By letsgetitdone (Joe Firestone, who is Managing Director and CEO of the Knowledge Management Consortium International (KMCI). Originally published at New Economic Perspectives.
Lambert here: I’ve commissioned Part Two from Joe, which will address the issue of how to spot a neo-liberal “in the wild.” Beautiful plumage!
* * *
During the run-up to passage of the Affordable Care Act (ACA), I wrote a number of posts (here, here, and here) assessing the ACA very negatively, and pointing out the shortcomings of the various versions of this bill, preceding its final passage. My focus was on contrasting varying versions with HR 676, the Conyers-Kucinich Medicare for All bill, in relation to its likely impact on fatalities, bankruptcies and divorces attributed to lack of health insurance coverage in the US.
At that time, about 47 million people were uninsured, and based on the rate of 1,000 fatalities per million established by the Wolper-Woolhandler-Himmelstein et al study of 2007-2009, I anticipated 47 thousand fatalities in 2010. In addition, I predicted that
— In the “band-aid” period before the health insurance exchanges became operational in 2014 we were still looking at an average of 31,000 fatalities per year due to lack of insurance, or a total of about 140,000 expected fatalities before the exchanges would be effective sometime in 2014.
— After that we were still looking at 23,000 annual deaths per year through 2019.
— A grand total of expected fatalities of 267,000 by the end of 2019
— The bill will not cover 30 million additional people, as claimed by its advocates, but more like 15 million due to rising insurance costs and un-indexed subsidies in the ACA.
— In addition, due to population growth, we would still be looking at 35 million uncovered and 35,000 fatalities due to lack of coverage.
Now 2.6 years have passed since I made those predictions, and the Commonwealth Fund has just released a new study of the ACA. The study projects what we can expect from ACA coverage compared to what we can expect from a baseline do nothing scenario and from Mitt Romney’s latest pronouncements about his health care plan, which, in all likelihood will be obsolete before election day.
The projections are based on Jonathan Gruber’s simulation model. Gruber was a consultant whose ideas were incorporated both into Romneycare in Massachusetts and the ACA at the national level. Gruber’s model isn’t something one can count on in my view, if only because long-term economic projection models using CBO-like methodologies are subject to accumulating errors over time as well as wide deviations from their policy assumptions in reality. Decade long projections are particularly likely to be science fiction rather than science.
Having said that, however, it’s still worthwhile to use Gruber’s projections as a basis for comparison of the various scenarios, simply because they are likely to under-estimate the rate of coverage, as well as the level of projected fatalities, over time. We can be pretty confident, for example that if Gruber’s model projects 286,000 fatalities over a particular period of time; then actual fatalities will be at least that high.
The Comparison
Here’s a Table I constructed using data from the study. There are four scenarios compared in the Table: The ACA, the Romney Plan as described on his web site, http://www.mittromney.com/forms/welcome-0 a baseline scenario assuming that the ACA wasn’t implemented, and a final scenario assuming that HR 676, Medicare for All, had been passed by June of 2009 either through Democrats forgetting bipartisanship and using reconciliation, or the Constitutional Option to overcome the Senate filibuster. The Commonwealth Fund doesn’t include this scenario; but I think it needs to be included in any comparison to indicate what might have happened if the President and Congress had wanted to solve the most serious consequence of maintaining the private health industry, rather than simply put a band-aid on the health insurance problem while bailing out the health insurance companies.
Let’s begin by looking at the first three years 2010 – 2012. Think about the numbers for a minute. It’s nearly three years since a Medicare for All Bill might have gone into effect. If we were living under the Romney Plan, roughly 148,200 people would have died. Under the baseline of no legislation at all, the fatalities would have been slightly lower at 146,600, and under the ACA we’ve had nearly 140,500 fatalities. The ACA is slightly better than the other two alternatives; but the conclusion that jumps out at one is that the failure to pass and implement Medicare for All has cost at least 140,000 lives in three years, or 47 times the number of lives lost on September 11, and about 14.6 times the number of fatalities on 9/11, during the Iraq War, and in Afghanistan up to the present, combined. I’ll return to this point later.
The years between 2013 and 2022 show a marked divergence of the uninsured estimates among the Romney, ACA, and benchmark scenarios. The ACA saves hundreds of thousands of lives compared with the benchmark and Romney scenarios; but it still projects an additional 286,000 fatalities through 2022 under the ACA scenario, and a total of 427,000 fatalities from 2010 through 2022. This compares to nearly 800,000 under the Romney scenario and just over 700,000 for the no change benchmark. Certainly, the ACA is much better than the Benchmark or Romney alternatives, but it’s hard to avoid noting that the most striking comparison is between any of these three alternatives, and the Medicare for All alternative. Had that alternative been legislated in 2009 and implemented by January of 2010, we’d be looking at virtually no fatalities due to lack of insurance rather than 400,000 or 700,000, or 800,000. Since The Commonwealth Fund Report excludes the Medicare for All alternative from consideration, and in doing so, moves the Overton Window of its policy impact evaluation to the Right, it doesn’t bring the real cost of legislating the ACA option to the fore. That cost, based on Gruber’s simulation is 427,000 lives over the time horizon ending in 2022.
What Was the Justification for Accepting the Cost of Those Lives?
There are a lot of reasons, motivations, and political dynamics which together explain why the ACA, rather than HR 676 passed the Congress. I’ve written a lot about these in the past and have imputed corrupt motives to various people involved in the legislative process producing the ACA often enough. But apart from all this, there is the question of justification or rationalization, of why Medicare for All could be so quickly and easily taken off the table without a major fight from the progressives?
Part of the reason was the promise of Administration support for the public option sparkle pony, as it came to be called in some of the more cynical progressive circles. The PO idea split progressives and stripped away support of DC-based progressive organizations from Medicare for All, on grounds that the PO was a more politically “realistic” alternative than Medicare for All. That is a sad story that has been told very often. But looking past it; what was unrealistic about Medicare for All, the type of system that has been successful in providing coverage and lowering costs in so many nations?
Apart from the political opposition from the insurance companies that Medicare for All would have engendered, I think the main justification for abandoning Medicare for All and switching to the PO and eventually the PO-less ACA, was actually neoliberalism. The President, his main advisers, the Democratic leaders in Congress, and most progressives working for Washington progressive organizations were steeped in neoliberal doctrine. They viewed the Bush tax cuts and the two Wars as unpaid for. The ARRA stimulus Act was similarly unpaid for and added to deficit spending and to the debt-subject-to-the-limit. They believed and most believe today that the Federal Government can have solvency problems if the debt-to-GDP ratio increases too much, and interest rates on the national debt are driven up by the bond vigilantes.
A Medicare for All Act would have required Federal spending on health care to rise by $800 – $900 Billion per year over present levels. They were not ready to cover that with higher tax revenues, and they were not ready to deficit spend it because they viewed that as fiscally irresponsible, and believed then and still believe now that it’s necessary to decrease the debt-to-GDP ratio over time.
So, they wouldn’t consider spending for Medicare for All. They wouldn’t look seriously at the hundreds of thousands of lives they were consigning to oblivion, at the bankruptcies and divorces they could prevent, or at the obvious fact that while HR 676 would have cost the Government $900 Billion more in money annually that the Government can create at will and at zero real cost; it would have saved the people who have to pay for health insurance, and health care out of pocket and in the form of “co-pays” $1.8 Trillion annually, thus providing a marvelous boost to the economy. Instead, they just said to everybody, that it was impractical and that the United States couldn’t afford it; but that it would be able to to afford a self-supporting PO bill, and later when that was taken off the table, a deficit neutral insurance bailout like the ACA.
So, here we are at the denouement, neoliberalism, and other false social and economic theories, kill. In this case, belief in neoliberalism has already killed approximately 140,000 Americans since the beginning of 2010. And if we don’t reject it, over the next decade it will kill 286,000 more, more than 2/3 the number of US fatalities during WW II. And these are only the fatalities resulting from a refusal to deficit spend to pass Medicare for All.
In addition, there are also the fatalities resulting from our collective failure to end the joblessness, the crime, the reactions to family breakup, the social disintegration, and the climate change and environmental effects, and all the other serious problems we refuse to solve because we and our leaders have been captured by neoliberalism and its false notions about fiscal responsibility and fiscal sustainability. We have reached the point, now, where it is neoliberalism or American Democracy, or, if you like neoliberalism or us. There is no alternative! Neoliberalism is one of our worst ideas. And as Popper said, life is about killing your worst ideas before they kill you. So, it’s time for us to free ourselves of neoliberalism, switch to a paradigm that works, and get full employment, Medicare for All, and much else. That paradigm is called Modern Money Theory.
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The UK spends approx. 9-10% of GDP on its universal health care system – better known as the National Health Service – and on a outcomes basis, has one of the highest standards of care globally – obviously, neoliberals detest this and talk about choice, privatisation and breaking the system up – which essential is what the Coalition policies for the NHS will do in the UK, that is ‘ape’ the dysfunctional US system and bleed it dry of funds via unnecessary demands for a profit – how the fuck can you profit from a human life, that is the morality issue.
Whilst on one scale many health care services in the West have better individual outcomes than the NHS, overall and for the cost and benefit to society as a whole, its second to none, or at least was second to none.
