Open Thread And Link Farm: Shoulder Angel Edition
- Health is not an obligation | Fierce, Freethinking Fatties
- Who Would You Shoot?. Testing shows that people hesitate less to shoot at Black people.
- I’m Demanding Better Representation For Black Girl Nerds In Geek Culture
- Cockblocked by Redistribution: A Pick-up Artist in Denmark | Dissent Magazine
- SC Grants ‘Stand Your Ground’ Immunity To Man Who Ran Out Of His House And Shot A Random Bystander To Death. Well, I certainly feel safer.
- I’ve always liked The Order Of The Stick’s take on the classic “one guard always lies, one always tells the truth” logic puzzle. XKCD’s take, too.
- 10 Incredible GIFs Showing How Aging Changes Our Appearance | Fstoppers
- A DAY AT THE PARK. Which is better to have, questions or answers? I’m not sure, but this short comic addressing the matter sure has lovely drawings.
- Lucha Libro: Peruvian writers ‘duke it out’ for a book contract in masked competitions – CSMonitor.com
- “If it were considered normal to get pregnant, birth babies, breastfeed, and actively engage in childrearing, then the assumption in the workplace would be that all adults would spend some time doing these things, and workplace policies would be designed around that assumption.”
- “I didn’t know unborn children had lawyers… I said, “Where’s my lawyer?”
- To Help The World’s Poorest, Give Them Cash
- I really loved Danger!, a short comic by my friend Becky Hawkins. Becky is doing a new take on journal comics by illustrating true stories from her own life with the addition of a less-than-helpful “Shoulder Angel,” who is sort of a combination inner child and id.
- White Collar Criminals Don’t Appear to Do Worse Behind Bars Than Any Other Type of Prisoner – Mike Riggs – The Atlantic Cities. Interesting, but the data’s a bit old.
- Lessons of The Colorado “Trans Bathroom Harassment” Hoax | Ethics Alarms As well as the post itself, which is mostly good (although not perfect), make sure to read Zoe Brain’s excellent contributions in the comments.
- Teach for America recommendations: I stopped writing them, and my colleague should, too. (Hat tip to ClosetPuritan for the link.)
- A Black intern for Marvel in the late ’70s… and Race In Comics, two good autobiographical essays by a Black creator and editor who has worked for mainstream comics.
- Economist’s View: Good News on Health Care Costs and the Budget
- NOM’s Brian Brown Helped Export Homophobia To Russia | ThinkProgress
- Analysis: Do Business-Friendly Tax Climates Yield The Most Jobs?
- A List Of Must-Have Graphic Novels For Any School Library by yours truly.
- An Interview with Jesus and Mo
- Not Taking it Anymore: One Woman Talks Back to Street Harassers with her awesome artwork.
- Epistemic Openness Watch « Why it’s good that lefty bloggers have reported the Healthcare.gov website as a disaster.
- Fake lie-detector reveals that many women lie about how many sex partners they’ve had.
- Permission To Play Devil’s Advocate Denied
- The story behind the story: Thomas King on The Inconvenient Indian | National Post
- Swiss try drive-in ‘sex boxes’ for safer prostitution
- What Kind of Problem is the ACA Rollout for Liberalism? | Next New Deal
- Zombies vs. animals? The living dead wouldn’t stand a chance – Boing Boing
- Extraordinary episode three hundred. Well worth looking at even if you haven’t read this webcomic before; extensive and beautiful. If you have the option, view this on a large monitor.
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Roosh certainly comes across as a complete asshole on his own website, but his response to Katie Baker’s article is worth looking at, if only for what he accidentally says between the lines.
The main character (or possibly one of two main characters) in Max Gladstone’s _Three Parts Dead_ is a black woman. I recommend the book highly– it’s a legal thriller set in a far future, post magical apocalypse world where the gods are made of contracts.
In re the mating frenzy between questions and answers: The question may die, but if it’s an interesting topic, the result should be a new generation of questions and answers.
Thanks for the link to Roosh’s response, Doug S. Trigger warning / content note for the last paragraph, however, as it contains a relatively explicit rape analogy, with Roosh as the victim (I don’t really know how to describe it).
Autostraddle is doing a really interesting series at the moment on LGBT people in STEM fields, with feature interviews, discussion of research on the subject, and lots of people sharing their own experiences in the comments. It’s currently a weekly feature on the site; here is a link to its archive: Queered Science. (note: so far there’s been more focus on the LGB than the trans* and genderqueer side of things, but hopefully that will be addressed in upcoming installments)
Sorry for the double post – just wanted to mention that it looks like this Queered Science post, which profiles a trans professor and discusses misogyny in STEM fields, accidentally didn’t get properly tagged, and thus doesn’t show up in the archives.
Uh, Roosh said he slept with an ’18 year old virgin’ on the trip, which I’m sure counts as a big success by his standards, if not by mine (personally, I’d be more interested in whether he managed to start a relationship, but I’m not sure if relationships are his thing.)
That being said, the whole discussion of Denmark, socialism, and impacts on dating culture are idiotic, though I suspect the fault is with Roosh more than with Katie Baker.
1) Denmark isn’t a socialist country.
2) I’m sure women in Denmark, or a lot of them, do want to find a man they can depend on for status, security, income, etc.. Regardless of the existence of the welfare state. Security, and status, are things you can’t really have ‘too much’ of, and it’s rational to prefer having a steady job, social benefits *and* a high status man, than just the job and benefits. Plus, the general tendency for women to trade sex for status is probably pretty much hard-wired in us, and not something culture is really going to change, although it can certainly change how status is defined.
3) There’s some wild misunderstanding of how resource availability should affect the popularity of ‘cads’ (i.e. the pickup artist, ‘bad boy’, overtly hypermasculine types) vs. ‘dads’ (the kind of men who attract mates by their ability to provide for them- financially, emotionally, socially, etc.). In resource rich environments, women should favour ‘Cads’, since the relative benefits of the ‘cad’ genetics are more valuable relative to the economic resources provided by the ‘Dads’. Women who want men who can provide for them, are going to be *less* willing to sleep with Roosh and his boys, and more likely to seek out men who are dominant through high economic/social status rather than through aggressive personalities.
If women in Denmark are less interested in pick-up artist techniques than women in other countries (which I have no idea if they are- we just have one person’s anecdotes here) it might have to do with lots of other things, but probably not with the existence of the welfare state.
I really enjoyed “A Day at the Park”, Amp. Thanks for linking to it.
Grace
There are no purely socialist countries in the world, but Denmark has one of the world’s largest public/taxation-funded welfare economies, which makes it count as “socialist” in the eyes of most Americans (and Europeans).
The 300th episode of Extra Ordinary is, well, extraordinary. One of the most beautiful things I’ve seen in a while.
Hector: I don’t agree with your somewhat arbitrary ‘masculinity scale’ which posits that “cads” are on one end of the male desirability spectrum while ‘financially well off’ resource providers (“dads”) are on the other end.
It seems to me that an equally compelling case could be made that ‘hypercompetitive traits’ (which would put cads in with greedy ‘resource accumulaters’ that could be seen in your worldview as ‘dads’) could be on one end of the scale, while ‘cooperative traits’ (emotional vulnerability, playfulness, and sensitivity) are on the other end. In hypercompetitive environments like the U.S., ‘cads’ find more traction because violence and overt impoverishment is a very real phenomenon endured by millions. In Denmark, the welfare state appears to have substantially reduced that possibility for most of its residents, so women feel less pressure to have a male ‘violence/resource provider’ in the home and can go for more sensitive males instead.
This would seem to jive more with what Roosh complained about, though obviously his tale is just anecdotal and people are free to make of it what they will.
However, I do think the relative merits of our particular assertions are, in fact, testable to some degree, though, simply by measuring the relative incomes of men and women in couples in the U.S. vs. those in Denmark. If yours is more accurate, one would expect Danish men to have higher relative incomes than the women they’re pairing off with; if mine is more accurate, the opposite should be true.
Now we just need to get the data …
(BTW, I’m well aware that both of these two worldviews are very reductionist, and I do think there is something to the idea that there is a tension between people’s desires for long-term relationships with emotionally stable partners, and their attraction to people who may be more exciting and less emotionally stable.)
On a completely different note, Lou Reed has died.
Sara Kruzan imprisoned for killing her pimp won’t have her parole blocked by Gov. Brown
@Eytan: The workers in Denmark do not control the means of production. Yes, Americans would call it ‘socialist’ but the word ‘socialist’ is used very indiscriminately in the USA. I don’t know any European who would call Denmark a socialist country.
Denmark and the other countries follow a model often called social democracy or alternatively Nordic capitalism (although I have only rarely heard the latter term used). From the Wikipedia article:
Hugh – I live in the UK, and it is quite common for people here to refer to the Sweden and Denmark as “socialist”. I have also encountered Scandinavians – mostly Norweigans – and Germans – who have also said so, at least while they’re here in England. So anecdotally, at least, there are Europeans who will use the term. I probably shouldn’t have said “most” Eurpeans, though.
I am perfectly aware that it’s not technically correct from a historical/economical point of view, but I think that that’s not particularly pertinent to the discussion of Roosh’s experience in Denmark. My point wasn’t that Denmark is socialist, my point was that we all understand perfectly well what people mean when they say Denmark is a socialist country.
[Deleted by request of RonF.]
Re: My point wasn’t that Denmark is socialist, my point was that we all understand perfectly well what people mean when they say Denmark is a socialist country
Sure, I understand that. I was just making a technical point, I guess. Denmark certainly isn’t socialist in the same sense that, say, Venezuela is.
Delete my previous comment, will you Amp? I was going to make a play on words based on #2’s title, not it’s content, but it turns out that my attempt at humor is not going to work ….
About being a kid. Amazing.
(he’s got some other super neato poems on “that tube thing” as my professor calls it)
well that didn’t work
So what do you all think of the current commentary from the Administration and the MSM in describing the functioning of healthcare.gov as “some glitches”.
My company supports either websites, or access to them, or both for numerous companies. If their web sites were functioning at the level that healthcare.gov is they would not describe it using the word “glitches”. They would describe it – if they were expressing themselves unemotionally – as “complete failure”. If we tried to snowjob them by calling it “glitches” or suggesting that they tell their customers to call them or mail in orders, etc., they would a) not be unemotional and b) fire us. And still bill us for $100,000’s if not $1,000,000 in penalties.
Would you call this “glitches” or “failures”? And what’s your opinion of how the process worked in getting this thing set up in the first place and where it’s going from here?
The MSM has, by and large, correctly described healthcare.gov as a disaster. For that matter, even most liberal bloggers are describing it as a disaster. Which is because healthcare.gov is (so far) a disaster.
What I think about how the media is describing healthcare.gov is that it really won’t matter much three years from now. If, four years from now, Obamacare is helping millions of Americans, then the GOP will have a very hard time getting rid of it, just as it has a hard time getting rid of Social Security or Medicare. On the other hand, if it’s still a disaster then, getting rid of it will be pretty easy.
