Who Knew?

Lot’s of hubbub lately about Obamacare.  The website stuff is embarrassing but predictable and typical anytime ‘American government’ and ‘IT’ get together, but eventually it will get resolved at the ‘just barely functional’ level.

The website failure is only a symptom of a dysfunctional governance structure in which nothing can get done right and on time if it crosses jurisdictional boundaries and requires agencies to coordinate without a Czar in charge of the entire project and actually empowered to order people around.  Hint: The Secretary of the Department of Health and Human Services can’t do this.  That’s the problem.

UPDATE: Quote from the WP, How political fear was pitted against technical needs:

On one side, members of the economic team and Obama health-care adviser Zeke Emanuel lobbied for the president to appoint an outside health reform “czar” with expertise in business, insurance and technology.

Nearly a century after Nicholas II, the ‘czar’ is already our knee-jerk, go-to concept for what we have to do to actually makes things work in our government. /End UPDATE

So when things do get built that ‘work’, people are so traumatized by the experience that they refuse to revisit the issue for an entire generation.  At least.

People complain that Obama’s principal staff has embarrassingly little private sector experience.  I worry that they have even less understanding of how things actually work in the public sector because they’ve never been at the ground floor level of anything.  Have they actually ever typed anything into a major government computer system?  The better ones have just recently caught up to 1998.

For example, soldiers, who could be ordered to submit their information to any new digital system no matter how awful and insecure, are still required to personally carry paper medical and dental records around from base to base when they change stations, because the military, with all its authority over them, and exemptions from civilian requirements, still can’t make an automated medical system that actually works.  And even though there is an entire industry dedicated to providing it.  The Brits could tell a similarly sad and expensive tale.

For example, the CHCS system is – I kid you not – still running in a DOS program.  You can try and learn it yourself, just login as a ‘new user’ with any made-up email address:

Look; I’ve seen things man!  Monsters normal people born after 1980 just can’t understand because, outside government, they went extinct and disappeared a generation ago!  In the 21st century, I’ve seen grown men switching out big reels of magnetic tape and storing information on cassette tapes.

I’ve seen giant, laser-disc-like hard drive plates that fit in a stack in something that looks like a washing machine but holds slightly more data than an old floppy disk. I’ve seen billion dollar weapon-launching platforms just recently upgraded to Windows NT.  There are space-control systems running on PDP-8’s or some original-generation but immortal Unix box surrounded by lead-acid-batteries, forgotten in a locked closet with a painted-over door and a random custodian who wonders where that fan noise is coming from and why a few random cables seem to be going directly into the wall.  That abandoned, lonely box permanently buried alive behind the drywall, remains prepared to play its microscopic role is unleashing annihilation and is what keeps you safe at night.

Machines that never die and can’t be killed!  Systems that can’t be hacked only because no one knows how their proprietary protocols work anymore; they outlasted all the paper manuals which were never digitized or translated into Mandarin and which disintegrated long ago.  I’m not too proud to admit I pissed my pants in fear and awe when they showed me the shoe boxes full of punch cards and the machine that read them, or that 300 baud MODEM that fits onto a handset!   Things so dripping with toxic heavy metals you can’t even scrap them or move them out of an office; so there they will sit until the end of time.

Whoa, take a breath; these flashbacks to the distant past of the Obama administration are crazy intense.  You can imagine how this all looks to a new recruit, born with a cell phone in his hand, and who has no memories prior to the end of the original internet bubble.

Despite all this, they’ll fix the damn website somehow.  What won’t get resolved, however, are the millions of people experiencing ‘rate-shock’ and ‘plan-churn’ (i.e. cancellation).

Conservatives warned that the very structure of the plan would inevitably produce this result, not as a side-effect, but on purpose and by design because it was essential to the redistributionist scheme.  After all, Obamacare is universal and mandatory and accomplishes most of its subsidy distribution obscurely by implementing price controls on premiums through the insurance companies.  Nothing else but what we see today was even possible, and anyone who claimed otherwise was lying.

In order to counter that accurate narrative, the President accused the Republicans of mendacious fear-mongering and lied when he promised, “If you like your health care plan, you can keep your health care plan.”  The suckers bought it.  They wanted to believe it was true.  Duh, it wasn’t.  Sorry Abe, turns out you can lie to all the people all the time.

Greg Mankiw is more cautious about publicly concluding that Obama is a ‘liar’ and holds out the possibility of staff negligence and so asks, “Who Knew What When?

The answer – as with any legal-ish issue in our modern, overcomplicated, over-lawyered, and inaccessible society – is that practically the only people who can actually know anything about anything are those who are paid to know it.  Professionals well-studied in the field, specialists, experts, etc.

