The Affordable Care Act: A Square Peg in a Round Hole

The Supreme Court is finally reviewing the constitutionality of The Affordable Care Act. Finally. And I too have been reading about it, watching and listening. But I can't add much new or insightful--except one overriding thought that kept suggesting itself through the days of arguments and all that has been said and written about them. And that is, this is what you get when you have to force delivery of a public good--and healthcare is surely that--through market constructs poorly conceived, inappropriate and inadequate to deliver any service equally and dependably to all citizens.

Markets by their nature discriminate by ability to pay--and the more finely tuned their functions become, the more clearly and effectively they discriminate. Trying to jury rig a complex and labyrinthian set of rules, contingencies and incentives to move market processes to clumsily approximate the same result appears very much a fools errand. And now a poorly prepared and politically distracted group of nine old people in robes will likely try to restructure it so that the result makes some sense, but only in that it will touch a few disputed principles and guideposts in the process of juridical review of the legislative process and the legislation produced.

Public goods, like education, social service programs and healthcare, are the natural province of the public sector, and a national health service, or at least a single-payer (government) insurance function, are the only logical and truly workable answers. Upon reading my sentiments expressed in an earlier e-mail, a friend responded that it was like trying to fit a square peg in a round hole. So true. The best we can now hope for is a result that sets the occasion for future movement in the right direction. But I have no idea what the Supreme Court will do--and it appears they do not either, struggling as they are to understand the implications of their charge, and the array of poor results and degrees of damage which are their only choices, other than an unqualified finding of constitutionality.

When Everything Is For Sale

From The Atlantic Magazine: Market thinking so permeates our lives that we barely notice it anymore. A leading philosopher sums up the hidden costs of a price-tag society.

We live in a time when almost everything can be bought and sold. Over the past three decades, markets—and market values—have come to govern our lives as never before. We did not arrive at this condition through any deliberate choice. It is almost as if it came upon us... [A]s growing numbers of countries around the world embraced market mechanisms in the operation of their economies, something else was happening. Market values were coming to play a greater and greater role in social life. Economics was becoming an imperial domain. Today, the logic of buying and selling no longer applies to material goods alone. It increasingly governs the whole of life.   

[...] Why worry that we are moving toward a society in which everything is up for sale? 

For two reasons. One is about inequality, the other about corruption. First, consider inequality. In a society where everything is for sale, life is harder for those of modest means. The more money can buy, the more affluence—or the lack of it—matters. If the only advantage of affluence were the ability to afford yachts, sports cars, and fancy vacations, inequalities of income and wealth would matter less than they do today. But as money comes to buy more and more, the distribution of income and wealth looms larger.   

The second reason we should hesitate to put everything up for sale is more difficult to describe. It is not about inequality and fairness but about the corrosive tendency of markets. Putting a price on the good things in life can corrupt them. That’s because markets don’t only allocate goods; they express and promote certain attitudes toward the goods being exchanged. Paying kids to read books might get them to read more, but might also teach them to regard reading as a chore rather than a source of intrinsic satisfaction. Hiring foreign mercenaries to fight our wars might spare the lives of our citizens, but might also corrupt the meaning of citizenship.   

Economists often assume that markets are inert, that they do not affect the goods being exchanged. But this is untrue. Markets leave their mark. Sometimes, market values crowd out nonmarket values worth caring about. 

--- "What Isn't For Sale?" by Michael J. Sandel, The Atlantic (April 2012)

This is an article everyone should read and think about. Everyone. Yes, it is long, but do it anyway. For we have come to a place where it appears economic processes are no longer understood as mechanisms to be managed and regulated to best serve and protect society. Rather, the nature and value of people and society are understood and justified by how they are shaped by and conform to ever more compromised and unregulated forms of market capitalism. And as a result, the very notions of humanistic values, of public goods and services, are under attack and flagging.

But as the introduction noted, this broader understanding or perspective is one that eludes most people. They feel it, but they cannot put their finger on it or explain it. Sandel helps clear up the picture and our understanding considerably. It is interesting to me because my recent thinking has been taking me in those same directions--pondering the fact that the marketplace and the market capitalism has more and more moved toward a self-justifying ideology/religion that defines who we are as a society, where we are placed in it, and by that determination, our personal value.

I was tempted to say there is more a sense of Ayn Rand's Objectivism ascendant. But Ayn Rand would rightfully object, I think. Our marketplace and capitalism is anything but pure; it is distorted by an uneven economic and social playing field that is controlled by dominant financial and industrial forces, and the wealthy individuals created by them. And political power falls in line behind the influence of that wealth. Mediating and ameliorating legislation and regulation are denied or frustrated in application.