To put it bluntly, ObamaCare and RomneyCare suck and is but a Charter to print cash for the Insurance sector.
Obviously, we have a lack of morality with DC and the two dominant legacy parties in the USA – this applies to certain quarters in the UK too.
Strange how the US government can ring fence funds for absurd military adventures and denial of civil liberties to the average US citizen via the Patriot Act, whilst at the same time doing all in its power to protect the interests of the 1%.
I remember being forced to study Alexis de Tocqueville’s Democracy in America and its central concern about the ‘Tyranny of the Majority’ and how the US Constitution mitigated against this, basically, from day one of the revision of the US Constitution you have had a ‘Tyranny of the Minority’ and its time this ended given the deaths this tyranny in the USA and worldwide causes – neoliberalism and neoconservativism is the greatest expression of this process – time for a change me thinks.
Come election day, I trust my US peers posting on these boards will vote for a third party, any third party as its the only language your masters understand.
Other nations with single-payer or national health services also spend a much lower percentage of their GDP each year on health services and get a much better standard of service and outcomes for what they spend. Canada, Australia, Taiwan and France are all cases in point. The US system gives the least “bang for the buck” of any health insurance system in the world. It’s a true disgrace!
I neglected to mention that the Model fro Taiwan’s very low cost, excellent outcome system was US Medicare. The system is an enhanced version developed using US consultants.
Didn’t that include Prof. Hsaio, the guy who did the study for Vermont?
I don’t remember.
Hell, you don’t even have to consider advanced industrial countries. Colombia’s health care system is in the top 10 worldwide according to the World Health Organization while the USA is outside of the top 40. That’s what you get when you organize a health care system as a profit maximizing business rather than a wellness maximizing system.
Cheers Chris for the skinny.
Neoliberalism is just the response of the capitalist class to declining industrial profits.
Tertiarization (financialization), credit bubbles, stagnant/declining wages, and expanded market access in China and the ex-USSR restored profitability from 1980 – 2007. Because this was the only avenue that could restore profitability, it became an ideology. Therefore, Neoliberalism is not “bad” policy; it is class policy.
It is an exercise in futility to proselytize MMT (or Keynesianism). The capitalist class has already decided that class war and austerity are the means to drive down wages across the board and thereby raise profitability (a fallacy of composition, but “common sense” in the eyes of the individual businessman).
Do you mean that MMM is not an appropriate antidote to Neoliberalism or that doing anything is pointless?
He means that the problem is one of political power.
The people in power have set their minds on a very stupid and destructive course of action, and no rational argument is going to convince them to do otherwise, not even when it is in their self-interest.
Trying to reason with cult members is somewhere close to impossible.
The path to removing these people from political power is also unclear. In Germany there may be a path (vote Green / SPD), but in most countries all the major political parties have been captured by the cult mentality; this is certainly true in Ireland (where the top FOUR have been captured), the UK (where the top THREE have been captured), and Greece (where the former “left” and “right” parties are now just considered the “establishment” parties).
The US is in a somewhat different position because the Democratic Party is not a cohesive political party and does not have coherent views. While President Obama is clearly captured and so are many other Senate Democrats, there may be a possibility of recapturing the Democratic Party. The Republican Party is almost completely captured, however, and the Republican who aren’t captured by this cult are mostly captured by OTHER, even CRAZIER cults, so they’ll be no help.
I believe Spain is also in a different position. Although Spain’s “Socialist” party agreed to some of the austerity nonsense, it did so under repeated protest and under conditions of being blackmailed by other countries; this bodes well.
“In Germany there may be a path (vote Green / SPD),…”
Bad information.
Under Schroeder’s (nominally SPD) premiership HARTZ IV programee – read, an impoverishment of German’s working class – was enacted. Wages lowered as much as 30%.
Greeen and SPD are most likely worst than CSU/CDU – nominally right-wing parties. After all, them all, belong to ruling class who govern by own version of neoliberalism called ordo-liberalism. The result is Hartz IV.
http://blogs.lclark.edu/hart-landsberg/2012/02/15/germany-a-false-model/
When we talk about this, than for the sake of reality and sanity (for ones who want to be in these state of mind) one must admit that in Germany (as usual) just as it the case in the rest of “advanced” countries one might conceivably to say there is word of extreme chauvinistic national or nation-state policy. When you strip off all their rhetoric and pseudo-science one can see that their default identity and ideology is: Fascism.
Wait a minute — aren’t there more of us (people) than of them (the capitalist class)?
The utter impotence chosen by ordinary people as our primary response to crimes committed against us is depressing as hell.
The American dream is the perfect memetic vaccine against class related uprisings as it makes people think of themselves as .1%-ers in the making. This makes them back policies favoring their “future” class.
Frankly, anyone who believes that there is a solution within the pseudo-democratic electoral framework has an analytical ability below that of the average tea party patriot.
Simply adding numbers is too clever by half. Yes, about 95% of people are exploited in some way or another by financial capital, but there are also many sub-exploiters in that 95% that have in interest in the status quo. Also, the cultural hegemony of the capitalist class has produced many alienated working poor who will defend the exploiters. It is that hierarchy and that alienation that are the props of the political superstructure.
Instead of adding numbers, in politics you must use the law of the parallelogram. In such a parallelogram, we know that the resultant is shorter, the more component forces diverge from each other. In other words, more “moderation” brings the resultant closer to 0. Civil war, in which the force of naked coercion is hardly effective, demands of its participants the spirit of supreme self-abnegation. The working class can assure victory only if they wage a struggle for their own emancipation. Under these conditions, an to attempt to mobilize them with MMT or a Keynesian program beforehand is to assure defeat in a civil war.
Great points. Just to add–the dynamic we are looking for is to address cultural issues. Our politics is a result of a culture dependent on creating intellectual/mythological frameworks based on the narrative presented by the entertainment and big-media industries; without common narratives people flounder and most will accept any kind of political arrangement including being nailed to a cross if it has cultural meaning and fits what they consider a cohesive narrative. If change comes it must start from the structures that provide meaning for most people.
Last time I checked, death was monetized.
All this bread and circuses about health care are meaningless when the profit driver – not life – is the only thing that matters.
Misery = money and business is looking fantastic for the skinning of the boomers.
‘ … a paradigm that works … that paradigm is called Modern Money Theory.’
Also known as Muppet Mesmerization Theology.
After new recruits go glaze-eyed with the cool new pseudoscientific jargon, it’s time to drape them with acolyte cloaks and usher them into the sanctum sanctorum for the solemn Kool-Aid sacrament.
After that, they’ll be immune for life from cult deprogramming. Though they may have to go Buddhist and collect alms after pallets of rainbow-colored confetti currency not only fail to enhance their purchasing power, but actually corrode it.
TANSTAAFL, kids — They Ain’t No Such Thing As A Free Lunch. So don’t accept Skittles from strangers promising you the beautiful unicorn that your mean mommy and daddy refuse to buy you.
No free lunch? Unless you’re a One Percenter.
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Beautifully woven invective, utterly devoid of content. So what is actually wrong (i.e., incorrect) about MMT?
There is no fiscal constraint on the state that is sovereign in its own currency. Where the currency in question can purchase any good or service offered for sale – as is the case with the $US – then the only limitation on the state’s purchase power is self-imposed. Such self-imposed constraints can be a good idea (e.g., where inflation is a concern), or a bad idea (e.g., where the population suffers chronically high unemployment), or utter madness (e.g., fiscal cliffs). But in any case, we should never have to countenance the discourse of austerity – “we is broke!” “We” (in the sense of the state) is not broke. “We” can’t be broke.
That’s it – MMT. Is this wrong?
I think MMT is basically sound.
If we look at hyperinflation in Weimar Republic Germany,
in 1923, Germany was stuck with trying to repay an extravagant debt in a currency it couldn’t print or manufacture (I think). So, it had to use foreign exchange
reserves, some hard currency. Also, French forces occupied the Ruhr. According to Wikipedia, the French invasion of the Ruhr was to pressure Germany due to default on timber deliveries and maybe coal deliveries (they could not print those).
http://en.wikipedia.org/wiki/Occupation_of_the_Ruhr
WW1 war reparations were payable in gold, because the rest of europe didn’t want to be paid in funny money. Germany had to export lots of coal and whatever else they could so that they could get paid in foreign currency or gold and they had something to make debt payments with.
Then for some reason they printed boatloads of currency for domestic use. maybe they thought they were goosing the economy or something – there was early “chartilist” ecoonmic theory back then and some think that influenced Keynes and also the Weimer guys. It didn’t seem to work so good.
So you could say the real problem was huge external debt – but what’s new?
It wasn’t the external debt. It was that it couldn’t be paid back in Germany’s fiat currency. Japan’s debt, on the other hand can. As can ours.
1) External creditors (or manufacturers) don’t accept funny money.
2) Japan is a large net creditor and their debt is not held by external creditors, but rather domestic “investors”, and Japan can pay them in funny money.
US debt is held almost entirely by domestic “investors”, with most of the remainder held by China. And China desperately wants to make sure the US does NOT pay off its debt. (Yes, really. China wants to keep its export industry going.)
So the US is in a position more like Japan; zero danger of hyperinflation from THAT cause.
