What’s Wrong with the World

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Down to the brass tacks

From the moment man was self-conscious (or, if you like, from the moment he emerged out of the state of nature) he faced a political choice something like this. He could have rule by the one, rule by the few, or rule by the many. Those exhaust the options. This is a basic question of political science.

America, almost alone among nations, has sent forth a bold cry for rule-by-the-many, which means self-rule, since her earliest days. Our political tradition stands emphatically for rule-by-the-many, for popular government, for democracy; our nation is a republic.

I submit that this health care reform bill is a very considerable step away from rule-by-the-many and towards rule-by-the-few -- both on the level of state-capitalism, where we have established near-monopolies, and on the level of bureaucratization, hard on the heels of which will surely follow corruption on a vast scale. We have further "managerialized," if you'll forgive a jargon term, our society.

Now, I hasten to add that because America has, historically, stood for rule-by-the-many, and very boldly at that, does not make rule-by-the-many ideal or even best. We ought to separate our love of country from our estimate of the science. Of course Americans tend to think rule-by-the-many is the best way; many of us appear to think it is the only reasonable way. Objectively this is not so. Many reasonable arguments have been given, by many a serious thinker, for aristocracy or for monarchy, or for some principle of minority dictation. In the last few months star columnists at The New York Times have written admiringly of China, a nation unapologetically founded on a plutocratic or managerial or rule-by-the-few framework.

So someone is free to answer me: "well medicine is one area where we must have planners," or "let's face it that the managerial model ain't so bad when it comes to health issues." I will not gainsay that answer (for now), except to state that it has departed, at least in certain important particulars, from the American tradition of rule-by-the-many.

Comments (120)

There are certain obstacles toward the managerial model you describe that are created by our culture, the biggest one being that most Americans will scoff at the notion of a technocratic commission being empowered to override the legal system on malpractice. The fact is that doctors, not lawyers and judges, are the ones whose opinion should be given primacy on what constitutes malpractice. For all of their bluster, lawyers are, as a profession, rarely individually competent to grok the nuances of technical fields. I can't count the number of times where I've heard lawyers say things which are just **wrong** about the software development industry and our field has a lower barrier to entry vis a vis education than does medicine.

In fact, liberals like Al will end up horrified with the end state of such a system because it will necessarily become quasi-totalitarian in order to keep costs down. The underclass in particular tends to engage in behaviors which require medical care (overeating, promiscuity, drug use, reckless behavior, you know what I mean). The state cannot simultaneously promise universal care and let people behave however they want since liberals will scoff at the idea of the government sending a bill to irresponsible patients with a monthly payment plan when it has to pay for medical operations that are the result of unhealthy living, not genetics or accidents.

The simple fact is that if we are going to have to cover white trash that blew their brains out on crystal meth alongside honest blue collar workers who got hurt in industrial accidents (or say, got lung diseases from working in shoddy mines), then the state will have to curb individual freedom heavily with the former. I've said it here before, and I'll say it again. The only way we can make a welfare state work is by making it somewhat cruel in how it treats most of its recipient. For most of them, it should be cruel enough to them that they consider getting a job--any job--and saving every penny they can to be sweet liberation versus staying with the welfare state.

We departed from that tradition of rule-by-the-many in the second half of the nineteenth century, when, in that Great Barbecue, the postbellum regime of governance-by-corporate-power, we instituted the political economy of the managerial, limited-liability corporation, and - obscenely - robed it in the raiment of Jefferson's yeoman farmer or shopkeeper. Everything that has transpired since that low and sordid half century has been a playing-out of the dialectic, with the regulatory/welfare state emerging to counteract and balance the worst, most predatory instincts of the corporate state, and then succumbing, gradually, to the machinations of that state, at last consummating an unholy union, most vividly demonstrated in the solicitude of the regulatory state for the corporate state of finance.

The intellectual tragedy, as distinguished from the existential one of these things having transpired at all, is that so many conservatives desire to pick and choose which expressions of this long secular trend they will retain, and which they would dispense with, had they only the power. But such a stasis, such a halting of history, is impossible; logics will be played out to their limits. There is no historical return, no recreation of what has been lost, only a partial return through the new forms that have arisen.

But I am not understood.

Paul,

The left is now going after 401ks and IRAs.

I'm just waiting for Al to tell us that this is necessary for the good of the middle class and why we conservatives and libertarians are "on the wrong side of history" again by opposing a plan to give even more control of private citizen finances to the same money managers that tanked the system already.

I'd like to note that 3 of the 4 arguments in defense of their "pooling" (read seizure) of retirement assets are inherent to 401ks and IRAs as well and the 1 that isn't is there mainly to keep meddlesome hands out.

But I'm sure we'll find out that we're a bunch of f#$%ing morons for thinking that this is socialist since it doesn't perfectly fit 19th century socialism.

Maximos: I get it, and I must say that that's as good a short summary of the thing as I've ever read.

"I'm sure we'll find out that we're a bunch of f#$%ing morons for thinking that this is socialist"

The fact that it may not be paint-by-numbers socialism does not mean it's not socialistic in tendency. Check any decent dictionary for a definition of "socialism" and you will find multiple variants; this fiasco definitely falls under that general socialist umbrella.

I don't think the line "America has, historically, stood for rule-by-the-many" is completely correct, America was intended to be a Republic, a Republic where the Rule-by-the-many idea would only be applicable in certain situations, there were areas where the Founders thought the rule-by-the-many idea was immoral and even dangerous but this idea that rule-by-the-many trumps everything else in american political life has lead to the rule-of-the-few because it means the transfer of responsibility for there problems can be transfered to a few politicians who can then be blamed for all the problems, rather than the Public who voted for the politicians and there ideas, it deprives people of Responsibility for there own lives.