It is an anachronistic process that fails to recognize and serve more modern, better-informed notions of humanistic values in the role of society. It ignores the research and realities that demand a more civilized and stronger society--both economically and humanisticly--and the increasing importance of the federal government's role in providing and strengthening the essential building blocks: equal opportunity, education, healthcare,  justice, and support for the aged and unable.

http://www.theatlantic.com/magazine/archive/2012/04/what-isn-8217-t-for-sale/8902/

Khan Academy: The future of education? [60-Minutes]

Many of you know my view is that more effective, universal education must form the core of any effort by America to address her future and challenges successfully (followed closely by universal preventative and basic healthcare). I have followed closely new education ideas and innovations at the margin, but such incrementalism has produced little improvement. In fact, America continues to fall further behind.

Now comes the young, brilliant and undaunted Mr. Kahn and his "Kahn Academy." The former hedge fund analyst hasn't paid much attention to what people say can't be done. He's just doing what he thinks can be done, done better, and at very modest cost. And he's doing it very well. His approach has turned traditional notions of education and teaching on their head, "flipping" the education model, as it has been described. It has taken elementary education by storm, and promises as much for high school and higher education, as well. So promising is it that Bill Gates and others have taken out their check books to fund major expansion of Kahn's work. If you missed the piece on "60-Minutes," if you think this is important, you might consider viewing it here--or viewing it again. (Just click on the highlighted text or the link below.)

http://www.cbsnews.com/video/watch/?id=7401696n&tag=contentMain;contentAux

"Socialist": A Black Guy with Power (Doonesbury)

Yes, bending or reshaping definitions to meet one's purpose or view--especially one's political purpose or view--is what we are talking about. Too often, it just seems like that's what it's all about these days. Too often it's all just too cynical--and worse. And sometimes--like Sunday's strip--Doonesbury just nails it.

Greg

       

• Mar 11, 2012    

NBC/WSJ Poll: Primaries Take "Corrosive" Toll on GOP, Candidates

From a recent NBC/msnbc article:

[A] new national NBC News/Wall Street Journal poll shows that the combative and heavily scrutinized Republican primary season so far has damaged the party and its candidates. Four in 10 of all adults say the GOP nominating process has given them a less favorable impression of the Republican Party, versus just slightly more than one in 10 with a more favorable opinion. 

Additionally, when asked to describe the GOP nominating battle in a word or phrase, nearly 70 percent of respondents – including six in 10 independents and even more than half of Republicans – answered with a negative comment. Some examples of these negative comments from Republicans: "Unenthusiastic," "discouraged," "lesser of two evils," "painful," "disappointed," "poor choices," "concerned," "underwhelmed," "uninspiring" and "depressed." 

And perhaps most significantly, the GOP primary process has taken a toll on the Republican presidential candidates, including front-runner Mitt Romney, who is seen more unfavorably and whose standing with independents remains underwater. "The primaries have not raised the stature of the party, nor enhanced the appeal of the candidates," says Democratic pollster Peter D. Hart, who conducted this survey with Republican pollster Bill McInturff. "The word you'd have to use at this stage is: 'Corrosive,'" McInturff adds. 

[...] In January's NBC/WSJ poll, Romney's favorable/unfavorable rating stood at 31 percent to 36 percent among all respondents (and 22/42 percent among independents). But in this latest survey, it's now 28 percent favorable and 39 percent unfavorable (and 22/38 percent among independents). 

In fact, Romney's image right now is worse than almost all other recent candidates who went on to win their party's presidential nomination: Obama's favorable/unfavorable ratio was 51/28 percent and John McCain's was 47/27, in the March 2008 NBC/WSJ poll; John Kerry was at 42/30 at this point in 2004; George W. Bush was 43/32 in 2000; and Bob Dole was 35/39 in March 1996. (The one exception: Bill Clinton, in April 1992, was at 32/43 percent.) 

[...] The damage from the Republican primary season – in addition to a rising job-approval rating for President Obama and more optimism about the U.S. economy – has given Democrats an early advantage for November's general election. Indeed, the president's job-approval rating now stands at 50 percent; Obama leads Romney in a hypothetical general-election match up by six points; and Democrats hold a five-point edge on the generic congressional ballot. When it comes to President Obama, the poll contains mostly good news.  

---"NBC/WSJ poll: Primary season takes 'corrosive' toll on GOP and its candidates," By Mark Murray, NBC News Senior Political Editor, msnbc.msn.com (3.4.12) 

There can be little doubt about it. We're seeing the Republican Party for what it has now become. Its limited political spectrum represents the most conservative, often extreme and irresponsible expressions of laissez faire economics, anti-government and anti-tax ideology, intolerant religious traditions, and resentment of immigration and today's realities. And the candidates' range of general appeal runs from marginal to disappointing within the GOP, to unattractive and unacceptable among independents and Democrats.

It isn't a pretty picture. And there can also be little doubt that, to most of the electorate, President Obama is looking like a more knowledgeable, wiser, and more balanced leader of 21st-century America than any among the GOP candidates can even pretend to be.