Health Care Proposals

As the various Republican candidates attempt to invoke the spirit of Reagan and be tougher than ever with terror suspects, the Democratic candidates seem to be pitching health care reform. The proposals so far seem to be cautious, perhaps based on Hillary Clinton's experience with the health insurance lobby and its intensive misinformation campaign during the early days of her husband's presidency. Fear of the major health insurance companies does seem to be at the heart of the candidates' timidity. Proposals to effectively force statewide or national group rates would require a significant population of insureds, so as to spread risk, making it difficult to impossible for small insurance companies, or regional insurance companies operating in more expensive health markets, to compete. Similarly, mandating that a basic set of services be covered would likely take the profit out of the high margin, low service plans many companies currently offer to the self-employed.

I personally believe that individual mandates, where each individual is required to purchase health insurance from a set of approved plans, are foolish. They seem designed primarily to avoid including in the federal budget the actual cost of a national health plan, while adding an unnecessary level of bureaucracy to the system. They would create problems for individuals who suffered cash-flow problems, and thus were unable to pay their premiums - something likely to happen when, for example, when a self-employed persons business dips or a family member suffers a major illness. The continued tie of most health coverage to employment perpetuates the same type of problems in the event of illness or unemployment. Would the plans cut off health benefits if somebody was unable to meet the mandate? Would there be what amounts to insurance to cover health insurance premiums under such circumstances?

What would make more sense would be to offer a set of health care options in the same manner as employers - here are your options, here's what they cover, here's your out-of-pocket cost if you want more than the basic plan offers. Offer annual "open enrollment" for plan switching. Use the existing tax system to collect premiums and to determine eligibility for subsidies, even if you classify any additional payment a "premium" as opposed to a "tax". Ensure continuity of coverage, even if at the basic level, despite job loss or a missed premium - figure out if additional monies are owed at tax time.

Insurers should have to compete with the public plan. If private insurers are as superior as their proponents contend, that shouldn't be a problem. If not, why should working people be forced to subsidize their waste and inefficiency?

One approach not yet suggested by a candidate which, at a national level, is not unreasonable is to announce to the states, "As of Date X, you are to have a health care plan that provides universal coverage to state residents, covering (at a minimum) this specified set of services," tied to various federal grants and subsidies. Let states fashion their own solutions within those parameters, and see what works. Federalism... what a crazy idea.

I've Been Spammed By... Yoda?

I find it hard to believe that this type of "sales pitch" works:

Self employed can be you

But as has been pointed out many times, if you send out a million spam emails, you don't need a very high response rate to make money.... (There's a sucker born every minute, and they're contributing to the mess in my inbox.)

Religion Is Great... If You Keep It Secular

That's the message David Brooks seems intent on conveying in his latest column, The Catholic Boom:

Quasi-religious people attend services, but they’re bored much of the time. They read the Bible, but find large parts of it odd and irrelevant. They find themselves inextricably bound to their faith, but think some of the people who define it are nuts.

* * *

In fact, if you really wanted to supercharge the nation, you’d fill it with college students who constantly attend church, but who are skeptical of everything they hear there. For there are at least two things we know about flourishing in a modern society.

First, college students who attend religious services regularly do better than those that don’t. As Margarita Mooney, a Princeton sociologist, has demonstrated in her research, they work harder and are more engaged with campus life. Second, students who come from denominations that encourage dissent are more successful, on average, than students from denominations that don’t.

That latter point probably weighs in on the much-ballyhooed survey which shows that college faculty are more inclined to have cool feelings toward Evangelical Christians and Mormons. Perhaps it's not so much about religion, but instead reflects classroom experiences where students were resistant to or intolerant of different viewpoints.

The increasing proportion of religious conservatives on college campuses has brought problems in the classroom and in residential life, particularly in secular universities. Sectarian and fundamentalist Christians often come to college with little or no preparation for understanding or tolerating ideas which confront their beliefs, or interacting with people who do not share their opinions. The focus on religious explanations for all manner of phenomena in fundamentalist communities does not conform to the standards of secular education (Hood et al. 2005). The focus on religious sacred texts as the only source limits the cognitive complexity of thought (Hunsberger et al., 1994, 1996; Sherkat 2006), which may well lead to poor performance and exacerbate conflict with professors.