If Rule-by-the-many vote to be ruled-by-the-few and have goverment centralise the many by the few, then there is no way to stand up to this idea. When the Public vote for people who say they will rule and control the public or create institutions that will do this the Public vote to be ruled by the few through there own Freewill, just because they are offered perks by the goverment, the public sells its Freedom for Security, Absoultes, Perks and to deprive thems of Responsibility. This is why America was intended to be a Republic to stop this from happening must in the end what we have seen is Democracy override the Republic.

In the situation where the Politicians voted for a Bill that most of the public disliked is just another case of this, Public voted for Politicians. Politicians don't see the limits of the Republic because they were voted in Democraticly, the only difference here is that the Politicians voted for a Bill that would have been defeated in a Public vote, but there idea was the public voted for us hence we can do what we want until the next vote.

This is just the eventual outcome of these processes.

Maximos, I'm sympathetic to a lot in your historical narrative, as you know; but I would hardly describe it as invulnerable to critique.

For instance, to asseverate that "we departed from that tradition of rule-by-the-many in the second half of the nineteenth century" right after the Civil War, does, I think, require some unpacking. Are we to suppose that Abraham Lincoln did not stand for rule-by-the-many? If we acknowledge that he did, shall we then say that his project got off the rails almost instantly, such that within 20 years of his assassination, we had abandoned the cause of democracy? More broadly, where does Lincoln fit into your narrative?

Everything that has transpired since that low and sordid half century has been a playing-out of the dialectic, with the regulatory/welfare state emerging to counteract and balance the worst, most predatory instincts of the corporate state.

Again, these claims are noticeably categorical in nature. I think they conceal some major elisions. For example, I don't see how anything in the late-19th century model of aristocratic private banking, with traditionalist tycoons like J. Pierpont Morgan more powerful than heads-of-state, at all resembles that democratization of finance that attended the last two or three generations of banking. Morgan would undoubtedly be as appalled as you (though for different reasons) by the kind of finance model that gave everyone with a 401k or IRA a chance to get exposed to the commercial paper market. Both Morgan (in 1907) and Paulson (in 2008) put themselves on the line to bail out capital markets; both did so to rescue the bankers, who in 1907 were a class of peculiar aristocrats but by 2008 were, well, almost everyone -- from the filthiest rich on down to the little guy with the money market fund.


Well it seems the Few, raised in their own eyes to seer status, are planning on reneging yet again on Social Security. It's getting to be a regular thing.
The Few's publicist, or is it their creator, the NY Times, did a front page story on this. Agile minds will recognize that first the media does the groundwork, cry "crisis", and Democrats follow in the path laid out for them.
Expect another extension on age for eligibility and raising of tax. Yet another commitment broken, another burden added, another expression of contempt for the Many, in this case everybody.

By all means, trust government, liberalism, and federal management of health care, which Congress exempted itself from.

The rule by the few doesn't so much refer to the forcing through of the bill in Congress, though that was certainly done by dishonorable bribing and whipping of Democrats by their fellow Democrats. The rule by the few concerns the increasing centralization of healthcare decisions. Anyone who does not see this, or who implies that it is or will be no different from what we have currently with insurance companies and HMOs is, not to put too fine a point on it, a fool. Wesley J. Smith has done yeomanly work documenting the almost slavering desire of the intellectual "ethics" elite to tell people what healthcare they may not have, to guide in rationing their healthcare, to take away from them the choice to have life-saving treatment or even what I would consider basic care. With the increased centralization of the system comes lowered variability on coverage and increased centralization of such decisions. In completely socialized systems (which the liberals tell us openly is their true goal) patients and their families do not have a choice on such matters, and people are, to speak plainly, killed by the government by neglect across the board with no recourse in lawsuit or other effective mechanism. Big Brother decides. Those who consider themselves pro-life do well to heed this: Increased government control of medicine is not your friend. The elite are not to be trusted, and the elite will increasingly control your life and your death and those of your loved ones. And this bill is a further step in that direction.

I do think Lincoln is the start of the Rise of Big goverment he laid the Groundwork for Goverment Intervention during times of Crises and after him when Goverment Expanded during major Events it never shrugged off the the baggage and institutions that were set up, or not enough of them anyway.


On your point with the 1907 market, there was no 100% Gold Reserve Money Standard which caused Bank Runs see here:

http://blog.mises.org/6319/do-central-banks-really-inflate-no-say-the-post-keynesians/comment-page-2/

Read some of the comments by Björn Lundahl.


Also some other Articles:

http://mises.org/daily/1389

http://mises.org/daily/3350

Paul, it did go off the rails pretty rapidly after the Civil War, as soon as a variety of legal cases connected with the fourteenth amendment, the predations of the railroads, and the attempts of states to regulate corporate entities entered into the body of law the notion that the corporation was an individual, deserving of the rights, privileges, and immunities guaranteed under the Constitution. This inhibited the ability of states to trammel corporate power - and was as blatant a form of Federally-protected social engineering as anything ever contemplated by its critics - and enabled corporate power to purchase state governments quite openly, a power differential only partially redressed by both the Progressivism of TR's era, and the New Deal, particularly after SCOTUS was compelled, among other things, to repudiate the utterly unconstitutional correlate of corporate personhood, substantive due process. The very incompleteness of this counterbalance, however, set the stage for the eventual reassertion of corporate power, the consequences of which surround us, from finance to health care.

I don't perceive the involvement of millions of ordinary Americans in the commercial paper market as a counterpoint to my narrative; most 401Ks and IRAs are still in the toilet; but the Feds sure acted to backstop the bonus-generating architecture of usury for the meritocrats of finance, didn't it? The fact of vampire financial aristocracy endures; only its form changes.