ETA: And as for how Obama describes it – he’s a politician. Of course he’s trying to spin things so he looks good.
That last is way too facile an explanation. I still keep seeing “glitches” in common use. And “he’s a politician” doesn’t cut it. He’s the President of the U.S., he campaigned on openness and truthfulness and transparency. That’s one of the big reasons he got supported and elected. The media need to call him out on that. And they need to acll him out big time and make him and Nancy “We need to pass it to see what’s in it” Pelosi and Reid on “You’ll get to keep your plan if you like what you have already.” It would not have passed if that promise hadn’t been made – and even MSM outlets are now saying that it was a lie and he knew it.
SS and Medicare didn’t take things AWAY from people who currently had them. A lot of people are finding out that they were lied to and that their health insurance costs are shooting up. Mine are up 5+%. Other people’s costs are going up a lot more.
Also, we’ve got an election in a year. The House will likely stay GOP. The Senate has a lot of seats up for election. It’s unlikely to end up 60:40 GOP, but the ACA could help push it to a GOP majority.
I think it’s still too early to have overall numbers, but do you have any links to descriptions of the situations of people whose costs are going up by a lot? Of the people I know who have discussed it, just about everyone is either keeping the same cost or paying less. The only person I know who’s said they’re going to have to pay a lot more is someone who lives in San Francisco and was on the Healthy SF program.
Ron:
1) You say your health care is up 5%. Did you never experience an increase in health insurance costs prior to Obamacare? If so, you’re statistically pretty rare.
2) I agree with Austin Frakt – Obama’s repeated promise that if you like your current insurance, it won’t change was both stupid and dishonest, and I won’t defend it.
3) That said, this aspect of Obamacare was widely reported on, and criticized publicly by Republicans, back in 2010. I can see why people who pay no attention at all to the news are surprised, but not people who were following the Obamacare story.
Ballgame,
Well, the ‘cads vs. dads’ division is a standard typology that people use, in applying behavioural ecology to human mating choices. To the extent that some of the ‘moral’ traits like agreeableness, cooperativity, etc. fit into one or the other strategy, they go with the ‘dad’, ‘resource provider’ type strategy. The Cad strategists tend to be more individualistic.
Here’s a good introduction to the variety of male reproductive strategies:
http://ink.library.smu.edu.sg/cgi/viewcontent.cgi?article=2376&context=soss_research&sei-redir=1&referer=http%3A%2F%2Fscholar.google.com%2Fscholar%3Fas_ylo%3D2009%26q%3Ddads%2Bcads%2Breproductive%2Bstrategy%26hl%3Den%26as_sdt%3D0%2C33#search=%22dads%20cads%20reproductive%20strategy%22
The question isn’t whether this typology is “standard” (at least, that’s not the question for me), the question is whether it’s compelling and demonstrably superior than the alternatives, Hector. In this case, I think my alternative typology is at least as persuasive as yours. In order to be a ‘resource provider,’ you have to either have inherited wealth or have the ability to outcompete other males for it (through either legitimate or illegitimate means). Depending on how desperate the men in question are (i.e. how close to the brink working people have been pushed by capital), this can lead to hypercompetitive “cad” behavior.
Money isn’t a “thing,” RonF?
The firefighters are incompetent! Let’s bring in the arsonists!
*sigh*
Ballgame, your typology isn’t persuasive at all because it relies on deeply flawed economic viewpoints. You do not have to inherit or outcompete other males to be a ‘resource provider’; resource providers are found all over the socioeconomic continuum. ‘Cad’ behavior shows little competitiveness in an economic sense and is not driven by class struggle.
By ‘things’ Ron was referring to existing pension/retirement programs or health plans. Roosevelt didn’t seize existing pension funds to fund Social Security or mandate that workers with a union medical plan had to disenroll to be eligible for Medicare.
The second statement does not corroborate the first, Robert. Of course you have to outcompete others to be a resource provider if you haven’t inherited your wealth. When you go get a job, you’re outcompeting those that were not selected by the employer. Even in those (rare) conditions where there are literally no other applicants, you’re at least outcompeting those who didn’t bother to apply in the sense that you at least had the motivation to apply (or maybe a car, or whatever).
Now, the question is to what extent that the male ‘resource providers’ at the bottom of the socioeconomic continuum are selected by women to father their children. If you say “at the same rate as those above them” you would be both a) wrong, and b) invalidating Hector’s whole thesis. So there you have the dynamic of males striving to outcompete other males to be ‘resource providers’, a dynamic which is heightened in highly degraded and exploitative economic environments like the U.S.
Really? I’m not a mindreader, Robert. If that’s what he meant, that’s what he should have said.
But hey, if RonF’s point was that the ACA was a poor way to bring the US into the 20th century in providing universal health coverage to its citizenry, I wouldn’t argue. If he (or you) have a plan to get us to single payer, I’m all ears! I’m pretty sure dumping Dems for a bunch of right-wing extremists who were only too willing to torpedo the economy in order to deny non-rich people the meager health care protections the ACA does provide won’t do it, though.
At the bottom end of the socioeconomic scale, the men are not in competition with other men to get resources. They are in competition with women to demonstrate that their earning potential is sufficiently greater such that the woman would be rational to choose child-rearing over paid work.
If he (or you) have a plan to get us to single payer, I’m all ears!
1. Realize that single payer isn’t all that great, that health care is a product and service subject to economic constraints like other human endeavours and that socialism is going to deliver another crap sandwich, and instead change the goal to be having a market-based health care industry, with ample welfare and social insurance for humanitarian purposes.
2. ???
3. Profit!!!
Also with regard to “torpedoing the economy” – the Federal government is important. We need one. It needs to function. But if we reach a point where a temporary interruption in the least-important sixth of that enterprise can torpedo the national economy, we might as well pack it in – we’re done.
As it happens, though an extended slowdown would have had some deleterious effects, and some groups of people would have been very hard hit by a longer-term closure, it is very difficult to make a rational case that temporarily reducing the government back to the size that it was back in the Dark Libertarian Age of Anarchy, ca. 2000 AD, is going to break everything. They had the occasional spurt of economic vitality all those many years ago.
Robert:
At the bottom end of the socioeconomic scale, the men are not in competition with other men to get resources. They are in competition with women to demonstrate that their earning potential is sufficiently greater such that the woman would be rational to choose child-rearing over paid work.
I didn’t think that men at the bottom of the socioeconomic scale were likely to have wives/girlfriends who didn’t work…
Robert, there have been many times when I’ve read your comments here at Alas and have been impressed with your keen argumentative abilities.
This is not one of those times.
I’m hard pressed to find a single substantive point in the comment you just made that isn’t sheer and utter nonsense.
At the bottom end of the socioeconomic scale, men are in intense competition with other men (and women, to some extent) to get resources. The competition is so intense that many will willingly undertake extremely dangerous work, enduring very real risks of injury, incarceration, and death, at extremely low levels of compensation. I’m having a difficult time reconciling the sharp brain I know you have with the absurdity of the statement you just made.
Uh, compared to what, exactly? It beats what we have now all to hell, both in terms of efficiency and cost. Here’s a nice anecdote for you: Socialized Medicine Sucks. And there’s this chart that Amp ran a while back that demonstrates the costly inefficiency of what passes for a market-based health care delivery model in the US.
OK, there’s a generous way to read this and a more stringent way. The generous way is that you’re making the banal statement that producing health care requires economic resources (capital and labor), which need to be managed and paid for. OK, no disagreement there.
The stringent way is that you’re saying health care is a product which is most efficiently delivered via a market economy, and there you are demonstrably in error. Car crash victims do not have the ability to call around to different hospitals, put out precise specs for what is needed, solicit bids for treatment, evaluate those bids, and select on the basis of his or her desire for quality vs. cost savings. Insurance ‘products’ also pose unique challenges to laissez-faire market dynamics, as the spectacular meltdown of AIG clearly demonstrates. Finally, as a matter of moral principle I reject the notion that it’s OK for Bill Gates to receive better medical care than a random homeless person.
In short, in both theoretical and real-world terms, a market-based health care coverage system is demonstrably incapable of efficiently delivering quality medical care on an equitable basis.
A default would have been more than a ‘temporary interruption’, and like it or not we live in a modern economy with deeply intertwined economic processes — many requiring the oversight of a governing body — on which hundreds of millions of people depend for survival. We’re not ‘done’ unless people who deny this fundamental economic fact of life get their hands on the steering wheel and drive us all into the ditch.
Umm, Episode #300 of “Extraordinary” consists of a single picture–a girl in the forest with her cat, holding a box over her head. OK, it’s cute, but what’s so breathtaking about it?
Did you press the box labeled “start,” just above the box she’s holding?
I can get the comic to start, and sometimes paging (I forget whether it’s down or up) shows me some of it, but I haven’t gotten more than half of it to load.
We wouldn’t have defaulted, unless both Congress and the President decided to default intentionally to make political hay. Our revenues vastly exceed the obligations that we must pay in order to not default, by about 10:1. What would have happened was that some spending would have not happened; which spending, and how the non-happening happened, would have been interesting and/or politically fiery, but not catastrophic to the world economy. Disruptive, possibly.
” I reject the notion that it’s OK for Bill Gates to receive better medical care than a random homeless person.”
Is it OK for him to have a better house? Better food? More friends? Better access to education? More and better service from public safety organizations? A nicer car? More cars? A nicer computer? Better clothes?
I am aware of a coherent, if largely unpersuasive, theory of morals that is not OK with any differences in outcome. I am aware of a coherent and largely persuasive theory of morals that is OK with pretty much all differences of outcome other than those that derive from deliberate governmental oppression or favoritism; i.e., it’s OK for the homeless guy and Bill Gates to have differences of wealth but it’s problematic if those differences result from the Screw That Homeless Guy Act of 2010.
I am not aware of any coherent theory of morals that proposes that it’s OK to have better food, education, housing, public services, etc. if you’re a rich dude, but that health care is the one thing that has to be equal. If you have such a theory, do trot it out because I’d like to see the bloodlines on that one.
Also, under a single payer system that isn’t also a tyranny, Bill Gates is STILL going to have better medical care than the homeless guy. They’ll both pay their taxes, and they’ll both be eligible for the crappy or adequate or great public-health-system treatment…and Bill Gates will still fly to Dubai and get his treatment from his personal clinic full of off-system Harvard Medical grads. So single payer of the ordinary sort is ALSO rejected by your theory of morals.
