Once Again, The Right Works the Ref

Wasn't expecting the "ref" to ever be Ezra, of course, but then he goes and shuts down a liberal/centrist mailing list because conservatives lost their shit over it.

That this will not mollify them should go without saying. That much is clear from seeing the fine collection of hypocritical mouthbreathers in the comments who scream about "POST LIBERAL BIAS" while letting throwbacks like Hannity and Limbaugh or Krauthammer pass with a chuckle and a smile.

But, then again, he's a Post reporter now. It wouldn't be the Washington Post if it didn't roll over and show its belly at the slightest Republican whine, now, would it?

Edit: Not that I was ever really a fan of Journolist. It started as a collaborative project with Joe Klein, and that never bodes well. It was probably always doomed, too, since "privacy" on the Internet between people using their real names is about as solid and weighty as a desert cloud. It was likely to be shut down sooner or later.

But damn, Ezra, you didn't need to feed the wildlife when you did it. I mean, you helped give aid and comfort to Jeffrey Goldberg. That should be some kind of misdemeanor offense.

Still Disappointed in Ezra (Edit: Reps on the Line)

...who seems not to understand what a merger is. Or collusion, for that matter.

Yes, Ezra, competition would reduce the extent to which insurance companies gouge their customers under a system of mandated insurance. But mandated insurance would provide enormous incentives for collusion and monopolization, so much so that it would almost be required to merge under simple fiduciary responsibility. And remember, they aren't going to be subject to anti-trust laws. That got taken out.

He also points out the "cadillac tax" and exchange regulators as agents who could keep prices down:

But the exchanges actually have a fail-safe solution, too. Rewind the tape to BCBS's decision to jack up premiums. Imagine that BCBS insures 420,000 people in California's exchange. As directed by law, they duly submit a notice to the Exchange Board saying they're increasing premiums. The exchange sends a letter back noting that underlying health-care trends don't justify that increase, which they're allowed to do under the law. BCBS says it doesn't care. The exchange, which doesn't much feel like being bullied, says fine, you're decertified. BCBS loses more than 400,000 customers, and has to reapply the next year.

And then, of course, there's the excise tax. Jack up your prices enough and suddenly you're paying a 40 percent surtax on the plan you're offering. Now you're way more expensive than the competition, and you're hemorrhaging customers.
Health-care reform isn't creating a monopoly market. There are other industries where people need to patronize some for-profit company. Food, for instance. But if there are a variety of companies competing for customers, monopoly problems don't emerge.

Two problems with that. First, there is no definition here on what is or isn't "justified". I suppose the exchanges will have to determine that for themselves. If the exchanges are staffed by anybody but the most dedicated public servants the Union has to offer, some of them are going to flub that decision; Especially when faced with a regional monopolist with deep mandate-fattened pockets. armies of lobbyists and pet politicians.

Second, do you honestly think that regulation and punitive taxation is going to deal with this problem? Your Democratic friends have already had their clock cleaned by the Republicans, America is already in this mess because Democrats can't pass legislation that isn't terrible. What the hell makes you think that the regulations and "cadillac taxes" won't get gutted by the Republicans, or even the ConservaDems, between now and 2013?

Especially when the most powerful lobby on the Hill—and it will be after this—is doing everything it can to water down the regulations, which has already been watered down to begin with? There WAS anti-trust reform in the bill. That got taken out, and language allowing these mandated insurers to get out of providing care was inserted in.

There is no reason to think that this process won't continue. There's no reason to believe that the regulations will stand. There is no reason to trust these exchanges to be immune to lobbying. There is no reason to expect the "cadillacs" to stay as they are. There is no reason to believe the lobbyists won't run rampant. There is no reason to believe that the Republicans and ConservaDems will ever improve this exercise in naked corporatism.

It will just get worse.

I'm still waiting for an answer to my question. Is there a bill these people wouldn't support? Is there a line they wouldn't cross? When women's health and safety are sacrificed to get Ben Nelson's vote, is that still not going to convince them that some things are indefensible?

Obviously the Dems are never, ever going to have a line that they won't cross, because they're terrified of the possible consequences. But that's why they supported the Iraq debacle, too, in all its destructive horror. The LieberCare hawks are primarily the "Liberal hawks" of 2002-2003. Have they learned anything? Have they changed at all?