* * *

In many disciplines, the scripturally based orientations prevalent among conservative Christians may give them a considerable disadvantage in coursework because it lowers the complexity of thought (Hunsberger et al., 1994,1996). Young fundamentalists are convinced that they know the “Truth” and that perspectives which deviate from the scripted narratives of their tradition are not only false, but potentially heretical. Critical argumentation about issues in politics, history, ethics, or sociology is difficult for fundamentalist Christians, since they believe that biblical pronouncements are not only necessary explanations, but also sufficient.

This interpretation is consistent with what Brooks argues in relation to Catholicism - that Catholics have fared better in American society as their views "began to converge with Protestant values" and as "They raised their children to value autonomy more and obedience less".

Brooks makes a novice's error of logic when asserting that because church attendance is correlated with better academic performance, other students' academic performance would improve if only they attended church. I doubt that I need to elaborate on this point, but just in case... while correlation is necessary to establish a causal relationship, it is not sufficient to establish causation. Also, my college experience is replete with examples of brilliant, high-performing students who never set foot in a church. Does Mr. Brooks believe that church attendance would have further improved their performance? That they are irrelevant to his "analysis". What of church-going underperformers? Brooks would have us assume them too dogmatic? Also, although Brooks doesn't mention this, there's more to the picture than church attendance:

Most studies of the effects of religion on college success focus on personal religiosity or on religious participation, and these indicators are likely to produce positive effects. In contrast, more sophisticated longitudinal research shows that sectarian religious affiliation and biblical fundamentalism—beliefs in the inerrant truth of religious sacred texts—have a substantial negative effect on educational attainment (Darnell & Sherkat 1997; Sherkat & Darnell 1999; Glass & Jacobs 2005). Sectarian affiliation and biblical fundamentalism have an especially negative impact on the educational attainment of women (Sherkat & Darnell 1999; Glass & Jacobs 2005). In sectarian and fundamentalist religious communities young women are expected to marry early, have many children, and be primarily responsible for childcare (Roof & McKinney 1987; Sherkat 2007). Even if young sectarian and fundamentalist people choose to attend college, sectarian and fundamentalist Christians are more likely to choose religious colleges, which have fewer options for majors, lower prestige, and are more costly. Finally, the narrowing of social networks and the restriction of information sources advocated in sectarian and fundamentalist religious groups is associated with smaller vocabularies (Sherkat 2006), which can undermine academic success.

I suspect Brooks is familiar with those studies, but chooses not to directly address their implications.

Brooks seems to be arguing for spirituality but against religiosity. He argues that there's a societal benefit in being religious, as long as you are quick to reject religious teachings and doctrine whenever they trigger feelings of skepticism. Given his recent history of platitudinous prosaisms to the "family values crowd", I suspect his suggestion that "We would be smarter (or at least do better in school) if we all went to church" is a fig leaf, offered to disguise what is otherwise a column favoring humanism over religion.

Dental Phobia

A random thought for the day....

Does fear of dentists highlight one of the many peculiarities of the human mind? When somebody has dental pain, perhaps letting a tooth become abcessed, before seeing a dentist, they suffer through a type of chronic pain that is far more prolonged than they would experience by obtaining prompt dental care. They will often require a more invasive dental procedure, have more discomfort during that procedure, and have a more complicated recovery... which, rather than convincing them to never again delay proper dental care, probably contributes to their phobia.

Platitudes

On the heels of marriage as "the best educational institution we have", addressing immigration policy, David Brooks offers us this gem,

People who qualified could bring their nuclear families with them, since families are the foundries of responsible behavior.

This creates some question about his prior objection to current immigration policies,

Under our current immigration system, most people get into the U.S. through criminality, nepotism or luck. The current system does almost nothing to encourage good behavior or maximize the nation’s supply of human capital.

Perhaps in his world, the term "nepotism" doesn't involve the favored treatment of relatives?

For that matter, I wonder if he deems migrant farm workers to be "criminals", beneficiaries of "nepotism", or "lucky"... After all, more than a million are presently legally in the United States, and together with their undocumented brethren they comprise more than half of the nation's population of farm laborers. Typical wages? $7,500 per year for an individual, or $10,00 per year for a family.