There hasn’t been anything close to a free-market system of healthcare in your lifetime or mine, so your confidence that such a thing couldn’t work is based in theory, not in observation. I’ve read, many times, the arguments for why a market in health care can’t work, and they are unpersuasive. “Car crash victims can’t shop around…” and the like ignore things like the ability of people to make arrangements in advance, of services to provide informational assistance, even of governments to weed out fraudsters and boost educational levels. Pointing to the pre-ACA US healthcare system’s foibles and failures and saying “see, the market can’t…” is similarly a dud; our market has been so distorted and perversely incentivized, for decade upon decade, that clear conclusions are difficult to find. The market operations which are allowed to work, in the face of massive regulation, tend to be found on the outskirts and outliers, and they do in fact work where and when they are allowed to do so. Yes, the government can break any market’s ability to function; that it has done so is not proof that markets can’t work in this area of life.
I think the statement you quoted does go a little too far, in that a rich person will always have greater capacity to travel and to buy things.
But I think the sentiment behind the idea that a random homeless person deserves the same care as Bill Gates is rooted in the moral notion of human rights. One could say that a homeless person deserves the same freedom of speech as Bill Gates, but not the same ability to purchase a publishing company.
If we decided to define basic human necessities as human rights, then we could say that a homeless person deserves the same ability to eat as Bill Gates, but not necessarily the same food. The same access to clean water and clean air. The same freedom from violence, etc.
In practice, I think all we can say is that, if health care is a human right, then a poor person deserves the same basic minimum standard of care as Bill Gates. I don’t think there’s a practical or humane way to say that both should actually get exactly the same care.
It seems very difficult to speak of health care as a human right, other than in the gauziest of rhetorical poses. What, I have a right that compels other people to go to years of expensive and difficult professional training, to build gargantuan and high-tech facilities from which to use that training, to toil into the night curing my ailments and treating my conditions, and if I can’t pay them recompense for all these efforts on my behalf (the way in which I expect to be compensated when I work in turn for them) then they must simply smile and continue to serve me? That’s not a human right, that’s being the king. It’s good to be the king, but only one of those at a time is the general rule.
And if the “right” *doesn’t* have that compelling power, then how does it operate, exactly? I DO have, for example, a human right to be free from violence. If you come over and start beating me up, my right authorizes me to resist in kind. If my resistance is insufficient, my right authorizes my friends and family to join my side. If even that does not secure me in this human right, I have the power to levy the leviathan state and oblige it to send armed men to subdue my attacker, and even to imprison him or her after a trial finds that he was indeed oppressing my rights. I don’t even have to pay for the trial!
That there’s a hell of a right, right there.
Does my health care human right operate the same way? Can I make smart kids drop out of their candlemaking class and go to med school? Forbid that a Wal-Mart be constructed and instead mandate a hospital? Etc.?
I think that the most can be said, while retaining a rational connection to the way our society operates, is that if there is a publicly-financed health care option – be it single-payer, Medicare, Medicaid, or Obamacare (which has public subsidies for insurance) – everyone follows the same rules for that option. Two families, same income, same locality, same everything – if one qualifies for the subsidy from Obamacare, so does the other. If there’s a free ER service, the homeless guy can use it and so can Bill Gates. Etc., etc. No worries there – common sense and totally in accord with American ideals.
But that modest level of egalitarian formalism does not seem to preclude any organizational structure for health care finance other than terribly prejudicial ones, and to everyone’s credit, nobody is proposing such ideas.
Your right to be free from violence has not forced anybody to become a cop, and it’s been decades since it’s forced anybody to become a soldier. Why would a right to health care force people to become doctors? The right of every child to a free and appropriate public education has not yet forced anybody to become a teacher.
This is identical to communists who argue that we don’t know if communism works because pure, real communism has never been attempted. For both folks like you and the capitalists, it’s a very convenient viewpoint, since it means your beliefs will never have to be tested by real life in any way. Until there is a pure anarchist free-market nation, after all, there will always be a government you can point to and say “it’s their fault” whenever there’s a market failure.
So wait, when I take a trip to Chicago, you want me to spend hours and hours beforehand researching which hospital I should go to in case something happens? What about when I go on a five-state book tour, should I be doing that level of research for each of the cities I’m going to be in? What if I drive ten hours, taking myself through ten towns or cities on the way – do I need to research each one?
Oh, wait, now you’re saying that in addition to paying for my medical bills, you want me to spend more money on “services to provide informational assistance,” presumably one for every city I’ll be in if I pay for them in advance, or while I’m lying on the pavement with a broken leg if I wait until after I’ve gotten a need. Yeah, THAT’S realistic. Tell me, Robert, if the free market will provide such services, and they work so well, why don’t they already exist and have wide usage? Oh, right: (The government is to blame. Convenient excuse, that.)
And regardless of if people “have the ability to make arrangements in advance,” as if every person in the world is medically literate or able to become so, the fact is not everyone will. If your system can’t deal with that fact of human nature in a practical way, then your system won’t work in real life.
It’s a basic fact, Rob: Sometimes people in the real world have medical emergencies they haven’t prepared for, and when that happens they may be in no shape at all to be engaged consumers. In that situation, doctors and hospitals will be rationally motivated to provide the most expensive care they can at all rationalize providing, whether or not it’s actually helpful to the patient, and to charge outrageous prices for necessary care. How can the free-market solve this problem, that someplace like France hasn’t already solved better?
“Tell me, Robert, if the free market will provide such services, and they work so well, why don’t they already exist and have wide usage? Oh, right: (The government is to blame. Convenient excuse, that.)”
You want to know why the free market hasn’t provided information-deficit-mitigation services to correct the information-deficit problem in a hypothetical future free-market health care system?
Um, because as of yet we don’t have reliable time-travel or alternate-reality-transport technology?
“This is identical to communists who argue that we don’t know if communism works because pure, real communism has never been attempted. For both folks like you and the capitalists, it’s a very convenient viewpoint, since it means your beliefs will never have to be tested by real life in any way.”
No, it is not identical to the communists, because unlike the communists, I can point to a past era when there was a good-enough-for-broad-brushwork free market health care system: the United States, ca. 1900 AD, when there was little regulation and only very spotty market distortion from state charity, etc.
And in fact I pointed to that era, and point to it now again. Was that era a perfect utopia? No, of course not – but its flaws and failures were much more failures of technology and wealth than problems of systemic inability to function. We had free-market pricing, free-market entry and exit, and only minimal – probably inadequate, in fact – government regulation. People were not dying in the streets by millions because only plutocrats could afford healthcare, the nations travelers were not set upon viciously every time they stubbed their toe in an unfamiliar city and bankrupted by million-dollar podiatry bills.
“In that situation, doctors and hospitals will be rationally motivated to provide the most expensive care they can at all rationalize providing, whether or not it’s actually helpful to the patient, and to charge outrageous prices for necessary care. How can the free-market solve this problem, that someplace like France hasn’t already solved better?”
Citation of the problem actually existing, anywhere, first, please. You’re middle-aged, you’ve lived in what you’d call a free-market health care system for coming up on 50 years, you travel a lot, you’ve had health expenses and dealt with them for most of that time. What percentage of your health care expenditures over your lifespan have come from gouged, extortionate doctors swooping upon you in strange places?
“Why would a right to health care force people to become doctors? The right of every child to a free and appropriate public education has not yet forced anybody to become a teacher.”
Finally, a valid point. Thank you Ruchama.
Your point is well taken, and I exaggerated too much for rhetorical effect in my list of demands that a person with a real human right to health care could make.
On the flip side, a right to education or peaceful life may translate into an obligation to do something for themselves in the absence of a paid professional – but how meaningful is such a right in an area of life where one cannot self-provide? People can teach themselves from books at need, and can defend themselves from violence themselves (however ineffectively) if they have to, but I can’t perform heart surgery on myself and I’m a little old to start learning how to be a nurse.
That’s one reason that the positive model of rights (“you have right to X”) is less intellectually compelling than the negative model (“nobody has the right to do X to you”); your enjoyment of positive rights may absolutely depend on someone else’s time and money in a context where you cannot compel such contribution. Forbidding Senator Bob from stopping your novel’s publication is a lot easier than obliging Senator Bob’s constituents to buy it.
Robert, are you seriously claiming that there’s no information-deficit problem in the status quo?
If that’s not your claim, then again I ask: Why hasn’t the magical god of the free market solved this problem yet? Is there some law outlawing the “information-deficit-mitigation services” you predict will arise if only government gets out of the way?
In an ordinary, efficient marketplace, informed consumers are able to be their best advocates. Without that aspect, markets cannot be efficient. The medical market can’t and won’t function that way, because 1) few consumers have the education or confidence to question what doctors say, and 2) when a consumer is badly sick or injured is when they’re least able to make decisions well.
In the current US, we only sort of address that problem, which is why US medical prices are out of control, and why we pay so much more for medical care than citizens of other wealthy nations. In other countries, they have price controls and other cost-control systems in place, and as a result prices are much lower. (Obamacare has some price-control aspects as well, but it’s too early to say if they work, although so far things look good).
“Some future systems will magically arise to solve the problem” isn’t an “intellectually compelling” response to the problem that medical markets are inherently imperfect, but that’s all the answer you’ve provided so far.
I, too, exaggerated for rhetorical effect. But the whole US is an example of what I mean. It’s well-documented that there are areas of the US where the local medical culture prescribes care that is unnecessary, and that the more profitable the care provided is for the doctors, the more likely this is to happen. If the way doctors are paid functions so that they don’t profit more by prescribing more procedures, then they’ll tend to prescribe fewer procedures, without having worse outcomes. Read this article written by a surgeon for more discussion of this aspect.
I’m curious; you’re a believer in the free market. That being the case, why do you think doctors wouldn’t be drawn to ways of organizing their businesses that maximize profitability?
Also, you were discussing Massachusetts before – and what a shock, CATO didn’t like it! Of course CATO is ideologically opposed to all government spending to help poor people afford health care, so that’s not very meaningful. Without getting too deep into the weeds, let me quote Factcheck:
99.8% of kids. Do you seriously believe that the unaided free market is capable of doing that well?
It should be noted that Massachusetts didn’t start, pre-Romneycare, with relatively good numbers because the free market had done the job; it started with good numbers because programs like Masshealth had begun reducing the ranks of the uninsured years before Romneycare began.
Nor has Romneycare bankrupted Massachusetts.
Of course, there’s also Medicaid spending – but the large majority of that would have happened with or without Romneycare.
And Obamacare, unlike Romneycare, has cost controls built in from the start.
Heh.
I’ve been thinking about this, but before discussing it I wanted to ask you: What kind of evidence are you basing your views on?
I mean, I genuinely have no idea where I’d look to find out what poor people in 1900 who were sick did if they couldn’t afford medical treatment. It’s a pretty common trope in Victorian novels that characters get sick and are in desperation because they can’t afford to pay for medicine. But that doesn’t tell us how common the situation was, just that it wasn’t unheard of.
There just wasn’t the same amount of healthcare in 1900 that there is now. No one had to worry about being able to afford insulin, or inhalers, or chemotherapy, or antibiotics, because that stuff didn’t exist. And much of the stuff being sold as health products didn’t work. As compared to today, there were relatively few conditions where access to healthcare or not would determine whether you lived or died — most of the stuff where that’s the case today would have killed everyone back then.
