rose from an effective state senator to an inspiring U.S. senator to the Democratic Party’s nominee for president. We have tremendous confidence in his intellectual rigor, his moral compass and his ability to make sound, thoughtful, careful decisions. He is ready.

Won’t get fooled again–or will we?

We’ll be fighting in the streets
With our children at our feet
And the morals that they worship will be gone
And the men who spurred us on
Sit in judgement of all wrong
They decide and the shotgun sings the song

–Pete Townshend, The Who

For some reason, seeing and hearing the hate-filled lunatics at the recent McCain-Palin rallies, seething with anger directed at Obama, makes me think of Pete’s wonderful lyrics. After 8 years of Bush-Cheney, is it possible that some people will get fooled again?

Try as I might, I really can’t understand all the anxiety and animosity at the McCain rallies. It’s not like even conservatives think that things are going swimmingly now. Most of the people who voted for Bush now think he’s been a disaster, as recent approval ratings show. So, what are these angry mobs raging about?

One of them vented his rage at the prospects of “socialists” taking over the country. Yes, well we can’t have that, can we, since the free market ideologues are doing such a wonderful job of bringing peace and prosperity! More seriously, people who love to toss out the “socialist” label any time liberals want to implement programs that are intended to reduce inequality or help the poor really need to go back and study their Economics 101 textbooks–and perhaps read the Obama-Biden platform. If these yo-yos do understand enough about socialism to recognise that the Wall Street bailout is the closest thing we’ve had to the government owning the means of production, well, their own president was the chief sponsor of that one.

Another poor, gullible soul at the rallies fretted that Obama is really an “Arab” and going to do horrible things to the country, reflecting all sorts of misinformation and prejudice.

And then, there are the rants of “terrorist”, “treason”, and even “kill him” that have caused so much stir this week.

McCain and his campaign people want to play innocent on all this, but they’ve stoked this hatred, especially since they announced (stupidly) that they were focusing solely on negative campaigning in the remaining weeks until the election. They’ve painted Obama as dangerous, unpatriotic, and “palling around with terrorists”.

Meet the new boss. Same as the old boss…

Fortunately, most haven’t fallen for it. In fact, there’s been a backlash, and Obama’s fundraising has surged as supporters responded to the attacks.

But clearly, some people have taken the bait. They’re willing to be fooled again. As Pete said later in the song,

I know that the hypnotized never lie. Do ya?

Why are “elites” overwhelmingly liberal?

Scott Adams, the creator of Dilbert, recently commissioned his own survey of over 500 economists, drawn from members of the American Economic Association. Despite Adams’ day job (creating Dilbert cartoons), it’s a legitimate survey, conducted by a respected research firm. The results are interesting, and Adams’ writing about the survey (also here), as expected, is pretty funny.

The results are interesting –the majority favor Obama on 11 of 13 issues–but the part I want to focus on are the demographics of the sample: A random sample turned out to be 48% Democrats, 17% Republicans, with the rest being independent or “other”. You can look at this at least two ways. One is, “What do you expect from a bunch of pointy-headed academics? More evidence of a bias by the arrogant elites in college classrooms.” That’s what we’d hear from the Limbaughs, O’Reillys and Hannitys of the world–if they were to acknowledge this survey (which they won’t).

The word elite is mostly a dirty word today, a label attached by conservatives to dismiss both wealthy Hollywood types as well as the highly educated. But it also has other meanings including, in the political arena, the best and the brightest. As Maureen Dowd said recently, “Elite is a good word, it means well above average.” All other things being equal, I’d want an elite–say, a Harvard-educated lawyer–rather than Joe Six Pack–say, someone who graduated near the bottom of his class at the Naval academy–running the country.

Which brings me back to the survey sample, and the second way you might interpret those demographics. So, the majority of American economists are Democrats. As it turns out, the same is generally true for business, science, and law professors. And outside of those faculties, the percentages who lean leftward are even more striking. A recent survey found that 81% of humanities and 75% of social science profs describe themselves as liberal. Another found that that at elite law schools, faculty who made political contributions overwhelmingly gave to Democrats. This is nothing new, of course. It’s been documented since at least the 1950s that academics tend to be more liberal than the public at large, although a comprehensive recent study shows that the largest group in most fields of study are moderates, not radical lefties.

Academics aren’t the only elites who park on the left. Surveys consistently find that the majority of US journalists are registered Democrats. Similarly, in Australia and in New Zealand, more journalists are left-leaning than right-leaning.

