Okay...I think it's time to bring in the health care reform bill that Obama signed into law last week (plus the revisions signed into law today). I won't possibly be able to cover all of the details but I'm going to provide my two cents. For more information, here's a quick synopsis from a University of Pennsylvania professor (who happens to be very critical of the bill), a great article by The Economist, and a great podcast from the folks at NPR's Planet Money that does a great job of analyzing the bill.
So let's first analyze the bill in the context of the problems and potential solutions that I already covered. A big part of the bill is to try and cover more Americans that were previously uninsured (problem #2). The bill attempts to cover more people by various health insurance regulations and tax [dis]incentives. One easy way it does this is by changing the health insurance rule to allow young adults up until the age of 26 to stay on their parents health insurance. This provision will be effective relatively soon and will have a large impact on a segment of the population that has been hit hard by the recession (young adults). A second way is to decrease the number of uninsured by forbidding insurance companies from not covering someone because of "pre-existing conditions" (fully effective by 2014). Now this provision really gets at the heart of the issue. I personally agree with the idea that everyone should be allowed to have some kind of health insurance available at a reasonable cost. But if that were to happen, then health insurance really becomes something fundamentally different than any other product...even fundamentally different than any other insurance product. The whole insurance industry rests upon the foundation of calculating risk. An insurance company wants to avoid insuring anything risky in order to increase profits. But if a regulation comes along that forbids them from refusing to insure something that they deem as too risky, then the whole industry gets turned upside down.
But I would argue that this new regulation is, overall, a good thing for a developed country like the U.S. There have been way too many horror stories of people not being able to get insurance through no fault of their own. It just doesn't seem fair.
And just think about it...this is a very similar situation to the one that was mostly responsible for the creation of Medicare. Old people are a risky bunch in the eyes of the health insurance industry. If we didn't have Medicare, old people would have to pay very high premiums because they are such a high risk. It's nearly the same situation for people with pre-existing conditions. The only difference is that everyone, of course, gets older and becomes riskier but not everyone develops "pre-existing conditions". But the "pre-existing conditions" umbrella has gotten so large in the past few decades that anyone has a reasonable chance of being put under it at some point through no fault of their own (random chance).
And although this new regulation seems like a raw deal for the health insurance industry, keep in mind that while they will be covering more risky people, they will also be covering more non-risky people through the third way that the bill decreases the number of uninsured: a requirement that everyone take out some minimum level of health insurance or pay a $695 tax (effective in 2014). This is by far the most controversial provision in the bill. (There's been a lot of talk about the constitutionality of this and it looks like it will be challenged in court. But I'm inclined to think that it will not be struck down because of this argument by Jack Balkin of Yale.) In order to help lower income people pay for this mandated health insurance, subsidies on a sliding scale will be available to the working poor and uninsured who make less than $88,000. In addition, Medicaid will be substantially expanded to cover more of the very poor (anyone under 133% of the federal poverty level which is just under $30,000 per year for a family of four).
So those are the major elements that decrease the number of uninsured Americans. So how the hell are we going to pay for all of these subsidies and the expansion of Medicaid (keeping in mind the third problem - Medicare and Medicaid becoming fiscal nightmares)? Well, there are four ways: 1) a new Medicare payroll tax on investment income of the wealthy (families making more than $250,000 per year and individuals making more than $200,000 per year), 2) a tax on "Cadillac" insurance plans (those that are worth more than $27,500 for families and $10,200 for individuals), 3) a 10% tax on tanning salons (seriously), and 4) a $500,000,000 cut in Medicare spending over the next decade (although the details on how this cut will happen are pretty unclear). So leaving aside the issue of whether these taxes are too progressive, will they be able to cover the huge increases in government spending to help cover more Americans? Well, the Congressional Budget Office thinks that it will. It looks, though, that it will all rest on what health care costs will do in the future.
And that (as the first problem that I discussed) is something that is horribly lacking in the bill. It has several very watered-down measures that try to get at the whole cost issue. One of these is to set up an agency that will research ways to "bend the cost curve" and specifically try to find ways to pay health care professionals based on health care outcomes instead of fees for services (i.e., stop paying specialists based on how many tests they do and start paying them based on whether or not the patient got healthier). Another is to set up an advisory board to help reduce Medicare costs. But all of these measures absolutely pale in comparison with what really needs to be done in order to significantly reduce health care costs in this country.
So the pessimist in me thinks that no politician is willing to make the tough decisions to re-vamp the system of health care (e.g., moving away from an employer-provided system) and our federal budget deficit will continue to balloon as we increase the amount of money the federal government spends on health insurance.
But the optimist in me thinks that this might be a start (albeit a small one) to something better. That part of me thinks that if everyone is under the tent of the American health care/insurance system, then we'll be forced to make those difficult decisions together...as a community, which is exactly how health insurance began in this country over 80 years ago with a non-profit organization called Blue Cross. In addition, the health insurance industry will now be thinking of innovative ways to reduce the riskiness of those that they insure (instead of just dropping them) and this could very well lead to better preventive health care (and do I dare say a leap into the world of food policy???). Here's to hoping.
I'm going to have one final post on the health care reform bill that is going to deal with the ugly politics and fear-based rhetoric we've been hearing lately...then I will be done.