We could eventually get post-Soviet-style hyperinflation caused by simple local distrust of and repudiation of the currency, combined with people wanting to use another currency — but that situation takes decades to build up and requires an artifically inflated exchange rate to start with, which we don’t have. So that won’t happen for decades either.
Actually, Japan holds as much as China, the total for both being $2.5 trillion. Then the ROW holds a substantial portion, but I don’t have the current figure handy.
You can also be sure that whatever pisses off China, Japan and ROW will also piss off Wall Street, pension funds, life insurance annuities, and social security.
Sorry Jim, this is nothing but labeling, ad hominem, and unwarranted assertions. In other words BS!!!
Not sure which alphabet letter represents the 18-25 year old class, but they do seem demoralized as to achiving success in the present economy. That said, just where will the money come from if the neo-whichever fulfill their desires? If the economy tanks, there will be a real threat of revolution, be it peaceful at first, but then turning ugly after a short time, especially if the idiots let the junk yard dogs loose. We have witnessed just how successful the neo’s have converted the M.E. to date, the E.U. with the austerity is working, which they want to impliment here. Is this what we want for our future?
A……….generation Apathy.
An apathetic affect often results from repeated abuse.
Almost nobody seems to understand that most healthcare is not pro-health, it is simply “business”. 47,000 premature deaths per year deaths per year might be small compared to the additional deaths if given unlimited “healthcare”.
For example, “Medical mistakes injure or kill hundreds of thousands of Americans every year” per http://www.thedailybeast.com/newsweek/2012/09/16/are-hospitals-less-safe-than-we-think.html. I suspect the overtreatment premature deaths are actually underestimated.
The Vioxx debacle (or what should be called the Vioxx mass murder) is business as usual for the drugmakers (i.e., suppressing negative evidence). American medicine is not “evidence based” but “greed based”. In healthcare, the only “evidence” being sought is the evidence that makes money. There is little search for “root causes” and “We don’t know what causes …” is the mantra of doctors; but the search for “remedies” (particularly lifetime prescriptions) is unrelenting.
I’ll admit that US trauma treatment is effective (even if overpriced). But, for chronic problems (where the real money is), the healthcare system is a disgrace. The most prescribed drugs, statins and anti-depressants, have long-term consequences that completely negate their overstated or non-existing value. Most people are aware the overly aggressive “prevention” of breast cancer and prostate cancer is of marginal or negative benefit, but that is the tip of the iceberg. It is also true that most heart bypass surgeries and stents are ineffective in extending life. The “treatments” for diabetes, acne, Crohn’s disease, IBS, etc., are also mostly long-term ineffective. The mostly self-regulated healthcare business cannot even reign in its universally acknowledged overuse of antibiotics; this recklessness has not only bred the superbugs, but its gut flora destroying side effects have unnecessarily created severe long-term damage in many patients.
Most chronic healthcare problems are due to diet (i.e., an excess of manufactured foods mostly based on sugar, wheat, vegetable oils, soy, modern dairy, and other cheap and subsidized junk). This not a new revelation; look into the 80 year old work of Weston A Price if skeptical. Lousy food is, in effect, promoted by the USDA because cheapening food, regardless of consequence, seems to be their main driver. Anybody who truly cares about our health needs to worry less about funding and access to the profiteers of chronic disease and more about the lack of knowledge (or intentional obscurification) about what makes us fatter, more depressed, and more vulnerable to disease.
So part of universal healthcare needs to be reformation of the healthcare system … else you just feed the already too big monster.
I totally agree. Everyone should read this interview of Gary Taubes http://m.thebrowser.com/interviews/gary-taubes-on-dieting
Then you will love Jill Stein’s approach – Single payer health care to cover all for necessary care and promotion of local organic food stuffs as an answer to much of what you talk about ….
Methinks more and more folks in the medical profession are coming around to the realization that health has to do more with what’s in the food pantry than what’s in the medicine cabinet ….
And get rid of those WMD Gmos ….
The NY Times had an article within the past 3-5 weeks reporting on the observed decline in lifespan of poor white women in the United States. The key report was that, on average, women in this demographic group have lost 5 years of life over the past 30 years. Some of the decline may have to do with smoking incidence and obesity/high blood pressure prevalence. Still this is an unprecedented decline for our country to experience. Social inequality and financialization of medicine are probably contributing factors. Attacks on Planned Parenthood, Medicare, Medicaid and so forth are hardly helpful.
Actually quantifying these effects scientifically is not easy but people are doing on it. It is already pretty well established that people without insurance have less access to health care and much poorer outcomes when ill.
The US gov. has done surveys on access to care and health expenditures. Many epidemiologists and economists have used these data to write papers that document associations between access to care and insurance coverage.
While access to care is of marginal value to the healthy, it truly is life and death to the poor and the ill. Moreover, while most of us are healthy for most of the time, sooner or later we will all be ill or in acute emergency situation. And also many of us go through periods when we are financially challenged. So if society undercuts access to care to the vulnerable among us, keep in mind, eventually all of us will be affected.
That is the key – we will enact/support policies that benefit those we identify with. In the 50 years ago the deprivations of the depression and the war were fresh enough and proximate enough to give us SS/Med. In the last 2-3 decades,the zeitgeist of the individual in the market has prevailed and hence our identity with those who have “done well …
Methinks the tipping point on our politics will be when we once more identify more with the vulnerable than with the powerful …. The question is how low do we have to go before we get there ….
All you have to do is to point out to people who’s really in charge.
The average right-wing voter thinks he’s identifying with the “elite” — but he’s really identifying with the upper-middle-class professionals. Which is understandable; their lives aren’t *so* different from his, although they’re much more secure.
But he doesn’t usually have a fucking clue what the life of the actual elite, the 0.1%, the million-dollar-a-year crowd, is like. When you show him what most of those people are actually like — namely, Mitt Romney, who’s a perfect example — the average man is repulsed.
This is why the million-dollar-a-year crowd likes to advertise the “black sheep” billionaires (Warren Buffett, Paul Allen) who live reasonably comprehensible lives — while hiding the way the loot-and-burn financiers, who constitute most of the 0.1%, actually live. They live in “Richistan”, as the book title describes it.
“Lousy food is, in effect, promoted by the USDA because cheapening food, regardless of consequence, seems to be their main driver.”
Actually, the USDA’s job is to promote profits for agribusiness. Offically, its job is to promote profits fo for all farmers. But in practice, it’s complete regulatory capture by industrial-farming agribusiness.
Note that its job has NEVER been to improve the health or safety of our food supply.
Three comments:
1) International comparisons to the US are seriously flawed because for the most part, countries with national systems have largely homogenous populations or simply dopn’t pay attention much attention to minority populations. That doesn’t happen in the US (for political reasons) and as a result our health care programs attempt to address all the niche elements (ethnic and religious issues) that add to health care costs, but do little to impact the overall health care outcomes.
2) We really need to move away from using “lives saved” as the ultimate measure as success. While it’s more difficult to measure, it’s really the quality of life that’s important, but we make the error of assuming that “saving lives” means a better quality of life overall. If your end goal is saving lives, then any intervention that results in even another 24 hours of life can be classified as “saving a life.”
3) The current US system of Medicare has resulted in incentives that promote health care utilization that is expensive and largely useless. Hugely expensive cancer therapies that cost >$100K, yet offer mere months in terms of better survival are one example. We’ve created a system of blank checks for that period (old age) when health costs are already high and the private sector is more than willing to respond accordingly.
BTW, longevity is not a good surrogate for the qulaity of health care because life style choices have a much greater impact. In fact, in the US, if you control for accidents and violent deaths (crime related), US longevity is better than everyone else.
“We really need to move away from using “lives saved” as the ultimate measure as success. While it’s more difficult to measure, it’s really the quality of life that’s important, but we make the error of assuming that “saving lives” means a better quality of life overall.”
You can’t have quality of life if you’re dead.
“BTW, longevity is not a good surrogate for the qulaity of health care because life style choices have a much greater impact. In fact, in the US, if you control for accidents and violent deaths (crime related), US longevity is better than everyone else.”
Prove it.
“. . .for the most part, countries with national systems have largely homogenous populations or simply dopn’t pay attention much attention to minority populations. That doesn’t happen in the US . . .”
Another self-absorbed white man. If you think the health of minorities isn’t ignored in this country, you’re either a fool or a liar.
Bullshit.
A recent study (I’m not having great luck in tracking it down, but it was widely discussed in the UK) took middle aged men in the US and UK, made sure they were ethnically homogeneous, as in white. Stratified them by income, three groups in each country, top third, middle third, bottom third.
The poorest 1/3 in the UK was healthier than the richest 1/3 in the US.
Yves,
Many thanks for jumping in, I nearly had a fit reading some of the bullshite this guy wrote.
Further, the UK presently is a multicultural society with a very large Asian community spread across the entire country – as such, and given the multi-ethnic composition of our NHS itself, its a travesty to talk about an homogenous population – even in my neck of the woods, over the past 35 years their has been a vast change in the ethnic composition and funnily enough, much of this has been driven by the NHS itself.
To reiterate once more, in terms of overhaul health outcomes for society in general, and not its richest element, the UK is second to none – a matter I as a socialist am proud about, its just a great shame for the past 20 years many of our politicians and their neoliberal masters would rather follow the US path than the socialised UK/European path.