IS there a line?

Edit: I'm wondering whether or not this has less to do with policy and more to do with pride. There are no small number of LieberHawks who have poured a ton of time and effort, now, into defending this crap. Convincing progressives that the bill is actually defensible is one thing: ultimately progressives want to be convinced, because they don't want to believe that they now have to take up rhetorical and political arms against the people that they had worked so hard to elect only last year.

Convincing the "wonks", however, is going to be much harder. (I scarequoted "wonks" because it is insulting to argue that the critics don't understand the legislation, but that's what its supporters insist.) If people like Ezra and Yglesias and Drum turn on the legislation, they're in deep, deep trouble. The Dems will shun them, because the Dems believe that their electoral fortunes will be better if they pass it than if they don't. (They're wrong, but it's a question of belief.) The Washington Establishment will probably shun them, too, because they'll have associated themselves with all those nasty dirty hippies, and irritating pseuds like me and digby and atrios. And progressives probably won't be terribly supportive, either, since this is twice now that they've been yelling at us for speaking Truth to Dems.

It's a hard place to be in. But, remember, we didn't put you in that place. They did.

Well Isn't This Interesting...

I hadn't thought about this, but Jake McIntyre makes an excellent point:

Has anyone else noticed that the split in the progressive blogosphere between those who are saying "it's a good bill in spite of everything" (Kevin Drum, Matt Yglesias, Ezra Klein, Josh Marshall, to name a few) and those who just can't bring themselves to support Liebercare (Markos and Digby come to mind, among bloggers who have been at it since 2003*) is eerily similar to the split between those who grudgingly backed the invasion of Iraq and those who fought against the war seven years ago?

To a large degree, it's the same cast of characters, with the same tone to the arguments. It's the policy wonks versus the activists. On the wonky side, there is (and was, in 2003) a resigned sense that this isn't an ideal action, but that we don't live in an ideal world, and that consequently we should suck it up and support an imperfect initative. On the other, there is (and was, in 2003) a resistance born of an awareness that Congressional Democrats will more often then not -- and often unintentionally -- screw themselves and the country, out of a misguided belief that powerful forces with agendas very different from that of the Democratic Party can be managed and trusted.

It's been long enough since the invasion of Iraq that the two camps - the credulous wonks and dirty fucking hippies - have reconciled (and even interbred), but the dynamic that separated us in 2003 is the same. The fundamental difference in approach is still there. When all is said and done, the wonks trust Democratic politicians to protect our interests. The activists don't. That doesn't mean that we don't like certain Democratic politicians, or that we don't cherish our wonky brethren. It just means that we're not willing to get fooled again.
______________________

*I imagine that Jane Hamsher and most of the other bloggers calling for opposition to Liebercare also opposed the Iraq invasion, but Jane et al weren't blogging way back then, at least as far as I know.

I've been around since 2002, Jake. I remember. I'll never forget. I remember, for example, that the "policy wonks" were not basing their arguments on policy per se. They were basing it on a particularly innocent and none-too-successful kind of politics: the kind that says that you can always take progressives for granted, and should therefore do whatever you can to ingratiate yourself to conservatives. That isn't precisely what's going on here, but what is going on here is motivated by much the same thing: adherence to the groupthink of "experts" and "leaders" and "wisemen" whole bunches of other fatuous gasbags who richly deserve scare quotes.

What they didn't get then, and don't get now, is that while the perfect may be the enemy of the good, the terrible is the enemy of both. That a policy isn't perfect doesn't make it good. It may include so many horrible things that they wipe out any and all good that might have been done. It may also leave doors open for terrible things to be done in the future that do much the same thing.

That was the case with Iraq. Getting rid of Saddam was a moral argument, since Saddam was a terrible man. But the people responsible were terrible enough, the plan was vacuous enough, and the consequences terrible enough that it was transparently going to do more harm than good. That is exactly what happened: the side effects were horrible, and the execution worse.

That is also the case with the Senate HCR proposal. Expanding Medicaid, regulating insurers, and getting everybody health care are laudable goals. But it is transparently obvious that these things will come at the cost of forcing people to buy terrible insurance, and taxing away even the possibility of decent insurance. Anything even remotely moral, like the subsidies for the impoverished, will almost certainly be removed by a future Republican administration, leaving nothing but the terrible parts behind.