Your Daily Dose of Outrage

In case you feel the need to shake your fist angrily at your monitor....

• At Crime and Federalism, Mike explains why an insurance company would prefer to pay life insurance proceeds to a murderer rather than excluding him as a beneficiary; and

• If you're in the U.K., watch where you point your Lara Croft doll....

• When you give somebody psychotropic medication and they get worse, maybe it's the medication....

Human Capital

A recent column by David Brooks, A Human Capital Agenda, left me a bit perplexed. He endorses as "conservative" a slate of ideas not traditionally associated with conservativism, tosses in a platitude or two to appease the "family values" crowd, and embraces the Horatio Alger myth in defense of inequality. I know he calls himself a conservative, but what does he believe that means?

He embraces Bush's early endorsement of "compassionate conservativism", an idea that never got off the ground, as a "masterstroke [that] should be instructive to anybody running for president today." I could sarcastically ask, "Who says they haven't noticed? Find me a candidate who isn't spouting a load of nonsense that he or she doesn't actually believe." But Brooks seems sincere in this call for conservative populism. He continues in his column with a call for better investment in public education, including the provision of quality daycare for the children of "disorganized single-parent homes". (I guess organized single parents and disorganized "intact" families will have to continue to pay their own way.) To make this call "conservative", he endorses school vouchers - who cares that there is no evidence that, on the whole, they provide any meaningful benefit to their recipients.

He also endorses an expanded wealth transfer from the rich and middle class to the poor in the form of "increasing child tax credits to reduce economic stress on young families". And in almost ths same breath he deplores "liberal populists" who believe in "redistribution policies".) He obviously doesn't consider himself to be a liberal populist, but he tells us, "Conservatives and independents do not" believe in redistribution policies. So again, what does that make Brooks?

Brooks presents the platitude, that his human capital agenda "means encouraging marriage, the best educational institution we have". Sure. Let's shutter the schools, marry preschoolers to each other, and we'll have the best educated society in world history. I would ask what Brooks is thinking, but with the possible exception of "this prattle will make some of my less thoughtful, 'family values' readers happy," he obviously isn't.

Brooks also advances this idiotic caricature:

Liberal populists believe the global economy is so broken all the benefits of it go to the top 0.01 percent. Independents and conservatives observe that hard work still leads to success. Liberals emphasize inequality. Moderates and conservatives believe inequality is acceptable so long as there is opportunity.

In the 1980s, Republican supply-side policies helped spur investment. Today, the world is awash in money. That’s not the problem. Instead the shortage is in people to invest in.

Gee... So the reason that wages aren't rising for the poor and middle classes has nothing to do with the nature of our system. It's that they don't work hard enough, and aren't a worthy "investment." Brooks ovestates his case - not every independent or conservative is as quick to lock Horatio Alger into that type of bear hug.

Sick Days For The Working Poor

A while back, Bob Herbert proposed what seems to be a most equitable idea, guaranteeing "sick days" for all workers:

It sounds reasonable: seven paid sick days a year. Why should you have to lose a couple of days pay, or maybe even your job, because you had the misfortune to catch the flu?

* * *

The reality, for a surprising percentage of the U.S. population, is more like the 19th century. Nearly half of all full-time private sector workers in the U.S. get no paid sick days.

He is unimpressed with the Cracker Barrel Old Country Store's response to this idea:

A spokeswoman said in an e-mail message: “Because employees working in the restaurants have flexible schedules, they can schedule doctors’ appointments and other appointments that sick leave and personal time are generally used for at times when they are not working.

“If employees need to miss a shift due to illness, there are generally many opportunities to make up that lost shift later in the week, or the next week.”

As somebody who once managed a food service establishment, I think the issue is a bit more complicated than Mr. Herbert recognizes.

Within the context of food service and similar jobs, there is a great deal of flexibility in the scheduling of shifts, and it is possible for employees to see doctors on the days they aren't working. It's not an office setting where the doctor has few, if any, office hours outside of your standard work day. It is not unreasonable for employers to expect their employees, when possible, to schedule medical care at times which will not cause them to miss work. But that's more of a quibble than a criticism.