Now, usually when such surveys are discussed in the press, the tenor of the discussion is that something insidious is afoot. The fear is that there’s an “extreme partisan bias” that is bent on brainwashing students and the public. Frankly, it drives conservatives crazy, and many of the surveys that have demonstrated this trend have been commissioned by right-wing think tanks with an agenda of getting rid of all those old lefty profs or dismissing those pinko journos. I’m old enough to remember a book in the late 70s called Harvard Hates America that railed against the liberal intelligentsia. And as the title of that book suggests, the right wing equates being liberal with being unpatriotic.

But while it is reasonable to discuss the lack of viewpoint diversity and its consequences–the usual focus–perhaps we might question why it is that the majority of “elites” are consistently liberal and Democrat. Here are some of the reasons typically offered:

  1. Discrimination in hiring and promotion. In other words, there are just as many good, conservative candidates out there, but we’re just not hiring or promoting them. While some have claimed to have evidence of such a trend, it’s pretty flimsy. And certainly in my professional experience — 25 years in academia – I just don’t see it happening. Frankly, in the institutions where I’ve worked, if we think you’re going to be a great teacher and publish like a fiend, you’ll get the job or the promotion.
  2. Birds of a feather. Liberals are attracted to the profession because they know they’ll work with like-minded people. I suspect there’s some merit to this argument, although it’s probably a minor consideration in most people’s career planning.
  3. Unwelcoming climate. In other words, people whose views don’t fit in with the majority are driven away from these professions. They feel uncomfortable and leave–or never show up because they choose different careers. I suspect this also happens occasionally, but most academics actually like an argument. Plus, note that for this explanation to hold water, it requires assuming that the status quo was already liberal.
  4. Academics–and to a lesser degree journalists–are idealists. That is, they don’t live in the “real world” so it’s easy for them to support a liberal agenda. Well, I think we’re guilty as charged on being more idealistic than the average person. And to me, that’s the way it should be. Higher education and journalism ought to challenge us to reach higher. And so should our political leaders. I don’t accept idealism as a fault. And as for the “real world” bit, I don’t know about everyone else, but my world is pretty real. I pay bills and taxes, raise a family, run a consulting business on the side, am on the boards of two charities, and work 50+ hours a week at my “day job.”

Now, consider a couple of explanations you won’t see in the mainstream press or the right wing blogs when discussing these survey results.

  1. The values of academia and journalism simply align better with a liberal worldview. Tolerance, openness to diverse opinion, critical thinking, and challenging authority are fundamental to academic work as well as journalism. For example, the university’s role as the “critic and conscience of society” is enshrined into law here in New Zealand. Considering and respecting diverse views, gathering and critically examining the evidence, and then articulating a reasoned argument is what we’re trained to do. Those practices just don’t sit very comfortably with the socially conservative mindset that adheres to dogma, rejects inconvenient science, and is intolerant of people who are different.
  2. Academics and journalists are better informed than the general public. This may sound arrogant and elitist (rather than just elite), and that’s not my intent. But it’s just possible that academics and journalists make better, more informed choices than the general public. Isn’t it interesting that the the majority of people whose life work is studying economics, science, business, and law consistently support Democrats and hold liberal/progressive ideologies? And that this trend is more extreme at the best schools?

Academics and journalists are in general far more engaged in political issues than the general public. They read, write, and talk more about politics than the average person. They have more complex views. (Right wingers may be disappointed, but most of us have no interest in pursuing a strict Marxist-socialist agenda).

Let me say it bluntly: People who, as a group, have studied the evidence most closely — and are trained to do so — overwhelmingly side with liberal-progressives.

Now, I’m not saying academics and journalists are smarter than everyone else and their opinions should be somehow elevated. I’ve known lots of academics that I wouldn’t trust to change a tire. And, as a believer in democracy, I strongly support every citizen’s right to his or her own opinion and vote, (although I often have conversations with people that make me wistfully sympathize with Churchill’s well-known quote, “The best argument against democracy is a five-minute conversation with the average voter”). What I am saying is that the fact that most academics and journalists lean a bit left can be interpreted in more than one way–and not necessarily as a problem.

Most people just aren’t that engaged with political issues. Maybe the next time you hear about media bias and liberal academics, you might think more deeply about why journalists and professors think and vote as they do.