The only difference is that both parties got to wear the Iraq debacle. The Dems, however, will be forced to stand alone on HCR. That's why Ezra et al are dangerously wrongheaded. They think that passing this bill will help the Dems next year and in 2012. But the polls are very, very clear. It won't. They may have traded foreign policy groupthink for more general Washington groupthink, but that groupthink is wrong.

(I will refrain from discussing how being wrong on Iraq was a smart career move, and question what sort of career moves are involved in being wrong on this one. After all, I still feel somewhat responsible for Ezra. That's probably why I'm not even angry at him. Just somewhat disappointed.)

"It's the Structure, Stupid!" No, It's Not. It's About Power

Ezra responds to the somewhat blistering criticism of his apologism for Obama abandoning his base by arguing, well, this:

Put simply, it's the structure, stupid. The health-care system is like a house. It's easy to add the furnishings later. It's not that hard to upgrade the kitchen, or redo the trim, or re-carpet the floors. Some of that might be expensive, but it's not actually hard. But it's really, really hard to add another room, or rip out all the wiring, or build a bathroom that wasn't previously included.

So too with health care. There's a basic structure that's been present in all of the bills, and for good reason. It's a structure that a lot of good and smart people have put a lot of time and energy into thinking through. It creates a universal system through an individual mandate and an employer mandate, and makes that system affordable and dependable through a mix of subsidies, insurance market reforms, and out-of-pocket protections. It creates health insurance exchanges that individuals and companies can choose to enter if they prove more efficient and consumer-friendly, and that offer an array of different insurance options, some public, some private.

And who, exactly, will be adding these things? Sure, you can add rooms to the house. But you can't walk into somebody's house and start adding things, because you don't have the power and authority to do so. Nobody can do the same thing for your house, either. They don't have the power. And, let's be honest, they don't have the intention, either.

So who, exactly, would have the power and intention to make these changes? Liberals? The way that this is moving, they would have practically no power whatsoever. Remember, power is about consequences: it's about getting people to do things they wouldn't otherwise do, and that is all about showing that there are consequences if they don't go along with you. The Republican base has showed that there are consequences to spurning them: you lose primary battles in the House and Senate to people who will go along with you. Pretty soon they don't need to exact any consequences: they can just threaten to do so, and the threat will be credible enough that lawmakers will go along with it. Eventually, you don't even need to threaten, because they know what the base will do and adjust their behavior accordingly.

But the Democratic base won't have that. They can't exact a price for ignoring them, and any attempt to threaten the Dems will lack credibility. They'll be powerless. In fact, they already are powerless, of course—or else Obama, his various White House apparatchiks, and Big Media Types like (tragically) Ezra wouldn't be treating them like a puddle of especially foetid scum that is best avoided when it can't be ignored. Without action, that belief won't change.

What about the people that do have power? Will they have the desire to change things for the better? Well, no, clearly not. The "centrists" won't. Those few who aren't wingers with the wrong letter beside their name are too frightened of the right. The Republicans certainly won't, they'll just change things for the worse. The media won't: their fetish for useless, worthless bipartisanship was half the reason the impressionable, timid Democrats ended up in this horrible mess. And they basically do what the conservative movement tells them to. Corporate America certainly won't.

As for the Obama Administration? If they actually cared, there would be a public option, and this whole debate wouldn't be taking place.

So sorry, Ezra, but your "house" doesn't hold water. Those with the power to change things won't, because they're happy with the way things are.

And those with the desire to change things? We're just scum. Powerless scum. Beneath notice. Beyond contempt.

Straightforward Answers to (Surprisingly) Dumb Questions

"Can you beat centrists at their own game?"

Yes. If you couldn't, the Republican base wouldn't be as successful as it is.

Ezra says that progressive should support the health care bill, no matter how bad it is, because otherwise nothing will pass. Well, yes. That's true. But if we're talking about bad bills, progressives and liberals shouldnt want them to pass. If we're talking about health care bills that are actually worse than the status quo, then we don't want them to pass.

