Against Pseudo-Reform

MoveOn has a petition opposing the healthcare bill on the grounds that it’s a giveaway to insurance companies. I signed for the heck of it, though I suspect their approach to improving the bill might diverge in some particulars from mine.

34 Responses to Against Pseudo-Reform

  1. MBH December 19, 2009 at 11:20 pm #

    I can sympathize with your position. But I’d still like to hear your take on a couple issues:

    (1) How “pseudo” will the reform feel for the 150,000 or so lives that are saved by the bill? (Ezra Klein makes this case here at about 2:30)

    (2) What’s more free market than a bill which does more to reduce the deficit than any bill in American history? CBO estimates nearly a $200 billion savings in the first ten years — 3/4 trillion dollars over 20.

    (3) Why not tout this as a left-libertarian victory? No government-run program will be operating. Further, Bernie Sanders (speaking today here) has ensured — through the bill — that 10,000 community health centers will be set up throughout America. 25 million Americans without insurance today will have access to the cooperative system! Balloons! Confetti! Champagne! Music! No?

    • John Markley December 20, 2009 at 7:09 pm #

      MBH,

      I’d dispute the claim that no new government program will be operating because of this. If this passes, I’d question whether the health insurance industry would really count as “private” any more. The mandate is basically a payoff to the insurance industry: the government imposes new controls on them requiring them to do things that do not make financial sense if you’re in the insurance business, such as ignoring preexisting conditions, and in return the government will force everyone to buy their product.

      The insurers would be government agencies in everything but name, and the insurance they “sell” would simply be a welfare program (albeit one that, like social security, would produce a net transfer of wealth from the relatively poor to the relatively rich) disguised as a commercial transaction. They would exist to serve purposes chosen by the government, their activities would be controlled by the government, and their funding would be given to them by the entire population under threat of government force. In this scenario, there are no private health insurance companies, just welfare agencies with unusually well-paid management.

      • MBH December 20, 2009 at 9:51 pm #

        By your logic any government-regulated industry should not count as containing private companies. If you think there shouldn’t be any objectively defined rules for private companies, then fine. But argue that. Don’t conflate regulation with government ownership.

        • Roderick December 21, 2009 at 11:10 pm #

          Don’t conflate regulation with government ownership.

          Well, what is the difference? It seems to me to be a matter of degree. How would you define a sharp difference between a government agency and a government-privileged, government-regulated private business? It’s got to be more than just that one is called private. (Is the Post Office private?)

        • MBH December 22, 2009 at 12:59 am #

          How would you define a sharp difference between a government agency and a government-privileged, government-regulated private business?

          An agency is operated by members of the government; a business operates through rules from the government.

          This just for you.

        • Roderick December 22, 2009 at 12:18 pm #

          An agency is operated by members of the government; a business operates through rules from the government.

          But that’s a tautology; it’s not helpful in identifying the difference. Obviously, Group X is part of the government if and only if it’s operated by members of the government; but when one side of that biconditional is in dispute, so is the other.

        • MBH December 22, 2009 at 3:21 pm #

          I see. I’ll accept that it’s a matter of degree. Though that still wouldn’t mean that regulation = ownership. That would just put regulation at one end of the government property spectrum and ownership at the other.

          John says, If this passes, I’d question whether the health insurance industry would really count as “private” any more.

          But by your understanding of the relationship between regulation and ownership, the insurance industry would never really count as private in the first place.

      • Soviet Onion December 21, 2009 at 12:16 am #

        the government imposes new controls on them requiring them to do things that do not make financial sense if you’re in the insurance business, such as ignoring preexisting conditions

        Just out of curiosity, have libertarians ever proposed a solution to the problem of providing health care to people with preexisting conditions?

        • Roderick December 21, 2009 at 11:15 pm #

          Well, just the two prongs: under libertarianism it will be easier for people to become affluent and so be able to afford healthcare, and for those (a smaller number than now) who can’t afford it, welfare programs will be better funded and more efficient. (On this last see here and here.)

    • Aster December 20, 2009 at 7:49 pm #

      http://en.wikipedia.org/wiki/Stupak_amendment

      http://www.npr.org/templates/story/story.php?storyId=120450447&ps=rs

      No champagne.

      The majority of libertarians can save themselves a few precious minutes of life by refraining from rationalising and moralising about why they don’t care. There’s no need to strain your voice. We already know.

      • MBH December 20, 2009 at 9:47 pm #

        Aster, the Stupak Amendment is not in the bill. And as a Randian/Left-Libertarian I would think you would appreciate efforts to keep the government from subsidizing or preventing abortion.

