Avik Roy was on Up with Chris Hayes this morning. He is something of a healthcare expert. But you know what “expert” means when it comes to a conservative: effective apologist for the status quo. And he didn’t miss a beat this morning. He started right out cherry picking studies that showed that having Medicaid is worse than having no insurance at all. Hooray for the broken US healthcare system!
The problem, of course, is that Roy and his corporate friends don’t think, “Medicaid has problems, let’s fix it!” Instead, it is, “Medicaid has problems, let’s kill it!” This is what you get when your guiding philosophy is that the poor are morally repellent and so should just be allowed to die. (This is not an unfair characterization. Conservatives want the poor to just go away. I’m not suggesting they want to do it with a gun. But depriving them of healthcare is the same result by different means.)
Last week, Roy and Douglas Holtz-Eakin wrote an article for Reuters, The Future of Free-Market Healthcare. In it, they claim that maybe Obamacare isn’t that bad, but they would like to make some changes that will make it truly a free-market system. And so they pull out Switzerland and claim that we should be more like them.
Aaron Carroll, the medical economist, took them to task on this argument. He concludes, “I don’t think the Swiss health care system is what they think it is.” They claim that the Swiss system is better because it doesn’t have a public option. This doesn’t make any sense at all. First: neither does the United States! How does that make it more free-market than America? What’s more, Carroll points out that they are wrong on this point even still. The Swiss system requires private insurance companies to provide non-profit healthcare products. In other words, “Yeah, they effectively have a public option.”
Next, the dynamic duo claims that the Obamacare state exchanges are terrible because they are “larded with costly mandates and regulations.” Carroll really doesn’t like this bit of chicanery:
There are other problems. But the biggest problem is their claim that the Swiss healthcare system is cheaper than the American system because—Wait for it!—it is more free-market. Carroll points out that it is cheaper because doctors get paid about half as much there. On top of this, Paul Krugman reported that they were greatly underestimating the cost of the Swiss System, because so much of it is private. This is an old conservative claim: if we don’t pay for Medicaid, we’ll save money! Well, the government will save money; the country will end up paying far more.
Look at the following graph from Krugman’s first article about the Holtz-Eakin and Roy paper:
Do you notice something interesting in this chart? The only country that pays more for their healthcare than Switzerland is the United States. And despite this, Switzerland is ranked 20th by the WHO.
Take a moment to think about this. Avik Roy and all his pals are committed to a particular form of healthcare. What works well is not the issue at all. The only thing that matters is to keep corporate profits high. Note: this isn’t about giving the rich the best healthcare available. They will always have that. Even in countries like France, the rich can still buy private insurance. The problem from the standpoint of Roy is that all his buddies might make a few dollars less. And when you compare a couple of dollars in profit for the already wealthy to tens of millions of people without access to healthcare, the conservative answer is clear: the dollars matter far more than the people. Because, hey, the people are poor; they don’t matter at all.
Update (23 February 2013 4:12 pm)
In the segment Now We Know, Avik Roy talks about how even with Obamacare there will be 30 million people without healthcare. As I recall, it is now looking like it will be a lot less than that. The main problem is that there will be a lot of people who will qualify for it, but won’t know it. Regardless, when Roy said that, he seemed like he was going to burst out laughing. I often have conversations with conservatives who now complain that Obamacare is (1) too complicated and (2) non-universal. This is rich! It is exactly because of conservatives like Avik Roy that we have a system that is (1) too complicated and (2) non-universal. At this point, it seems that Roy is thrilled that his dastardly plan worked so that he now has a “multi-year project for us to try to make the case to conservatives that actually universal coverage is the path to getting our fiscal ship in balance.” I’m sure it will be very lucrative at the same time it won’t provide a single person with healthcare.
It’s not that they want the poor to go away. They want the poor to be here, forever, and forever poor, so that they are forced by necessity to pay for whatever meagre social services the worst of the worst of predatory corporations provide. (Preferably by taking out loans at an astronomical APR.)