One of the downsides of our hyper-specialized, niches-in-niches, subcultures-of-subcultures, lower-and-lower-dungeons of usenet reddit, all-effort-on-the-frontiers-of-diminishing-returns economy is that it’s difficult for an ordinary man to even grasp the basic outline of the overall terrain.

Forget the renaissance man; he’s walled-in by default.  You have to be a kind of amateur connoisseur of anything these days to even know the names of the real connoisseurs. All you can do is ride the waves of others and rely on the weird subculture enthusiasms of the SWPL’s to bring some obscure 1% improvement at a 1000% increased cost to your local Whole Foods.

For instance, perhaps you think you know salt.  Not the chemical term, just the stuff you add to food.  What could be simpler than salt?!  Well, you don’t.  How can you!?  There’s a whole world out there.  Mark Bitterman wrote an entire salty tome and even blogs the salt news.  How do you like this line?:

Each quality described above have about 10 nuances each that are important, but which would take pages more, and perhaps a few Martinis, to do full justice.

Important nuances of gradations of subtleties wrapped in trace distinctions?  About salt? Important!?  I guess I’ll have to take your word for it, Mark.  I’m just going to tolerate injustice in this instance.  But seriously folks, this is exactly how your government works.  Or ‘works’. Like that website.

But apply this to the health care market.   Ordinary people, as usual, can’t have known anything about what their government was doing.  But the category of people ‘who knew’ certainly includes the large army of executives, finance specialists, analysts, and actuaries in the ‘private’ health care industry who definitely were crunching the numbers in the earliest stages of debate and undoubtedly knew the score as well as anyone could years prior to implementation.  That’s outside the legion of similarly specialist government workers, but it makes sense that the civil servants would be easy to silence.  Explaining silence in the private sector is another matter.

In other words, there were, at least, tens of thousands of people to whom none of this was (indeed, could not have been) any surprise whatsoever and who were under no governmental obligation to shut up about it.  So, why in our society, with its so-called ‘freedom of speech’, did none of them speak up?

It’d be nice if any of them had spoken at the time of debate when Obama lied, of course, but getting publicly involved in active political debates discomforts many people.  We can cut them a little slack.  But you’d think the coast would have become a little clearer after the bill was signed and became law.

But no.  Maybe they’re a little concerned on getting on the wrong side of the administration and how that might impact their certification to do business with the entity paying all the bills?  Like so?

And what of all the journalists who are supposed to educate the people in a democracy about the working of their government?  Ha ha … ah.  A big joke.

As Ross Douthat notices, many of the folks getting hit with these unpleasant non-surprise surprises are exactly the same people who were doing exactly the kinds of things that all smart policy people have insisted that they would want them to do in a genuine marketplace; economizing, prioritizing, avoiding unnecessary expenditure, shopping around, choosing amongst competitive options for solutions best tailored to their individual preferences and circumstances, etc.

But actually the policy people were just paying lip service to those quaint capitalist notions.  Everybody knows people are too dumb to know what’s best for them and not get scammed.  I mean, look at the Tea Party!

Understanding Obamacare is important because it tells us a lot about the nature of the people who wrote it.  So, we ask, what is Obamacare?  For that answer one must understand what the Progressives who wrote it really wanted it to do.  Where does it come from in an ideological sense?  What do Progressives really want?  We know they don’t want Socialism; only stupid, paranoid, and delusional Tea Party crazies believe that nonsense; as Sunstein explained to us.  So what do they want?

A bridging strategy.  They want a way to transition from the absurd and awful American Health Care system SNAFU, where most health care benefits are paid for by employers (because of the legacy of WWII labor price-controls) or an insane crazy-quilt of government agencies to a single National-American-Socialized-Institution Health Service for everyone.

In the (near?) future, everyone will pay for the NASI-HS in their (progressive!) taxes, and everyone will receive equal service, whatever their income or ailments.

From each according to ability (to pay), to each according to needs (for medical treatment).

Jeder nach seinen Fähigkeiten, jedem nach seinen Bedürfnissen! – Karl Marx, 1875

Or Louis Blanc, 1839.

Or Morelly, 1755.

Or maybe even the Apostles, 50(?)

Well, I’m bound to get a lot of comments on that last one.  But what about our favorite group in American History, the Puritans?

Well you may have heard from such crazy, evil, idiot propagandists as Glenn Beck and Rush Limbaugh that they originally lived according to a collectivist Socialist scheme so egalitarian even some youths were equal in status with adults, but which was failing and was abandoned in favor of restoring private property and ensuring everyone belonged to patriarchal households.

The New York Times and Professor Budiansky are here to help and tell you it was, in fact, not a Socialist communal agricultural operation, like a Soviet or Chinese collective farm, or Israeli Kibbutz, or Shaker Communalism.  [You may notice that all this stuff gets tried repeatedly in History and except for cults with high turnover, or the Amish, is always effectively privatized in due time].  No, instead, it was all about private corporate profit, and it was all working well enough except for some griping and complaining over nothing, and also all the lazy aristocrats who couldn’t be bothered even to save their own lives by working the land.  Nothing ideological to see here, please move on.