Tuesday, March 30, 2010
Saturday, March 27, 2010
Is Health Care Reform a "Big F*#king Deal"? PART 3
Alright, so I have laid out the main problems with health care and health insurance. So what are the potential solutions and what is in the recent health care reform bill?
Well, first let's take the third problem that was just discussed in Part 2. One potential remedy to any problem related to the federal budget is to raise revenue (i.e., through tax increases). This is the stereotypical "liberal" response to most federal budget issues. Just raise taxes on the rich and we'll be able to pay for our government-subsidized health insurance programs. Some may even go as far as to advocate for expanding our government health insurance program to everyone by having a "public option" that people could enroll in. The logic here is that we'll just be able to tax the rich more so that all of us (even the poor that may not be able to pay into a government insurance program) can have subsidized government health insurance.
Now, I am pretty sympathetic to the idea of increasing the tax rate for the super rich mainly because the gap between rich and poor has widened so dramatically in the last few decades (see the figure above from this great report from the Center on Budget and Policy Priorities). Just look at that figure. It's staggering. I consider myself very much on the capitalist side of things (incentives are critical to our society) but there is something really, really wrong when the rich-poor gap expands that dramatically. It's impossible to "prove", but I just cannot imagine that those at the top 1% of household income really "deserved" that much of an increase in their incomes. For example, look at CEOs of the big banks and their huge bonuses right in the middle of a crisis largely caused by their mistakes (more on that later, for sure). I know that may sound a little fishy to the die-hard capitalists but...wow. It's just staggering.
But with all of that in mind, increasing taxes on the rich only gets us partially to the point where we could possibly have a sustainable universal health care system (heavily dependent on government subsidies) implemented on top of the current health care structure of the country. So I would argue that just raising taxes on the rich and implementing a public option (plus expanding subsidized health insurance programs such as Medicaid) is a very dangerous position to take for two reasons: 1) just mindlessly raising taxes to solve a fiscal problem can definitely qualify as an attack on individual liberty (one of the non-negotiable principles of this country as I addressed here) and 2) it does nothing to address the other side of the potential solutions...reducing the costs of health care.
The reason that universal health care with government subsidies in other developed countries work so well on a national scale (higher life expectancies, lower child mortality rates relative to the U.S.) and are largely sustainable (Germany has had universal health care since 1883) is that the costs of health care (regardless of who is paying for it; the government or an individual) are much lower compared to the U.S. (and again, that is mostly due to the idea that brand new and expensive medical technologies and drugs are not pushed so much and health care professionals are not paid as much in those other countries). So if people truly want to advocate for expanding the role of the U.S. government in supporting health insurance to all, they would also need to advocate for dramatically changing our health care system. And there are enormous obstacles that face that proposition...like the power of the pharmaceutical and hospital industries, for instance.
In addition, we would definitely need to expand the scope of what we consider as "health care" in this country to include things like food policy, which I and many others would argue is a vital part to the health and wellness of a country's population. (This is a whole other subject that I will probably address in a later post).
So I am sympathetic to the idea of increasing access to health insurance through government means but we also must absolutely address, and address with great determination, the growing costs of health care and also the food policies that make us less healthy.
Okay, so that's a big part of the potential solutions. What about other ideas?
In Part 4, I will talk about increasing regulations on health care and health insurance to reduce costs and maybe finally get to the new bill.
Well, first let's take the third problem that was just discussed in Part 2. One potential remedy to any problem related to the federal budget is to raise revenue (i.e., through tax increases). This is the stereotypical "liberal" response to most federal budget issues. Just raise taxes on the rich and we'll be able to pay for our government-subsidized health insurance programs. Some may even go as far as to advocate for expanding our government health insurance program to everyone by having a "public option" that people could enroll in. The logic here is that we'll just be able to tax the rich more so that all of us (even the poor that may not be able to pay into a government insurance program) can have subsidized government health insurance.
Now, I am pretty sympathetic to the idea of increasing the tax rate for the super rich mainly because the gap between rich and poor has widened so dramatically in the last few decades (see the figure above from this great report from the Center on Budget and Policy Priorities). Just look at that figure. It's staggering. I consider myself very much on the capitalist side of things (incentives are critical to our society) but there is something really, really wrong when the rich-poor gap expands that dramatically. It's impossible to "prove", but I just cannot imagine that those at the top 1% of household income really "deserved" that much of an increase in their incomes. For example, look at CEOs of the big banks and their huge bonuses right in the middle of a crisis largely caused by their mistakes (more on that later, for sure). I know that may sound a little fishy to the die-hard capitalists but...wow. It's just staggering.
But with all of that in mind, increasing taxes on the rich only gets us partially to the point where we could possibly have a sustainable universal health care system (heavily dependent on government subsidies) implemented on top of the current health care structure of the country. So I would argue that just raising taxes on the rich and implementing a public option (plus expanding subsidized health insurance programs such as Medicaid) is a very dangerous position to take for two reasons: 1) just mindlessly raising taxes to solve a fiscal problem can definitely qualify as an attack on individual liberty (one of the non-negotiable principles of this country as I addressed here) and 2) it does nothing to address the other side of the potential solutions...reducing the costs of health care.