Any concentration of power anywhere in the social system will suborn other elements of the system to its purposes, further concentrating power. Neither the left nor the right have the slightest glimmer of an answer to this perennial problem, only their respective admonitions to mystify a given concentration of power as not-a-concentration-of-power, invocations of their respective mystagogies to veil one form of coercion and unfreedom as freedom.

But I am still not understood.

... limited-liability corporation ...
As a mostly unrelated side-note, I am becoming more and more convinced that a core problem is not with the fact that corporations are treated as legal entities with limited financial liability, but that individuals are treated as legal entities with unlimited financial liability. Or at the very least that the one is at least as much a problem as the other. See my recent posts on usury if this is of interest, no pun intended.

We now return you to your regularly scheduled program.

Or at the very least that the one is at least as much a problem as the other.

I don't disagree with this.

"elite to tell people what healthcare they may not have,to guide in rationing their healthcare, to take away from them the choice to have life-saving treatment or even what I would consider basic care. With the increased centralization of the system comes lowered variability on coverage and increased centralization of such decisions. In completely socialized systems (which the liberals tell us openly is their true goal) patients and their families do not have a choice on such matters, and people are, to speak plainly, killed by the government by neglect across the board with no recourse in lawsuit or other effective mechanism. Big Brother decides"

The case that Liberals would make in this situation is that your Healthcare is already being Rationed by the Insurance Companies based on your plan or the costs, so all the Goverment is doing is Switching from Private Insurance Rationing to Goverment Rationing (they would then explain how Evil Private Insurance is) and the goverment is for the people and Private Industry is for Profit, so the goverment wins.

(I should say I don't share this View).

Allowing millions of middle class folks to pool their capital and lend it at interest to corporations, governments, funds, etc. in various short- and long-term securities markets is a counterpoint to the suggesting that "everything" (or, I presume, all bad things) since the post-Civil War era "has been a playing-out of the dialectic" of plutocracy, "with the regulatory/welfare state emerging to counteract and balance the worst, most predatory instincts of the corporate state."

How does the break-up of the old class of plutocracies, and their replacement by a class of parvenus which gradually expanded to include much of the middle class, compose a discernible dialectic here?

In a word, there are still too many gaps in this narrative for it to add up to a convincing argument that managerial health care as national policy was inevitable and I should just get over it so we can all get back to the important business of castigating earlier generations of Americans.

That class of parvenus does not include, in any meaningful sense, the vast middle classes invested in capital markets. They are not protected, their interests not secured, in the ways that those of, say, Bobby Rubin, let alone Lloyd Blankfein, are secured. They do not matter, for they are allowed to fail, and when they fail, there is no cushion of extracted rents they get to retain, despite their having invested in failure and criminal conduct.

The dialectic of health care is analogous to that of finance, and other aspects of managerialism. Owing to a combination of technological advancement and policy decisions, it became impossible for the average individual to access necessary quanta of medical care apart from some form of risk pooling. This risk-pooling function, in America, is performed by corporations, apart from the high-risk elderly, and some classes of the poor. Being corporations, their operational logics and incentives are often orthogonal to those of sound medicine, human need, and so forth. So people find themselves excluded by the logic of the system. Government steps in to ensure their access by slotting it into the already-existing logic of the system, essentially subsidizing a subset of the plutocracy in order to accomplish this. Government guarantees the rents of the health sector, in a relationship Belloc would recognize.

The inevitability is that people will not indefinitely accept exclusion, not so long as they have the franchise, and this moves the dialectic onwards.

Phantom Blogger, I, too, do not share that view. In fact, I've heard it ad nauseum and am, accordingly, nauseated. It's baloney on stilts. (Can baloney walk around on stilts?) There will be an _increase_ in such taking of the decision-making out of our hands, a _decrease_ in variability of the provision of care and in patients' rights, a _decrease_ in quality, and an _increase_ in the danger to those of us who don't believe in killing people to get them out of the way or in being killed for that reason. Again, this has been documented and documented regarding other systems as they have moved towards increased government control. Nor is the mechanism obscure, strange, or exceptional. It makes perfect sense that this should happen. Those who consider themselves pro-life should take heed, even if they think that some sort of Benevolent Paternal Christian Government control and provision of healthcare could be good in a hypothetical world of their own (with which I would in any event disagree). But that isn't the world we live in, anyway, so they should think. And think again.

That class of parvenus does not include, in any meaningful sense, the vast middle classes invested in capital markets.

Sure it did. One of the key triggers for the major rescues in fall on 2008 was the collapse of the oldest money market fund. That meant that the losses could no longer be contained on Wall Street and were spreading rapidly to Main Street.

Owing to a combination of technological advancement and policy decisions, it became impossible for the average individual to access necessary quanta of medical care apart from some form of risk pooling.

In other words, "owing to contingent developments and prudential decisions" X consequences became inevitable. Meh. We all know that the connection between salaried employment and health insurance was an essentially accidental one.

I certainly agree that the strengthening of the insurance corporations into near-monopolies is a big problem. I find it hard to see how replacing three or four monopolist corporations with one monopoly would be an improvement.

Owing to a combination of technological advancement and policy decisions, it became impossible for the average individual to access necessary quanta of medical care apart from some form of risk pooling.
Is risk pooling really the issue?