But let’s engage in a bit of Slow History and read Governor Bradford’s commentary on the Socialist scheme from the 1620’s in his History of Plymouth Plantation: [some clarifying punctuation, paragraphination, and emphasis supplied.  Sometimes I used modern spelling.]

All this whille no supply was heard of; neither knew they when they might expecte any. So they begane to thinke how they might raise as much corne as they could and obtaine a better crope then they had done that they might not still thus languish in miserie.

At length, after much debate of things, the Govr with the advice of the chiefest amongst them, gave way that they should set corne every man for his owne perticuler, and in that regard trust to themselves in all other [activities that were collectivized] before.

And so assigned to every family a parcell of land according to the proportion of their number for that end only for present use but made no devission for inheritance and ranged all boys & youth under some familie.

This had very good success for it made all hands very industrious so as much more corne was planted then other ways would have been by any means ye Govr or any other could use, and [thus] saved him a great deall of trouble and gave farr better contente.

The women now wente willingly into ye feild and tooke their litle ones with them to set corne which before would aledge weakness and inabilitie whom to have compelled would have been thought great tiranie and oppression.

The experience that was had in this common course and condition, [‘collectivization’] tried sundrie years, and that amongst godly and sober men, may well evince the vanitie of that conceite of Platos & other ancients applauded by some of later times [the applause never stops] that ye taking away of propertie and bringing in comunitie into a comone wealth would make them happy and florishing as if they were wiser then God.

For this comunitie so farr as it was was found to breed much confusion & discontent and retard much imploy met that would have been to their benefite and comforte

For ye young men that were most able and fitte for labour & service did repine that they should spend their time & strength to worke for other mens wives and children with out any recompence[You mean like this guy in the LA Times?]

The strong, or man of parts, had no more in division of victuals & clothes, then he that was weak and not able to doe a quarter the other could, [and] this was thought injustice.

The aged and graver men to be ranked and equalised in labours and victuals, clothes, etc. with ye meaner & younger sort,thought it some indignity & disrespect unto them.

And for men’s wives to be commanded to do service for other men – as dressing their meat, washing their clothes, etc. – they deemed it a kind of slavery.  Neither could many husbands well brooke it.

Upon this point, all being to have alike, and all to do alike, they thought them selves in ye like condition and one as good as another, and so if it did not cut of those relations that God hath set amongest men, yet it did at least much diminish and take of ye mutuall respects that should be preserved amongst them.

And would have been worse if they had been men of another condition. [he means ‘by less righteous men’] Let none object [that] this is [all due to these] men’s corruption and not [caused by the] the course itself.  I answer, saying [that] all men have this corruption in them.  God in his wisdom saw another course fitter for them.

Thank you Governor.  I’m sure the whole world closely studied your text, took your words to heart, learned the lesson of the Puritans, and avoided many predictable tragedies over the next four centuries.  Oh, wait, no they didn’t.

Fail at a utopian scheme once with some less-than-fatal consequences?  Shame at naive optimism. I mean, “Who Knew?”

Fail, over and over, for over a dozen generations, with plenty of available literature on the subject, with dozens of millions of pointless deaths, and shame on … who? Shame on what?

What was the driving impulse here?  Why did the Puritans set up the system the way they did and not in some more traditional manner?  And why do we never learn; why does it never go away?

The answer to the last question is that every generation thinks ‘this time is different’ and that, with various new capabilities unavailable to their predecessors – new knowledge, management techniques, communication, transportation, technology, unprecedented levels of wealth resulting from high-productivity, etc. – they can do it better and, finally, actually make it work.

I’ve mentioned repeatedly elsewhere that the beginning of the 20th century was one of such radical and rapid technological change, and generated such intense excitement, awe, and optimism that the progressives of the time can, perhaps, be forgiven for believing that we had ‘gone hyperbolic’ and irreversibly broken away from the past, and, soon, anything and everything would be possible, materially and politically, so why not try?

Add to that an endless list of excuses.  They were dealing with Old Men, and the stubborn, lingering corruptions of the obsolete past, but we will wipe all that clean, and make New Men, and start fresh!  But, unlike the endless multiplication of new excuses, the new men never come.

It’s kind of like the flu.  It comes around periodically, it’s always bad, some instances are much worse than others, and we never seem to achieve immunity.  We know it’s coming, but we can’t stop it.