And, more importantly, does Ezra want the base to fight for anything at all? It sure doesn't seem like it. Look at this:

There's no successful model for blunting the power of centrists to write -- or kill -- the final compromise. President after president has found himself foiled by congressional centrists. George W. Bush never truly managed to bring Susan Collins, George Voinovich, or Olympia Snowe to heel. His tax cuts were smaller than he wanted, his Medicare expansion was pricier than conservatives liked, and his attempt to privatize Social Security was batted back. Bill Clinton fared little better. The hardest votes are the people who don't fundamentally want to vote for your agenda, not the people who do. And those are always the votes you get last.

The outcome of this strategy, then, seems to be that the Democratic Party pretty much collapses into infighting and fails to pass its top priorities and loses a bunch of seats in the next election. The media explains that the liberal Nancy Pelosi and her liberal House Democrats caused the electoral disaster, or that Democrats couldn't agree on an agenda. Long term, I'm not sure who that helps.

Honestly, this isn't difficult. The Democratic party is already "infighting". It's just that it's a one-way fight. The "centrists" (read: right-wingers) are mowing down progressives again, and again, and again. Progressives aren't getting a damned thing out of this Administration or this Congress, and they're sick and tired of it.

And Klein's historical analogies don't hold water, either. In ALL of those cases, the Republican base showed tremendous power in holding the government's line. No, they didn't get everything they wanted, but they have got one hell of a lot more of what they wanted than liberals are now.

The reason why? Because they will be obstinate. They will run primary challenges. They will choose to lose a district rather than compromise their principles. They do it, because they know that during the next vote, and the one after that, and the one after that, the reaction of the higher-ups in the party will be "can we sell this to the base". Democrats clearly couldn't give a damn about their base. (Certainly journalistic Washington doesn't.)

Klein (and Yglesias, and a lot of the other disappointing former-bloggers-turned-washingtonians) doesn't get that many progressives see no future whatsoever for them in the curent Democratic party. They aren't going to be listened to, they aren't going to be respected, and the country will just keep moving in the Republicans' direction until the whole damned thing burns.

Whether the Dems lose seats in 2010, or in 2012 is totally irrelevant. Progressives aren't the Democrats. They aren't part of the team, nor will they ever be. Progressives are in it for good policy and good governance. Nothing more.

No, the base has to confront the fact that it will not be listened to, not ever, unless they put their foot down.

So that's exactly what they must do.

"Jane Galt" Truly Revealed!

HAH! Oh boy is this too good.

Mark Ames just penned an expose on Megan McArdle, my old "friend" "Jane Galt". Far from the Libertarian hero she's portrayed herself as, it turns out that Ames has revealed a person who has benefited, from beginning to end, from public largess. Why? Well, meet her dad:

Megan McArdle is the daughter of one Francis X. McArdle, who built his career as a public servant in the New York City administration, then moved over to the private side, where he could leverage his contacts with the government -- and finally moved back onto the public payroll in 2006, when Mr. McArdle was appointed by then-Sen. Hillary Clinton to advise the federal government how public funds should be spent, and on whom. Earlier this year, Mr. McArdle was reportedly in Albany lobbying the New York state government for a job as the "stimulus czar," appropriating President Obama's federal spending money.

Megan was born in 1973, a few years after Francis got his big fat job on the public payroll in the New York City administration, where he stayed for 11 years. Among the first big jobs Megan's daddy took while climbing up the public payroll career ladder were jobs as Inspector General for the New York City Health and Hospitals Corporation, and Director of Program Budget for the New York City Health and Hospitals Corporation.

So Megan McArdle's entry into this world was literally greased by taxpayer funds. But of course, it wouldn't stop there.

Francis McArdle, rose up the Big Government ranks in the New York city. His public-funded career reached its peak in 1978 when then-Mayor Ed Koch named him as Commissioner of the New York City Department of Environmental Protection, where he served until 1981. That job put McArdle in control of all sorts of public works: water supply, waste water, sewage infrastructure. It's kind of fitting that McArdle's privileged childhood was funded by taxpayer's shit and urine -- a Freudian might say that this is the source of her inexplicable hatred of the same Big Government that pissed dollars and shat gold on the McArdle household.