        • Soviet Onion December 20, 2009 at 10:31 pm #

          as a Randian/Left-Libertarian I would think you would appreciate efforts to keep the government from subsidizing or preventing abortion.

          How about the simple observation that the effect of this will be to push abortion coverage out of existing plans? Can you appreciate that, or is this one of those situations in which deference to purity demands that we never bring inconvenient reality to the dinner table, or pretend for a moment that we care about consequences?

          If I set up a tightly-regulated cartel in which no one can realistically enter the market and operate without joining, then take steps to prohibit certain actions by members of said cartel, how is that not effectively the same thing as banning those actions all together? There is no practical difference between the internal mechanics of the cartel and “the economy” where health care is concerned.

        • MBH December 20, 2009 at 11:33 pm #

          How about the simple observation that the effect of this will be to push abortion coverage out of existing plans?

          Where do you get that idea? What in the legislation says anything about that? I understand that you’re cemented into a certain belief system, but please, quit this “blah blah blah the government’s gonna control blah blah blah.”

        • Soviet Onion December 20, 2009 at 11:54 pm #

          Where do you get that idea? What in the legislation says anything about that?

          Insurance companies would have an incentive to exclude abortion coverage from their plans in order to make those plans suitable for receiving subsidized costumers. Deny it all you like, but the practical effect of government funds is to alter the incentives and promote the dissolution of abortion coverage where it currently exists.

          I would think this is obvious. It certainly has been to groups like NARAL and the ACLU, just not people that are . . . what’s the phrase, “cemented into a certain belief system”.

        • MBH December 21, 2009 at 12:18 am #

          Insurance companies would have an incentive to exclude abortion coverage from their plans in order to make those plans suitable for receiving subsidized costumers.

          Umm. So you’re saying that the subsidized customers — who cannot afford any insurance — will now be screwed because the insurance they do get doesn’t include subsidized abortions — though it doesn’t permit abortions? That’s all you got?

        • Soviet Onion December 21, 2009 at 12:43 am #

          Umm. So you’re saying that the subsidized customers — who cannot afford any insurance — will now be screwed because the insurance they do get doesn’t include subsidized abortions — though it doesn’t permit abortions? That’s all you got?

          Not quite. People currently on plans with abortion coverage will begin losing it, and insurance plans in general will not offer it to anyone, whether subsidized or not, since that would forgo the opportunity to take on subsidized customers. Why offer it all when that just screws you out of a nice candy grab?

          The effect is that there will be fewer options for women seeking coverage for abortions, and making an already crappy situation worse for them.

        • MBH December 21, 2009 at 12:50 am #

          So Company A could not offer plan B to non-subsidized customers and plan C to subsidized customers? You’re suggesting that all insurance companies can only offer one plan?

        • Aster December 21, 2009 at 1:05 am #

          wikipedia lists “restrictions on abortion coverage in any insurance plans for which federal funds are used” as a “key provision”. If wikipedia is wrong, please correct me.

          As for the broader issue, I’m no longer a libertarian or a left-libertarian, precisely because I find dialogue on these kind of issues impossible. I call myself a ‘left-Randian’ in some contexts, but I don’t mean to imply total agreement with Rand’s philosophy. My views are closer to Karl Popper’s- if limited social engineering is necessary to prevent private power from closing down the open society for all or some, then so be it. Sexual and reproductive autonomy is far more important than the cost in taxes to provide abortion for poor women. In the best of all possible worlds I would prefer Roderick’s or Charles’ position, but such a world does not exist. Better the state than the church or private patirarchy, and sadly when it comes to womens’ politics sometimes these are the only operant choices.

          In this case, the state is first cartelising medicine and then showing moralisitic favouritism with regards to what services the regulated oligopoly will provide. Libertarians used to howl when the state would require recipients of federal grants and contracts to adopt affirmative action policies. I doubt few will care now that the requirement is cutting access to abortion for those least able to pay out of pocket. The point is that while theoretically libertarians decide these things on individualist principle, in practice the judgment calls on policy options get made according to conservative and patriarchal priorities. This doesn’t have to be the case, but is.

          ~~~~

          I like the lyrics to the music; thank you! I wish libertarians had the kind of accompaniment one finds in the social anarchist scene. People call it fluff, but the difference between an open and closed society can often be measured by the prevalence of street performers. A rave is a more definite answer to H.H. Hoppe than any essay.

        • Soviet Onion December 21, 2009 at 1:48 am #

          So Company A could not offer plan B to non-subsidized customers and plan C to subsidized customers? You’re suggesting that all insurance companies can only offer one plan?