It’s also like really wanting to invade Russia.  Lots of people before you have really wanted to invade Russia.  They tried, but failed, usually catastrophically.  But even though you know it’s been an utter disaster in the past, hey, now you’ve got the Luftwaffe!  Substitute ‘Afghanistan’ and ‘Counterinsurgency Doctrine’ accordingly.  And maybe China too will make both of these mistakes later this century.

The mistakes keep repeating because the seductive dream that numbs our senses never dies.  In the invasion case, the dream is the logic of geopolitics as an extension of the fundamental human drives for winning power, status, and resources and defeating competitor rivals.

And in the Communism case, it’s the fundamental appeal of the idea of equality, and even human uniformity.  The appeal is not of just of equality under the law, or equality as an ideal, but of the notion of creating and building the utopian equal society via the mechanism of law and coercive governance.  It’s an actionable ideology and by joining the cause you actually get to see things done and feel like you’re part of it and doing something too.

Let’s get back to the Progressives like Cass Sunstein.  They all insist that they are neither Communists nor even Socialists, and it’s silly and paranoid to suspect they are.  They say it’s ridiculous for Tea Partiers to think that progressives are going to use gimmedat-democracy and changing demographics to establish New-Deal-Era-style one-party rule and gradually collectivize the country into the ground.  Should we trust them?

In order to trust them on this matter, you have to understand the motivation force of their dream.  They don’t like gulags or border walls, ok, but every time you look, Progressives are going on and on and on about inequality, especially of the racial and gender and income types, but really about anything at all.  They’re obsessed with it.  It’s the single lane in their one-track mind.  And they never met a collectivist scheme or redistributionist program they didn’t like.  If they fail in the past, they just wait because, in due time, they’ll take that second bite at the apple.  Or the third or fourth or whatever it takes.

In other words, when Tea Partiers accuse Progressives of being crypto-communists, they are simply saying that they, very reasonably, do not trust other human beings not to pursue their longstanding dreams when they have the chance and power to do so.

If absolutist egalitarianism social justice is not the Progressive dream, what is?  What limiting principles, moderating tendencies, or institutional commitments do we observe that can be trusted to contain their urge to ratchet the society ever further in that direction?  The Constitution?  Please.

America Is A Communist Country because it has been pursuing this dream, and spreading it by the sword, since it was born.  For every two steps forward it takes a reckless action and tries for a bridge too far, stumbles, gathers its senses for a brief moment, and then reacts and takes a step back away from the cliff.  The Pilgrims restore private property; Reconstruction ends, the country returns to normalcy; It’s morning in America.

But some collectivist innovations become permanently part of each new foundation, and the space for restorative corrections shrinks and shrinks.  When Obamacare fails, as it was designed to do (it’s large purpose is mostly to break the link between employment and insurance), it will no longer be possible to establish a genuinely private-sector healthcare system in America. It’s a ratchet and it’s never going back.

If the Tea-Party-exorcised Republican party still exists by that time, their entire freedom of maneuver will be restricted to the role on the ‘Conservatives’ in Britain: being the stingy face that tries to keep the NASI system afloat, while the Democrats pillory them with insults, find a little girl dying of the world’s most expensive – so untreated – disease, and promise voters that they’ll be more generous with rich people’s money.  And after losing ten elections in a row, some Republican strategist who thought using the word ‘Socialist’ was beyond-the-pale will look back, shrug his shoulders, and ask, “Who Knew?”

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25 Responses to Who Knew?

  1. James says:

    Britain lacks the American right-libertarian tradition, but the mainstream is not communist. Health care and education are regarded as a sacred right by everyone I know.* The role of a central state or political movement, or logistics at all, in supplying health care and education for free is little thought about. In other areas of life, profit discipline is also taken for granted. There is no trace of a proletarian, macho communist youth movement on the streets, although middle class kids can do a decadent impression of socialism when they want to make a scene. You do get posters about ‘socialist revolution’ at university, but it would be gauche not to take all that with a grain of salt.

    Capitalism can serve progressive ends, to the extent that it rationalises sacred norms. This leads to the dark irony of a BBC documentary maker chastising Hutterites for their archaic ‘communism’. Despite sarcasm, I think that you are right: progressives have adapted so that they are in synchrony with a version of capitalism. Their goal of a European-style welfare state, with markets sandboxed and administered by experts, would not lead to catastrophe.

    *Some people are indisposed to use private health care that they can afford. The younger generations are less socialist in that respect.

    • Dan says:

      Isn’t the European welfare state leading to catastrophe presently? Out of control debt, family collapse and demographic collapse, financial woes and decline that is obvious to most people? And remember, these are Europeans, with higher levels of average human capital, then diverse Americans. What has led to catastrophe for them would surely lead to a double catastrophe for us…

      • asdf says:

        The fact that Europeans health care systems are half as expensive then the American or even cheaper shows healthcare isn’t the problem in Europe. Europe’s problems come from unrelated sources, their health system in a strength compared to ours.