And, to recall Nye Bevin the founding architect of the NHS, “The Tories are lower than vermin” a fact I concur with 100%.
An apology for grammar errors, I really must get a pair of glasses shortly – my eyesight is abysmal presently.
The Tories have always been on the wrong side of everything. Isn’t that the essence of their party platform?
The sad part is how *many* of them there still are — but the really sad part is that they still wield any power.
I assure you, if Labour had not gotten complacent, corrupt, authoritarian, and power-hungry — specifically, by deciding not to implement proportional representation based on corrupt short-term political calculations — the Tories would be a permanent minority by now. There would be a lot of parties competing with Labour, but there would be a fundamentally social-democratic coalition every single time. However, Labour’s *collusion* with the Tories to retain First Past the Post has kept the Tories alive.
Yeah, that’s right. That was a European study which was followed up by Harvard School of Public Health researcher Iwaki? ( something Japanese). There were one or two article on it in Dollars & Sense & one in Harvard Magazine. Nothing else in the USA. Had hardly any luck finding it on the net, until I found my old copy of Dollars & Sense under my mattress. See if I can dig it up. My copy of Harvard magazine was in my bathroom, but it got lye spilled on it. I really think THEY (the Illuminati, the Bilderbergers etc) did that & are trying to keep people from knowing about this. :-)
Yves:
Have to agree with you and kudos to you for the Bull Shit reply. Diabetes is the disorder of the last two decades impacting not only adults in an ever increasing percentage; but, the youth of America who may not outlive their parents the generation of babyboomer kids.
Have you considered Maggie Mahar as a potential poster to your blog with an article or two on the PPACA? I generally quote from her words.
Go ahead, control for violent death and accidents, and while you’re at it also control for the role of the weak social safety net in violent death and accidents, and then what are the Numbers?
Also, I don’t think homogeneous population quite explains what’s going on either, since in case you haven’t noticed, Australia and Canada are also growing heterogeneous populations as the years go by.
The link to the Commonwealth fund study in the article returns a 404 Error. I believe THIS is the link to the study…hopefully anyway.
The “Wolper-Woolhandler-Himmelstein et al study” also returns an error. HERE’S a PNHP link to a press release that contains a link to the report itself and other state-by-state information.
The “here, here, and here” links also return the same error. The NEP links at the end seem to work.
Don’t get me started on Jonathan (We Don’t Know How To Fix It!)Gruber…or Jacob (Bait-N-Switch) Hacker for that matter…I’ll end up tweaking the Spam Filter.
The reason a Single Payer, Improved Medicare-for-All, healthcare system is never considered in political policy or media reports or studies is because it’s not an insurance plan. It’s a healthcare plan. Health insurance is not healthcare. Health insurance is a pass through the door into the For-Profit Health Services Casino and a couple of chips to get you get you to the tables…or the slots…or the keno. A Single Payer Plan, like H.R. 676, provides for healthcare, giving everyone in the country access to all medically necessary treatments, including dental and vision, when needed, without exclusion or rationing based on economic class. That’s not insurance…that a Plan…a system to provide healthcare. Calling it “insurance” connects it to the same kind of bourgeois politics that supports Neoliberalism.
Neoliberalism abhors any mention of Single Payer because it promotes social solidarity, something Bourgeois America fears more than taxes, The Deficit™, Black Presidents, the Tea Party, Sharia Law or even atheists.
I wouldn’t venture a guess on wether MMT could defeat Neoliberalism, but if capitalists want to save their system, their class, their privileges, they better come up with something…soon.
MMT can’t defeat neoliberalism. People in the streets, lots of people in the streets, eventually will defeat neoliberalism. MMT just gives such people some reasons to be there. Our received verities are wrong, or less charitably, are lies. MMT shows received “economic truths” to be lies, in simple and straight-forward terms easily accessible to anyone with an internet connection. Misery and degradation are not sufficient to fuel the fire that you anticipate. There have to be ideas as well, some of which are ideas about the economy which can be found here.
At least, that’s my view from the cheap seats, here in pelagic America. I have no background in economics, and am in no way associated with UMKC etc.
I’ve been working my way through the MMT Primer at NEP. Slow but sure. Thanks for that by the way.) I’m not an economics wonk, so it’s probably more slow than sure. But I don’t see how MMT “…just gives such people some reasons to be” in the streets.
Historically, immiseration and the collapse of economic systems has been “sufficient to fuel the fire” that more people than myself “anticipate.” There’s Marx…Trotsky…Henryk Grossman. And the people I see in the streets today…in Greece…in Spain…in Portugal…The U.K….South Africa…and even outside your friendly neighborhood WalMart…are they inspired to act by MMT?
Slogging my way through the MMT primer may help raise the consciousness…I hope…but that’s not what get’s me into the street to fight against a system that picks my pocket, takes the food out of my mouth, the roof over my head and then demands more.
Immiseration by itself is actually not a strong motivator to social change. Immiseration (1) + the idea of an alternative (2) is stronger. Immiseration (1) + the idea of an alternative (2) + knowledge that the immiseration is the product of a monstrous untruth (3) is stronger still. MMT provides (2) in the form of its jobs guarantee (which is controversial here). MMT provides (3) in its anti-austerian foundations (which is not controversial, I don’t think).
The nation sovereign in its own currency is not fiscally restrained. Yes, it seems trivial, but it is actually a powerful concept, if for no other reason than that it puts the lie to the ideology that animates all acceptable mainstream discourse and policy in Europe and the US right now.
You’re exactly right, of course. An immiserated population who does not have a conceptual alternative will merely riot, rather than revolting.
That is far far worse, from my point of view. I’d much rather have a revolution than endless riots.
Medicare for All is National Health Insurance without National Health Service. It is not equivalent to the UKs NHS as you can see by comparing Canada or Taiwan to the UK.
MMT is capitalism riding a unicorn. As long as money even EXISTS it will be a force of corruption.
Only capitalist societies have money? Surely not.
One would think there is a more interesting anarchist answer to “The state spends its money into existence” than that!
Some people want to abolish money because they want to eliminate industrial society, which they see as immoral.
Good luck with that. Even if some group of nihilists succeeds in abolishing industrial society in their part of the world, their society will never withstand conflict with those who haven’t. This is even more true in a post-petroleum society. Even Derrick Jensen admits that a post petroleum society will depend on coal. Let’s not forget that coal powered industrialized societies were easily able to subjugate everyone else.
People forget that the technological tools that allow third world insurgent groups to operate come from industrial society– explosives, personal electronics and personal automatic firearms.
The lesson of the 19th century is that you either master industrial technology and organization, or those that do will master you. Deal with it.
Primitivists can hardly be considered Anarchists (the ‘mainstream’ of Anarchist thought is -Syndicalist/-Communist) and Anarchism is nothing if not a proposal for a way of organizing society. But you really kicked that strawman’s ass.
Sorry, I wasn’t clear enough: I don’t think you can have an industrial society without money. But hey, prove me wrong by doing it.
Of course there are multiple systems which use money. MMT may be ‘true’ but it’s completely non-actionable, and pointless since it challenges none of the fundamental principles of modern capitalism (namely quid-pro-quo economics and title-based property). Any luck convincing Obama to print the magical $10 Trillion platinum fetishes yet?
No. He just doesn’t want to win this election! He’d rather get into his second career as a $400,000 a shot orator, than spend his time waiting for call backs from John Boehner.
Anyone with money is corrupt?
Meaning that slaves are moral. They’re happier being looked after and told what to do?
Same with monks. Dunno about that monk thing. Celibacy…
Or is anyone who looks after money corrupt? Those bankers can’t help it, it’s the money makes them do it.
While the love of money is the root of all evil, you have to broaden that dicta to get at the truth. Not just the digits in the accounting journal. Material good replacing human good. Pricing things that aren’t for sale. Measuring all good in dollars.
What does morality have to do with happiness?
Wow.
OK, how about this (from dictionary.com):
mo·ral·i·ty [muh-ral-i-tee, maw-]
noun, plural mo·ral·i·ties for 4–6.
1. conformity to the rules of right conduct; moral or virtuous conduct.
2. moral quality or character.
3. virtue in sexual matters; chastity.
4. a doctrine or system of morals.
5. moral instruction; a moral lesson, precept, discourse, or utterance.
If you go by the primary definition at (1), you’ll see that there is a vagary of what exactly defines right/virtuous conduct. But if you assume that “right” or “virtuous” conduct means acting in such a way that your actions do not intentionally harm others, then there is a high probability that a society which participates in this assumed form of morality will have a higher perception of happiness in the lives of individuals than a society which indulges in self-interested and/or destructive behavior.
YMMV, of course.
“All, on grounds that the PO was a more politically “realistic” alternative than Medicare for All.”
Ah, yes, how to hook a lefty – convince him/her that your desired option is the only “realistic” one, so of course a “rational” person would choose it. No “rational” person would go for a pie on the sky, “can’t win” idea like single payer, even if it is the best choice .. LOL
Here’s the definitive history of the public option debacle* from PNHP’s Kipp Sullivan: Bait and switch: How the “public option” was sold followed by Reply to critics of “Bait and switch: How the ‘public option’ was sold”.