          1. You run a business. You have limited resources to invest, and ravenous shareholders yapping at your heels. Do you invest in the less profitable option, or the one that is not only more profitable, but that is underwritten by the government?

          2. Even if companies do offer special plans that are similar in every respect but abortion coverage, the pool for that kind of insurance is going to be vastly reduced when almost everyone, including everyone without a uterus, moves over to the (artificially) cheaper subsidized plans. Again, the result will be fewer options of worse quality for women that want plans with abortion coverage.

        • MBH December 21, 2009 at 1:52 am #

          …[There are] restrictions on abortion coverage in any insurance plans for which federal funds are used[.]

          Yeah. Wikipedia has that right. If you are subsidized, then your insurance policy cannot cover abortions. But that’s how the law has stood since 1976 (see Hyde Amendment). So the new legislation changes nothing. If you aren’t subsidized you’re still allowed to buy plans with abortion coverage. No incentive for insurance companies to do anything other than create additional plans — not to withdraw already existing plans.

          As to your position, I think that’s really cool. I feel an extreme affinity to what you might call Left-Randianism with dreams of situations in which Individualist/Mutualist/Collectivist Anarchism was more practical.

          [T]he requirement is cutting access to abortion for those least able to pay out of pocket.

          I don’t think that’s right. To cut implies to take away from what already is in place. There is no help in place. It’s unfortunate that this service won’t be offered, but it sure doesn’t subtract from something already there.

          [T]he state is first cartelising medicine and then showing moralisitic favouritism with regards to what services the regulated oligopoly will provide.

          I would grant your second point. But I’m afraid that the cartelizing of medicine is nothing that this legislation creates — maybe does-not-change-immediately. If anything this legislation will loosen the cartels’ grip over the industry. As it stands now, the average family pays an extra $1,000/year in premiums because of uncompensated treatment. Those costs are passed from the hospitals to the insurance companies to the customers. And this strongly enforces the cartel structure because that treatment is market demand for treatment, not market demand for insurance. But the insurance companies are able to treat it as if it were market demand for insurance. Mandating coverage — aside from the moral benefit of saving lives — will force insurance companies to be more responsive to customer demand. That’s never good for cartels.

          A rave is a more definite answer to H.H. Hoppe than any essay.

          Well said.

        • MBH December 21, 2009 at 1:53 am #

          Soviet,

          Do you invest in the less profitable option, or the one that is not only more profitable, but that is underwritten by the government?

          If I’m a good businessman, I invest in both.

        • Aster December 21, 2009 at 3:32 am #

          “As to your position, I think that’s really cool. I feel an extreme affinity to what you might call Left-Randianism with dreams of situations in which Individualist/Mutualist/Collectivist Anarchism was more practical.”

          MBH, thank you kindly. It’s more than a little encouraging to find a libertarian who is willing to show some sympathy to this social democratic sell out. Soviet Onion barely tolerates it, which is truly noble, considering how lousy social democrats are on weapon rights issues. Of course, I’m nice enough not to make public comments about his beady eyes (just LOOK how beady they are!), so I think we’re even.

          Actually, I just got off the phone with a particular ranking bison of a social democrat who is inspiring me to invent new swear words. THANK YOU for the eight hours of utterly senseless unraveling work on 36 hours notice. I’ll just squeeze it in somewhere between the 30 emails which all have to be answered NOW, the volunteer work, the dinner interview tomorrow, the trip into town to fix my vampire hair (again), not to mention shopping for Christmas presents and someone’s nonexistent pet colour in hair dye. Merry Solstice and love you too.

          Frackin’ senior partners… if this keeps up I’m going to start empathising with you respectable people. Where am I going to find time for catnip and video games??

        • MBH December 21, 2009 at 10:11 am #

          Senora Aster, que tipo de trabajo tienes?

        • Rad Geek December 21, 2009 at 3:03 pm #

          MBH:

          If you are subsidized, then your insurance policy cannot cover abortions. But that’s how the law has stood since 1976 (see Hyde Amendment). So the new legislation changes nothing.

          Of course it does. Specifically, the new legislation (through a combination of subsidies, captive-market mandates, and new regulations on insurance corporations) is designed to corral more women (and men) into government-subsidized plans. That is, last I checked, the point of the “reform.”

          Of course, more thoroughly statist options (like, say, putting everyone on Medicare, as some “social democrats” have proposed) would be even worse, in that total conversion of the healthcare industry to political allocation would mean the total subordination of women’s reproductive healthcare to the political mandates of Hyde et al. But this proposal is bad enough. And if your response depends on a claim that government subsidies to one good don’t tend to crowd out substitute goods, then I have to wonder where you would get that notion.