The reason that universal health care with government subsidies in other developed countries work so well on a national scale (higher life expectancies, lower child mortality rates relative to the U.S.) and are largely sustainable (Germany has had universal health care since 1883) is that the costs of health care (regardless of who is paying for it; the government or an individual) are much lower compared to the U.S. (and again, that is mostly due to the idea that brand new and expensive medical technologies and drugs are not pushed so much and health care professionals are not paid as much in those other countries). So if people truly want to advocate for expanding the role of the U.S. government in supporting health insurance to all, they would also need to advocate for dramatically changing our health care system. And there are enormous obstacles that face that proposition...like the power of the pharmaceutical and hospital industries, for instance.
In addition, we would definitely need to expand the scope of what we consider as "health care" in this country to include things like food policy, which I and many others would argue is a vital part to the health and wellness of a country's population. (This is a whole other subject that I will probably address in a later post).
So I am sympathetic to the idea of increasing access to health insurance through government means but we also must absolutely address, and address with great determination, the growing costs of health care and also the food policies that make us less healthy.
Okay, so that's a big part of the potential solutions. What about other ideas?
In Part 4, I will talk about increasing regulations on health care and health insurance to reduce costs and maybe finally get to the new bill.
Is Health Care Reform a "Big F*#king Deal"? PART 2
A couple of things to add on the first two problems...
I view health care as a product that is fundamentally different than, say, a TV or a car or food, even. It's obvious why it's different than a TV or a car because we don't need them to survive. So let's take that last one, food, because we do need it to survive. If someone all of a sudden loses their job for whatever reason, most people can still buy food because they probably have some money saved up (and food doesn't cost all that much relatively speaking...if you really need help, I think most people could find some food from friends and family). When the first time that you get hungry comes around after you lose your job, all you need to do is go down to the grocery store and drop a few bucks. But if you get hit by a car on your way to the store (after you lost your job) or you all of a sudden start feeling a pain in your appendix...well, then you're screwed (COBRA plans do obviously help here but they also suffer from problems of being too costly and limited to 18 months after you lose your job). Food may arguably be more critical than health care in our ability to sustain ourselves over the long run but we pay relatively small amounts of money each day for it instead of in huge lump sums like we would have to do if we needed serious medical care.
Okay, so what about the third problem: Federal budget issues related to Medicare and Medicaid? Boring, right? Wrong! Let's just spend a little bit of time here.
First, what exactly is Medicare. You may be roughly familiar with it because you see it taken out of our paycheck (1.45% from you, 1.45% from your employer) but let's get down to the details. Essentially, it is the U.S. government's health insurance program for people over age 65, under 65 with certain disabilities, and any age with permanent kidney failure. You might be saying to yourself, "Wow...that sounds an awful lot like socialized health insurance"...and you'd be right. And we've had this since 1965.
There are several parts (A-D) to Medicare. Part A is hospital insurance (inpatient care at a hospital, hospice, etc.) and if you or your spouse have paid payroll taxes towards Medicare for at least 10 years, then this insurance is provided without charge. You essentially paid for it your whole working life and when you retire, it's supposed to be there for you (at least that's the idea). Part B is medical insurance (covers anything that Part A does not, like doctors' services and some preventive services like flu shots), which you have to pay an extra premium of ~$100 per month in order to receive. If you are enrolled in Parts A & B then you can opt for Part C (Medicare Advantage), which provides the same services as A & B but through a private insurance company that is approved by Medicare. Typically, those that choose to enroll in Part C also pay for additional coverage for prescription drugs, dental, vision, etc. The final part is Part D, which provides subsidized prescription drug coverage. This is what was passed in 2006 under President Bush. You can enroll in this program through the original Medicare (A & B) or Medicare Advantage (C).
Okay, how about Medicaid? Medicaid is government-provided health insurance for the poor and it is essentially provided for free (some small fees may apply in certain situations). Medicaid is funded by state and federal governments, but management is handled by states. Thus, eligibility and program specifics vary from state-to-state. Medicaid is even subcontracted out to private insurers in some states. So Medicaid is even more socialized than Medicare because we really are giving it away for free to those who are just too poor. It's our society's safety net.
Boring, right? Well, okay...But the problem is that these large government-provided health insurance programs are in big financial trouble. One of the big reasons, again, is that overall health care costs are rising (as mentioned in Part 1) but the other is that the baby boom generation is getting old and requiring more services from Medicare. This is a huge part of the problem when you hear about the federal deficit. I don't think everyone truly grasps the enormous amount of money that the government spends on health insurance. Over the last decade it has been around 65% of the total expenditures of the federal government! 65%!! (You can do your own Excel research by downloading all of the data here.) I have railed against the huge increase in defense spending related to the "War on Terror" (and will continue to) but even that (at ~20%) is dwarfed by the amount of money spent for health insurance. Now, it's true that a lot of the receipts that the government takes in as revenue is devoted specifically to health insurance (and it is clearly stated as such on your paycheck for instance) and there is no similar transparency for defense spending (i.e., you don't see that separated out nicely on your payroll or income taxes). But still...health insurance completely dominates federal expenditures.
Bottom line: The government is just not getting enough revenue to cover the increasing cost of providing this subsidized health insurance to those who qualify. It's a friggin' mess!