“If that’s not your claim, then again I ask: Why hasn’t the magical god of the free market solved this problem yet? Is there some law outlawing the “information-deficit-mitigation services” you predict will arise if only government gets out of the way?”
Specify which portion of the current information-deficit problem you want an explanation for, and I’ll see what I can figure out. As a general rule, however, I can predict that if the market has not produced a solution for a particular information deficit issue it is because
a) the i-d issue is not really an i-d issue; the person who thinks it is sees people making decisions he or she thinks are wrong and assumes the decisions must be wrong because of incorrect information on the part of the decider
b) there is a law prohibiting the correction of the information deficit, and breaking that law isn’t profitable enough to make it worthwhile
c) the information is genuinely unattainable; nobody actually knows, and if one party or another is getting an advantage it is because they have some greater ability to manage uncertainty or tolerate ambiguity or recover from risks gone wrong, not because they have better information
d) the people with the information deficit do not believe they have an information deficit, and the cost of educating them that they do + correcting the deficit is > the profit from correcting the deficit
e) there is an information deficit but its impact on the economics involved is smaller than the cost of collecting the information would be, and so it doesn’t pay to correct the deficit, or it is cheaper to take different precautionary measures or add redundancy to a system than to collect the information.
“I’m curious; you’re a believer in the free market. That being the case, why do you think doctors wouldn’t be drawn to ways of organizing their businesses that maximize profitability?”
Why wouldn’t they be? Wouldn’t doubt it for a second.
Fucking over tourists and yokels on an exploitative one-off basis is not the way to organize your business to maximize profit, however. It might be the thing you can do right at this instant to get the most money, for this instant. But that ignores the opportunity cost from not (for example) just delivering a good product at a competitive price and earning a loyal return customer, and it ignores the potential cost from blowback from the scam, whether informal (“I heard you charged my friend Amp a million dollars for his toe surgery, and I’m here to kill you for it”) or formal (“NYPD. Open up!”).
I agree that the way doctors get paid can have significant effects on the smooth functioning of the system, but any such compensation system can be implemented in a free-market or a mixed-economy or a single-payer or a Cuban medical environment. Such considerations just don’t foreclose the possibility of a functioning system.
“Also, you were discussing Massachusetts before – and what a shock, CATO didn’t like it!”
I discussed Massachusetts in the lets-not-default thread, where Charles threw MA out as a “see, this can so work!” counterexample, which was demolished. I didn’t cite CATO, however, so I don’t know what they have to do with anything. I cited the Henry J. Kaiser Family Foundation, RealClearPolitics.com, CNN, NBC, and the Obama administration.
“99.8% of kids. Do you seriously believe that the unaided free market is capable of doing that well?”
You quote five paragraphs of numbers to wind up agreeing with the number I expressed in my critique; RomneyCare improved insurance coverage by about 6% of the population. 99.8% of kids!!!! That’s a whole 7.2 percent better than it is in the rest of the non-RomneyCare US! And you’re asking me if I think that the free market could improve things by 7%, and thinking this is some amazing ‘gotcha’ moment, why exactly?
If the distorted, weighed-down, crushed-with-regulation, insurance-crony-capitalism-laden US system can get to 92.6%, and adding another layer of coercion and price mismanagement ups that to 9.8%, then yeah, I think throwing out all the socialism and Federal control of band-aid prices might just possibly be able to match that. Color me nutso.
Then you talk about Romneycare isn’t bankrupting MA. And again you end up *agreeing with me*. Did you READ what I wrote in response to Charles? Yes, Romneycare isn’t bankrupting *the state government of Massachusetts*. That’s because it distributed the costs to three different places: a huge chunk to the Federal government, a huge chunk to the individual citizens and businesses of the Bay State, and a modest chunk to its own coffers.
As I asked there, where exactly is Obamacare going to shift costs? The NIH? Canada? Massachusetts’ program didn’t bankrupt the state because it passed lot of the costs up to a higher level of government. News flash: the UN hasn’t got the budget to pay for Obamacare.
“And Obamacare, unlike Romneycare, has cost controls built in from the start.”
Oh, well, COST CONTROLS. Now you have me wriggling in the crushing grip of fear. Surely no mere economic incentives, physical realities, or human psychological traits will work in tandem to make government-ordered COST CONTROLS into a farce or a disaster, depending on how much force the state decides to deploy in defense of its stupidity.
If I’d know that COST CONTROLS were going to happen, I’d have assumed the ACA would soon be a brilliant success of a program, the same kind of genius centrally planned innovation that has made Manhattan a center of reasonable rents for young working-class families.
I hide my foolish face in shame.
Ruchama, again you come up with a reasoned and intelligent response. Knock that shit off.
True, medicine is a lot more useful/valuable than it was now.
So we have thing which used to be of iffy, marginal value, but which has improved (thanks to technology and science and stuff) over time, pretty steadily really, and is now quite valuable. Over that same time period, governmental involvement and intervention, whether in terms of direct regulatory control or just adding public money into the pot and futzing with the prices, has also increased steadily.
So the industry is getting better and better, and the government’s ability to influence/manage the industry has gotten better and better, over the relevant timeframe.
If government influence and management, rather than free-market operations, enhance the access to and success of health care, then, we should see an ever-improving healthcare industry in the United States, right? Starting out in laissez-faire awfulness, and low-tech ignorance, and proceeding up to the present day with an ever-building government intervention and ever-increasing technological sophistication, everything should be getting better and better across the board, really, with each passing year.
Is that what we see?
The article on Real Clear Politics says it was reprinted from CATO’s website. The author is a CATO senior fellow.
Romneycare didn’t “shift costs” in the sense of a change being made midstream. The large majority of Romneycare was paid for the way it had always been intended to be – with the mixture of money you describe. Money from the Feds was always part of the equation. There was an initial bump of greater-than-expected setup costs, but for the last few years Romneycare is costing just about what it was always projected to cost.
As for Obamacare, why would it need to shift costs? There’s no reason to think it’ll cost significantly more than projected. How it’s paid for is already well-established, and was from the start. The cost curve seems to be bending in the hoped-for direction, and premiums are actually less than what the CDC projected, which means the whole thing now has some wiggle room.
If Obamacare does end up costing a lot more than projected, then Congress will have to decide how to handle that; it can either budget more money to Obamacare, or make cuts in Obamacare, at that time. That is Congress’ job, and it’s hardly an insolvable problem (especially if by that time Republicans have either returned to responsible governance, or lost the House).
There’s no actual question that medical cost controls can significantly effect the cost of health care; they can, and have done so successfully in many countries. (“Significantly effect” and “dictate” are not the same thing, of course, but I never claimed “dictate.) Whether or not the ACA’s cost controls are strong enough is an open question.
Re: No, it is not identical to the communists, because unlike the communists, I can point to a past era when there was a good-enough-for-broad-brushwork free market health care system: the United States, ca. 1900 AD, when there was little regulation and only very spotty market distortion from state charity, etc.
Uh, I’d be willing to bet that the average standard of health care was better anywhere in Eastern Europe or Russia post-1956, or in Cuba, than it was in America circa 1900 AD.
We did, in fact, have quite a lot of illness and early death back then.
Re: In this case, I think my alternative typology is at least as persuasive as yours. In order to be a ‘resource provider,’ you have to either have inherited wealth or have the ability to outcompete other males for it (through either legitimate or illegitimate means). Depending on how desperate the men in question are (i.e. how close to the brink working people have been pushed by capital), this can lead to hypercompetitive “cad” behavior.
Except that the ‘resource provider’ phenotype correlates with higher agreeableness (the article I linked to has a link), which makes you less likely to make a lot of money, but also more likely to use it in a responsible fashion to provide for a wife and child.
Ah, I didn’t recognize that the RCP piece was a Cato guy, my bad. That said, since I presented data, not opinions, from that piece, why is it relevant what the biases of the author may be?
Are the data wrong, or are the data correct?
“As for Obamacare, why would it need to shift costs? There’s no reason to think it’ll cost significantly more than projected. How it’s paid for is already well-established, and was from the start.”
Charles presented MA as an example of the ACA’s strategy being a viable, affordable way to get more people insured. But its affordability is predicated on Other People contributing a huge slug of the needed resources. At the state level, there is a huge Federal Other People pool to theoretically draw from. At the Federal level, there is not.
“Uh, I’d be willing to bet that the average standard of health care was better anywhere in Eastern Europe or Russia post-1956, or in Cuba, than it was in America circa 1900 AD…We did, in fact, have quite a lot of illness and early death back then.”
Yes, of course we did. And hell, probably most of Africa in 1956 had a better standard than the US in 1900, because ANTIBIOTICS. We’re not comparing the technics of different eras. The claim was made that free market healthcare systems just cannot function, because of information asymmetry and rogue podiatrist gangs. The US in 1900 is a counterexample that shows, not that the medical care was all that great (it wasn’t, anywhere, because technology was poor) but that the system itself could be organized on market lines without medicine being reserved to the fantastically rich.
I think you underestimate the contribution of modern medical technology. The reason the US in 1900 could have a functioning free market medical care system was *because* the standards it had to achieve were not particularly high. When all you needed to have is a trained physician with low tech instrumentation and supplies, there’s no barrier for competition, and no need for regulation beyond the basic “check that the doctor actually has some medical knowledge before giving him a license” or whatever.
I’m not saying it’s impossible to have a free market health care system today that’s functional and gives people fair access to the medical services they need (though personally I don’t see how that is possible, but that may well be my personal limitation and not a reflection of fact). But the 1900s system is entirely irrelevant as an argument, unless you also are talking about returning most people to the same types of medicine that were available in 1900.
Transportation technology was similarly primitive and dangerous in 1900, yet functioned on a free-market basis; transportation today, though it often has governments as customers, operates on a free market basis and delivers a high standard of safety and performance.
Computing technology was primitive in 1900, yet office machines were a huge free-market industry; computing today is probably the most advanced field of human technics, yet operates on a free market basis.
Etc., etc, etc.
There are criticisms of the free market that are fair and that can be argued fairly. And it is perfectly plausible to argue that some particular industry or function can be handled more efficiently or more effectively by government than by the market – you can have private security firms and vigilante justice, or you can have a sheriff’s office; both approaches can be made to work, but the sheriff’s office ends up delivering a lot more peace and order at a smaller cost. There are areas where government works, and even areas where it works better than an unfettered market would work. Those industries deliver “public goods” and there’s a well-developed economic literature about how and why the state can do them better than the firm.
Health care is not a pure public good in that economic sense. There is ample evidence that governments *can* run health care systems, or have enormous involvement in the market, without it being a Soviet disaster; there are public-good components to some kinds of heath care. But there is also ample evidence that markets can deliver pretty much any kind of good – even public goods – without it being hugely awful for the people.