        The standard alt-right response to healthcare is that sick people should just drop dead. They talk a lot about how insurance isn’t insurance without any understanding without any idea of how health insurance has never been the same as something like auto insurance. Auto insurance happens on a “incident basis”. So if the accident happens while you have insurance all related costs are covered no matter when they are incurred. However, health insurance isn’t incident based. Let’s say you buy a one year health policy and get cancer. For that year, treatments will be covered. However, cancer is an ongoing condition, so after that year is up there is no way that the insurance company is going to renew that policy (unless they are forced to by the government) so even if you paid for “insurance” you are still fucked. No insurance company will offer a health policy that goes for longer then a fairly short amount of time. The costs can’t be predicted well and they get selected against. The one attempt to do a very limited version of this, LTC insurance, was a complete disaster for the industry.

        So health insurance doesn’t really exist, because if you get sick with any kind of ongoing condition it won’t cover that unless the government forces them too. Which is another way of saying that even people that don’t have pre-existing conditions right now could have pre-existing conditions tomorrow, and they don’t want that group of people to be totally fucked because anyone could end up in the same place themselves one day. So the interest group becomes no only the already sick but anyone worried about becoming sick.

        The alt-right will then go and say that mutual aid societies or charity will fill the void because it did back in the age before expensive medical treatments were available, which is an apples to oranges comparison. When my Dad and I were really sick it wasn’t private charity that came to aid us. And the mutual aid society my Dad belonged to could only provide limited support (not even close to making a real difference). It was only the fact that a government law forced his insurance company to sell him insurance (despite his pre-existing conditions) and keep him covered when he was sick a long time that kept him alive. Ditto for me, I had pre-existing conditions in the womb.

        I understand there is a certain class of healthy well off people who won the genetic lottery and don’t like the idea of losing a little discretionary income to fund an insurance scheme that isn’t a great actuarial expected value deal for them even though it removes a lot of uninsurable tail risk for them in exchange and has positive external affects for society. I just don’t really give a damn about their (selfish and petty) concerns.

        • Handle says:

          I tend to agree with Derb on the issue. Some form of socialized health care provided through the government is inevitable for some people in a modern society. I also think that such socialization is humane and justifiable within reasonable limits. Though I consider myself a reactionary, I do not hold what you claim to be the ‘alt-right’ positions of ‘charity will fix it all’ or ‘let them die in the streets’ or ‘luck or tough luck!’

          I also agree that if we had the per-capita expenditure rates of other developed countries we wouldn’t need anything but a tiny bit of socialization, and that this would almost disappear as an issue. Fun fact: if we cut all federal health-care related expenditures in half, the budget for 2013 would be balanced.

          The problem is that whole ‘within reasonable limits’ bit. With modern and expensive technologies it is possible to allocate marginal, wasteful, or even ruinous, amounts of resources to health care. To keep that under control, someone, somewhere, has to draw some line about what does and does not get paid for. It’s very hard, but there are rational ways to go about that in as fair and humane way as possible. Do you think our system can do it? I don’t see it. It can’t be done in the private sector because an HMO will get sued for liability and juries will always side with the sick kid, whatever the contract says. And I’m skeptical it can be done in our government.

          As an example, we spend far more on end-of-life care for very elderly people than is possibly justifiable in terms of benefit. It is certainly not ‘equal marginal rates of transformation efficient allocation’ of our health care dollars. With socialization, someone has to say no and be immune to political pressure from these people. Good luck. Also as McArdle points out, it is usually better in our system when people don’t get everything they want because they are denied by affordability and impersonal market forces rather than personal decision-makers who can be lobbied.

          There is also the matter of paying for ‘coverage’ you won’t use, or that other people will use, but which violates the dictates of one’s conscience. It’s one thing to take care of unlucky people with congenital conditions. It’s another to cover abortions and birth control. But you play the Cathedral’s game, you’ll play by their rules.

          Also there is the issue of incentives. It’s difficult to get people to take care of themselves and avoid risky activity if the consequences of those actions mostly manifest themselves in publicly provided health-care expenditures. It is also difficult to prevent people from over-consuming health care for trivialities when they don’t have much skin in the game. As an example – my own mother. A $20 copay isn’t going to stop her from getting an unnecessary multi-thousand dollar colonoscopy ‘just for peace of mind’.

          Finally, back to risky activity. Another problem with socialized health care cost is that it gives people a feeling of justification to get into everyone else’s business (as if we need more of that these days). Whether you smoke, or are fat, or have unprotected sex, or eat too much salt, or like to ride dirt bikes or ski or do other sports that tend to break a lot of bones – all of these things now result in costs borne by the public, and thus the public feels perfectly justified in passing laws to regulate or ban those activities. It’s the classic private gain, public cost problem. There is also a ‘risk compensation’ behavioral problem.