I view health care as a product that is fundamentally different than, say, a TV or a car or food, even. It's obvious why it's different than a TV or a car because we don't need them to survive. So let's take that last one, food, because we do need it to survive. If someone all of a sudden loses their job for whatever reason, most people can still buy food because they probably have some money saved up (and food doesn't cost all that much relatively speaking...if you really need help, I think most people could find some food from friends and family). When the first time that you get hungry comes around after you lose your job, all you need to do is go down to the grocery store and drop a few bucks. But if you get hit by a car on your way to the store (after you lost your job) or you all of a sudden start feeling a pain in your appendix...well, then you're screwed (COBRA plans do obviously help here but they also suffer from problems of being too costly and limited to 18 months after you lose your job). Food may arguably be more critical than health care in our ability to sustain ourselves over the long run but we pay relatively small amounts of money each day for it instead of in huge lump sums like we would have to do if we needed serious medical care.
Okay, so what about the third problem: Federal budget issues related to Medicare and Medicaid? Boring, right? Wrong! Let's just spend a little bit of time here.
First, what exactly is Medicare. You may be roughly familiar with it because you see it taken out of our paycheck (1.45% from you, 1.45% from your employer) but let's get down to the details. Essentially, it is the U.S. government's health insurance program for people over age 65, under 65 with certain disabilities, and any age with permanent kidney failure. You might be saying to yourself, "Wow...that sounds an awful lot like socialized health insurance"...and you'd be right. And we've had this since 1965.
There are several parts (A-D) to Medicare. Part A is hospital insurance (inpatient care at a hospital, hospice, etc.) and if you or your spouse have paid payroll taxes towards Medicare for at least 10 years, then this insurance is provided without charge. You essentially paid for it your whole working life and when you retire, it's supposed to be there for you (at least that's the idea). Part B is medical insurance (covers anything that Part A does not, like doctors' services and some preventive services like flu shots), which you have to pay an extra premium of ~$100 per month in order to receive. If you are enrolled in Parts A & B then you can opt for Part C (Medicare Advantage), which provides the same services as A & B but through a private insurance company that is approved by Medicare. Typically, those that choose to enroll in Part C also pay for additional coverage for prescription drugs, dental, vision, etc. The final part is Part D, which provides subsidized prescription drug coverage. This is what was passed in 2006 under President Bush. You can enroll in this program through the original Medicare (A & B) or Medicare Advantage (C).
Okay, how about Medicaid? Medicaid is government-provided health insurance for the poor and it is essentially provided for free (some small fees may apply in certain situations). Medicaid is funded by state and federal governments, but management is handled by states. Thus, eligibility and program specifics vary from state-to-state. Medicaid is even subcontracted out to private insurers in some states. So Medicaid is even more socialized than Medicare because we really are giving it away for free to those who are just too poor. It's our society's safety net.
Boring, right? Well, okay...But the problem is that these large government-provided health insurance programs are in big financial trouble. One of the big reasons, again, is that overall health care costs are rising (as mentioned in Part 1) but the other is that the baby boom generation is getting old and requiring more services from Medicare. This is a huge part of the problem when you hear about the federal deficit. I don't think everyone truly grasps the enormous amount of money that the government spends on health insurance. Over the last decade it has been around 65% of the total expenditures of the federal government! 65%!! (You can do your own Excel research by downloading all of the data here.) I have railed against the huge increase in defense spending related to the "War on Terror" (and will continue to) but even that (at ~20%) is dwarfed by the amount of money spent for health insurance. Now, it's true that a lot of the receipts that the government takes in as revenue is devoted specifically to health insurance (and it is clearly stated as such on your paycheck for instance) and there is no similar transparency for defense spending (i.e., you don't see that separated out nicely on your payroll or income taxes). But still...health insurance completely dominates federal expenditures.
Bottom line: The government is just not getting enough revenue to cover the increasing cost of providing this subsidized health insurance to those who qualify. It's a friggin' mess!
So what to do? Well, there are several different ways to try and address each of these problems. Part 3 will look at the bill that was just passed in a little bit more detail as it relates to the problems that I just outlined.
Wednesday, March 24, 2010
Is Health Care Reform a "Big F*#king Deal"? PART 1
Alright, Tom. Here you go. I've been holding off on writing about health care/insurance reform because I haven't had adequate time to go through the bill and understand what it all means. I haven't still but I'm going to go ahead and make some comments based on what I know so far. Of course, it's subject to criticism (comments?).
So was Joe Biden correct when he pulled a "Biden" and whispered "This is a big f*#king deal" to Obama in front of a microphone to the world just before the signing ceremony? Well, yes and no.
First, let's spend a little time trying to understand why we even had this enormous debate in the first place. What was the problem? Well, you can really break it up into three problems: 1) high and rapidly growing costs for health care and insurance (the percentage of GDP devoted to health care grew from under 6% to over 16% from 1962-2007), 2) a lot of uninsured people (~46 million U.S. residents did not have health insurance in 2008), and 3) very large projected Medicare deficits and increasing Medicaid costs that are leading the federal budget down a very unsustainable path.