Megan's dad moved from the public sector overseeing public works to a job with real estate developer Olympia & York -- just in time to take advantage of the huge Battery Park City project that Olympia & York was developing under contract. The success of the project relied on huge taxpayer subsidies -- at least $65 million in 1981 dollars -- as well as major public works projects to make the development attractive, including the disastrous Westway road project, which drained at least $85 million of federal subsidies until it was finally mothballed in the mid-80s, due to environmental concerns and public protests -- the kinds of protesters whom grown-up Megan McArdle would later attack. No matter, though, because by the time the Westway was canceled and all that public money was wasted, Olympia & York, Megan's daddy's company, had catapulted into one of the top real estate moguls in the world, and Megan's daddy was ready to move on to even bigger things.

In 1985, F. X. McArdle had moved from the private sector to a position that Megan understands better than any other: a lobbyist who manipulates Big Government on behalf of private companies. Francis X. McArdle was named to head the General Contractor's Association of New York. He stayed in that lucrative position for the next 20 years.

So. Her dad was a public servant who cashed in on the private side, and then made even bigger bucks as a lobbyist. Our heroic libertarian individualist is the daughter of a wealthy lobbyist.

It doesn't stop there, though:

Megan showed how much she owes to her dad's way of doing business when she admitted in a blog post that she owes her success to personal contacts "I sent out about 1400 resumes blind after my firm failed. I got not one response. All the jobs I interviewed for came from personal contacts."

We learn just how useful these personal contacts are for Megan McArdle thanks to a gushing profile on her published in early 2007 in a rightwing magazine called "Doublethink" -- put out by a corporate-funded advocacy group with ties to Tom Delay and Cato, whose mission is to "identify and develop future conservative and libertarian leaders." In the profile, we learn that Megan's first job in 2001, after graduating from the University of Chicago's graduate business program as a committed Ayn Rand libertarian, was canceled due to the market drop in 2001. So instead of flipping burgers to make ends meet, the libertarian moved back home into her parents' Upper West Side digs -- a home that taxpayer money helped to fund. There, in the hard knocks of the Upper West Side, the 28-year-old MBA seethed in libertarian anger at all the welfare queens and wasteful government spending programs she saw all around her. But it wasn't until bin Laden created an opportunity that Megan finally got a job -- as an "executive copy girl" for a post-9/11 cleanup crew near the site of the WTC. It was exactly the sort of job that those "personal contacts" can help you get in the "byzantine" world of construction in NYC.

It was at this time, living in her parent's swank Manhattan pad and working a job in her daddy's line of business, that Megan McArdle's blogging career as a right-wing libertarian crusader was born.

Instead of admitting that she got her first job thanks to daddy's shady connections with the corrupt construction trades, Megan pretended that she took the WTC-cleanup job as a sort of personal penance, a gift to the people of her stricken city: "[I}t was easier to bear it all than it would be working somewhere else, and worrying, and unable to do anything about it." Really Megan, you shouldn't have born that cross for us.

There's a lot more there about the Atlantic Monthly, which I'll leave aside, since it is the former employer of Matthew Yglesias, a blogger I still respect.

And, honestly, the quality of an argument is not dependent on the identity and nature of the author. This whole enterprise of mine here would be somewhat silly if I didn't believe that. I could have just gone eponymous like the aforementioned Yglesias. I didn't, and that was for a reason.

So, instead, I'll say that this is more instructive than anything else. it's about a key problem with modern opinion journalism, which is that far, far too many people in that business are in it because of being born to the right people and belonging to the right class, instead of due to skill, talent, and insight. They are wealthy and secure enough that they don't have to worry about the economic repercussions of what they have to say; yet somehow almost inevitably spout conclusions that support the wealthy and powerful, because that's who they identify with.

And, yes, the "libertarians" tend to be the worst, because they don't understand and don't recognize the structures that placed them where they are. They want to think the best of themselves, they want to think that they're responsible for their success, so they adopt an ideology that lets them do that. It's understandable, sure, but that doesn't mean the rest of us should fall sway to that same ideology. Yet precisely because it's so convenient, they're the ones with the bullhorns, at least on "economic" issues.

I see this in a number of the defences out there, too. John Carney's rant about how "ugly" the Ames piece is ignores the privilege that he enjoyed as the son of a successful antitrust lawyer. (I have little sympathy for it anyway, considering how "ugly" the results of the policies both Carney and McArdle advocate, but regardless.) Ezra Klein posted a more thoughtful response, but again misses the point that it's McArdle's privilege that is the point here, and the incoherence of her ideological advocacy in light of that privilege.