NOTE * To be fair, the “public option” wasn’t a debacle from the point of view of the health insurance companies, or the Obama administration and the career “progressives” who ran interference for it.
And let’s not forget Sullivan’s classic Two-thirds of Americans Support Medicare For All. (A PDF…but one link is better than six sayeth the Spam Filter.)
The more Americans know about Single Payer, the more they like it.
That is what is so interesting about their failure to carry through at the polls – they want it but they don’t vote for it because they are told 1)the candidate who supports it “can’t win” 2) it is not “politically feasible” so we must be “reasonable” and “pragmatic” and “practical” and take what we can get – isn’t that the “logical”, “rational” thing to do? The hook; if you can convince a lefty that something is the “rational” thing to do, you are likely to get agreement even if the “rational” thing to do is actually a POS ….
Well, can’t help wondering if there isn’t a simpler explanation for why these schmucks didn’t change the filibuster rules or use reconciliation or whatever to get single payer besides being deeply committed to an “ideology” – they were convinced that supporting such a plan would have resulted in a total drying up of their own funding, a barrage of negative ads re them = the death knell for their political or post political ambitions and the neoliberal justification was just a fig leaf thrown over their naked self interest. Shucks, even Kucinich dumped his own plan in favor of ACA …
That’s why they needed to take the filibuster down in early January, make sure the mark-to-market was never changed through Congressional pressure, take down the insolvent big banks and begin investigating and prosecuting the frauds with the documentation found by the regulators, and then: 1) Pass a $1.8 T ARRA with full payroll tax holidays, 1,000 per person revenue sharing; a Federal Job Guarantee at a living wage w/full benefits; and the rest spent on infrastructure and green energy projects, rather than Republican tax cuts 2) a credit card reform bill limiting interest rates to 5 points over prime; a tough Finreg bill destroying the international gambling casino, and providing for very tough consumer protections, 3) public funding of campaigns, and only then, after Wall Street’s power was broken 4) Medicare for All by the summer of 2009.
After that the Ds wouldn’t have had to worry about money; because the Street wouldn’t have been able to afford throwing money at Republicans.
The point is that when you have majorities like the ones the Ds had in 2009, you pull out all the policy stops, and change the power structure while you can, up to and including impeaching justices of the Supreme Court (Scalia and Thomas) who were obviously taking corporate money. The game in 2009 was to take away the power. The Democrats utterly failed to do that either because they didn’t understand that, or because they didn’t want to.
A very forceful summation and closing argument …
(no irony).
“because they didn’t want to.”
Bingo – That’s my point …
They don’t want to bring down those fat cats because they are their meal ticket – they want to “compete” with the R’s for the fat checks, not eliminate those checks – that’s why the “shift to the Right – that’s where the money is, man ….
That’s why we have to, as Stein says, “throw the bums out”.
Right, but my point was that they wouldn’t have needed the money if they’d done the right things. So, why wouldn’t they act? Why did they run for office in the first place?
Check out dieoff.org. The world’s sustainable population is about 1/7th of the current number. This just describes one way to get there without. Recognizing what is happening.
As far as not wanting to spend the money – hah, they have been willing to spend the money on a bunch of other crap, if they were serious about this deficit nonsense, they would re-institute progressive taxation and stop these god awful wars …
And the case could be easily made, ISTM – using Reps own argument – all gov’t spending is “taxpayer” = citizen money – and healthcare spending is also “citizen” money so if you want to put more money in citizens pockets, take it out of the insurers to the tune of $400,000,000 and put it into theirs – their spending on healthcare decreases …
“Give me Liberty, or Give me Death!” – Patrick Henry
What a brilliant ruling by the United States Supreme Court on the affordable health care act (Obamacare). Stunningly brilliant in my humble opinion. I could not have ask for a better ruling on a potentially catastrophic healthcare act than We The People Of The United States received from our Supreme Court.
If the court had upheld the constitutionality of the individual mandate under the commerce clause it would have meant the catastrophic loss of the most precious thing we own. Our individual liberty. Thank you! Thank you! Thank you! Supreme Court.
There is no mandate to buy private for-profit health insurance. There is only a nominal tax on income eligible individuals who don’t have health insurance. This is a HUGE! difference. And I suspect that tax may be subject to constitutional challenge as it ripens.
This is a critically important distinction. Because under the commerce clause individuals would have been compelled to support the most costly, dangerous, unethical, morally repugnant, and defective type of health insurance you can have. For-profit health insurance, and the for-profit proxies called private non-profits and co-ops.
Equally impressive in the courts ruling was the majorities willingness to throw out the whole law if the court could not find a way to sever the individual mandate under the commerce clause from the rest of the act. Bravo! Supreme Court.
Thanks to the Supreme Court we now have an opportunity to fix our healthcare crisis the right way. Without the obscene delusion that Washington can get away with forcing Americans to buy a costly, dangerous and highly defective private product (for-profit health insurance).
During the passage of ACA/Obamacare some politicians said that the ACA was better than nothing. But the truth was that until the Supreme Court fixed it the ACA/Obamacare was worse than nothing at all. It would have meant the catastrophic loss of your precious liberty for the false promise and illusion of healthcare security under the deadly and costly for-profit healthcare system that dominates American healthcare.
As everyone knows now. The fix for our healthcare crisis is a single payer system (Medicare for all) like the rest of the developed world has. Or a robust Public Option choice available to everyone on day one that can quickly lead to a single payer system.
Talk of privatizing/profiteering from Medicare or social security is highly corrupt and Crazy! talk. And you should cut the political throats of any politicians giving lip service to such an asinine idea. Medicare should be expanded, not privatized or eliminated.
We still have a healthcare crisis in America. With hundreds of thousands dieing needlessly every year in America. And a for-profit medical industrial complex that threatens the security and health of the entire world. The ACA/Obamacare will not fix that.
The for-profit medical industrial complex has already attacked the world with H1N1 killing thousands, and injuring millions. And more attacks are planned for profit, and to feed their greed.
To all of you who have fought so hard to do the kind and right thing for your fellow human beings at a time of our greatest needs I applaud you. Be proud of your-self.
God Bless You my fellow human beings. I’m proud to be one of you. You did good.
See you on the battle field.
Sincerely
jacksmith – WorkingClass :-)
Time to erect the guillotines. . .Nothing that helps “We the People” has been accomplished without bloodshed!!!!
I can’t thank Naked Capitalism enough for maintaining a focus on this aspect of neoliberalism, society, moral hazard, economics of health.
As for Joe.. You sir, are a tireless advocate, a righteous patriot and a decent human being. Thank you.
Thanks ES, Thanks for the friendly support over the past few years. I don’t know about the tireless. Yves and Lambert are tireless! I just do the best I can. Thanks again!
The hallmark of contemporary neoliberalism, globally and now in Europe and the US, is the combination of state coercion of populations with profit maximization for private corporate entities along with the forced privatization of public assets.
The end goal of contemporary neoliberalism is thus the control of cash flows through state coercion, not the deficit that is the cultural fixation of Tea Party libertarians.
The deficit is merely the hammer with which the new model brownshirts like public union-busting Wisconsin governor Scott Walker and Medicare voucher salesman Paul Ryan forcibly privatize public assets and redirect the flow of both public and private funds to the financial and managerial classes, and into the coffers of money managers and their upper middle class clientele in the form of profits. (Or so they aspire).
The “MMT-ers” thus focus on the symptom, not the disease. I suppose this is what one should expect from people who run money on the side, when focusing on the disease might require them to turn their legendary rhetorical nastiness– unemployed! couch! bonbons! TV!– on themselves.
To which self examination their fierce posse of internet fanboyz– and for some reason I’m certain my pea brain will never be able to puzzle out, they are almost all boys– would surely object.
Well, now that I’ve said my piece about the current status of teh ever evolving neoliberalism, I’m going to go finish that great article from the Smithsonian on Thomas Jefferson in today’s links.
4%! Numbers are just magical, aren’t they? It is a must read.
JTF, I have a feeling we’re in strong agreement in underlying values. But where do you get laying this on the MMT folks? They’ve been working hard for years to unmask the neoliberals and get back to Government fiscal policy that serves the public purpose. There’s nothing wrong with the motivation of may of the developers as far as I can. So what kind of grounds have you got for leveling these charges at a group of people all of whom have been risking their careers and well-being to develop and promote this new economic paradigm?
What careers? Let’s be frank about how academia works–all academia, not just in economics.
These people are in Kansas City, MO. If they hide in the weeds as standard issue business school economists, they have no career. Publishing in academic journals is a problem for them, no matter what their ideological persuasion, although they would apparently have their fanboyz believe otherwise, promoting instead the narrative that they are oppressed “economic progressives” as if that were the only factor at issue in their poor showing.
Meanwhile, they can always run money on the side, because the barriers to entry there are… lower.
On the other hand, if they turn themselves into internet provocateurs and public policy entrepreneurs they can have Scott Walker’s (eventually lucrative) career infighting formerly unemployed guaranteed minimum wage public service employees with unionized public sector employees, who the neoliberals already have under attack, on multiple fronts, including the privatization of formerly publicly funded and publicly run facilities. So, it’s important for that reason to drive labor costs down.
Politically, that’s where they are right now. Is Jacob Hacker dumb or pernicious?