So why have health care costs risen so much in the U.S. anyways? Well, unfortunately there is no smoking gun here. There are many different factors at play. One of the most convincing causes to me is just the idea that we adopt and diffuse expensive medical technology at much higher rates than other countries. In addition, health care providers (physicians, nurses, etc.) just make more money here. So what's wrong with all of that? Well, it turns out that this increase in the cost of care doesn't really translate into better quality of care. On one hand, we do not have to wait long for noncritical surgeries compared with other countries and we are able to quickly have access to the latest and greatest products from our big medical companies. But on the other hand, our life expectancy is pretty below average compared with the rest of the developed world (check out this excellent graphic by the National Geographic) and infant mortality rates are high compared with other developed countries. That just doesn't seem right.
What about health insurance costs? Well, it obviously is tied to this increase in health care costs and that's the primary reason it has also increased (it's essentially how the insured pay for care...through premiums and deductibles). But you also need to add in the administrative costs. I'm not sure how those costs have trended through time.
So as a country we are paying way more but getting less. But should we really care about the situation at a national scale? Well, I would argue that we definitely should when the imbalance between cost and quality is this enormous. What gets so many people fired up about this subject is that the people with insurance generally love their health care. I love mine that is provided to me as a state employee. I don't use it too often but whenever I have, it's been fantastic. And I am confident that if anything bad were to happen to me, I would have great care immediately available to me. So any change from the current system is understandably going to raise the eyebrows of the people with great insurance.
But what about the people without insurance? Well, they are one of the primary reasons we are lagging behind the developing world in those quality indicators. They really don't have any care unless something catastrophic occurs when the government (i.e. taxpayers) or a charity foots the bill. So why would anyone not have health insurance? Well, they just can't afford it because their employer doesn't help pay for it or they're unemployed. Apologies for stating the obvious but it's important to emphasize and understand that not all uninsured people are blood-suckers who are just hoping for a government hand-out. This is even more apparent during a recession like our current one when everyone knows someone close to them that cannot afford health insurance for one reason or another. Sure there are abusers of the system but I don't think anyone would claim that the status quo is A-Okay (unless you truly are a selfish troll that thinks that they are impervious to the threat of unemployment during difficult economic times).
Okay...are you still with me? In PART 2, I will address the third problem and then get into the actual bill that was signed into law yesterday. Stay tuned.
So was Joe Biden correct when he pulled a "Biden" and whispered "This is a big f*#king deal" to Obama in front of a microphone to the world just before the signing ceremony? Well, yes and no.
First, let's spend a little time trying to understand why we even had this enormous debate in the first place. What was the problem? Well, you can really break it up into three problems: 1) high and rapidly growing costs for health care and insurance (the percentage of GDP devoted to health care grew from under 6% to over 16% from 1962-2007), 2) a lot of uninsured people (~46 million U.S. residents did not have health insurance in 2008), and 3) very large projected Medicare deficits and increasing Medicaid costs that are leading the federal budget down a very unsustainable path.
So why have health care costs risen so much in the U.S. anyways? Well, unfortunately there is no smoking gun here. There are many different factors at play. One of the most convincing causes to me is just the idea that we adopt and diffuse expensive medical technology at much higher rates than other countries. In addition, health care providers (physicians, nurses, etc.) just make more money here. So what's wrong with all of that? Well, it turns out that this increase in the cost of care doesn't really translate into better quality of care. On one hand, we do not have to wait long for noncritical surgeries compared with other countries and we are able to quickly have access to the latest and greatest products from our big medical companies. But on the other hand, our life expectancy is pretty below average compared with the rest of the developed world (check out this excellent graphic by the National Geographic) and infant mortality rates are high compared with other developed countries. That just doesn't seem right.
What about health insurance costs? Well, it obviously is tied to this increase in health care costs and that's the primary reason it has also increased (it's essentially how the insured pay for care...through premiums and deductibles). But you also need to add in the administrative costs. I'm not sure how those costs have trended through time.
So as a country we are paying way more but getting less. But should we really care about the situation at a national scale? Well, I would argue that we definitely should when the imbalance between cost and quality is this enormous. What gets so many people fired up about this subject is that the people with insurance generally love their health care. I love mine that is provided to me as a state employee. I don't use it too often but whenever I have, it's been fantastic. And I am confident that if anything bad were to happen to me, I would have great care immediately available to me. So any change from the current system is understandably going to raise the eyebrows of the people with great insurance.
But what about the people without insurance? Well, they are one of the primary reasons we are lagging behind the developing world in those quality indicators. They really don't have any care unless something catastrophic occurs when the government (i.e. taxpayers) or a charity foots the bill. So why would anyone not have health insurance? Well, they just can't afford it because their employer doesn't help pay for it or they're unemployed. Apologies for stating the obvious but it's important to emphasize and understand that not all uninsured people are blood-suckers who are just hoping for a government hand-out. This is even more apparent during a recession like our current one when everyone knows someone close to them that cannot afford health insurance for one reason or another. Sure there are abusers of the system but I don't think anyone would claim that the status quo is A-Okay (unless you truly are a selfish troll that thinks that they are impervious to the threat of unemployment during difficult economic times).
Okay...are you still with me? In PART 2, I will address the third problem and then get into the actual bill that was signed into law yesterday. Stay tuned.