My experience tells me that if you give low-wage workers sick days, you will create a context which may be worse than the status quo. I can recall covering many shifts for workers who called in "sick" at the last minute, most often between Friday afternoon and Monday morning. Most, of course, weren't actually sick. The best way to minimize this effect was to allow employees to trade shifts, which gave them the best of both worlds - the time off that they wanted, with no loss of income. If they had received "sick days" which would have paid for their missed shifts, the incentive to trade shifts would largely disappear. Also, I know that some of my employees would have worked while sick, either because they would be trying to "save" their sick time or because they had exhausted their sick days early in the year. For that matter, some have a strong sense of duty. Does it surprise anyone that even in low wage jobs, there are workers who will drag themselves into the workplace to avoid leaving their colleagues short-handed? (A good employer, of course, identifies the situation and sends them back home.)

To avoid paying double - the wages of the employee called in to cover the shift plus the "sick pay" to the employee who missed work - pressure would have come on me from above to end my liberal policy of taking the employee at his or her word, and employees would likely have been required to medically document their illness. Workers who get no sick days are not particularly likely to have good (or, for that matter, any) health insurance - so they get sick days, but in many cases it would cost them more to take (and medically document) sick leave than they would receive in sick pay.

I doubt that a legislative initiative which forbade employers from requiring medical verification would pass. If it did, it would effectively transform the sick days into "personal days" or "vacation days". That wouldn't be so bad, actually, and would perhaps be more consistent with how many workers would actually use their sick time.

After All, We Can Only Lose If We Don't Win....

In yesterday's Column, The Insurgent Advantage, David Brooks reviewed a book, John Robb's Brave New War, in a manner which I hope doesn't reflect the actual conclusions of that book. The points he actually attributes to Robb make a lot of sense:

Robb observes that today’s extremist organizations are not like the P.L.O. under Yasir Arafat. They’re not liberation armies. Instead, modern terror groups are open-source, decentralized conglomerations of small, quasi-independent groups.

There are between 70 and 100 groups that make up the Iraqi insurgency, and they are organized, Robb says, like a bazaar. It’s pointless to decapitate the head of the insurgency or disrupt its command structure, because the insurgency doesn’t have these things. Instead, it is a swarm of disparate companies that share information, learn from each other’s experiments and respond quickly to environmental signals.

For example, the U.S. has spent billions trying to disrupt attacks from improvised explosive devices, but the I.E.D. manufacturing stream has transmogrified and now includes sophisticated metallurgy, outsourcing and fast innovation cycles. The number of I.E.D. attacks has remained pretty constant throughout the war.

By engaging in "system disruption", such as by bombing oil pipelines, the insurgents get a significant return with a modest financial or "miliitary" investment. Robb argues that these groups do not seek to overthrow states, but to weaken them and cause the collapse of law and order, while maintaining a level of conflict below what their target states might deem an existential threat. This supposedly inspires target nations to "try to fight wars on the cheap, and end up in a feckless semibelligerent state somewhere between real war and nonwar." (Is that what Brooks sees in Iraq? The U.S. military fighting a war "on the cheap"?)

If the Iraqi insurgents defeat the U.S. then every bad guy on earth will study and learn their techniques. The people now running for president will find themselves in bigger heaps of trouble than the current one now is — trouble that this presidential campaign hasn’t even dealt with.

As Israel's recent experiences in Lebanon indicate, you don't have to be in a shooting war with your enemy, nor do you have to be defeated on any battleground, for "extremist organizations" to learn from your tactics, devise strategies against you, and implement those strategies in the field. Brooks himself seems to acknowledge that the learning and adaptation is a constant process, and has occurred throughout the time U.S. forces have been in Iraq. If Brooks truly believes that the danger is in teaching the insurgents how to implement effective strategies against U.S. forces and interests, staying in Iraq may be the worst option. They stop learning from us the day we go home.