I think it’s interesting that you bring up their pissing and moaning about how they have no careers, given the likely effect of their austerian labor policies on the career prospects of others while normalizing government sanctioned austerity in employment by repackaging it as “progressive.”
In this, they’re a whole neoliberal Obama Administration unto themselves already, normalizing as a progressive agenda that which was formerly conservative. Newt Gingrich has shed his skin and the snake reappears, shiny and new.
This, in the face of their tender concerns with their own careers, makes them hypocrites.
I also think it is interesting that, while they apparently haven’t studied the impact of their labor policy agenda on public sector employment and on the broader labor market, preferring their own assertions about it, they hold this policy agenda as a non-negotiable.
In addition to their blatant hypocrisy, this also makes them anti-democratic.
Meanwhile the lack of study just means they have quite a bit in common with the business school economists who pontificate based on aery models that may or may not bear any resemblance to the real world.
Not only is all this questionable, but anyone who actually likes this is questionable. That they’ve gathered this aggressive posse of internet fanboyz around themselves while promoting austerian labor policies as the new progressive norm is the most disturbing thing about this.
Like I said, in my read of it, neoliberalism is about control of cash flows, not the deficit. For people who insist that the deficit is not a national crisis, I find the “MMT-ers” own austerian labor policies curious. If we’re not in crisis, why are they promoting labor austerity–and under a reputedly “progressive” label, no less?
Because unemployment is worse? Nice false choice, and one to which they insist “there is no alternative,” like Margaret Thatcher herself.
I don’t have time or more importantly the inclination to follow these people around like the fanboy posse, but I don’t need any more reason than what I’ve skimmed off the surface to put them on the likely prospective perp side of the ledger.
I’m happy to be proved wrong, just like Obama can always come to Jesus in his second term. Although, their self-spun hagiography is just another way in which they resemble Obama, that handpicked faithful servant of neoliberalism.
I mostly exempt Bill Black from this assessment as he actually has a career as a public servant and I exempt Michael Hudson because he has a broad perspective that I can respect. Frankly, I can’t figure out what they’re doing with the rest of these hacks.
And anyone who has ONE single policy cure all for what ails the US labor market can only be a hack and not a well intentioned one either.
For someone from a non-econ background trying to understand all this stuff, can you explain what you mean by a the “labor austerian” aspect of MMT? I would rally appreciate it …
I have real issues with what i heard of Mosler’s ideas on trade – is that related? Or is there something else, that i missed?
I mean “really appreciate”, seriously …
(Although i appreciate a good rally now and then, too ..)
JTF, This is one silly, ridiculous rant, reading all kinds of motivations into the MMT people that don’t exist; and the bit about their austerian labor policies is total nonsense. What’s that based on? The Job Guarantee? If so, you don’t understand the Job Guarantee and its likely impact on the economic system. You also don’t understand that we now have close to 30 million people who are dis-employed and who could be employed by a JG at a living wage with a full spectrum of fringe benefits, including Medicare. What’s “austerian” about that?
Yup, Joe – a rant of words not connected by thought. Could sound good, but means – what? Saying that people have a right to have a way to get money – A right to satisfy otherwise insane demands made on them – is austerian? What does this mean? Raising the real minimum wage from zero to a living wage is an assault on the working class, could weaken unions? And 2+ 3 = -58. Do tell.
Neo-liberals with ‘beautiful plumage’?
Even better to wing shoot the bastards.
Screw the rational discourse!
Should make a lovely dream catcher.
dublinopinion.com/
Ireland and the shadow banking system.
I’m still trying to figure out what a “Neo-Liberal” is. Seems the term is being slung around here like greasy hash. Is it an attempt to demonize liberals in the same way neo-cons are deservidly labeled? Its not working. If Neo-Liberal has a meaning is certainly cant be intuitively defined from the literal meaning of the term.
Here is one definition:
http://www.globalexchange.org/resources/econ101/neoliberalismdefined
For the most comprehensive history of Neoliberalism, I suggest reading Naomi Klein’s “The Shock Doctrine”.
Are you seriously trying to tell us that you can’t google and read a wikipedia article on neoliberalism, or Washington Consensus, or Chicago School? If we were talking about this year’s makes and models would you expect us to include a biography of Henry Ford and histories of the internal combustion engine and the wheel?
Liberals have been beating the drums recently telling us we should vote for that most neoliberal of Presidents Barack Obama, but we are not supposed to infer a connection between the two?
On a deeper level, political liberalism and neoclassical economics which serves as the theoretical underpinning of neoliberalism are both grounded in Enlightenment concepts of autonomous rational essentially interchangeable individuals and the political and economic structures these fictional entities would create. The Framers while paying lip service to these democratic Enlightenment ideals wrote a Constitution that guaranteed that the many which entities were supposed to represent had as little power as possible and that real power remained in the hands of a few, i.e. the rich. We see much the same in the theoretical trappings of capitalism, similar rational actors motivated by enlightened self-interest when the reality is massive inequality with wealth concentrated in the hands of a predatory, kleptocratic 1%.
I am sure this common heritage makes liberals uncomfortable. It should.
To be fair, Hugh, I thought that was a lacuna in the piece as well, which is why I commissioned the second part from Joe.
The term neoliberalism is ambiguous and also changing over time. So, it does make sense for me to lay out what I mean by it if I want to communicate why I think it was an important reason why Medicare for All was taken off the table.
Yes, but your intellectual debt to the “MMT-ers”– and the deficit framework they themselves tirelessly promulgate– has you convinced Congress took it off the table because of the deficit. They didn’t take it off the table because of the deficit, they took it off the table for profit.
Methinks this illustrates again why “debate” should be a HS requirement …You start out with a proposition and then a definition of each of the terms of the proposition. Other folks can disagree with your definition, but at least one can discuss the merits of the argument or discussion in terms of that definition …. Otherwise pages of heated “argument” go by and the discussants are actually arguing about different ideas … Yes? No?
TJF – methinks we agree on this point – as i said above, I think the ideology was a fig leaf …
JTF, I didn’t say it was taken off the table “because of neoliberalism.” I said that neoliberalism provided the main justification for taking it off the table and that it was also a causal factor in the process. That’s different!
I also think that for Obama the deficit likely to come with single-payer was a big factor. He knew he’d be severely attacked for that. He’d already declined to get the filibuster in his quest for bipartisanship. So, he really wanted a bill that he could say was deficit neutral. I’m sure he wanted to sell out too, because of the advantages he perceived in that course. So, I think a number of things came together in his decision, including that he’s a neoliberal himself who believes strongly in the market and the American free enterprise system.
HK, here are a few links and a brief description.
Summarising neoliberalism
To conclude, here are summaries of neoliberalism in two forms. First a list of key points in neoliberalism: Transaction maximalisation
maximalisation of volume of transactions (‘global flows’)
contract maximalisation
supplier/contractor maximalisation
conversion of most social acts into market transactions
artificial maximalisation of competition and stress
creation of quasi-markets
reduction of inter-transaction interval
maximalisation of parties to each transaction
maximalisation of reach and effect of each transaction
maximalisation of hire/fire transactions in the labour market (nominal turnover)
maximalisation of assessment factors, by which compliance with a contract is measured
reduction of the inter-assessment interval
creation of exaggerated or artificial assessment norms (‘audit society’)
A final summary definition of neoliberalism as a philosophy is this:
Neoliberalism is a philosophy in which the existence and operation of a market are valued in themselves, separately from any previous relationship with the production of goods and services, and without any attempt to justify them in terms of their effect on the production of goods and services; and where the operation of a market or market-like structure is seen as an ethic in itself, capable of acting as a guide for all human action, and substituting for all previously existing ethical beliefs.
http://web.inter.nl.net/users/Paul.Treanor/neoliberalism.html
The term Neoliberalism is most commonly used to refer to economic liberalizations, free trade and open markets, the privatization of government-owned corporation, deregulation, and enhancing the role of the private sector in modern society. Today the term is mostly used as a general condemnation of economic liberalization policies and its advocates.[1]
The term was introduced in the late thirties by European liberal intellectuals to promote a new form of liberalism after interest in classical liberalism had declined in Europe. In the decades that followed, neoliberal theory often tended to be at variance with the more laissez-faire doctrine of classical liberalism and promoted a more strongly regulated market economy, known as the social market economy. In the sixties, usage of the term heavily declined. When the term was reintroduced in the following decades, the meaning had shifted. The term neoliberal is now normally associated with laissez-faire economic policies, and is used mainly by those who are critical of market reform.
http://en.wikipedia.org/wiki/Neoliberalism
What is Neoliberalism?
Dag Einar Thorsen and Amund Lie
Department of Political Science University of Oslo
Economic liberalism is, basically, the
belief that states ought to abstain from intervening in the economy, and instead leave as
much as possible up to individuals participating in free and self-regulating markets.
Economic liberalism and neoliberalism should, in our view, be held separate from liberalism
in general, which we understand, along with the Oxford English Dictionary (1989), rather broadly as a political ideology which is “[f]avourable to constitutional changes and legal or administrative reforms tending in the direction of freedom or democracy”. The same dictionary describes neoliberalism also, which is said to be “a modified or revived form of traditional liberalism, [especially] one based on belief in free market capitalism and the rights of the individual” (Oxford English Dictionary 1989a).
http://folk.uio.no/daget/What%20is%20Neo-Liberalism%20FINAL.pdf
Skippy… Its not new and not controversial in its application.