And that's all assuming that she makes utterly impersonal, completely logical and rational arguments. But she doesn't. Her blogs have always been peppered with autobiographical details that are supposed to support her claims, and I remember "Jane Galt" constantly appealing to her authority as some kind of economic expert. She isn't, and has been roundly castigated for that already- but if you want to appeal to your personal authority, you're fair game, because it's your credibility that's at question here.

(That's also not getting into the hypocrisy of the right complaining about personal attacks. Seen her birth certificate lately?)

For all that his column may be uncomfortably personal, Ames has delivered an explosive broadside to McArdle's credibility. And considering how much he's written on privilege in America, it makes a lot of sense. "Ugly" or no.

I'm Deeply Disappointed in Ezra Klein

Come on, Ezra, you must be joking:

"[E]ven if getting any bill called 'health care reform' passed would be good short-term politics," writes political scientist Scott Lemieux, "it's worth further emphasizing that signing a bill without (at a minimum) a public option would be a substantive disaster." Elsewhere, he says, "the public option is the core of the reform; a Blue Dog bill isn't so much half a loaf as a few meaningless crumbs." And, finally, "a bad bill would be worse than no bill."

The public option, as it exists in any bill moving through Congress, is not the core of reform, nor anything near it. It is, for one thing, limited to the Americans who buy into the Health Insurance Exchanges, and the exchanges are in turn limited to the unemployed, the self-employed and small businesses. In the House bill -- which is the strongest of the bills -- the Congressional Budget Office estimates that 27 million Americans would be in the exchanges by 2019. That's not nothing, but it's not much. Imagine half choose the public option (CBO estimates many fewer than that). You now have 13.5 million Americans in a public insurer with no substantive advantages over private insurance. That's not a gamechanger, it's a tweak.

But it's also worth offering a more general reality check here: The public option is not now, and has not ever, been the core of the argument for heath-care reform. It is the core of the fight in Washington, D.C. It is an important policy experiment. But it was not in Howard Dean or John Kerry or Dick Gephardt's plans, and reformers supported those. It was not in Bill Clinton's proposal, and most lament the death of that. It is not what politicians were using in their speeches five years ago. It is a recent addition to the debate, and a good one. But it is not the reason were are having this debate.

Rather, what has kept health-care reform at the forefront of liberal politics for decades is moral outrage that 47 million of our friends and neighbors are uninsured. That medical costs are one of the leading causes of bankruptcy in the United States. That an unemployed machinist gets screwed by fly-by-night insurance schemes while a comfortably employed banker need never worry. That the working class ends up in emergency rooms with crushing chest pains because they didn't have health insurance and didn't get prescribed cheap blood pressure medications five years before.

All due respect to a guy who got his start reading this very blog, but Ezra, are you high? Of course the Public Option is at the center of all this!

Without the public option—unless you strip out the mandates too—this whole thing becomes a bill that forces people to give money to the insurance companies! It's a gigantic handout of economic rents to the very actors who provoked the reform in the first place, and would ensure that so much insurance industry money floods into Washington that any and every attempt regulation would be made toothless within picoseconds!

And since when is it all just about the uninsured? It's not just the uninsured that is the problem. It's the underinsured: the people who can't choose their doctors, can't get the treatment they needed, and can't afford the immense co-payments for those procedures that they're lucky enough to actually get covered. I'm pretty sure that most liberals think about those people quite a bit. I imagine that a lot of liberals have been those people.

Why would Ezra, of all people, mischaracterize their concerns?

Yes, you could rationally argue—as Ezra did—that "[i]f reformers cannot pass a strong health-care reform bill now, there is no reason to believe they will be able to do it later." But what's being proposed isn't a strong bill. This isn't even a weak bill. It's billion-dollar pork to the real constituents of all those paid-for Democrats out there that might as well have"D-Insurance" next to their name.

And, sorry, but they damned well don't deserve it.

Ok, Now For Less Silliness: State vs. Federal Health Care

Yeah, fine, Honey Badgers are interesting and all, but "aged grandfather Demosthenes" should probably write on something more substantial.

Ezra Klein and David Sirota have had a rather nasty little infight over universal health care: Ezra claimed that it can only really work as a D.C. initiative, and David Sirota got ticked at a D.C. insider (?) claiming that only D.C. could do something like this. He linked in turn to Nathan Newman, who responded to Ezra's points.