I can tell you right now that the only reason I have health insurance at all is to get negotiated rates. I'd love to be able to buy catastrophic coverage (the risk pooling bit) only, and otherwise get a market price from providers; but I just haven't found a way to do that. Providers absolutely screw me when I go self-pay - in some cases the cost is literally ten or more times the insurance company negotiated rate. So the insurance company performs a function for me similar to the function that a labor union at least ostensibly performs for labor. (In both cases we get screwed by the folks we are paying to look after our interests, but the idea is that we get some protection from an even bigger screwing. I'm not sure that has actually worked out in practice, mind you, and so far I haven't loved Microsoft Excel enough to figure it out).

The inevitability is that people will not indefinitely accept exclusion, not so long as they have the franchise, and this moves the dialectic onwards.
There you go.

I'm generally inclined to think that part of the American tradition is that politics is messy, that no structure is ideal, and that a republican mix of rule-by-few and rule-by-many provides checks and balances against the tyranny of either. It is a good, reasonable, commonsense tradition; but it doesn't seem to have held up well against the more ideological Enlightenment elements in the American tradition.

Jefferson - 1; Publius - 0

The dialectic of health care is analogous to that of finance, and other aspects of managerialism. Owing to a combination of technological advancement and policy decisions, it became impossible for the average individual to access necessary quanta of medical care apart from some form of risk pooling. This risk-pooling function, in America, is performed by corporations, apart from the high-risk elderly, and some classes of the poor.

So we have a kludge and keep building on it rather than begin scrapping it and rearchitecting it. Then we wonder why it doesn't work. Trying to build a competitive, profitable and just medical system on top of our current monstrosity is like trying to make an octopus by nailing four more legs onto a dog.

That meant that the losses could no longer be contained on Wall Street and were spreading rapidly to Main Street.

Main Street did not have its losses made good, not at the individual level, in the way that Wall Street did, after their bad bets were guaranteed and the bonuses were doled out; and not only that, but the logic and "rules" of the system redound wholly to the advantage of the large banks and funds, and not so much to the individual investor.

We all know that the connection between salaried employment and health insurance was an essentially accidental one.

Sure. I'm not gainsaying that, because it would be ignorant to do so. What I'm saying is that political evolution is path-dependent. We have a given system, and further developments will presuppose that system, rather then overthrowing it altogether. What I'm saying, beyond this, is that the employment-based system, flawed though it may be, is the only way that vast swathes of the population even gain access to health care, for, on the individual markets, they'd receive nothing, unless they were rich. In other words, even had the decisions yoking employment to insurance never been made, with the result that only an individual market existed - by the nature of the case, given that the operational logics of the insurance companies would be the same, along with their selection/exclusion mechanisms - many people would be excluded, and this would generate political pressures for reform, which, given the nature of the managerial state, would assume a managerial/corporatist form.

I certainly agree that the strengthening of the insurance corporations into near-monopolies is a big problem. I find it hard to see how replacing three or four monopolist corporations with one monopoly would be an improvement.

We're not replacing a handful of monopolies with a single monopoly, but insuring the revenue streams of several dozen local monopolies.

There you go.

Human need is a powerful motivator, and the notion, implicit in so much conservative discourse on the subject of health care, that "we" can prevent, indefinitely and forcibly - albeit indirectly - the subjects of those needs from asserting themselves, is arrant fantasy. Imagine the final logic of this discourse: that we will disenfranchise people to preclude their asking for health care. Not going to happen. Shouldn't happen. And we shouldn't waste our time talking about it.

Screwing of patients often occurs outside the insurance system, but that is a complex problem, encompassing everything from the cost-control mechanisms of the insurance industry to the, ahem, expectation of professionals for a certain level of income. Not easy to address that sort of thing.

So we have a kludge and keep building on it rather than begin scrapping it and rearchitecting it.

Yes. This is pretty much how all human affairs function, and it is, in some respects, a perfectly conservative disposition.

The goverment program has done a stange thing. The bill which is a strange combination between Socialism and Corportism, it is Indirect Socialism in the sense that goverment controls how the busniness can and cannot operate with its Goods and services (meaning its no longer a Free Market) but at the same time goverment has actually increased there amount of Customers and there Monopolys in there states and districts. The goverment did nothing to solve the problem of Monopolys but at the same time tryed to solve problems that Monopolys create by the Goverment Socialising those problems and costs, or forcing the companies to act in a way the Goverment see as correct.

Human need is a powerful motivator, and the notion, implicit in so much conservative discourse on the subject of health care, that "we" can prevent, indefinitely and forcibly - albeit indirectly - the subjects of those needs from asserting themselves, is arrant fantasy. Imagine the final logic of this discourse: that we will disenfranchise people to preclude their asking for health care.

Disenfranchise people? To what final logic are you speaking?

No fantasy in the health care debate is more arrant that the one pressing for a right to top high-quality health care across 300 million. We might as well demand that every state get the same amount of rain. May as well ask the Supreme Court to stop the drought or the floods in the South!

There is not yet the power in man, much like in his art of government, to insure that all our diagnoses will be right, or that none among our doctors shall ever be weary or hungover or distracted. We have yet to conquer misfortune.

The system we had, before this bill, was defective but hardly worthless. Ask someone who has lived from the Second World War until now what he thinks of where medicine has come. It habituated a whole people to care better than 90% of their contemporaries, and 99% of those who have ever lived, could hope for. It allowed thousands, perhaps millions, to have their knee, hip, kidney, even heart replaced; and they themselves to live on to play with their grandkids for another 10 years. It repaired countless injuries that would have been crippling. It gave millions of sickly infants life.

We shall see soon enough what kind of system we have cursed what we had in order to get.

The right being alleged is hardly to top-notch health care. The right being alleged is to be able to see a doctor outside of an emergency room without going bankrupt. I would claim that surely we agree that the poor in this country have a right to better health care than being able to receive acute care, but I'm afraid I'd be putting words into people's mouths if I made such a claim. And since this reform is quite circumscribed and is hardly socialism, we shall see the credibility of conservatives lost once again as the end of the world that they have promised doesn't come.