If Brooks' earlier comment about fighting wars on the cheap is meant to be applied within the context of Iraq, take an objective look at the manpower invested in the battle. Take a look at the commitment of armament. If that commitment is not sufficient to crush an insurgency led by these loosely knit "extremist organizations", how many nation states can be reasonably said to have sufficient resources to do so? (At about $100,000,000,000 per year, the annual cost of the war exceeds the GDP of more than 100 nations.) I suspect that if you look at the nations which have successfully put down similar "extremist organizations" or grassroots resistance to occupation, you will find that it in most cases it was not the investment of overwhelming military might which led to their successes, but instead that it was brutal, ruthless tactics. Things that even post-911 America would quickly recognize as atrocities and "war crimes".

It may be that a more expensive invasion and occupation force would have been able to suppress the insurgency and maintain public order, while an effective government was constructed for post-war Iraq. Fundamentally that would not have been a "military victory" over these groups - it would have been the manifestation of sufficient military force that they choose not to act, while a political state was constructed which had sufficiently broad support that at the end of the day they could not maintain a sufficient body of fighters to engage in a meaningful "insurgency." Given the realities of Iraq, I'm not sure that would be possible while maintaining a unified state. But the necessary investment would have made the current effort appear to have been conducted "on the cheap".

Energy Policy As A Precursor To Withdrawal From Iraq... Is That An 800 Pound Gorilla....

Or is it a pygmy marmoset? Either way, in Only Halfway There Thomas Friedman is concerned that the Democrats haven't taken due notice.

To call for withdrawing from Iraq by a set date, no matter what the situation is on the ground there - without a serious energy plan here - is reckless. All we would be doing is making ourselves more dependent on an even more unstable Middle East, because any U.S. withdrawal from Iraq is likely, in the short run, to be destabilizing.

Should I give him credit for departing from other pro-war pundits by no longer arguing that it is reckless, per se, to advocate for withdrawal from Iraq? Or should I observe that he was one of the many enablers of this war, despite its being reckless to have entered the war without a competent plan for at least establishing stability in post-war Iraq. Should I joke that the least he can do is offer the Democrats another six months to formulate the withdrawal plan?

Friedman suggests that we need an energy policy which unchains us economically from the Middle East, and he suggests that policies which bring down the price of oil will bring about positive change in the Middle East by forcing its leaders to "extract the talents of their people by educating, empowering and connecting them." That's a wonderful platitude, but if we look to world history, where exactly do we find the developing nations, poor in natural resources, which do as Friedman describes? Unless the form of extraction he suggests is the extraction of people with marketable skills to work in more developed nations - as with the extraction of nurses and other health professionals from African nations to staff hospitals in Europe and North America.

But to hasten that day, Democrats have to be a lot more serious about energy than they have been up to now. Everyone has an energy plan for 2020. But we need one for 2007 that will start to have an impact by 2008 — and there is only one way to do that: get the price of oil right. Either tax gasoline by another 50 cents to $1 a gallon at the pump, or set a $50 floor price per barrel of oil sold in America. Once energy entrepreneurs know they will never again be undercut by cheap oil, you’ll see an explosion of innovation in alternatives.

Everybody has a plan for "five years from now" or ten or twenty, because our system all-but-ensures that nobody will have to take responsibility for the enactment, success or failure of such a plan. Any President proposing change "in five years" knows that he will either be reelected or out of office when the target date arrives.

The idea that any party will embrace as part of their platform, "We want to increase the tax on gasoline", is absurd on its face. Embracing a regressive tax that hits the pocketbooks of poor and middle class voters once, twice or three times per week? That's a formula for losing elections. There was a point, immediately after the 9/11 attacks, when the Bush Administration might have been able to create such a tax while maintaining popular support. But that would have threatened their overriding agenda of slashing taxes for the wealthiest Americans, and the Bush Administration has never had the slightest interest in energy conservation. ("Conservation may be a personal virtue, but it is not a sufficient basis for a sound, comprehensive energy policy." Dick Cheney, 2001.) Have we completely forgotten the secret energy policy meetings that Cheney held with energy industry executives, and the hard-fought court battle he ultimately won to keep their identities secret? Apparently so....