Among many on the economic left, there is a presumption that health care is somehow different, that it simply cannot be delivered on the market without it being a moral atrocity, or that it cannot be delivered on the market at all. This view rarely is presented with any supporting evidence and every argument I have ever seen for it has been weak and illogical at best.
On the basis of history and observation, the correct presumption is that the market can deliver whatever is needed; cases where it can’t become clear quickly and then it becomes a good idea to think about state solutions. Many people on the left will read this and say “but…” and launch into a breakout of some market failure they’ve seen recently. But notice they are usually talking about here and now – where the level of government intervention and price distortion is epic – and not a time or place where the market was allowed to work. You can’t really justify government ‘fixes’ in a ‘market’ which has been battered by year after year of escalating state intervention, by pointing to that market’s poor condition.
“We’ve been fixing this for 70 years and now it is in such bad shape that we need to REALLY fix it” is just not a compelling starting point.
The chance that I will some day involuntarily need my own million dollar computing system is zero. The chance that I will involuntarily ever need a million dollar speed boat is zero. The chance that I will ever involuntarily need a million dollars in medical treatment is much larger than zero.
Needed computing high technology is well within the means of the American middle class, and reasonably within the means of most Americans. Needed transportation technology is likewise. The range of computing and transportation needs is not very large. The range of medical needs is quite large and the upper end of medical needs are beyond the means of most people to pay. The only way to make much of modern medicine available to most people who needed it is some form of system that provides medical care based on need rather than based on ability to pay. Private insurance is one such mechanism, in which a large group of people agree to pay much more money than they need for medical care on the promise that if they are one of the unlucky ones who needs more medical care than they could ever pay for, that it will be paid for none-the-less. All the various systems of public health care provision, be they single payer, national health, or any of the many systems that use public subsidy of mandated private insurance do this same thing. They take money from people who aren’t sick to pay for expensive care for people who are sick.
My brother was in a car accident at age 25, when he was working as a house painter. In 4 hours, he accrued a $250,000 medical bill. By the end of 6 months, he had accrued a $500,000 medical bill. There is no possible means by which a 25 year old house painter could have saved $500,000 for unexpected health care needs.
If you can’t point to a single country in the past 50 years that has had what you would call a free market health care system, there is probably a very good reason that none exist.
The chance that I will ever involuntarily need a million dollars in medical treatment is much larger than zero.
The cost of an insurance policy or other financial hedge that puts a million dollars at your disposal, but which is not expected to manage or cover your hundred dollar doctor visit or thousand dollar garage accident, is well within the means of even an American in the “working poor” category. The cost of subsidizing that insurance for the very narrow group of people who are below “working poor” is non-trivial but readily affordable by the state; the cost of providing basic care to the very poor is similarly manageable, and is in fact already being appropriated and spent albeit not always wisely.
“If you can’t point to a single country in the past 50 years that has had what you would call a free market health care system, there is probably a very good reason that none exist.”
Who said I couldn’t point to one? Hong Kong had a very free market system for decades, and was one of the healthiest places in the world. Great outcomes. I don’t generally point to overseas examples because they are rarely good matches for the US – too many distinctive differences; I told ballgame we hadn’t seen one in our lifetimes on the working theory that he hasn’t been to Hong Kong either.
Can you cite some creditable sources for your claim about HK?
This says you are wrong.
Also, this (although note the actual content, not the editorializing, and note the catch by a commenter: 50% of spending is in the public health system, but 80-90 % of activity is in the public hospitals).
Here is a more detailed history of the HK medical system, I’m not seeing the period where things were free market and going great.
The HuffPo piece is talking about the system today, not the pre-97 free city days. The detailed history link you provided seems pretty credible, and supports my viewpoint, starting from the very first paragraph:
“If the history of Hong Kong’s health system had to be summarised in one word, that word would be “expediency”. Government policy in the area of health care has been dominated by inactivity unless the government has been forced to act in the direction of economic (or to a lesser extent, political) considerations. Little has been done for purely social reasons. This can be attributed to public indifference, which has reinforced the official philosophy of laissez-faire and reliance on market forces.”
More: “Government intervention has usually been forced by a crisis, rather than being part of any long-term social strategy or policy. Even then, it has only responded by doing the minimum necessary. In the private sector, the government has allowed health care providers to operate largely without external regulation.”
Through World War II, the colony’s health systems were more or less a wreck and, while of interest historically, not what I’m pointing at. The ‘golden age’ of the system started in the early 1960s, when colonial administrators rejected the UK’s NIH-omnicare approach in favor of continued nonregulation, along with a program of generous direct support for the poor. This worked very well, and from around 1964 to 1997, the health care system was laissez-faire with regard to regulation and intervention, with lavish provision for the poorest citizens who nonetheless maintained complete control over their own healthcare decisions.
In 1997 the handover to the ChiComs took place, and naturally the statists couldn’t stand the idea of having a system where the technocrats weren’t running everyone’s lives, and started putting more and more emphasis on the public side of the system and providing care for everyone, not just the poor. For about ten years that ran things steadily into the crapper, until a few years ago when they recognised that they were pissing in the soup and declared an intention to return to the philosophical roots of the system, the 1964 white paper that laid out the laissez-faire approach while promoting care for the poor.
Robert: The story you are telling is not true.
Also: ChiComs? Seriously?
yrs–
–Ben
Ben –
In that? Citation, please. Charles’ third link, which I quoted from, didn’t have anything in it I could argue with, and seems pretty solid.
ChiComs – Seriously? I should joke about such things? They’re the Chinese, living in China; they still self-describe as Communists, though I gather from my expat friends who live or do business there that Marx is more a memory than a mentor these days. The word itself has an etymology older than me. What’s your objection?
[NOTE: This is actually Charles, accidentally posting as Amp]
Robert,
That was a fantastically willful misreading (or you only read the opening description and not the detailed history). The article specifically talks about how the HK public health system does not involve any subsidies to the poor (in 1990). Instead it was based on building publicly run hospitals, which everyone can (and does) use, and which charge very low nominal fees. Additionally, the polyclinics were introduced in the 90s, before the transfer of power.
Before the NHS style hospitals, there were free public/charity Chinese medicine hospitals. Intriguingly, despite the health care system being a mess before the NHS style system, life expectancy matched the US in 1960, and really high infant mortality of 1950 was already in an exponential decline.
Not that I care to get into, but “its old, and its an abbreviation for a descriptor” is not actually an argument for the legitimacy or acceptability of a term. There are a fuck-ton of abbreviations of long standing which are slurs. Looking up chicom just now, it is used (a) in “Call of Duty: Black Ops” (b) to discuss Chinese military weapons (c) by Rush Limbaugh, and entered popular usage from US military in Vietnam. Since you aren’t military intelligence, aren’t playing CoD, claim not to be Rush Limbaugh, and it has been objected to, please stop using it. (note: the objection is that using it makes you sound like a ridiculous pastiche of an anti-detente 1970s right winger, not that it is offensive).
[NOT ACTUALLY AMP]
Point taken about when the polyclinic “innovation” was introduced…but not seeing the misreading, fantastically willful or not, that you are seeing. I know about the public clinics; the point is that they were NOT “used by everyone”, though everyone was allowed. The point of the system was openness and choice – rather than make the public hospitals do means-testing or a limited menu, they just poured public money into the public facilities and let people choose how to fund their own health care decisions. Spend $10 at the cheap clinic or $200 at the private clinic or $20,000 at the ultra-clinic – your call. Insurance? If you want to buy it and can find someone to sell it to you; not the state’s problem.
I think you might be operating on the assumption that I see no role whatsoever for any government spending in health care. But that isn’t so; I regularly reiterate, as part of my free-market crusading, that there ought to be huge public expenditures for the poor, for humanitarian reasons. The way they did it in Hong Kong is one of the good ways – doesn’t create moral hazard, since the free clinics aren’t as good as the high-end private places, there’s a motivation to get the best care that you can afford.
I would like to know, from the people who say that the free market would end in a hecatomb of bankrupted out-of-towners, why the free market that operated in Hong Kong with almost no constraints didn’t end up creating a giant pile of corpses.
Re:ChiCom, very well. In 1997 the handoff to the People’s Republic of China took place.
Okay, so it isn’t misreading, it is just a really weird use of terminology. I have a very hard time seeing how a system of nearly free public hospitals that provide 90% of all hospital care in the country does not hugely distort the market for health care.
The HK system seems like a perfectly good system to me. It just doesn’t seem like a system that is primarily defined by its free marketness. It is sort of like describing a system in which 90% of food is bought from government bread shops that sell bread for a penny a pound as a free market system because there is also a free market in higher end food. I mean, it isn’t a purely socialist system, but it seems like it is at the socialist end of mixed systems. If you were claiming that we couldn’t talk about food scarcity issues in the US being the fault of the free market in food, because agricultural subsidies and food stamps and the FDA have distorted the US market for decades, I’d be pretty nonplussed if you pointed to Egypt as an example of a free market food system that worked really well.
In fact, there is a glaring example of the distortion in the free market.
1) In response to me talking about necessary medical care that costs hundreds of thousands, you said that high deductible insurance was an obvious free market solution to that problem.
2) In Hong Kong, there is basically no insurance market, including no market in high deductible insurance. The reason seems pretty obvious: why would you buy high deductible insurance when there is no such thing as needed medical care that costs hundreds of thousands? If my brother had been in a near fatal car crash in HK, he would have been rushed to a public hospital and treated for next to nothing.
Now, you are opposed to insurance, so this isn’t a market distortion you are bothered by (and I’m not bothered by it either), but it is a huge market distortion.
You’re taking the 90% figure from an uncitationed comment, by a commenter with an axe to grind. About half the spending in their system is/was public, about half private. It’s a mixed system, economically speaking, since there is public money flowing into it, but it’s pure free market in that there aren’t/weren’t government regulations stifling choice or mandating particular solutions.
12% of their medical spending comes from insurance, so I don’t know why you think there isn’t an insurance industry there. I’m not opposed to insurance, by the way; I am opposed to our companies, which are criminal enterprises, and I am opposed to mandating people choose insurance as their form of health care finance, and I believe (with considerable justification) that insurance is a dumb choice for financing many types of health care, but not others. (Why would I *recommend* insurance as the vehicle of choice for financing that subset of problems for which it is an excellent fit, if I was just opposed to it altogether?)
You call Hong Kong’s system at the socialist end of mixed systems, yet it has the lowest rate of insurance and the highest rate of patient out-of-pocket dollars and the lowest rate of public dollars among developed nations; which systems do you see as MORE free market? From what I can see, the ONLY thing in Hong Kong’s system that could be viewed as socialistic is the cheap public option portion of it, and as I have always acknowledged, there has to be some provision made for the poor. I think you’re rejecting the ‘free market’ label because you and/or your rhetorical allies have spilled (pixelated) blood defending the ideological ground of ‘free market system = dead people everywhere’ and you’re reluctant to give up that hallowed turf.