          We can try to be actuarial about these kinds of risky activities but that is both difficult and invasive and incentivizes people to lie. Under Obamacare, we aren’t charging people on an actuarial basis for hardly any of these voluntary risks. A welter of a million externality, excise, and sin taxes to compensate the health care system is also not an attractive option.

          So, again, like Derb, I break the market up into different segments. There are people born unlucky, or experience misfortunes for which they do not bear much of the blame, or who are impoverished, and it is perfectly justifiably for the government to help these people obtain health-care by extending a moderate amount of financial assistance. There are old people who we can help, but to whom we shouldn’t be expected to make extraordinary allocations towards. There are children who should be cared for by their parents to the extent of their financial ability, but that can be supplemented in appropriate circumstances, and, again, to a reasonable degree.

          There are plenty of ways right or conservative or traditionalist people can reasonable debate appropriate and feasibly strategies to make systems like this work. We don’t have that, and we won’t get it. The progressives aren’t interested in any of that. We’ll get the NASI-HS. Because equality.

          • asdf says:

            First dimension: Ordinary healthy people who get sick or suffer injury once in a while but can be restored to normal health.

            Second dimension: Ordinary healthy people who become chronic invalids through sickness or accident.

            Third dimension: People who are born with conditions that leave them chronic invalids.

            Fourth dimension: Helpless old people.

            I think what gets me about people is that they don’t understand that insurance for #2 doesn’t really exist. Quoting Derb: “The obvious solution here is catastrophic health insurance.”

            Derb thinks this because that is how “incident” based insurance works (like your car or home owners)*. However, health insurance isn’t incident based. In a case like #1 its effectively incident based, because the illness/injury is treated within the timeframe of the policy has no lasting effects. Catastrophic coverage works great for that. Private insurance can’t provide for #2 though. That’s what really scares people. If the only people pushing for socialized healthcare were #3 then it wouldn’t work. However, everyone is afraid of ending up in #2, so even relatively healthy people end up in the same political camp as #3 people. #1 is insurable, but #2 represents an uninsurable risk. That’s what they want socialized.

            If people on the right could just get that, that there is no insurance for #2 without the government and that is why people will always support some kind of government involvement, they might be able to move forward. Nobody in a democracy is going to take the statistically significant chance of getting cancer being a death sentence in exchange for slightly lower taxes.

            I agree on #4 and old people. The mortality rate of getting old is 100%.

            I don’t really think anyone is smoking or getting fat because they think health insurance will make the debilitating illness less financially devastating. From what I know such a hypothesis hasn’t withstood testing.

            I don’t think its impossible for the government to control cost better then the individual when it comes to healthcare, especially catastrophic necessary kind where the individual is in distress. I’m not the same rational consumer I am in the ambulance as I am picking between items in the grocery store. I could give some personal examples that are mirrored in the experience of many others. Many countries, even large democracies, are doing just fine at this. Whether America specifically can I don’t know.

            *Side note: Incidence insurance is way way easier to price and reserve for, its also less risky to the insurer. However, health insurance can’t be sold on an incidence basis because its too hard to define.

          • Handle says:

            ‘I don’t really think anyone is smoking or getting fat because they think health insurance will make the debilitating illness less financially devastating. From what I know such a hypothesis hasn’t withstood testing.’

            Of course they’re not. This logic is backwards. People do activities they want to do when the short-term impulse overcomes the short-term price and perception of risk or the negative long-term effects. But those risks and long-term effects exist. There are several ways to make people appreciate those risks and costs at the moment of decision. One is a hefty excise tax – like we place on tobacco or alcohol or gambling. All else being equal, higher prices reduce demand and consumption.

            The other way is to inform people that they will be held personally responsible for catastrophic results. You could do this through telling people they will be compelled to pay, through perpetual garnishment, lifelong nondischargable medical debts relayed to reckless behavior, and in a way that cuts you off from all other credit and consumption opportunities for life. Like alimony, or student loans.

            So, when you see that youtube video of some 20 year-old ‘invincible’ thinking it would be fun to be in the X-games and do a few loop-de-loops on the ski slopes and wiping out, generating $300K of bills that is paid for in total, no-questions-asked, by his parents ‘plan’ (i.e. by the other, more precautions, premium payers), you recognize you have a pretty awful incentive and subsidy problem. If you tell that guy, “Yeah, when you get fixed up, that $300K will follow you around forever like a permanent mortgage”, and then actually show him plenty of ‘faces of meth’ examples of people living that life, maybe he’ll think twice.

            In the alternative, as with legal-liability circumstances when businesses or individuals might be judgment-proof after you hit them with a big bill, you can compel these people, or the businesses which cater to them, to post bond (or be ‘insured’ in some equivalent way).