Excellent, Paul.

I do think, myself, that there is a very strong connection between the economic insight (for want of a better word) that there is no free lunch, that we cannot abolish differences and "include everybody" merely by goodwill and fiat, that we cannot create goods and services from nothing, and the _moral_ evils of government tyranny. A denial of reality always leads to other evils. In this case, the attempt to drastically increase access to healthcare as an entitlement will lead to increased demand and strain on the system, which will in turn lead to an increased need for government to control costs by top-down order. Which, in turn, will lead to increased wait-times and even denial of life-saving care. I do not really believe that one can deride concerns about socialism while at the same time recognize with full, clear-eyed understanding the dangers specifically to the pro-life cause inherent in this sort of incredible heating up, by government fiat, of the demand for healthcare and the sense of it as an entitlement. It all hangs together.

What sort of problems we would get if we had similar reality denial on the "no free lunch" problem but at the same time had a much stronger life ethic in the society at large and among the controlling elites who would receive enormous power in a government-controlled system, I do not know. But I do know how things hang together in the world as it presently is.

Who knows who the converts will be this time with the conservative's big lie? Part of my conversion traces itself to the promises of armageddon when Clinton raised the minimum wage and raised taxes. That didn't cause me to leave the conservative movement - I still have 2 votes for George W. Bush to my (dis)credit - but it sure made me skeptical of future claims they made in that area.

See this piece at Christianity Today, the comments are more interesting than the article, you see just how Liberal most of these people really are:


http://blog.christianitytoday.com/women/2010/03/protecting_the_least_among_us.html#more


"I personally am pro-life, but I'm disappointed that the general evangelical community (along with Ms. Tada) doesn't seem to have considered the positive impact that more accessible healthcare can have on reducing the abortion rate, among other pro-life benefits"

This is just one comment(among many) in this thread.

M.Z. -- I don't think a rights-based language even works here, which is what I was trying to get at. Health is too precarious a thing to go around promising people as a right, arising from nature, vouchsafed against the community or the state.

The problem of bankruptcy by health care expenses is a very real one. I am open to arguments about how this bill will forever solve that. I am suspicious that it will make things worse, perhaps in subtle ways we have not yet even heard of. (The slashing of HSAs hits a lot of middle class families who have come to rely on them, and will likely contribute to its own share of bankruptcies.)

Because if we're talking about natural "rights" then we are talking something on the order of things we must forever solve. The great natural rights theorists certainly set them at that level of importance.

This law, strictly speaking, includes a direct attack on the rights of those who rely on HSAa to finance their medicine bills.

What sort of problems we would get if we had similar reality denial on the "no free lunch" problem but at the same time had a much stronger life ethic in the society at large and among the controlling elites who would receive enormous power in a government-controlled system, I do not know.
This is an important point.

We have two general factors, as it were.

First is the extent to which resources can be mustered and reallocated to provide a perceived better economic system around health care for a large number of people for a significant period of time, and how much the "reality TV" public will go along with it. Given the atrocious state of the present health care economic system - distinct from the substantive operations Paul rightly points out as better than, well, anything that has ever actually existed in human history - I think the chances that this can be done for a quite significant period of time are pretty good. That is, I think dire predictions of imminent collapse - "within months" according to some of the more shrill - are not well founded. I think the "new world order" in health care could be economically sustained for quite some time, and that the present system is dysfunctional and horrifying enough to enough people that it isn't clear where the answer to "how are you now compared to 2009" is going to fall in majoritarian terms.

There is a reason, in short, why passage of the bill sent the stock market up; and that reason is not "because we are smarter than Wall Street".

On the other hand, given the amount of centralized control necessary to carry this out, combined with the attitude of controlling elites toward the unborn and the infirm, this is yet another quantum leap forward in temporal power for the culture of death. There is an extent to which any pro-lifer ought to have libertarian tendencies simply because our elites today are just plain wicked, so granting them vast new powers over any area of life is suicide. And of all the places to grant our elites vast new powers, the kind of direct control over the bodies of individuals implied here is the pinnacle of insanity.

Thank you, Zippy. I appreciate your agreement on that point very much.

Paul's point about HSA's is well-taken. This bill goes in exactly the wrong direction, IMO, further undermining the connection among payment, service, patient, and provider and furthering the third-party payer model. Yes, yes, this is all already underway, but it needed to be turned around, not pushed further. HSA's went in the right direction. In many ways, there are operating two sets of economic and practical ideas about what is wrong and how we should fix it, and they are utterly, completely, totally incompatible.

Disenfranchise people? To what final logic are you speaking?

How do conservatives, those opposed to my viewpoint, which would be the majority of them, propose to persuade the American electorate that it is acceptable for X millions of Americans to be bereft of medical care short of the Emergency Room, and those Americans bereft of that treatment not to engage in political activism aimed at securing access to treatment?

Telling them about the awesomeness of the American health care system won't cut it. By definition, the folks agitating are either excluded from it, save at the margins - the ER - or concerned about those who are. They are motivated by a variety of factors, not least of which is a Hobbesian-ish fear of a grisly, gruesome, un-cared-for death. So, how you y'all propose to turn them back, politically? Because, whether this kludge of a bill passed or not, they'd just keep coming back, and coming back, and coming back, until our kludge of a system failed, and they succeeded, probably winning single-payer.