This sounds a lot like the “market state.” So the elites, in classic fashion, are doubling down.
See Part 2!
This post is important because it reminds us of the real damage, death, and destruction that the rich and their enabling elites inflict on so many of us. They have real blood on their hands. They really are criminals, and not just any kind, but mass murderers. And they make sure that we stay too distracted to even see their crimes or realize that they are behind them. Even when we register some whiff of what has happened, they fall back to their second line of defense which is to blame us, their victims. They would have us believe we are reponsible for their crimes.
We need to understand once and for all that they are not like us but only with some mistaken ideas or that they are clueless or incompetent. They are criminals, and especially casual, callous ones at that. But they always try to keep a certain distance between themselves and their victims. They don’t want the blood of the people whom they kill or whose lives they destroy to get on their shoes or splatter their yards. They are very sensitive about this. They want to loot us and then have us go die somewhere quietly out of their sight. Put simply, these people are monsters, but as long as we deny that monsters can wear nice suits or like football or a hundred other things we associate with normalcy, they will use that normalcy to destroy us.
As for MMT, it has much to say about how a fiat currency works, but it is not inherently in opposition to the kleptocratic enterprise. Neoliberals use MMT principles when they want to pay for their bailouts, tax cuts, and wars. It is only when it comes to the rest of us, the social good, that neoliberals become all deficit and debt conscious.
Hugh, I guess we have to go around this circle again.
“As for MMT, it has much to say about how a fiat currency works, but it is not inherently in opposition to the kleptocratic enterprise.”
MMT is inherently in opposition to the kleptocratic enterprise and the kleptocracy because MMT postulates that the Government economic policy is for the public purpose. Here’s my own formulation of that:
“The Social/Value Gaps mentioned by MMT developers
— Failure of Economics to contribute to the Public Purpose as defined by the failure to close the other social value gaps listed below;
— the gap between actual output and projected “full” output;
— High involuntary unemployment vs. full employment;
— Price stability vs. inflation or hyperinflation;
— No right to a living wage;
— No operative right to health care for everyone;
— social exclusion and the loss of freedom;
— skill deterioration due to unemployment;
— psychological harm such as sense of identity, self-respect, and sense of empowerment;
— much greater ill health and reduced life expectancy than necessary;
— loss of motivation to live a full empowered life;
— deterioration of social relations, communities, social networks, and family life;
— increasing racial and gender inequality;
— increasing educational inequality;
— decreasing equality of opportunity;
— loss of social values and sense of individual responsibility;
— increasing economic inequality over time;
— increasing poverty;
— increasing crime rates including increasing use of control frauds by important economic institutions;
— Failure to prosecute and punish people who commit control frauds;
— The collapse of real estate values and the destruction of the wealth of working people after the crash of 2008;
— increasing anger against economic and political elites that get more and more and more wealthy, and more and more immune to the rule of law;
— increasing political inequality undermining political, social, and economic democracy;
— increasing political unrest and threats of political violence both from the privileged and those seeking change.”
This comes from my formulation of the essential aspects of MMT’s knowledge claim network (KCN) here:
http://www.correntewire.com/the_job_guarantee_and_the_mmt_core_part_fifteen_components_of_the_knowledge_claim_network
The tool is not the issue joe, its the user[s, abuse has to have conditions.
Skippy… Hugh only expresses history’s results, everything proclaimed to free humanity, seemingly has the opposite effect in the long run.
skippy, No one’s saying MMT is the answer to all of our problems. But it can get rid of the fiscal policy distractions we face now and help us to face our problems. Your reply is just negativist counsel. It may be true; but if we act as if it’s true, we may as well put a loaded gun to our heads and pull the trigger. Thanks, but I prefer to stay alive and fight to improve things.
Policy advocacy is the main problem Joe, advocacy for who?
The historical track record for that observations is abysmal and reverting to mean, so pardon my lack of trust if you will.
skippy… pulling triggers[?], its only suicide if you do it too your self, murder on the other hand – is not – self inflicted… eh.
It is a circle of MMT’s making which has been around since I first heard of MMT. If I argue that neoliberals use MMT theory, you invoke social purpose. But that proves nothing. Neoliberals still use MMT because MMT is a theory of fiat money and that’s what neoliberals use it as (for themselves).
The mistake you are making is in the philosophical hierarchy of ideas. Money is not some universal constant in the universe. It is a social construct, the means through which some social purposes are executed. Yours are not the only social purposes, and certainly not the only ones that can be executed through a fiat currency. Neoliberals have theirs too. MMTers do not have a monopoly on fiat money principles. Social purpose: What do we want? comes before How do we do it?, i.e. MMT.
MMT, as its name implies, started out as a monetary theory. It was not named Modern Social Purpose Theory. Now you want it to be one. But just because MMT came before in time does not mean it therefore comes before in the hierarchy of ideas where What do we want? will always come before How do we do it?
What you have is intellectually inverted. You have a theory of money. You then attach social purposes to it, and finally argue that your theory inherently implies these purposes. It is rather like inventing a hammer, deciding it might be useful for shelling nuts, and then arguing that hammers inherently have the one and only purpose of shelling nuts. It is just a very strange and unnecessarily awkward argument to make.
Hugh, MMT was first formulated in Warren Mosler’s synthesis of a number of different strands of thinking, and he specifically formulated it so that it was economics for the public purpose with the PP to be determined by people democratically. In this he followed John Kenneth Galbraith. Bill and Randy also develop MMT policies in terms of their views on public purpose as do the other MMT developers. The MMT paradigm is a one that combines both normative and descriptive aspects. That’s just the way it is. You say:
“If I argue that neoliberals use MMT theory, you invoke social purpose. But that proves nothing. Neoliberals still use MMT because MMT is a theory of fiat money and that’s what neoliberals use it as (for themselves).”
First, I don’t know which neoliberals you’re referring to as using MMT. I’m sure there are some; but neoliberals generally neither “use” nor believe MMT’s description of our present fiat money system.
Second, if one uses some of MMT’s ideas to formulate policies that are aimed at the well-being of the rich rather than public purpose, then that’s simply not the MMT approach. It’s a neoliberal approach because it’s committed to neoliberal value propositions and not MMT one.
And third, You can detach some of the things MMTers say, focus on those, and then say that’s MMT. But that doesn’t make it so. MMTers share the core of the paradigm’s knowledge claim network otherwise they’re not MMTers. One thing that is very central to that core for all the well-known MMTers is public purpose. Another is the Job Guarantee. Others who reject that are simply not doing MMT. That’s why we’ve had the split between MMR and MMT, not too many months ago.
And there we have it. This is the part of any discussion of MMT where MMTers assert that any criticism of MMT must come from a misunderstanding of it.
This is followed by the part where I point out that the biggest obstacle to the propagation of MMT ideas is its practitioners. There is no possibility of discussion or debate because MMTers demand as a precondition the total acceptance of MMT however they happen to define it at the moment. It’s like some kind of priesthood where only the anointed know the secret words. This has the unsurprising effect of exasperating even people sympathetic to its ideas. For people coming cold to its ideas, it makes them want to run the other way as fast as they can. And for now, I think I will join them.
“First, I don’t know which neoliberals you’re referring to as using MMT. I’m sure there are some; but neoliberals generally neither “use” nor believe MMT’s description of our present fiat money system.”
Well, the Bush and Obama administrations (for one thing) created trillions of dollars out of thin air (fiat?) to prop up (and actually strengthen) the kleptocracy. And I think there is some agreement that both administrations are ones that have executed Neo Liberal agendas. True, nobody in the Bush or Obama administrations (e.g. Geithner, Bernanke, et al) ever labeled the creation of trillions of bailout dollars as “MMT.” But isn’t that just semantics?
I defy you to explain to me how the MMT-ers’ single public policy point of austerity jobs for all, promoted as a new progressive norm, will fix any of those issues other than the technical point of satisfying some moral scourge’s requirement for universal toil.
JTF, You really need to do some work reading MMT stuff. It’s just ignorant to say that the JG is MMT’s sole policy point. See here: for list of categories of proposed MMT policies: http://www.correntewire.com/the_job_guarantee_and_the_mmt_core_part_fifteen_components_of_the_knowledge_claim_network
Also, MMT has no requirement for universal toil. Entering the JG program is purely voluntary. No one has to enter it, and MMTers don’t advocate it as a substitute for unemployment insurance or any other social safety net measure the people of the United States now have or want passed.
Working a Walmart job for the government instead of Walmart does nothing to alter anyone’s life condition, and is not to be reconstituted into a new progressive norm.
Period. Anyone who advocates that, in the absence of a real industrial policy platform, does that as the same conservative hack a****** they were yesterday.
In addition, I am not remotely interested in “aggregate demand.” That carries no moral weight with me whatsoever.
As for YOU, if you don’t understand what you’re doing– and I think you don’t– then you shouldn’t be so quick to sign on.
I had this exact same conversation with Ezra Klein several years ago about Jacob Hacker.
So, we’ll see.
“… will fix any of those issues other than the technical point of satisfying some moral scourge’s requirement for universal toil.”