          MBH:

          If that’s not Left-Libertarian enough, I hope this is. Charles suggested it. Please click the red ‘Recommend’ button at the bottom if you like.

          Although I certainly do support grassroots-organized community free clinics (on the model of the Panther clinics or the feminist women’s health center / women’s self-help clinic movement), I certainly do not favor having goverment “create” community health care centers. And while I very much appreciate the notions of (1) divorcing the idea of “universal health care” from “government health care”; and (2) doing so through voluntary grassroots alternatives to corporate health insurance, I will say that I strongly doubt that any one big voluntary plan for everyone everywhere is going to cut it. What I want to see is a thousand mutual aid societies blooming, and a thousand different approaches to the problem — not for there to be some one network that everyone signs onto, but rather that every one have some network that she individually can sign on to.

          Aster:

          The point is that while theoretically libertarians decide these things on individualist principle, in practice the judgment calls on policy options get made according to conservative and patriarchal priorities. This doesn’t have to be the case, but is.

          Maybe so, but I may I suggest that MBH’s position on government health care reform is, well, idiosyncratic among self-identified libertarians? And so that the argumentative moves he makes may not be indicative of how most of us would handle the issue?

        • MBH December 21, 2009 at 6:11 pm #

          Charles,

          I said, “So the new legislation changes nothing.” That’s my bad. I should have qualified: “in regards to accessing abortion coverage.”

          …[I]f your response depends on a claim that government subsidies to one good don’t tend to crowd out substitute goods, then I have to wonder where you would get that notion.

          Government subsidies to one service tend to crowd out substitute services if and only if opportunity costs exist. In these cases the subsidized-buyers-of-insurance cannot afford abortion coverage. You’d be right if the subsidized-buyers were purchasing abortion coverage before but relinquishing that coverage to sign up for a broader deal without abortion coverage. I would imagine that would be the case in less than a percent of the subsidized-buyers — something like 0.05%. So, in that sense, I’ll conceded that subsidized insurance would “tend to crowd out” abortion coverage. Though I would question whether that tendency is very significant in this instance.

          …I strongly doubt that any one big voluntary plan for everyone everywhere is going to cut it.

          I don’t think so either. I’m suggesting one big voluntary company with endless amounts of experimental plans. From my discussions with folks over at the Cafe, they contend that what usually happens in these instances — when a voluntary company becomes highly successful — is that the company gets bought out. I think we could be successful where none others have with a business model specifically of not-getting-bought-out.

          MBH’s position on government health care reform is, well, idiosyncratic among self-identified libertarians?

          It’s idiosyncratic among most self-identified libertarians. I doubt that Chomsky would kick too hard against plans which utilize the state.

        • MBH December 21, 2009 at 6:22 pm #

          Oh and Charles, this just for you.

      • MBH December 20, 2009 at 10:01 pm #

        If no champagne, then how about more music. Just for you.

  2. MBH December 20, 2009 at 2:56 am #

    If that’s not Left-Libertarian enough, I hope this is. Charles suggested it. Please click the red ‘Recommend’ button at the bottom if you like.

  3. Natailya Petrova December 22, 2009 at 3:06 pm #

    Roderick,

    How happy I am to see Progressives revolting against the bill! Hope for them yet….

  4. CD December 22, 2009 at 5:24 pm #

    Roderick,

    How happy I am to see Progressives revolting against the bill! Hope for them yet….

  5. Natailya Petrova December 23, 2009 at 2:32 pm #

    Anonymous masses of blog readers,

    The bill isn’t just say taxing the super-rich. They have all these weird taxes on things like breast augmentation and existing quality insurance plans. My temporary insurance with the Teamsters through my dad’s employment with them is very comfortable. I do not want to see what a 40 percent tax on it does for my healthcare. I may be considered expendable costwise by the Teamsters, because I am the child of one of their lawyers ~ not an actual employee. My parents also lost their retirement in the stock market crash, so they don’t really need increased costs.

    • Natailya Petrova December 23, 2009 at 3:02 pm #

      Re: Soviet and MBH’s discussion of tax funded subsidies.

  6. Natailya Petrova December 23, 2009 at 2:57 pm #

    MBH,

    Provocative economistic arguments! My own take is that neutrality on government funding for medical procedures is desirable, but I hadn’t considered the crowding out effects.

    Charles,

    I always wonder how much money every Progressive organization combined has and how much goes to the Democrats….

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