Does anyone imagine that they'll buy the argument that they haven't a right to health care - not the sort of care that Bill Gates and Carlos Slim can buy, nor even the care I receive, but at least some publicly-defined and guaranteed minimum that is more than "go to the ER when you feel really, really sick" - and suck up the suffering, the backruptcy, intoning piously that all is best in this best of all conceivable health care systems? Of course they won't buy this; we know this because they've not bought it yet. It is politically and psychologically impossible to get them to buy it, because you are asking them, explicitly, to be the 'holocaust of the particular' for the sake of the system.

I don't say these things to be incendiary. I say them because conservatives, even conservatives with whom I disagree on the subject of health care, and conservatives with whom I actually share opposition to this legislation, really ought to comprehend those positions opposed to their own, the judgments underlying them, the psychologies motivating them, instead of bewailing (what they wish to portray as) yet another addition to the culture of entitlement, not least because the dominant conservative discourses are replete with claims of entitlement, few of which - if any - carry the weightiness of life and death, health and sickness.

The compendium of social justice defines health care as a right, not that you are bound by that. Even if you aren't able to necessarily quantify the extent of that right, I think you would be able to agree that there is something. Certainly there is room for debate about the extent, but if we are able to come to an agreement that it is more than acute care, then we are in agreement that there is a violation of justice presently.

I think the bill does address the problem of medical bankruptcy in a couple of ways. 1) It increases eligibility for Medicaid. This will mean more people will be able to recieve care. 2) For those not eligible for Medicaid, it creates a gaurenteed market for insurance. That provide market is also subsidized based on income, so that cost is not as a substancial burden to receiving coverage.

I don't believe HSAs have panned out favorably. Certainly proponents will argue that we need more time, but the early indicators are that they have reduced affordability. Specifically, delinquent receivables at hospitals are very high for people that receive coverage with HSAs.

There is an extent to which any pro-lifer ought to have libertarian tendencies
One of the problems libertarian tendencies is that if you take as a premise that a social fiduciary responsibility is not only absent but irresponsible, there is hardly a leap of logic required that social justice requirement is absent. After all, rarely is it the State that is the party that desires abortion or euthanasia; it is most often the family. I think conservatives are wrong when they allege the State is the greatest threat to the weakest among us. The State is often the greatest defender of the weakest. Admittedly it has an advantage of being able to marshall the resources of a whole nation to support the infirm. While counterexamples are certainly present, the tendency has been for democratic states to embrace things like abortion and euthanasia whereas totalitarian states have been shown at various times to offer protection. While not a good guy, Romania's dictator Nicolae Ceauşescu banned abortion and conctraceptives. Among the bright spots for the US has been our treatment of the disabled. While I have issues with the Americans with Disabilities Act, it is certainly example of the state advancing the cause for the less fortunate. Needless to say history hasn't been filled with society having outstanding concern for the less fortunate. That concern has tended to manifest itself greatest with the State though, and not the family.

Yes. This is pretty much how all human affairs function, and it is, in some respects, a perfectly conservative disposition.

A kludge is harder to fix than an elegant system. That is an immutable fact of life. Kludges, by their very nature, often demand additional kludges to fix them. So the natural end there is to compound the mistake even while telling ourselves that we're fixing it. By the time people realize the system is irredeemably borked, it's too late.

M.Z.

"the tendency has been for democratic states to embrace things like abortion and euthanasia whereas totalitarian states have been shown at various times to offer protection"

The Soviet Union was the first place to legalise Abortion as we now no it, follow secondly by Nazi Germany who also legalised euthanasia.

A kludge is harder to fix than an elegant system.

There are no elegant systems in practice, because they all transform into kludges when confronted with the crooked timber of humanity.

By the time people realize the system is irredeemably borked, it's too late.

Also a universal tendency of all things human, from the level of the individual to the level of civilization itself.

The compendium of social justice defines health care as a right, not that you are bound by that.

Answer this simple question: why should people who inflicted their health problems on themselves through reckless and/or unhealthy behavior have a recognized "right" to health care? If you need some clarification, here are some examples:

1) An alcoholic who needs a liver transplant.
2) An obese individual whose obesity cannot be medically traced to any genetic defect.
3) A drug user whose drug use has permanently harmed their body.
4) A promiscuous individual who has contracted a STD.
5) A person who drag races in their car or was caught by the policing doing double or triple the speed limit (say 75mph in a 30mph zone) and wrapped their car around a tree.

I don't want to hear any explanation about public expediency. I want to know why you think that person has a moral claim on society for their health issues.

I think conservatives are wrong when they allege the State is the greatest threat to the weakest among us.
I think part of Lydia's point though is that the particulars, the signate matter of our actual State, matters. I'm not suggesting an ideological libertarian tendency, but rather a libertarian tendency in the face of a particular elite in this particular time and place which has become particularly accustomed to murdering thousands of innocent and infirm each week in the name of its conception of freedom and equality.

So while I agree that there are in other times and places particular elites where that works out differently, where indeed an opposite and authoritarian tendency might be implied in being pro-life, what we have to deal with is the actual cards in our actual hand.

There are no elegant systems in practice, because they all transform into kludges when confronted with the crooked timber of humanity.

Elegance is always relative. The US Constitution, in its conservative reading, is still 100% relevant to modern needs and society does not need the national government to possess any powers the Constitution prohibits the national government.

1) It increases eligibility for Medicaid. This will mean more people will be able to recieve care.

Yes, but others will receive less care. Increasing eligibility only guarantees more rationing, all else equal, it does not expand the supply of medical care. In fact, to the extent that Obamacare discourages the accumulation of capital in the various medical industries or even results in the consumption of capital already present in those industries, the supply of medical care will go down.

2) For those not eligible for Medicaid, it creates a gaurenteed market for insurance

Guaranteed markets in insurance are no longer insurance markets, they are massive subsidies. Medical insurance markets cannot exist without insurance companies being able to exclude on the basis of pre-existing conditions.