I agree. How is advocating crap jobs at crap wages an improvement rather than a universal normalization of the kleptocratic socio-economic system?
It may be my advanced age but I can’t help believing the lack of Medicare for All is probably making unemployment worse.
I’ve been lucky enough to put away some money for retirement but can’t imagine having enough to cover basic medical insurance until I qualify for Medicare ( and who knows how high the eligibility may be raised by then). The pile I have saved would be quickly wiped out by even a routine heart condition or carcinoma. Even with insurance. So I (and the person who might really need my job) are stuck until the clock strikes 67(? or later)
I’ve talked to enough colleagues and neighbors to realize I’m not the only 50something in this boat.
I would like to remember and thank George McGovern who passed away today. His honesty was inspiring and his antiwar stance in 1972 should be praised. We need a man for the people like George McGovern today.
He would have made a far better President than Nixon. Not to mention that if Nixon had lost, the Republicans might have been a lot less keen on the Southern Strategy than they became. In addition, no Watergate causing a presidential resignation, and probably Medicare for All during the years 1973-1977 because McGovern and Teddy Kennedy certainly would have worked together to get it. I haven’t estimated how many fatalities that would have saved over the 40 years since. Probably more than have died in US Wars since the founding of the Republic.
ACA is Universal Health Care for the USofA. The act is the first siege engine deployed against the disjointed incrementalist approach of health care in the USofA. The act provides for federal regulation of an entire industry by dictating the profit margin for the private health insurance companies. Additionally, many of the non for profits aka The Blues, while not as egregiously greedy as the for profit, often do much better in this regard and of course, the federal programs do it the best. Profit margins stand at a statutory 15-20%, meaning 80-85 cents of every dollar of premiums collected must go to actual health care, again, as statutory, as defined by the written law. This, rather than a bailout, cough cough, proscribes the entire industrial on a national level. No escaping by going to the Bahamas here!!
The equalization of the health care in the USofA with the rest of the global economy, where the business sector does not have to carry medical coverage as a cost of doing business is a matter of time. Only here do we spend more than half all health care dollars in the private sector. As the cost for health care sky rockets, and since the profit skim has been set, it is a matter of time before most people will be driven into Medicaid. Because it is a universal health care system, remember the mandate?, and because of continuing rising costs to insure, all but the most lucrative industries and the most highly compensated, profitable corporations, think Fortune 500 types mainly, will offer anything remotely like a medical benefit where you don’t have to fork over half of your paycheck back just to pay your monthly share of the premiums.
Finally, the entire medical complex is something of a scam, since most diseases have been wiped out for most people. The remaining medical problems are self inflicted by the medical delivery system, including pharma, environmental causes, industrial pollution and adulterated food and contaminated food supply chains.
All of this is well known. We have gone round and round this before. The last well meaning dope, in this regard, was Ted Kennedy himself who turned down Tricky Dicks offer of universal national health care.
http://www.bostonglobe.com/opinion/2012/06/22/stockman/bvg57mguQxOVpZMmB1Mg2N/story.html
How much blood is on Ted’s hands for not going along with Nixon and holding out for single payer? Oh, the pure and holy, staying virgin pure until the proper sacramental blessing is conferred.
But, again, most medical spending is on self inflicted wounds, of gunshot victims, usually drug dealers, drunken car drivers and their innocent victims, salmonella poisoning of the food supply, killer prescriptions and self medicated overdoses, like Michael Jackson, prescribed by a legit doctor no less!! People are killing themselves, and we blaming a lack of health care?
From “MEDICAL NEMESIS” by Ivan Illich:
Doctors’ Effectiveness—An Illusion
The study of the evolution of disease patterns provides evidence that during the last century doctors have affected epidemics no more profoundly than did priests during earlier times. Epidemics came and went, imprecated by both but touched by neither. They are not modified any more decisively by the rituals performed in medical clinics than by those customary at religious shrines.8 Discussion of the future of health care might usefully begin with the recognition of this fact.
The infections that prevailed at the outset of the industrial age illustrate how medicine came by its reputation.9 Tuberculosis, for instance, reached a peak over two generations. In New York in 1812, the death rate was estimated to be higher than 700 per 10,000; by 1882, when Koch first isolated and cultured the bacillus, it had already declined to 370 per 10,000. The rate was down to 180 when the first sanatorium was opened in 1910, even though “consumption” still held second place in the mortality tables,10 After World War II, but before antibiotics became routine, it had slipped into eleventh place with a rate of 48. Cholera,11 dysentery,12 and typhoid similarly peaked and dwindled outside the physician’s control. By the time their etiology was understood and their therapy had become specific, these diseases had lost much of their virulence and hence their social importance. The combined death rate from scarlet fever, diphtheria, whooping cough, and measles among children up to fifteen shows that nearly 90 percent of the total decline in mortality between 1860 and 1965 had occurred before the introduction of antibiotics and widespread immunization.13 In part this recession may be attributed to improved housing and to a decrease in the virulence of micro-organisms, but by far the most important factor was a higher host-resistance due to better nutrition. In poor countries today, diarrhea and upper-respiratory-tract infections occur more frequently, last longer, and lead to higher mortality where nutrition is poor, no matter how much or how little medical care is available.14
http://www.soilandhealth.org/03sov/0303critic/030313illich/Frame.Illich.Ch1.html
Actually, most medical spending is on “end of life” spending — heroic measures to keep people alive a few days longer. (You can look this up, it’s true.) Just cut that out and you get a much lower spending rate.
After you exclude that, most medical spending is actually on maintaining people with chronic illnesses, often ones they were born with but which manifested at puberty. This spending is well worth it.
You can’t blame the innocent victims of the illnesses, they can be productive members of society if they’re taken care of — and the illnesses couldn’t have been identified before birth so even eugenics wouldn’t have worked.
When you look at the *effectiveness* of medicine historically, what’s most effective has been sanitation first, followed by nutrition second. Prior to those great revolutions, you were actually more likely to be healthy if you *avoided* doctors — doctors were known for killing people.
Nathaniel:
I am going to disagree. While the elderly occupied 13% of the non-institutional civilian population, they consumed 36% of the healthcare expenditures due to chronic conditions. The average expenditure for those > 65 was ~$11,000 as opposed to those 19 to 64 at ~ $3,000 Most of the expense is due to chronic conditions such as heat disease, diabetes, hypertension, asthma, and mood disorders. If you believe the elderly are bd, read this factoid:
“The top 5 percent of elderly spenders accounted for 34 percent of all expenses by the elderly in 2002, while the top 5 percent of non-elderly spenders accounted for 49 percent of expenses by the non-elderly.” http://www.ahrq.gov/research/ria19/expendria.htm#diff1
Paul;
Good post!
Neither Obamacare, nor the “public option,” nor Medicare for All, as best as I can determine, have adequate cost controls compared to other developed nations.
The failure to stipulate that such cost controls need to be part of national health care is, let’s call it …
Paleo-progressivism.
I don’t want “Medicare for All” if we’re still spending 50 percent more per capita than other developed nations, or more, for health care.
Period.
There are times where legitimate financial constraints on medical insurance under any name need to be considered.
socraticgadfly DOT blogspot DOT com/2012/10/paleo-progressivism-neo-progressivism DOT html
Gadfly:
There are cost controls within the PPACA as well as Medicare and Medicaid applied to the healthcare industry. Why not pull up Kaiser and read about them?
The central cost-saving measure is to get the health insurance parasites out of the equation; that would save at least $350 billion a year. Let’s at least get the system into line with international norms, a la this chart.
“Paleo-progressivism” is cute, but no substitute for actual policy analysis, eh?
Lambert:
Eliminating insurance all together will not control the rising cost of healthcare as insurance is a reflection of this cost even with the MLR in place. The wanting of a Medicare, Single Payor, Universal Healthcare, etc. is a good want; but, there was no way we were going to get this type of program with the deals being struck in Congress, the protecting of turf, and the blocking of anything acceptable by the senator from Aetna Liberman. Everything the article says and what you have stated is mostly true; but, it is a so-what if we are going to retract the PPACA. The politics involved would certainly stop a new bill from coming forth. It would be better to evolve it into something else the same as SS was over the years.
I would point out the author claim to unadjusted subsidies may not be true (perhaps I misunderstand his words?). Here is a quote from the Kaiser Foundation:
“Because health insurance premiums have typically grown more rapidly than income, PPACA adjusts the percent of
premium that people are required to pay to reflect the excess of the premium growth over the rate of income growth.
Beginning in 2019, if aggregate premiums and cost-sharing subsidies exceed 0.54% of GDP, the premium percentages
would be further adjusted to reflect the excess of premium growth over CPI.” http://www.kff.org/healthreform/upload/7962-02.pdf
I will have to check his claim on coverage of 15 million instead of 30 million. Too many people do not know what the PPACA has in its contents as demonstrated repeatedly. This is unfortunate as the information is available at Kasier, The Health Beat Blog, and also on government websites.
Sidenote: I found the paper on Labor at the NBER interesting also.
Didn’t say it did. However, the disparities between us and the rest of the world in terms of dollars spent/health care outcomes are grotesque.
Let’s rip out the cancer. Then we can worry about becoming physically fit.
lambert:
I could not agree more.
Bill