The market distortion that bothers you because it doesn’t bother me does exist, but it’s about the most benign form of such a distortion that there can be. You can get a nearly-free college education at your local community college, but Harvard still thrives; there are soup kitchens and food stamps and breadlines, but the grocery industry booms and restaurants are everywhere. Options, even subsidized options, don’t usually kill off other options *when there is no coercion or force* and where the state doesn’t set out to make the ‘free’ option so good that the impoverished are better off than the middle class. In fact the existence of options tends to put selection pressure on the other options, forcing them to maintain quality. Hong Kong’s cheap care in the clinics has its own set of tradeoffs; waiting months for an appointment, for example, or the fact that experienced clinicians steadily leave the free system for the private system.
Your brother might have been rushed to the free clinic for a car accident, but if your brother had cancer and your family had a lot of money, the hell he would be waiting in line for a year to see a specialist; you’d pop him into a private clinic that day, stepping over the line of queued riffraff to do so.
Hong Kong government website says 90% of hospital bed days are in public hospitals. http://www.news.gov.hk/en/record/html/2013/04/20130409_190409.shtml The article also details some plans to try to get more people to use the private health system.
The article also details some plans to try to get more people to use the private health system.
Careful, Ben will be along shortly to call you a liar. No worries though, just ask him to specify which statements are lies, and he’ll ghost.
That said, OK, 90% of the bed-days now are in the public clinics. That wasn’t the case in 1964 or 1997; that’s the period when their health care system was at its maximum free-marketedness.
Your entire narrative is a lie. It’s possibly (and I’m trying to give you as much credit as possible here), that it’s a lie you got fed by some random US right wing fantasy source and are now passing on to the rest of us, not know that it’s a lie. But it’s still a lie, and that’s what I’m concerned with.
Since we’re discussing behavior patterns, this is a fairly common strategy for you, Robert. You show up, spout a bunch of right-wing platitudes you picked up from God-knows-where, and then insist that they are true and that we are required to debunk them, whilst ignoring anyone who actually bothers to do research or share information. It’s a great way of getting attention and making the conversation all about you.
Refuting specific points is playing into your attention-seeking antisocial behavior and I honestly don’t see why I should bother. I’m not interested in having a conversation with you. When you lie about a topic I happen to know about (the economics of Greater China, say) I will point out that you’re wrong simply to inform other readers that, despite your confident demeanor, you are completely ignorant of the subject at hand and your posts contain no functional information.
yrs–
–Ben
Uh huh.
Name a lie, Ben. Quote a sentence.
Quote two words in a row. This isn’t a giant opinion-based piece where I can repeat some right-wing puffery as my own; aside from an apparently honest talking-past-each-other with Charles about what makes a system “free market”, there isn’t much opinion in this conversation.
Maybe refuting my lies is a waste of your precious time, Ben, but I haven’t asked you to refute a lie. I’ve asked you to identify one. What falsehoods am I uttering?
I wonder how practical a Hong Kong style system would be in the parts of the US that are so much less dense than Hong Kong? Would it be enormously more expensive to keep clinics in reach and open for rural folks?
Practical worries like that aside, I’d accept a system like what Robert describes as the Hong Kong system, and suspect most liberals would. But it’s really not a “free market” system by the ordinary usage of the term; and I find it nearly impossible to imagine Republicans in Congress supporting such a system.
Out of curiosity, do any of the other conservatives here agree with Robert, in wanting a Hong-King style system?
I think it would work OK; the carless poor tend to be in the cities, because you just can’t live in the country without a vehicle. Some clinics would have to organize transportation services, and there would be a real delta in health care quality depending on your local transit quality. I think it’s workable but it’s a valid concern.
Out of curiosity, what health care system, which actually existed at some point in time in some real country, would you accept as being a bona-fide free market system? With the exception of some Ayn Rand novels, pre-commie Hong Kong was the most capitalist place on Earth. Has health care, in your view, been socialist from Hippocrates on?
Robert: “90% of the bed-days now are in the public clinics. That wasn’t the case in 1964 or 1997”
Allow me to quote from a source you claim to have read:
Referring to the 1964 onward period: “Subject to financial exigencies, this white paper set targets to provide public facilities and services for the estimated 50% of the population who could not afford to visit private practitioners and the 80% who could not afford private hospitals. Unlike the UK, no attempt was made to integrate private sector providers into the public funding or delivery system. The two sectors were to continue to remain rigidly separated.”
Referring to 1990: “With a daily quota system that limited its services to under 20% of all out-patient consultations, the Department of Health’s approach appeared to be catering only for the financially needy. Conversely, the Hospital Authority’s no-turn away policy invited access by all and had resulted in it capturing over 90% of total in-patient admissions. In addition, the government still clung to a system of subsidising the provider, rather than identifying and subsidising eligible patients.”
80-90% of in-patient hospital days, during the entire period you are claiming as the hey-day of the free market in health care in HK. Was that a lie, or merely a mistake you were particularly insistent about clinging to?
I’m pretty sure that is the end of my participation in this discussion.
I think you’re reading a little too much into those numbers, and being a lot too sloppy about taking one summary data point and asserting it as a 30-year constant truth. And, was WHAT a lie or mistake? Me not reading the ‘at the worst point of overuse of the public system, one measure of utilization was at 90%, ergo it was secretly 30 years of socialism’ that apparently you Illuminati can perceive from the source document?
You’re fixating on one statistic – and one with a lot of fairly obvious wait-what-does-this-really-mean flags – and ignoring the massive systemic truths. Highest use of individual dollars. Lowest percentage of insurance. Lowest percentage of public funding. If it’s not right-wing enough for your tastes to be be considered free-market, then name one that was more free-market, and name the criteria by which you make the judgment. Is ‘hospital days paid for by the state, never mind every other category of funding’ going to be your line in the sand?
Oh, and neither of those quotes, by the way, CITE bed-days, although they are related. And your 80% figure is the CONVERSE figure; they aren’t contrasting private vs. public, they’re talking about two separate public services, outpatient clinics which limited themselves to 20% of the total consults, and inpatient hospitals which took all comers.
Robert, in 1997 – a year you say was a good year – 54% of total health care spending in Hong Kong was public spending, according to data in this report.
Admittedly, the proportion of publicly financed health care had been going steadily up for a while – a decade earlier, the majority of spending was private.
But still, there was no point (ETA: In the period you named, as far as I can tell) when public spending wasn’t a huge part of the system. So while I agree with you that Hong Kong had (and still has) a health care system in which the free market plays a big part, it’s simply not a purely free market system.
If anyone here was arguing that there is no such thing as a good health care system that makes significant use of market mechanisms, then I think Hong Kong would be an excellent counterexample.
But I don’t think anyone here has been making that argument. Rather, we have been arguing that the free market alone is incapable of producing a health care system that does what we want a health care system to do (such as provide universal access). I think the Hong Kong system is actually a point in our favor: Even the most free-market-based health care system in the developed world, still relies enormously on the public sector in order to make the system work.
And Robert, I realize that you’ve been saying that a health care system must include large public outlays so that those who can’t afford medical care can get medical care, as a matter (I assume) of moral necessity. So I’m not ignoring that you said that. But to me, that seems to be you agreeing with us that the free market alone cannot produce the health care system we want.
If the wealthy are willing to pay the taxes to have the public hospitals and clinics, and – self-evidently – they were, then why wouldn’t they be willing to do the same as a charitable initiative? I think they would, but that the state provides some convenience, particularly a de-emphasized state like that of Hong Kong which people are inclined to trust a little more.
I do not agree that people on your side of the aisle are saying that market mechanisms will work but they need supplementation. It is regular and inevitable – health care isn’t a product, people have a right to the service, people cannot discriminate based on price, information asymmetry is overwhelming and inescapable, nobody can afford to simply pay the costs of the goods and services that they need, etc. etc.
The hell I can.
For what it’s worth, since Oct. 21 I’ve been having a protracted discussion about the social (vaguely Rawlsian) theory of the social safety net starting here.
There is a very strong case to be made for a Rawlsian subsidy of the bottom, and I don’t think any coherent economic thinker would dispute that case, even though the bottom (and its accompanying superstructure) do tend to disappear from a simplistic conversation about who pays for what.
On the flip side, from personal knowledge of your career, you are definitely in the 1% of the world’s highest-income people (~$33k/year), almost certainly in the top 0.5% (~$37k/year), and possibly in the top 0.1% (~$100k/year). If you think that there is a case for “the rich” to subsidize you in a Rawlsian state higher than that you can earn from your own economic productivity, then you are in the position of saying that your subsidies should come well ahead of those aimed towards poor Americans, and light-years ahead of those aimed at poor people in the Third World.
And while we may disagree on many things, I am pretty sure that you are not anywhere NEAR the level of asshole you would have to be to believe that.
you are definitely in the 1% of the world’s highest-income people (~$33k/year), almost certainly in the top 0.5% (~$37k/year), and possibly in the top 0.1% (~$100k/year).
Robert is wrong about this, as a trivial math demonstrates (the US has 5% of the world’s population and a median income in the neighborhood of 40k.
I don’t blame him terribly for this: he’s quoting inaccurate figures that spread widely both on the left and right (although most virulently on the right, during the anti-Occupy thing). They spread widely because Americans want to believe that we’re super well off compared to the rest of the world. However, despite being on the richer end, we are not.
yrs–
–Ben
I took my figures from http://www.globalrichlist.com, on the impeccably efficient theory that the first Google result for ‘income percentiles world’ was probably going to be decent. They in turn got their data from the World Bank’s 2008 global survey of household income and did currency conversions using the World Health Organization’s 2005 purchasing-parity comparative currency.
I don’t know where your numbers go wrong or why, but US household income median is about $52k, not $40k. I suspect that the quoted site’s methodology is basically sound and I don’t know what your methodology is, so for the moment I’m going to smile and nod at your ‘rebuttal’ and carry right on. But if you would care to present figures and/or methodology, I’ll be happy to read them, and without blaming you terribly to boot.
It matters if you’re talking per-person income or household income. The average household in the US has ~2.5 people in it, so that 52k median is around 20k/person, which must be at most 97.5 percentile as Ben Lehman noted (possibly more if larger incomes are likely to correspond to larger households–I couldn’t find this information anywhere–but then again that doesn’t include any other country, either) . But you’d also need to take that into account when assessing the percentile level of nobody.really’s household.
All of it’s a bit moot to this discussion, as I’m pretty sure nobody.really was making a joke about their name, and not making any statement on their ability to pay for their own health insurance.
(Unless you were referring to something in the linked conversation, which I haven’t had time to read yet; in that case, ignore my last paragraph, sorry!)