Setting a $50 minimum price per barrel for oil sold in the United States.... how does that do anything but ensure that nobody will offer oil for sale to the U.S. market at a price of less than $50/bbl? How does that encourage alternative energy, as opposed to the exploration of oil in regions traditionally deemed too marginal for drilling, or the further development of projects to extract oil from tar sands? How does that affect the monarchs and potentates of the Middle East, which can do just fine, thank you very much, with profits on oil at $50 or more per barrel?

In developed nations where there is a significantly higher tax on gasoline than in the United States.... which, I believe (save possibly for Russia), is all of them, where are the alternative fuel technologies which Friedman believes should have emerged years or even decades ago? Is Thomas "The World Is Flat" Friedman suggesting that only American scientists can develop alternative energy techologies? That American scientists cannot see any long-term profits in alternative energy, and thus won't focus on the problem unless we manipulate market forces?

I find it very interesting that Mr. Friedman struggles with the idea of supporting a Democratic Party which does not have a solid plan for Iraq, but has no trouble giving a Republican Administration incredible latitude in formulating any sort of policy for victory in that war. It would be insanity, after all, for Mr. Friedman to endorse doing the same thing over and over again while expecting a different outcome, which is no doubt why he has historically endorsed doing the same thing over and over again only in six month increments. Let's call it "hoping" for a different outcome. I find it interesting that he has thrown his literary weight behind an administration which opposes conservation and alternative energy (save possibly for nuclear power plants and subidizing the manufacture of corn ethanol, to the extent that either of those policies can truly be deemed "alternative"), but expects serious policy only from the Democrats.

Friedman has to know that President Bush detests "the soft bigotry of low expectations", so why is he being so disrespectful of the President?

Birds of a Feather

Andrew Sullivan suggests that fellow know-it-all Christopher Hitchens may be wrong in relation to Karl Rove being a non-believer.

Who knows Rove's religion best, do you think? Fred [Barnes] or Hitch?

Dare I say, Karl Rove knows Rove's religion best. Rove has ready access to the world's media, and is more than able to speak for himself.

Exporting Culture

In The Human Community, defending Tony Blair's legacy, David "Babbling" Brooks strikes again:

Over the past three years, people on the left and right have moved away from Blair and toward Huntington. There has been a sharp rise in the number of people who think it’s insane to try to export our values into alien cultures. Instead of emphasizing our common community, people are more likely to emphasize the distances and conflicts between cultures. Whether the subject is immigration, trade or foreign affairs, there is a greater desire to build separation fences because differences in values seem deeply rooted and impossible to erase.

Oh, come on. As if we're truly talking about "exporting culture". The wacky leftist weirdos in Hollywood (and their wacky, right-wing parent companies) have had no problem exporting American culture, and profiting handsomely at the same time. Every indicator is that they would like to increase this trade. We sell, they buy. A Starbucks on every corner worldwide, right across from the McDonalds.

What Brooks is talking about is "export" at the point of a gun. Even if you interpret Iraq sympathetically, assuming that Tony Blair truly did believe the "We'll be greeted as liberators, and showered with flowers and candy" line, surely that would raise some concern in your mind - destroying a foreign nation's government and much of its infrastructure as a first step in transforming it into a progressive democracy? Imposing neoliberalism, privatization, a flat tax, and other western constructs at the outset, without even examining if those constructs are consistent with what we would do at home, let alone how they would be received by those subjected to the "reforms"? (We're now exporting not our culture, as such, but what certain right-wing elements would prefer our culture to be?) And then we get to the fact that the occupation and "reconstruction" has been botched in a manner that many war proponents now concede has all-but-doomed the project to failure.

History will not be kind to either Tony Blair or George Bush in relation to the Iraq war. If the project cannot be salvaged, they will be blamed for getting us into Iraq. If the project can be salvaged, their successors will be credited with fixing the current mess.

To the extent that those who joined with Bush and Blair in a video game fantasy war which, not surprisingly, turned out to be a lot more complicated than they had anticipated? Their increased skepticism of similar interventionism can only be regarded as a good thing. To the extent that the Iraq war makes it harder to intervene in a nation where intervention could truly be helpful? That's not the fault of those now reacting to the mistakes of Bush and Blair - it is the fault of Bush and Blair.

Opposing Universal Health Care On The Basis That It's A Service?