Thursday, March 18, 2010
The incontrovertible link between the War on Terror and Israel-Palestine CONTINUED
Daniel Larison, again, is highly recommended reading on Israel-Palestine. Money quote:
Despite the perceived insult to Biden and the U.S., in a speech at Tel Aviv University the vice president reaffirmed the “total, absolute, and unvarnished” commitment of the U.S. to Israel. It is this unqualified support that allows Netanyahu to ignore the administration’s demands. Washington has opposed settlement expansion for decades, but no administration has seriously penalized Israel for blithely ignoring U.S. wishes—because even proposing such a penalty is unacceptable in U.S. politics.
Wednesday, March 17, 2010
The incontrovertible link between the War on Terror and Israel-Palestine
Here we go. The title of this post is more than daunting. To say that this is a delicate issue is quite an understatement and to say that I know all the in's and out's is also completely foolish. I will not do it justice in just a few paragraphs (even though it's taken 2 nights to write) but recent events have encouraged me to write about it.
This gets to the heart of the most dangerous cognitive shortcut we currently have in our political discussions. The Good vs Evil dichotomy. It's been ingrained in our heads since we were kids. It just makes thinking that much easier when we can root for the Good guys and despise the Bad guys. We crave that kind of simplicity.
In this example, the United States and Israel are the epitome of the Good guys. After 9/11, the United States could do no wrong. We were viciously attacked by a bunch of hopelessly misdirected Muslim men and the country came together to exact revenge. We were told by our President that the forces of Good would prevail. The 9/11 terrorists came from the Middle East where we (along with our British friends) have been meddling in affairs for quite some time. We have long decreed that Israel - a state solely created due to a religious movement - was a shining beacon of Goodness in a sea of chaos and our unwavering ally and friend. Although our recent presidents have all tried to sow peace between Israel and Palestine, we have always been better friends to Israel. This friendship comes in the form of massive diplomatic and military support as well as over $2 billion per year in direct financial aid. But even though the Israeli government is definitely a healthy democracy that values the liberty of their people (just look at some of the recent criticisms in Israeli newspapers of their government's harsh policies toward Palestine) they have definitely crossed the line into a dangerously aggressive military power.
And, of course, the Palestinian government on the other side can share the same reckless and manic fury as the Israelis (it's just been more aggressive from the Israeli side recently). But unlike Israel (barring a few shake-ups after elections), the internal affairs of governing Palestine have been extremely chaotic in recent years (especially after the death of their leader in 2004, Yasser Arafat) and this has been legitimately referred to as the Palestinian Civil War. Currently, the internal struggle has been between Fatah (the party of Arafat) and the more hard-line Hamas. After the death of Arafat, the US pushed for elections and were stunned along with the rest of the world when the Palestinians gave an enormous legislative victory to Hamas (the President was and still is Mahmoud Abbas, Arafat's successor within Fatah). Much was discussed at the time about how militant and unhinged Hamas was and that they wanted to rid the planet of the state of Israel. This seemed somewhat justified at the time, but from what I have gathered it seems that they have become more of a mainstream movement that is at least somewhat interested in brokering a lasting peace with the Israelis (i.e. self-preservation). But immediately following the elections, the US government tried to isolate Hamas and continued giving financial aid to Fatah (as they had been doing for many years to support the peace-making process...just an order of magnitude less than the aid to Israel). Today, the dispute over control of the Palestinian state is still largely unresolved.
But that didn't stop the hostilities with Israel. The crisis was at a rolling boil in 2008-2009 with the 3-week war in Gaza. If you don't recall the images on the news at the time, it was absolutely horrific and mostly one-sided (Israel). Both sides have been accused of war crimes by the UN.
The recent aggressive maneuver by Israel (and the subject of this post...finally) is the expansion of Israeli settlements into disputed territories. One of the most fundamental disputes has been centered on the city of Jerusalem, especially East Jerusalem. This holy town is seen as both the spiritual and political capital of both the Israeli state and the Palestinian state. Suffice it to say, it's been battled over for many decades.
Now last week, our white-haired VP visited Israel to partake in the age-old American activity of attempting to jumpstart peace talks. And what happens? Well, he gets one big ol' Israeli middle finger when Israel's interior ministry announces that they will construct 1,600 new housing units for Jews in East Jerusalem. Now, Prime Minister Benjamin Netanyahu was clearly embarrassed by this announcement right in the middle of the Biden visit. You see, Netanyahu used to be seen as a fairly reasonable politician back when he was Prime Minister the first time from 1996 to 1999. But the Israeli government has shifted to the right in the last several years and in response he has had to shift many of his stances to satisfy the right-wing contingency who are hell-bent on gobbling up more and more former Palestinian land.
So the Obama administration is predictably pissed-off about this huge "Fuck you" that just happened in Biden's face. They said reasonable things like "we condemn the decision" and Biden showed up 90 minutes late to a dinner with Netanyahu as payback. Wow...that's pretty ballsy.
And then what do we hear from the uber-Pro-Israeli politicians in our Congress (and our favorite former politician from Alaska)? Essentially, they criticized Biden for being too harsh in his rhetoric and that this faux-controversy manufactured by an "opportunistic" Obama administration would dramatically strain the relationship between Israel and the US. This is all too familiar of a reaction from a bunch of politicians who have pledged an unwavering allegiance to Israel no matter what kind of aggressive actions that they launch. Any sign of even criticizing Israel for being over the line is seen as anti-semitic and dangerous to American security. George Washington in his farewell address in 1796 had some pertinent advice for this exact situation (h/t to Glenn):
Observe good faith and justice towards all nations; cultivate peace and harmony with all. Religion and morality enjoin this conduct; and can it be, that good policy does not equally enjoin it? . . . . .