Harlequin’s point is correct. Ben doesn’t need a cite because his argument requires only a knowledge of the US population, the global population, basic numeracy. It becomes even more glaring if you realize that the US is not the only rich country with a median income in the 40-50 k range. Once you add in the populations of Western Europe (~300M) and Japan(~100M), even the US median = global 2.5% argument looks iffy. Looked at another way, the global 1% is 70 million people, which obviously doesn’t include the 150 millionth richest American. Really basic math. You might want to trust it over the good old “I’m feeling lucky” button on Google (Rich Santorum certainly hopes you will).
There are also obvious issues with comparing stats in 2005 dollars with stats in 2013 dollars. US median income in 2005 was $42k, so if you want to compare to numbers from 2005, you should probably use the relevant number, not the larger later number.
I haven’t found the World Bank stats directly, but here is a good summary of those results.
Lord, I cannot believe that I missed a nobody self-pun. I picked the wrong week to stop drinking. Points well-taken, all. (Ow!)
Ballgame:
Those people are not at the bottom of the socioeconomic scale. They have jobs and are making money. The people at the bottom of the socioeconomic scale are people living off of government payouts. There is no competition for those.
Robert, Harlequin, etc. – do these studies of median income in the U.S. include in an individual’s income figures any government payments or equivalent that he receives? I have to use my income to buy all the food I eat, all the housing I use and all the healthcare I receive. Someone who is in Section 8 housing and SNAP and Medicaid does not. So those payments are the equivalent of income for them and should be included if we are to calculate a fair estimate of the average income in the U.S.
RonF – Since you brought your own life up as an example, let’s not forget that the large majority of Americans with health insurance, get 37% or more of their insurance paid for by taxpayers, via a tax break. In fact, the average tax subsidy for health insurance is only a bit lower than what an average Medicare beneficiary costs the taxpayers, and higher than the subsidy received by Medicaid or projected for Obamacare. Ted Cruz, a wealthy man who likes to claim that his health care costs the taxpayers nothing, gets a subsidy of over $14,000 a year.
If you rent, then you probably aren’t subsidized for your housing, unless you deduct part of your rental space as home office. But if you own your house, then most likely you benefited from the home mortgage interest tax deduction.
RonF, do you really have no idea how median is calculated, or do you actually think that SNAP, section 8 and medicaid routinely give people household gross incomes substantially above $52k/yr (and, presumably, a Cadillac- or has that been upgraded to a BMW?). You should really try getting your head out of the FOX hall of mirrors more often (or review your basic stats).
For some reason, I decided to google this for you, and wasted an hour compiling the details of exactly how wrong you are, and how stupid your question was. Enjoy.
For a family of 3, the SNAP cutoff is $23k (130% of the poverty line). But SNAP benefits are tapered, so a family of 3 making $22k receives less than $1k in SNAP benefits (unless there deductible expenses are enormous). Even if a family making $23k somehow received the full SNAP benefit (e.g. due to exorbitant rent and dependent care expenses), increasing their income from $23k to $28 k, that is less than $5k/yr and has no effect on the median household income.
Section 8 is available to families making $100k/yr, so it is conceivable that there are a few families who receive section 8 in the D.C exurbs (Loudoun County, VA) and other wealthy communities whose section 8 benefits push them from below the median to above the median, but they are a small enough number (if they exist at all) that they would be unlikely to shift the median value appreciably.
Medicaid is available to a family of 4 with an income under $23k ($29k under the ACA medicaid expansion). Medicaid could reasonably be thought of as a $5k/yr equivalent. So a household with medicaid who also received section 8, living in Westchester County (highest Fair Market Rents) would receive $4k in section 8 vouchers and $5k equivalent in medicaid, raising their income to $32k, which is still less than the median for the US, so it has no effect on the median. Even if they had medical expenses that pushed their adjusted income to 0, they would get $5k in SNAP and $12k in section 8, pushing their total income to $45k, again having no effect on median household income (and remember, this is a rare household that has $23k in non-covered medical care expenses and lives in Westchester County).
A family of 4 with no income could receive $5k in SNAP and $12K in section 8 and $5k equivalent in medicaid, pushing them up near the poverty line (but only because they are living in Westchester and are lucky enough to have gotten into section 8).
I imagine it is comforting, as SNAP benefits are cut, to pretend that those lucky duckies are making more than the median income, but your pretense is wrong. (Oh, silly me, that assumes that the SNAP benefit cuts got mentioned in the FOX hall of mirrors).
I finally finished grading midterms. As usual for this semester, one of my sections did quite significantly worse on this than the other sections. It’s almost as if there’s something other than teacher quality affecting student test scores, or something. (Or the alternative hypothesis, that I’m a significantly worse teacher between 1:30 and 2:30 in the afternoon than at any other time of day.)
Thanks for that link – it was a really interesting discussion.
(Nobody could have done – er, I mean, couldn’t have done – it better.)
First, there’s the prisoner’s dilemma problem. If there are a hundred thousand rich people, and we tax them all $100 to build a hospital, that’s fine. But if we instead ask them all to contribute $100 to the build-a-big-hospital foundation, then they face the problem of throwing their $100 down the toilet if it turns out that only 10% or 20% actually do donate a hundred bucks, so no hospital can be built.
Second, there’s the problem that all people – including rich people – tend to give less to charity when economic times are hard. Which is exactly the time when services for folks without money are most needed. If you make it the government’s problem, then that can be handled, either through making people with money pay taxes even when it’s a bit uncomfortable (oh no! John McCain can’t afford buying a 12th house this year!), or through deficit spending. Charity funding is by its nature unstable.
Among mainstream Democrats, it’s commonplace to want to use a combination of government and market mechanisms. The whole idea of the exchanges is to use a market mechanism to lower prices through competition, for instance.
Go enough left, and you’ll find many people who will say that nothing but single-payer will do (although even single-payer uses some market mechanisms, actually). But looking at the real-world alternatives, it’s clear that many countries have very successful medical systems that use a mix of marketplace and government mechanisms. And many Democrats are not willing to go as far left as I’d prefer, which is why we wound up with Obamacare with no public option.
As for Hong Kong, it’s clear that they are not as free a market as you’re suggesting. For instance, as far as I can tell, the public hospitals are forbidden to offer primary care services (even though if they did, they’d probably save money overall), and doctors (unless they get a special exception) need to choose between providing services to the public market or the private market, rather than accepting both kinds of work. In effect, there are a lot of laws there preventing patients from choosing freely, and protecting the private market from having to compete with the public market.
I’d prefer a system with a comprehensive free or subsidized public market, but the private market is free to compete. If you’re right and the private market can provide better services for a reasonable price, there’s no reason such a system wouldn’t be workable. My guess is that in such a situation the public market would come to dominate, because most people given the choice would genuinely prefer it, but either outcome is okay with me.
* * *
I do think there are good reasons for regulating some drugs, most obviously antibiotics.
* * *
Some time earlier, you asked if anyone thinks that health care in the US has been improving. Count me for “yes.”
Medicare, for instance, was an enormous improvement that vastly reduced poverty among the elderly while increasing access to health care. Medicaid, also, has objectively increased access. Our ability to treat heart problems, and make heart problems less likely to develop, has gone up enormously. In the US, we’ve virtually eliminated measles. And smallpox. And diphtheria. And polio. Etc., etc. Not to mention the significant reductions in how racism and sexism act as barriers between people and medical care.
Maybe you’d like to go back to get the health care available in 1900, but I don’t think many people would join you.
Ruchama,
I don’t remember what subject you teach, but I almost always have a similar experience when I teach two of the same classes in any given semester. Either one is great and the other isn’t; or they both do very badly. I don’t think I have ever had it happen that both do very well.
I teach calculus. Three classes this semester. One doing fabulously, one that’s doing pretty well, and one that somehow ended up with far more than its fair share of students who either started the semester woefully unprepared in the prerequisite material, or who never come to class and never do homework but for some reason come to take every exam. On the last exam, I counted the number of students in each section who scored lower than 60%. It was 3 in one section, 4 in another, and 12 in the third. Each section is roughly 35-40 students.
I’m teaching two sections of technical writing and one class has a significantly higher number of people who are, right now, failing—I don’t remember the exact number—because they either haven’t handed in assignments or did not bother to rewrite assignments on which they received an F.
I allow students one chance to rewrite each major writing assignment. It means a whole lot more grading for me. I have 23 students in each class; each student does seven writing assignments, six of which can be rewritten. Still, the results, when students do rewrite and do bother to pay attention to my comments, are pretty impressive and so it’s worth it—though if they up my course load (English faculty currently teach 4 a semester instead of 5) and continue to increase class size (the max in these classes right now is 28 and that’s how many I started out with), I doubt I will be able to maintain such a generous rewrite policy. (To be fair, the increased course load is doubtful, but the increase in class size—if the pattern of the last few years holds—is not.)
I usually have one class that does somewhat better than the others, and one that does somewhat worse, but I’ve never had a difference quite this big before. The average score for that one section has been about 10 points lower than the others on just about everything.
RonF, do you really have no idea how median is calculated, or do you actually think that SNAP, section 8 and medicaid routinely give people household gross incomes substantially above $52k/yr (and, presumably, a Cadillac- or has that been upgraded to a BMW?).
I’m not RonF, but I’m guessing that he’s a little rusty on his stats, since he says,
do these studies of median income in the U.S. include in an individual’s income figures any government payments or equivalent that he receives? … So those payments are the equivalent of income for them and should be included if we are to calculate a fair estimate of the average income in the U.S.
And women are just tripping all over themselves to get those men at the bottom to father their children, right, RonF?
I don’t think so.
“RonF, do you really have no idea how median is calculated, or do you actually think that SNAP, section 8 and medicaid routinely give people household gross incomes substantially above $52k/yr (and, presumably, a Cadillac- or has that been upgraded to a BMW?).”
The median isn’t liely to be substantially above, but you could hit that ballpark pretty easily.
I did it fast and back-of-the-envelope, but take a family of 4 with minimum-wage dad, SAH mom, two kids. Dad makes $20k a year.
In Colorado, SNAP would be about $5k on top of that.
Section 8, depending on how nice a place they rented, would come to as much as $800/month, so $10k. (It could be less, too.)
The child tax credits (basically the NIT) will kick in a couple grand.
Medicaid spends $8k per beneficiary; now it may be that these folks just aren’t sick and so don’t “collect” as much on the benefit as the average, but that’s potentially $32k.
So as much as $69k without getting any unusual benefit level.
This oughtn’t to be too controversial, although there is some legitimate dispute over how to value the Medicaid piece of it, for example. It’s fairly common knowledge in the social services community that one of the big problems faced by the working poor is that they have insanely high marginal tax rates, because of the threshold nature of many benefit programs. Take a job making another $2 an hour, and suddenly your $400/month SNAP benefit is cut in half – so earning that extra $320 costs you $200 before income tax even gets applied. And so on; there are a lot of traps like that that make it very, very difficult to work one’s way out of relative poverty.
ballgame
I don’t know of any source that would give the average income of the fathers of the children of single women who are on some kind of assistance, but my guess is that a great many of them are such men.
closetpuritan:
Yep, sloppy writing there. I do know quite well the difference between median and mean. But my question is still valid. Government benefits provide things that substitute for cash income. It’s valid to add in their market value when calculating the income of someone receiving them. Was that included in those studies?