            That would make your ski fees triple or more (like the price of cigarettes or alcohol), but it would avoid the problem.

            Again, the point is that the socialization we are going to get in actual real-life America will cut off all this, and a hundred other attempts at reasonableness, justice, fairness, etc. and just impose an everything for everybody no-matter-what-they-do and at whatever cost it takes to win elections.

          • asdf says:

            I understand your desire to make people pay for their actions from a fairness perspective. However, I don’t think that some risk of financial feedback being thrown on top of catastrophic physical feedback in the far future is going to affect the actions of most people today.

            If the effects of drugs, fatty food, or physical injury aren’t enough to deter you is the addition of a financial penalty in the future going to change that. Looking and feeling like shit stops people from getting fat. Seeing faces of meth stops them from doing drugs. Fear of physical injury keeps people from buying motorcycles. If people have already overcome these much more immediate, tangible, and scary items I doubt throwing a financial penalty in the far future on top is going to change much.

          • Handle says:

            Yes, I agree with you. People make bad choices because they don’t appropriately perceive the long term costs at the point of decision, and/or they perceive that the cost will be borne by others and not personally.

            That’s why it is a rational and fair government policy, when the price is significant, and the behavior common and predictable, to have the long-term price be both 1. personalized to the extent there was personal responsibility and 2. accelerated to the point of decision.

            Devices like excise taxes (on calories, or nicotine, or alcohol, or sports) or posting bonds help to put that cost up front in the initial price and in a way borne by the individual that will affect his decision-making.

            A young man may not care much about some small risk of some broken bones and huge expenses when he’s hitting the slopes. But if the slope rate goes up to $150 or the dirt bike tax is $9,000 (to capture the otherwise socialized risk) he’ll either abandon the attempt altogether or end up paying paying a kind of premium in his price that isolated the participants in risky activities in a risk pool and away from the society at large.

            One problem is that taxes and fees and premiums always incentivize tax-avoidance activity. So, moonshiners try to run from the revenuers. Cigarettes will be smuggled into the UK or NYC. And people will trespass on some dangerous hillside to avoid the slope fees.

            The easiest way to end the war against these kinds of issues (and which may even be the economically efficient answer if it’s too burdensome to administer various elaborate personal-responsibility systems) is to surrender and establish a no-questions-asked NASI-HS that is paid for by general taxes.

          • Candide III says:

            Not only that, attempts to set premiums/tax rates/fees to a risk-appropriate level suffer from the socialist calculation problem except in the simplest instances (trauma while skiing), and in many instances also from ambiguity where the causal relationship is difficult to establish in individual cases (smoking and lung cancer, radiation and cancer). There may be ways to work around these problems without involving government agencies crunching statistics, but it is certainly not easy and may require unorthodox legal measures. For example, one might make ski slope operators liable for medical costs covering traumas on their premises. This seems to set up nice incentives. One might even consider extending the liability to cover persons on the premises illegally; this creates an incentive to prevent moonskiing. To take a different example, it is impossible to prove that a given case of lung cancer was caused by patient’s smoking, but supposing for the sake of the argument that 90% of lung cancer cases are caused by smoking, it may make sense to make a board of tobacco companies liable for all medical costs and (possibly) reimburse it for 10% of expenses incurred. On the other hand if the correlation is not close to 100%, or if cases appear only infrequently (nuclear accidents) such a scheme is unlikely to work well. Things like heart disease, which have a myriad of causes of unknown weights, are even more difficult to handle.

            The reactionary method of dealing with problems of this kind is, I believe, to apply the principle of collective responsibility combined with effective authority. E.g. if memory serves, in Roman law, the paterfamilias is liable for damages arising from his wards’ (wife, children, slaves) actions, but in exchange he has powers to regulate their behavior.

  2. James says:

    I would like to know what Sunstein and USG’s intentions are towards that right-libertarian constituency. Immigration is one curative. Do you have insider knowledge or a guess about how unhelpful attitudes towards the constitution, socialism etc. could be modified?

  3. VXXC says:

    Excellent Post.

    You’re the first person I’ve read who noticed that Individual private insurance was destroyed over the last 30 days. Which of course happens to be the Tea Party Insurance. Who knew?

    Good to bring up the point of Obamacare is to break the link between employment and insurance.
    That the Tea Party now has no Health Insurance and the Medicaid rolls have exploded – bankrupting the State budgets – is of course a bonus. Both Tea and State now come as supplicants…

    I don’t agree that we must endure New England eternally.

    • asdf says:

      I thought Tea Party Insurance was, “get your hands of my Medicare.”

      • VXXC says:

        Tea Party = small business, independent businessman. Individual Health Insured market. Until last month. They’re also white flighters. That’s the real race angle. The quote you are referring to was from 20 years ago. The voter was not known, except that it was a crone. Since the goal is maximum dependency and the racial angle is to ruin the white flighters at last, destroying the Tea party’s independence is a Trifecta Delish.