(Before I say anything, though, the fact that these comments were all made on sites that, as far as I know, don't allow pseudonymously-penned pieces looms a little large in my mind. I like the Washington Monthly, the Huffington Post, and TPM Cafe, but since this is Ezra I'm talking about, it came to mind. Anyway, digression.)

Ezra's complaint is by and large financial: that states really can't afford to provide universal health care (well, universal insurance). Sure, they can afford it to a certain extent when times are good, but during economic downturns, things can go south quickly if the Republicans take over the state house and start cutting like mad. Now, considering this is a constant danger in Canada, a sovereign state with a long, long history of socialized health care, it's pretty understandable that this would be an issue in individual states.

Nathan responds by pointing out that other states have been more successful, like New York, in providing insurance for the underprivileged. He also points out initiatives like Healthy Wisconsin, which would provide both freedom of choice in doctors and universal coverage. Healthy Wisconsin is being blocked by State Republicans, but it's likely to be a big election issue next year, and I have my doubt that the Republican party will enjoy monster success next year in, er, Wisconsin.

But, here's the problem that I think Nathan and David are overlooking. A direct quote from Ezra:

Hawaii, in contrast, went for the classic liberal approach: a giant government program. The state had already forced all employers to cover their workers in 1974. In 1994, hoping to cover all those without employer-provided insurance, Hawaii created the QUEST program, into which it merged Medicaid and a similar state program. Early reviews were good. At the outset, QUEST appeared so successful that Hillary Clinton used it as supporting evidence for the Clinton Health Security Act, proclaiming that Hawaii “has achieved nearly universal coverage and has less of a cost.”

What happened next wasn’t pretty. First, Hawaii suffered from the problem known as the “woodwork effect,” where a new government program entices people out of the woodwork, leading to more applicants and higher costs than anticipated. An economic downturn proved even more damaging. It’s a cruel economic irony—but an inescapable policy reality—that recessions rob government of the revenue it needs to cover the uninsured at precisely the moment that the most people need subsidies to get them through the lean times. And states are incapable of responding, since they, unlike the federal government, are constitutionally barred from running deficits.

So Hawaii responded in the only way it could: by cutting back the program. Instead of offering benefits for those whose income was up to three times the federal poverty line, it restricted eligibility to people whose income was twice the poverty line, and introduced an assets test. The dreams of universality evaporated. According to the Kaiser Family Foundation, 9 percent of Hawaii’s population is uninsured, compared to 15 percent nationwide, and it spends 12 percent of its gross state product on health care—exactly the same proportion as the rest of the country.

In order to advocate universal health care, you need to understand what its strengths and weaknesses are.

The strengths are obvious: it's cheaper, because it's a monopsony (single buyer situation) so you don't have buyers competing to pay more for services, so prices for the same level of service tend to go down. It covers everybody, so there isn't the sort of cherrypicking of the most desireable insurees that you see with private insurers. It covers preventative procedures, so you don't end up with expensive ER visits and hospital stays by people who should have had a little cheap preventative work done.

(This is one of the reasons I think Canada has dropped the ball on one thing, for example: dental isn't covered, and dental work is about the most blatant example of that sort of ramping-up of costs in all of medicine.)

The weaknesses are often overlooked, however: doctors probably aren't going to make as much as they would otherwise, and big pharma certainly isn't. It is also more expensive for the government itself than letting the private sector handle it would be; it is far cheaper for everybody, but that isn't necessarily going to matter when you're looking at the government's books. Canadian conservatives rail about how much is spent on health care all the time, and advocate privatization, because although that would mean more is spent overall, they would pay less taxes. Also, in order to work, it has to be universal; if the wealthy can pay to "jump the queue" for too many procedures, you end up pretty much back where you used to be.

So, why does this matter? Freedom of movement. Let's say that two states, right beside each other, pursue different paths. One goes universal. The other goes private (status quo). There is no real barriers to movement between states, so what happens? Everybody who needs the health care is going to go to the state with universal care, so their costs go up. Everybody who doesn't want to wait in line (that's overstated, but that'll be the perception) will move to the other state. Many of these will be un- or underemployed people who don't have corporate health care. The universal state has a larger base of people who need procedures, whereas the other state will end up with a lot of new, relatively affluent taxpayers.