Amp: I do own my own home, at least to a certain extent. About 40% of my monthly payment is property taxes, and if I fail to pay those for the rest of my life the government will throw me out. As far as the mortgage interest deduction goes, I’ve benefited to the tune of about $2.5K a year at it’s peak, but it’s a lot lower now and I’m going to lose it entirely in about 3 years.
Ron – when and how to count benefits is a question both vexing and valid. See:
http://economix.blogs.nytimes.com/2012/10/12/assessing-the-value-of-medicaid-to-its-enrollees/?_r=0
Robert,
As usual, you are simply wrong.
You are grossly over-valuing every component of that. A family on section 8 is not going to get that much SNAP (because they won’t get the utility related adjusted income deductions, and even without that, they are getting $3600, not $5k). Section 8 doesn’t pay that much for a family of 4 making $20k in Colorado (in Boulder, a family of 4 gets a 2-bedroom and pays $500/month out of an FMA of $1k, a $6k benefit, not a $10k benefit, in much of Colorado it would be lower), and very few people making $20k in Colorado are on section 8 (the section 8 wait list has been closed for years, opening for a few days every 3-5 year).
Medicaid is worth $10k/yr to the typical family of 4 ($3k/adult, $2k/ kid), not $28k, since most of the expense of medicaid goes to the elderly and people with disabilities. You could claim $5k/person, since that is the actuarial value, but every citizen, including whiners like RonF, gets a portion of that $5k value, since any of us could end up on disability or in long-term care (or just poor) eventually, so it seems inaccurate to assign it all to healthy adults and kids currently on it.
If there is some small number of people who do end up getting benefits greater than the median income (and if you insist on treating medicaid spending as a direct benefit, there are certainly some people who will get $1 million in medicaid spending this year), they are not common enough to have an appreciable effect on the median. You do understand what effect one thousand households moving from below median to $1 million above median has on the median, right? It shifts the median by one thousand households, from $52k to $52,000.85 (approximately).
Sure, a system of more gradually tapered benefits is better than a system with sudden cutoffs. Both section 8 (basically non-existent) and SNAP are designed to taper, although they could be designed to taper more smoothly at the upper limit. EITC tapers very smoothly. Medicaid is obviously the problem program on that account, but the ACA addition of insurance subsidies produces a system that is much less abrupt. So, yay, ACA.
(All this because you missed a nobody.really joke and quoted an old anti-Occupy lie.)
Robert, Wrong in 95, obviously. 97 is not wrong, and agrees with my numbers for medicaid. And before you claim that your way of measuring was consistent with the new CBO method, based on “In that report, the C.B.O. for the first time imputes to Medicaid recipients as ‘income’ the full average cost to the government of providing Medicaid insurance,” read the rest of that sentence and note the last 3 words: “measured by average expenditures per beneficiary, broken down by state and by risk class.”
And RonF, a median is an average (the mean, mode and median are all measures of average), so it wasn’t your poor word choice that was the problem. The problem was that you were simply wrong to think that the benefits provided to people with incomes near or below the poverty line are sufficient to push their incomes above the median. Wrong, wrong, wrong.
Charles – Apparently me saying explicitly that I was back-of-the-enveloping it isn’t good enough to grant a bit of rhetorical looseness to my narrative; you really just gotta throw down. OK, let’s throw down.
I didn’t back-of-the-envelope the SNAP calculations, because they are the easy ones to get an exact figure for. I went to the USDA’s SNAP benefit calculator at http://www.snap-step1.usda.gov/fns/. Oddly, the system worked quickly and had clear instructions, and at the end of the process I hadn’t given a hand job to an insurance executive *even a little bit*, so clearly it can be done. Kudos, Federal government.
Select Colorado, put four people in the family, nobody is a migrant worker or living in a homeless shelter. Add Dad (40), Mom (38), Number One Son (10), and Number Two Son (8), all US citizens, nobody disabled. Dad has $1000 in a checking account, Mom has $1000 in savings, and nobody else has any non-vehicle financial assets like annuities or pensions. Dad earns $20,000 per year, nobody else has paid work.
The family’s contribution to rent is $475 per month. They can claim a SUA of $283 per month in Colorado, or their actual utility payments, whichever is more, EVEN THOUGH Section 8 will be paying for it; Section 8 imposes a labyrinth of rules on *which* utility payments the family is entitled to use for purposes of SNAP, but it does not disallow ordinary expenditures from counting unless the “assistance unit” – the government’s charming term for a person getting help – just goes out of their way to not provide any verification of the actual bills. $283 is considerably more than I had allotted to the McHypotheticals, since as a Republican I believe that the poor should huddle semi-frozen in the dark. Thanks for prompting a deeper investigation; these poor folk needed the boost.
I assign the family no dependent care or child care expenses, since Mom is staying at home and is able-bodied. They could have both Mom and Dad working part-time, in which case there would likely be at least modest childcare expenses, or GrandDad might be geezering it up in their back bedroom, so my flinty Republican heart is saving the taxpayers some hypothetical money.
There isn’t anybody paying child support. Dad actually has 18 children thanks to his irresistible $10/hr glow of honest sweat, but he always told the women that his name was “Charles Seaton” so that some poor schmuck in another city would get all the dunning letters.
Total SNAP benefit in Colorado under these circumstances: $412 to $422 per month. That’s not a huge food budget, but it’s a decent one, and I’m sure they appreciate it, and it’s pretty obviously directly fungible with a cash benefit; you’re not going to spend less than that on food for two adults and two growing pre-teens unless you’re eating berries from the bushes at the park. So taking the midpoint value of $417 per month, we get…$5004/year.
On to Section 8. They don’t call it that anymore officially, apparently, though ‘Section 8’ references choke every website. The hardworking McHypothetical family, in Boulder, are abjectly poor, because they earn much less than 30% of the median local wage. With their $20k income, they are more than $8000 shy of the cutoff to be considered only “really poor”. This gives them the maximum choice of housing authorities; theoretically they could make more than $60,000 and still get Section 8 benefits, but they would be at the bottom of the list. And you are indeed correct that there is a wait list for benefits, and that is relative to the question of “how much income do families *with benefits* really see” how, exactly? Oh right, not in the slightest.
You do not appear to understand how the housing program operates; a family of 4 does not “get” anything. They choose the apartment or house they want to rent (or buy, under some circumstances) and the Feds kick in large percentage of the difference between the maximum fair market rent, and the family’s expected contribution. For the McHypotheticals, their total expense on utilities + rent is 30% of their adjusted income ($19,040 – two $480 deductions for the sprogs), or $475.
They may be considered eligible for a 2-bedroom FMR voucher level, or a 3-bedroom FMR voucher level. From looking online, it appears that the main consideration seems to be the gender of children; children of the same gender can share a bedroom, and the housing authorities will expect them to. If the kids are different genders and past the toddler stage, the housing authority will expect (and allot) a 3-bedroom FMR. For 2013, the FMR for a 2-br in Boulder $1068, and for a 3-br is $1574. To be fair, I’ll average these values, since half of two-child families will be in one situation and half in the other; our inaccurate-but-illustrative FMR is thus $1321.
The McHypotheticals have an expected contribution of $475 towards their rent + utilities. Los Federales pay the landlord directly for the difference; the benefit to the McHypothetical clan is thus $846 per month. (They get to claim the SUA utility deduction even though HUD is actually paying it, from everything I can see online. FMR includes utility estimates.)
Their total Section 8 benefit, which is again largely fungible with cash, is thus $10,152.
Let’s see, so far your critique’s prompting of a more thorough going-over of the data has…increased the amount of social service being received by these families $156 per year. Damned decent of you.
Now, do you have valid points about Medicaid and how it should be allotted? You do, and they are material, and I pretty much came right out and said so, and linked to news stories about them. There is one strong reason to value Medicaid at the contribution level I gave rather than your lower numbers, and that is that we do things the same way for employer-provided health insurance in the income statistics which are at issue. Medicaid isn’t perfect, but neither is Blue Cross, and if they’re dinging you (in the stats) the $4000 a year for Blue’s failure to protect you from Assclench Syndrome, then Medicaid’s contribution ought to be measured the same way.
And that said, I do think you’re right that a fractional-contribution valuation would be more valid and useful. For one thing, it’s the medical care that people actually go and get, rather than what they’re allowed to pre-schedule and pray they get to see someday, that drives their costs.
Even with Medicaid valued at zero – the case for a few residents I am sure – the system is adding $17,000+ to the income of a family man making $20,000.00. I would think a near-doubling of income is something that you could soon engage in a spirited conversation about America. One good viral stomach flu (complete with ER visit) for all of four of them might be the worst four-day weekend idea in the history of children and fun, but would put a few more grand on the tab. You get these families up to $50k then the big difference between them and the median is going to be … what?
And as it happens, the McPhersons are pikers when it comes to this stuff. I limited my scope to the specific programs mentioned; there are of course many others for which a family like the McPhersons qualify. See http://www.benefits.gov/benefits/browse-by-state/state/CO for details (some of which are for the initiatives we’ve been arguing for over here.)
“The problem was that you were simply wrong to think that the benefits provided to people with incomes near or below the poverty line are sufficient to push their incomes above the median.”
If they don’t, then why they hell not? If the deserving poor could make it on their own, obviously they’d be doing that. Not even the flintiest Calvin Coolidge admirer sees the working mom of 4 pulling 55 hour shifts at the Gas N Gulp so that her kids can have a roof and a locking door and thinks “that bitch is living too high for her station”. Not to put a partisan spin on this, since your own clear-eyed quest for truth is so manifestly bipartisan in its manifestation, but the “problem” is that a morally rational welfare system would make lavish provision for the deserving poor and the victims of unavoidable disasters, and would tell the lazy and the shiftless to fuck off and die. We have no indication in our scenario that Dad McHypothetical is working at a $20k job instead of a $200k job he could easily do, so that he can live with the most attractive of his many wives and avoid the million dollars in child support orders following him around town. We also have no indication that his goateed twin from the mirror universe is absolutely stricken with arthritis and bone spurs and painful gastric eruptions, 24/7, and that his working as a Wal-Mart greeter every day involves at least as much routine pain as an NFL player who rides through every exercise room for heavy training every day.
Dad McHypothetical, in that first example, should be left to starve because fuck that guy. Dad McHypothetical-sub-1, however, is a mensch and should have his statue on the damn town square. Our current system makes almost no distinction between the two when it starts handing out benefits. Better tapering would be a good marginal improvement; massively better screening would be a game changer.