Over at MedRants, Dr. Centor has posted an essay suggesting that universal health care is wrong because it involves the provision of services as opposed to, for example, guaranteeing a freedom.

The essay first asserts that recognizing a right to services would be a "positive right", with a finite supply of service providers unable to fulfill an unlimited demand. I don't dispute that, but it is no different from any other service we expect from government. For example we expect the government to provide police and fire services, but nobody realistically expects those services to be without limit. The notion that we would not impose any limits whatsoever on health care is a red herring - no nation, no matter how broad their national health plan, provides unlimited health services, and I have yet to see a serious health care proposal which calls for unlimited services.

The essay next asserts that to recognize a right to health care services would depart from traditional notions of morality.

We acknowledge an obligation to help the needy, but that obligation is unconditional only in certain circumstances: with family-members, people we have previously agreed to help, or certain kinds of immediate need that appear in our presence—such as the child drowning in a puddle as we’re passing by. If we had more general obligations to aid strangers that were absolutely unconditional—if we HAD to give our money to the street-person asking for it once we confirmed that he needed it to gain something he had a right to—our own negative rights to choose what to do with what is ours would be nullified; a conclusion most of us could not accept.

This argument is again a red herring, given that we already extend significant benefits to the poor through a wide range of government programs. It also confuses legal duty with moral duty. While we may not have a legal duty to assist anybody with whom we do not have a status relationship, we traditionally have recognized broader moral duties. Consider, for example, the long tradition of provision for the poor as practiced through religious institutions, whether through food aid, shelter, counseling, legal assistance, or (yes) charitable hospitals. My grandparents took considerable pride in the fact that their church would provide food, clothing and shelter to any passing vagrant who made the request, without any further regard for whether that person was "deserving" of the charity.

At its heart, this argument is that the poor are undeserving of medical care - that if you can't get good health insurance coverage from work, and can't afford to pay out of pocket, you should suffer through whatever health consequence comes your way. That's not good public policy given the possibility of contagion, but also because of the fact that if you create a context in which the poor cannot get treatment for disabling, debilatating, degenerative, or disfiguring conditions, you all-but-guarantee that they and their families will remain impoverished.

The author does recognize a "a conditional and limited duty to help" the needy, but in such a way that service providers are unaffected. That is, his greatest fear seems to be that any national health plan "not to endanger production and nullify the negative rights of producers" - which I read as a somewhat nuanced way of saying, "If you do this, make sure my salary doesn't go down." And at its heart, that seems to be author's fear - that a national health care plan will result in lowered physician compensation as one of the mechanisms of broadening supply while containing cost. Our "private" system already does this, as do Medicare and Medicaid - most medical care is provided within the context of that false market, with the insurer negotiating or dictating rates paid for particular services, so apparently the concern is one of degree.

I note that this doctor is silent in regard to the common practice of billing uninsured patients significantly more for the same service than would be paid by an insurance company. Can anybody point me to a similar physician's lament of national health care, which also acknowledges the unfairness of a system in whcih the poor, uninsured and underinsured often pay more for health care than wealthy, insured people "pay" (through their insurance)?

Watching What You Say....

The conventional wisdom is correct: When you have a two-year-old, words you use in front of your child can quickly come back to haunt you. So, as much as possible, I attempt to moderate my language. Not that I'm claiming to have reached a point even close to perfection, but I try not to make any comment more offensive than, "Come on, Loser".

A couple of days ago when I was stopped at a red light, with no car in front of me, I heard a little voice come from the back of the car. "Come on, loser!" "Is Daddy a loser," I asked. "Yes." (I got a good chuckle out of that.)

The next day we were stopped behind another car. Again I hear, "Come on, loser!" An opportunity for a teachable moment? Let's see how well I did:

"Emma, you know how when people do something that isn't nice you like to tell them, 'That's not nice'? Well, calling people 'losers' isn't nice. So when you hear Daddy say, 'Come on, loser", I want you to say 'That's not nice'. Do you understand?"

"Yes."

"So if I say, 'Come on, loser', you say 'That's not nice'."

"Okay."

Emma then addressed the car that remained stopped in front of us, "Come on, loser - that's not nice!"