The US Constitution, in its conservative reading, is still 100% relevant to modern needs and society does not need the national government to possess any powers the Constitution prohibits the national government.

That's an impressive piece of base-stealing, I'll grant that much.

Mike T,
Why should a drug dealer enjoy the protection from the police? Certainly it is reasonable to argue he shouldn't enjoy protection in selling drugs, but he still enjoys such protections as not being shot, even if it is reasonable to expect to be shot in that line of work. There is also the not so insignificant issue of correlative outcome and caused outcome. x% of people with lung cancer have never smoked or lived with someone that did smoke. For whatever reason they got lung cancer. Had we known this in advance, would it have been wrong for them to smoke? They were going to get lung cancer after all. If we can agree that one of our duties is to bury dead, no matter how dispicable that person is, then I think it is possible for us to agree that some level of care needs to given even to those that have acted recklessly. If a liver transplant were a trivially matter, the alcoholic should recieve it. It isn't a trivial matter though, and there is nothing wrong with showing preference to those likely to care for what we give them at a significant cost.

but rather a libertarian tendency in the face of a particular elite in this particular time and place which has become particularly accustomed to murdering thousands of innocent and infirm each week in the name of its conception of freedom and equality.

Let's take a case you're familiar. Who acted most to protect Shiavo from being euthanized, the State or her husband? I'm afraid that answer holds for the whole as well.

Who acted most to protect her? Republicans, that's who. And since they now mostly regret it, I think you've inadvertently reinforced Lydia's point.

And since they now mostly regret it...

As a side note, and not to intrude in that discussion, many Republicans, and a fair number of conservatives, blame this - in conjunction with other social matters - for losing them the Congress.

Anything to avoid blaming the Iraq War.

Who did the most to protect Terri Schiavo? Her parents, that's who. By bringing hopeless appeal after hopeless appeal. Ultimately, the state of Florida said that it would have put through and enforced the court orders for her death *even if her husband had changed his mind*, that _any_ guardian for her would have had those court orders mandated, once the judge had made his ruling by supposedly "clear and convincing evidence" that her death was her desire. Her wicked and murderous husband kicked the ball off, but once it was kicked off, the machinery ground on. Don't get me started, M.Z. I know that case inside and out--every little legal twist and turn of it. I wrote a lengthy article about it and many-a blog post on another blog. See the article here:

http://www.christendomreview.com/Volume001Issue002/lydia_mcgrew_01.html

But Terri's case is only one _in the United States_, and what delayed her death was chiefly the fact that it still has to be determined in the U.S. that this was ostensibly the patient's own wish. That is because of this notion that patients should be able to choose to have life-continuing measures (such as, you know, food and water)--an idea that ethics elites are just slavering to crack down on and eliminate. Wesley Smith has documented articles in journals bewailing the ability patients and their doctors still have in the U.S. to do what is best for the patient, God forbid, and how they would like to stop that, because it's so un-civic and costs too much money. In more controlled healthcare economies, matters are oh-so-much simpler. The system is in charge. In England, they put them on the Liverpool Care Pathway and dehydrate them to death over the objections of their families and with no pretense that the patient had said that this was his wish. Hence, no appeal and no legal delays.

"Why should a drug dealer enjoy the protection from the police?"

Because the Constitution says all people should be treated fairly under the law, you don't instantly lose protection when you break the law.

The other Problem is if you happen to pay in a certain percentage of yearly wage into the pot and when you finally need to use it you are being Rationed less than you payed in because it has been spread out amongst others who unlike yourself may not take care of themself.

Why should a drug dealer enjoy the protection from the police? Certainly it is reasonable to argue he shouldn't enjoy protection in selling drugs, but he still enjoys such protections as not being shot, even if it is reasonable to expect to be shot in that line of work.

The active protection of the state has never been regarded as an individual right that the state must fulfill. In fact, the legal system has unequivocally rejected it as high as the Supreme Court. The drug dealer has absolutely no legal right to the officer's protection from being shot.

There is also the not so insignificant issue of correlative outcome and caused outcome.

I tried to make this one easy on you by erring on the side of cases where caused outcome is the likely conclusion. You still didn't answer even that hypothetical as to why an individual, who a reasonable person of adequate educate would regard as having caused their condition, has a moral claim on society to help them. Going back to the example, why does an alcoholic have a moral claim on society for health care for liver damage? Why does the individual get the presumption of a moral claim rather than having to prove that he or she has one?

There is also the not so insignificant issue of correlative outcome and caused outcome.

Yes. An individual who asks society to bail them out has no moral right to take any action which would increase the financial risk to society.

If we can agree that one of our duties is to bury dead, no matter how dispicable that person is, then I think it is possible for us to agree that some level of care needs to given even to those that have acted recklessly.

Burying the dead is a qualitatively different act in that it is final and poses minimal harm to society. Bailing out reckless behavior without imposing firm limits poses a predictable pattern of problems for society.

If a liver transplant were a trivially matter, the alcoholic should recieve it. It isn't a trivial matter though, and there is nothing wrong with showing preference to those likely to care for what we give them at a significant cost.

How far are you willing to take that? If a welfare recipient refuses to stop using drugs, are you prepared to strip them of their state assistance? If a single mom refuses to stop having children out of wedlock, are you prepared to do the same?

This is a critical issue to many of us. The left has shown no regard for the issue of responsibility here and no willingness to differentiate between those who are down on their luck and those who refuse to stand up. Most liberals far from denouncing those who abuse public welfare, make excuses for them. That is why there is the intractable divide and why the right digs in its heels every time the left budges.

Because the Constitution says all people should be treated fairly under the law, you don't instantly lose protection when you break the law.