It’s the old economic case of the "free rider." If everyone pays their train fare, train fares are low for everyone. If one rider hides in the bathroom when the conductor comes by (note: when robbed and broke once in NYC, I did this on the LIRR), that person gets a free ride without unduly taxing the carrying capacity of the system. If everyone tries to get a free ride, nobody is contributing to necessary maintenance costs, and the system collapses.
One company can pay its workers nothing and still make a profit from consumers with money to spend. If they all do it, no workers have any money to spend, and we’re utterly fucked. Of course, now, we’re currently and utterly fucked.
What’s quite amusing about modern conservative ideology (and I have to find something amusing in it, or reading about assholes defending our health-care system might send me into terminal paralysis) is that it worships the free rider in some ways but not others.
It celebrates the company which torpedoes social cohesion via low wages as "innovative." But it hates urban crime, largely based on the illicit drug trade. What is urban drug trade? It’s people who don’t want to work for low wages making money by becoming "free riders" — by taking advantage of the fact that policing every illegal drug sale is impossible. Why not make a quick buck by gaming the system? (Obviously it is dangerous to do so, etc., but I think the parallels to corporate America are pretty clear.)
Conservatives want, since I can’t think of a better analogy right now, to have their cake and eat it too. They despise regulations that make free riding impossible. They want to take as much money from consumers with no other options as is humanly possible. And yet they get outraged by urban crime — even offended by how drug dealers announce their prominence by displays of "bling" like diamonds and swank living arrangements (surely less common in real life than they are in rap videos.)
The one is a product of the other. If you worship at the feet of Goldman Sachs, why not worship Notorious B.I.G.? At least B.I.G. gave us "Somebody’s Gotta Die," which I listened to on repeat twelve years ago watching Wall Street towers burn because crazies bombed them. Goldman has no such catchy tracks of which I’m aware.
@JMF – Servants aren’t "the poor"; they are "the help." And the rich want them to disappear just as soon as they are off work. They certainly don’t want to be bothered with their demands for healthcare and food. In the houses one sees in (for example) [i]Downton Abbey[/i], they were designed so that the upstairs people never had to see the downstairs people except when they were needed. And even then: fireplaces in rooms were supposed to be lit without waking the sleeping rich person. Light the fire and get out before they see you!
I think it is best to remember that human psychology is such that we convince ourselves that we deserve whatever we have. The rich truly believe they are better than the poor–in a moral sense. There isn’t drug crime because of the senseless laws. There is drug crime because the poor are immoral.
This is also how those in power thought it is right and fitting to bail out the banks. But when it came to refi home owners, these same government officials were really concerned that they were going to set a bad example. They didn’t have to worry about setting a bad example for the rich bankers, because they [i]knew[/i] the rich were moral, unlike the prols who were under water in their mortgages.
Timothy Egan had a nice article on "Downton" and social mobility, here:
http://opinionator.blogs.nytimes.com/2013/02/14/downton-and-downward/
His point is that upstairs/downstairs notwithstanding, rich and poor in 1913 England had more contact with each other than they do in 2013 America. I know very little about 1913 England, but the observation on 2013 America strikes me as accurate.
Egan also wrote an excellent book on the Dust Bowl called "The Worst Hard Time," well worth checking out.
Thanks as always for tolerating several months’ worth of rants . . .
@JMF – I wrote an article a while back about how it is more unequal in American today than it was in Russia before the revolution. The rich today have their own worlds to live in.
Did you ever see the short film [i]The Psychic Parrot[/i]? In it, the parrot (who has never been wrong) predicts that the earth will blow up at a certain time in the future. All the rich and powerful get in a rocket and set up a moon colony. The last scene is of the TV when Psychic Parrot appears saying, "I was wrong! I was wrong!" And then we see the moon blow up.
Maybe it is best to let them have their own places.
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Talk soon!