Yes, a lot of corporations like universal health care. Corporations who don't want to pay for health care will like the idea of the government footing the bill. A lot of income taxes are going to be leaving the state and somebody has to foot the bill, though, so they're going to soak a bigger hit than they would in the other state. They'll have to, because they're covering both the people who would have been covered by their own plans, and those who wouldn't. Those corporations that would have benefited would stay (car manufacturers, for example), but those that employ a relatively number of expensive professionals would almost certainly be better off leaving. Considering the dwindling number of firms that provide anything like comprehensive health care, the latter probably outweigh the former.

A lot of doctors would have left, as well, chasing the bigger dollars the private insurers would be offering.

So, the universal health care state ends up in a tough bind. It has a larger number of people who want coverage, but the tax base has bailed because of the enormous freedom of movement. They can probably handle it if they're relatively prosperous, this wouldn't be apocalyptic, but what happens during a downturn?

That's when having it be state-led runs into gigantic problems. Yes, States can run a deficit, but not indefinitely; and they lack the sort of tools that the federal government enjoys to manipulate the economy in times of downturn. If things get too bad, too fast, for too long, they must cut something, and health care is a huge target. If they don't, sooner or later another party will come into power, and they will.

If you federalize the program, you're in much, much better shape. Moving from the U.S. to another country is much more difficult than switching states; the cost and hassle of doing so will almost certainly prevent people and firms from trying to leave the United States to chase a lower tax bill (or higher medical paycheque) at the expense of universal care. No emigration is likely, or at least it'll be low enough that you won't need to worry about it. In a downturn, the federal government doesn't necessarily need to hack up its budget; it can ride things out, and employ fiscal and monetary tools to ensure that, yes, eventually things will improve. Plus, if it's universal, it's far less likely that elected officials will be pressured into weakening the system, because nobody can hold the threat of emigration over their heads.

Honestly, it's a better choice.

Nathan does point out the chief political obstacle; getting together 40 Senators to filibuster a serious health care proposal is relatively easy for Big Pharma to do. That's why a part of this MUST be other corporations leaning on said Senators to relent; Big Pharma is only one industry, and fixing things has less to do with removing their influence than swamping them with other lobbyists from other industries that really want the government to take this burden off their hands, along with a public outcry that ensures that not only will votes ride on this, but those nifty little $20-$40 donations that the Dems are growing increasingly reliant on.

(The biggest problem is not getting Republicans on board, but ensuring that Dems are reliable. The Republicans aren't exactly in great shape for 2008 in the first place, and a few Republicans aren't going to be hard to sway. It's the Dems that are the issue here.)

I'm not saying that state initiatives are impossible. Nor am I necessarily saying they're doomed, like Ezra seems to. I think he does overstate things slightly. I know, though, that Nathan and David need to realize that if it can be federal, it should be federal. "Universal" needs to be exactly that, if it's going to be effective.

I Swear, Always the Last to Know

So a few weeks ago, back during the "Digby has ovaries???!?" brouhaha, somebody said that they were a little sad that the reveal wasn't a bigger deal, akin to Demosthenes coming out as Peter in Ender's Game.

Ezra Klein, saying "people have no sense of history", reminded everybody that I, er, still exist:

Better not call her Demosthenes. Demosthenes is a grandfather of the blogosphere. If I'm not wrong, he's the first lefty blogger I ever read. And I remember being stunned -- genuinely astonished -- to see the word "props" in the context of a serious political post. It, like, blew my mind, man, and was, in retrospect, a weirdly meaningful signal that this type of political commentary was somehow fundamentally different, and open to some no-nothing college kid. And speaking of Demosthenes, the aged grandfather of the blogosphere is still slinging pixels.

First, word up, dawg. Thanks for the, well, props.

Second, it's a testament to the weirdly accelerated nature of these here Internets that a little over five years is a really long time to some people. It doesn't feel like it to me; I sure as heck don't feel like any sort of "aged grandfather", that "oldschool" jibe that was in the masthead regardless. It's still just me, my pseudonym, my ideals, and my little non-optimally colored site, same as it ever was.

Even if I'm not a Peter Wiggin, or even a Duncan Black, I'm glad I have this soap box to stand on.