In the execution of such a plan, nothing is more essential than that permanent, inveterate antipathies against particular nations, and passionate attachments for others, should be excluded; and that, in place of them, just and amicable feelings towards all should be cultivated. The nation which indulges towards another a habitual hatred or a habitual fondness is in some degree a slave.
It is a slave to its animosity or to its affection, either of which is sufficient to lead it astray from its duty and its interest. . . .
So likewise, a passionate attachment of one nation for another produces a variety of evils. Sympathy for the favorite nation, facilitating the illusion of an imaginary common interest in cases where no real common interest exists, and infusing into one the enmities of the other, betrays the former into a participation in the quarrels and wars of the latter without adequate inducement or justification.
Bottom line is that no matter how good of a democracy Israel is or how enlightened their population is, it is an absolutely tragic mistake to have this much unconditional allegiance to a country that engages in terrible and unreasonable hostilities in a powder-keg of a region.And now for the good news. It seems like some in the military are finally starting to get this message as revealed by a recent article in Foreign Policy magazine (another highly recommended read). Our ever-popular Commander of Central Command, General David Petraeus, was briefed back in mid-January by some senior military officers who made the case that Arab leaders throughout the Middle East (on whom we are desperately relying to keep the peace and help with our "War on Terror") are becoming more and more disenfranchised with the U.S. over our inability to stand up to Israel. They also argued that Israel's unwillingness to stop settlements and other unreasonable acts was jeopardizing the U.S.'s standing with Arab leaders. It appears that Petraeus may have been listening. And despite the power of the Israel lobby in Congress, the military lobby absolutely trumps it. If the Obama administration can make a strong argument that Israeli policies are actually making our troops less safe, then we may see things change. I guess we'll have to wait and find out.
And y'know...as far as the whole Israel-Palestine conflict goes, it really all comes down to the same fundamental question that has been thrown around for millennia in the region...Who is God? Both sides of this epic conflict have exacted terrible and despicable pain and suffering on their foes all in the name of their God. How can we possibly look at that fundamental question as a country and take sides?
Final thought...All I'm asking is that our political discussions about the Israel-Palestine conflict better reflect the Op-Ed columns in Israeli newspapers instead of this hyper-sensitivity to calling people anti-semites for any kind of critical thought against Israeli policies. Is that so hard?
Caveat: Some things are black and white CONTINUED
Daniel Larison had another great column in response to Ross Douthat's response to Larison (related to what I wrote about the other day). Essentially, his main beef with Ross is that you can't criticize Hollywood for using a cognitive shortcut by defending a horrible and much more consequential decision by the U.S. government that relied on it's own cognitive shortcut. Excellent.
Monday, March 15, 2010
Caveat: Some things are black and white
So the day after I start a blog that is intended to criticize the growing use of cognitive shortcuts, I see an Op-Ed in the NY Times by Ross Douthat that does this very thing:
What Ross was arguing about (and I encourage you to read the whole thing) is that Hollywood, and especially the new Matt Damon action flick The Green Zone, is just being too unfair and unforgiving to the Bush administration and their hawkish friends for the whole Iraq situation. He argues that the anti-Iraq war Bush critics are being too overly simplistic and that a civilized discussion about the decision to invade Iraq should be much more nuanced.
So how could a guy who started a blog called Cognitive Longcuts argue against that, you ask? Well, I think the reaction to Ross' piece from Daniel Larison of The American Conservative pretty much sums it up (the whole body-slam of a take-down is highly recommended reading):
So okay...what does this mean for what I'm trying to accomplish here. Well, it turns out that some things are pretty black and white. In the USA (and other democratic countries, of course) we have a profound respect for the rule of law and our system of justice that protect and uphold the universal rights of all humans. In any political discussion, the notion that you are for this system is a given. It is the very foundation of our country; inscribed in our most important founding documents - the Declaration of Independence ("We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.") and the Constitution ("We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.") These basics are fundamental to our society and are not negotiable.
Now I am going to avoid a lengthy discussion of the legality of the Iraq war (even though I largely agree with those that have concluded that it was illegal according to international law) but instead I would just argue that the invasion and occupation of Iraq along with the whole War on Terror are completely counter to the fundamental principles of liberty and justice. I'll be exploring that topic much more in the future but, for now, I'll let James Madison explain:
So to conclude, too many Ross Douthat's out there may seem like they are all for decreasing the use of the cognitive shortcut so that we can have a more civilized political discourse. Talking heads in the media love to spout about the Fairness Doctrine, which means giving equal time to both Democratic and Republican views (as if those are the only two possible views to have). They worship the idea that the best policy lies somewhere half-way in between these two "reasonable" views. But sometimes the views that some are arguing in favor of are so blatantly counter to our bedrock values and principles as Americans that they should be clearly reminded of that. Some things are black and white.
Our nation might be less divided, and our debates less poisonous, if more artists were capable of showing us the ironies, ambiguities and tragedies inherent in our politics — rather than comforting us with portraits of a world divided cleanly into good and evil.At first glance, you might think that Ross could easily be my wingman in the effort to denounce the use of the cognitive shortcut; to try and stop people from thinking so much in pure black and white terms. You'd be wrong, however.