        • asdf says:

          The Tea Party is small independent businessmen in your mind. An on the ground demographic account of the Tea Party would reveal far more get the government out of my Medicaid signs then small business owners.

      • VXXC says:

        I must relate that the common white has a common enemy, and that reaction shares this common enmity of the common white. The enemy of your enemy is your friend.

        Neo-Reaction will return to the Cathedral. With new pertinence pursue the hated ones with greater zeal than the Cathedral has mustered since Hitler was the enemy.

        Neo-Reaction cannot find it’s footing because they wish to remain employed and protected by the Cathedral, their interests are with the Cathedral. They will return home, the prodigal sons invigorated by their sojurn amongst the real, the common. They shall become the chief witchunters of those they briefly called friend.

        Watch.

  4. Max says:

    Lot’s?

  5. Candide III says:

    > Governor Bradford
    The original colony articles on p.45-46 are also instructive:

    5. That at the end of the 7 years, the capital and profits, viz. the houses, lands, goods and chattels, be divided equally between the adventurers, and planters; which done, every man shall be free of them from any debt or detriment concerning this adventure.
    10. That all such persons as are of this colony, are to have their meat, drink, apparel, and all provisions out of the common stock and goods of the said colony.

    The editor adds a comment by a Judge Davis on p.135 to the effect that “the community of interest which the colonists had hitherto maintained did not arise, as has been sometimes supposed, from any peculiar fantastic notions, but was required by the nature of their engagements with the merchant adventurers in England”, which may be even true, although the idea was hardly repugnant to the colonists, seeing as they have freely agreed upon the articles; but this does not matter for us here. The articles set out a communist scheme, plain as plain. If it had failed so spectacularly for the Puritans, it is unlikely to work for men ‘in other condition’.
    > now you’ve got the Luftwaffe
    No, it was more a case of invade Russia and face probable failure or wait for comrade Stalin to drive an icepick up your arse.

  6. Candide III says:

    I’ll link to a somewhat inside description of the development of the Obamacare website just for the record. Only during the weekend after HealthCare.gov’s Oct. 1 opening did the president’s aides begin to grasp the gravity of the problems? Showing off simplified demonstration applications three weeks before launch? The whole thing reeks of the Soviet Union.

  7. totalesturns says:

    Important nuances of gradations of subtleties wrapped in trace distinctions? About salt? Important!? I guess I’ll have to take your word for it, Mark. I’m just going to tolerate injustice in this instance. But seriously folks, this is exactly how your government works.

    This, a thousand times this. If something is relatively simple, rest assured that the tenured great and good are busy discovering new ways to complicate it.

    My own Navrozov moment came when I encountered a situation like this, involving the application of modern IT to a traditional government function. As a fresh-faced twentysomething with some tech experience entering a “policy”-oriented graduate program, it struck me as a challenging but tractable project, solvable by some roll-up-your-sleeves-and-get-it-done engineering work.

    But it turns out that an international fiefdom of retirement-aged department chairs, most of whom wouldn’t know a line of code from a line of blow, have issued the definitive work on this problem in a series of impenetrable thousand-page white papers that give it a “theoretical” grounding based (I shit you not) on deductive reasoning from first principles. (These principles happen to coincide eerily well with the existing disciplinary boundaries of their subfield.)

    And if the theory is an impossible mess that no one with actual experience implementing computer systems would dare attempt, well, so much the worse for reality.

    • Handle says:

      Spot on. And it gets much, much worse.

      My favorite is when the executive summary of one these monsters exceeds 100 pages. Having seen actual Senior Executives read actual Executive Summaries, if it goes past 3 pages, it’ll only be read by a non-executive subordinate, who will then be tasked to write an actual executive summary of the executive summary.

  8. DocClar says:

    Say what you want about the navy’s dos prompt system for looking up lab results, once you memorized how to navigate the menus it was lightning fast. The curse of many electronic medical software systems from the physician perspective is many small delays in navigating menus all add up.

    I’ll take an ugly system that saves me time over the reverse every day heh.

    • Handle says:

      Heh, yeah, it works, and it’s fast, but it’s ultra hard to update, secure, make compliant with new laws, or talk to any other modern system. It’ll get there … By 2020. Maybe.

  9. Thales says:

    “I’ve seen things you people wouldn’t believe: grown men switching out reels of magnetic tape and storing information on cassette tapes, hard drive plates that fit in a stack in something that looks like a washing machine. I’ve seen billion dollar weapon-launching platforms just recently upgraded to Windows NT . . . all those bytes lost in time like tears in the rain…Time to rm -rf…”

  10. Pingback: Randoms | Foseti

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