What Ross was arguing about (and I encourage you to read the whole thing) is that Hollywood, and especially the new Matt Damon action flick The Green Zone, is just being too unfair and unforgiving to the Bush administration and their hawkish friends for the whole Iraq situation. He argues that the anti-Iraq war Bush critics are being too overly simplistic and that a civilized discussion about the decision to invade Iraq should be much more nuanced.
So how could a guy who started a blog called Cognitive Longcuts argue against that, you ask? Well, I think the reaction to Ross' piece from Daniel Larison of The American Conservative pretty much sums it up (the whole body-slam of a take-down is highly recommended reading):
Yes, the problem might be that we do not have artists capable of rendering contemporary architects of a war of aggression that was based on shoddy intelligence, ideological fervor and deceit in a sufficiently subtle, even-handed manner. If only Hollywood were better at portraying the depth and complexity of people who unleashed hell on a nation of 24 million people out of an absurd fear of a non-existent threat! Life is so unfair to warmongers, is it not? Then again, the reason our debates are so poisonous and our nation so divided might have something to do with the existence of utterly unaccountable members of the political class that can launch such a war, suffer no real consequences, and then reliably expect to be defended as “decent” and “well-intentioned” people who made understandable mistakes. The unfortunate truth of our existence is that villains do not have to come out of central casting for comic book movies. They are ordinary, “decent” people who commit grave errors and terrible crimes for any number of reasons. Many great evils have found their origins in a group’s belief that they were doing the right thing and were therefore entitled and permitted to use extraordinary means.Ouch! He goes on to explain that yes, in general, it is important to appreciate nuance and complexity in political arguments but when you are defending an action (i.e., the invasion and occupation of Iraq) that essentially occurred because of one hugely consequential set of cognitive shortcuts ("good vs evil", "with us or against us") based on a completely unfounded fear of non-existent weapons of mass destruction, the whole nuance and complexity point goes out the window.
So okay...what does this mean for what I'm trying to accomplish here. Well, it turns out that some things are pretty black and white. In the USA (and other democratic countries, of course) we have a profound respect for the rule of law and our system of justice that protect and uphold the universal rights of all humans. In any political discussion, the notion that you are for this system is a given. It is the very foundation of our country; inscribed in our most important founding documents - the Declaration of Independence ("We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.") and the Constitution ("We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.") These basics are fundamental to our society and are not negotiable.
Now I am going to avoid a lengthy discussion of the legality of the Iraq war (even though I largely agree with those that have concluded that it was illegal according to international law) but instead I would just argue that the invasion and occupation of Iraq along with the whole War on Terror are completely counter to the fundamental principles of liberty and justice. I'll be exploring that topic much more in the future but, for now, I'll let James Madison explain:
Of all the enemies to public liberty war is, perhaps, the most to be dreaded, because it comprises and develops the germ of every other. War is the parent of armies; from these proceed debts and taxes; and armies, and debts, and taxes are the known instruments for bringing the many under the domination of the few. In war, too, the discretionary power of the Executive is extended; its influence in dealing out offices, honors, and emoluments is multiplied : and all the means of seducing the minds, are added to those of subduing the force, of the people. The same malignant aspect in republicanism may be traced in the inequality of fortunes, and the opportunities of fraud, growing out of a state of war, and in the degeneracy of manners and of morals, engendered by both. No nation could preserve its freedom in the midst of continual warfare.Those words were written over 200 years ago and, yet, today they could not be any more poignant as we are still very much in the middle of a war based squarely on unapologetic deceit and irrational fear.
So to conclude, too many Ross Douthat's out there may seem like they are all for decreasing the use of the cognitive shortcut so that we can have a more civilized political discourse. Talking heads in the media love to spout about the Fairness Doctrine, which means giving equal time to both Democratic and Republican views (as if those are the only two possible views to have). They worship the idea that the best policy lies somewhere half-way in between these two "reasonable" views. But sometimes the views that some are arguing in favor of are so blatantly counter to our bedrock values and principles as Americans that they should be clearly reminded of that. Some things are black and white.
Sunday, March 14, 2010
Introduction
Welcome to Cognitive Longcuts! Here I will explore a wide variety of issues ranging from the sustainable management of natural resources to the recent attacks on the American justice system...from the banking crisis to deeper issues of empathy, humility, and rootlessness.
The name comes from a modification to the more popular "cognitive shortcut", which is what all humans rely on to assist in decision-making when presented with complex information that they cannot easily understand. Too often I see people having their conceptions of reality challenged and instead of embracing the challenge and being free to change themselves, they just take the easy way out and use a generalization or stereotype to whole-handedly dismiss this new conception. Sometimes it's just too mentally exhausting to change your preconceptions in the face of a new reality. We all do it.
But I feel that today in many corners of America, the use of the cognitive shortcut has been increasing and has left us even more inadequate at solving the critical problems of our time; whether it is due to the swirling echo chamber of the internet where anyone's preconceptions can be constantly reaffirmed or the lack of knitting communities of diverse and respectful people.
My goal in this blog endeavor is to try and avoid taking the cognitive shortcut and instead taking the cognitive longcut; recognizing that very few issues are black and white.
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