There is constitutional right to police protection. That is why the second amendment issues are so dangerous. The left blithely ignores the fact that the courts, all the way up to the Supreme Court, have ruled that there is no right (period!) to law enforcement protection. You combine that with heavy gun regulations and it's a recipe for a self-defense scenario in many cities that can best be described as "too bad, so sad, you better run and cower in fear."

"The compendium of social justice defines health care as a right, not that you are bound by that."

A new right always imposes a new duty on someone else. When the newly created duty is monetary in nature, it is natural for the one from whom the duty is being collected to raise questions, esp. if he has doubts about the validity of the right being put forward.

To throw all this "rights" talk around without consideration of the correlating duties/responsibilities is quite wrongheaded, IMO, but it is typical of liberalism (see the 'forgotten man' argument).

Maximos, by the way, I hear every word you are saying. I hear the demands you are channeling from the poor and downtrodden at the (pretty darned good) margins of the emergency room. I have little sympathy for their demands. I think they are muddle-headed to the last degree, think that something can be created out of nothing, and have no idea how good they have it in our present world and our present medical system. So sue me.

But I'll say this much: If our Constitution were in anything like working order, they would have to make their clamorous demands for more, more, more entitlement on a state-by-state basis, rather than being able to have any hope of making this all happen on a national level. And that, at least, would be a gain.

Mike T, I thought he mean't protection from other citizens not the police.

Maximos, by the way, I hear every word you are saying.

This is, quite simply, the most astonishing piece of blogging I have ever read, one that probably surpasses all possibilities of satire or parody. Every extant social system instantiates a preferential option for some group or other, at least in terms of its orientation or teleology. One preferential option opposes another, one conception of entitlement another, and the common good dies, streaked in blood and excrement, lying prostrate in the mud.

And understanding dies with it.

MikeT,

The active protection of the state has never been regarded as an individual right that the state must fulfill.
The wicked enjoy the same protection under our laws as the innocent. "He was a drug dealer" is not a positive defense in court against the charge of murder. Scott Roeder was prosecuted for the murder of the thoroughly wicked George Tiller.

Going back to the example, why does an alcoholic have a moral claim on society for health care for liver damage?

He doesn't. The dying cancer patient does have a claim on society for morphine (or whatever prescribed treatment for pain) so that they may not suffer any greater than need be. Doing so is a recognition of their dignity, regardless of how the cancer arose.

Yes. An individual who asks society to bail them out has no moral right to take any action which would increase the financial risk to society.

You really seem to have embraced this idea of a parasitic relationship. Sometimes (oftentimes even) a parent does not force their child to bear the brunt of the consequences of their actions. They do this because they believe the child will be better off for having done that. Society does this well. God does this. There is a point where bearing the burden of choice goes from proper social order to sadistic. I'm not telling you where that line is here, but there is a such a line. When the desire for recrimination overpowers the desire to even protect the innocent, I think that line has clearly been crossed (like those opposed in principle to the government temporarily taking over the credit markets). If the idea that someone, somewhere might get inordinate benefit from a health care scheme (not necessarily this one) even though everyone else is better off with it is seen as a compelling argument against that system, I think that line has been crossed.

If a single mom refuses to stop having children out of wedlock, are you prepared to do the same?

As long as there is the ability to shelter the homeless, feed the hungry, and clothe the naked, it should be done. How is always a question, but the need to do so is not one, at least for a Christian.

Maximos why does this thought process just stop at healthcare, should we extend it to food, shelter, money, jobs, at what point does your using goverment programs to help people in need stop, you haven't laid this out and why can't in be done Privately. Most of the Hospitals prior to Medicare and Medicaid were Church run.

Gee, Maximos, and I hoped we could find a point of agreement on the matter of the requirement that people put such things through, if they are going to do them at all, at a state level. But maybe my unsympathetic first paragraph killed that possibility.

Well it seems that the Compendium for Social Doctrine that MZ cites connects the right to health care to the universal destinatin of goods and the preferential option for the poor. I would suppose that a good social justice catholic would say that good of health care is created by God for the benefit of all of his children, and if one of his children is prevented from participating in this good at at least some very basic level then his health care has been stolen from him. As one of the goods of creation, healthcare is a basic right of all based upon their dignity as children of God, and this right is unalienable by bad behavior insofar as a man, regardless of how hard he tries, in incapable of completely erasing the Image of God in himself.

"As long as there is the ability to shelter the homeless, feed the hungry, and clothe the naked, it should be done. How is always a question, but the need to do so is not one, at least for a Christian."

Christian tradition is extremely tough on those who don't help the poor and needy. That's a given. However, I do not see where the givenness of this concept entails A taking money from B by force and giving it to C, whether he needs it or not, based solely on the fact that A believes C needs it.

I have no problem with the notions of social justice and the preferential option for the poor. What I do have a problem with is the coercive nature of the proposals by which some proponents want to see them enforced. The Christian Left often rails against baptized capitalism, and I fully agree; Smith, Mises, Hayek, and Friedman are not the four Evangelists, and it's a good thing too. But baptized socialism is equally problematic, and sometimes "social justice" is simply code for Christian socialism.

M.Z.--

The compendium of social justice defines health care as a right, not that you are bound by that. Even if you aren't able to necessarily quantify the extent of that right, I think you would be able to agree that there is something. Certainly there is room for debate about the extent, but if we are able to come to an agreement that it is more than acute care, then we are in agreement that there is a violation of justice presently.

I am certainly able to agree that there is something. I just don't think it is a "thing" can be properly understood under the rubric of rights. Frankly I would much prefer the language of justice than of rights.

In that framework let me address you: This bill is proposed to repair certain defects of justice in our health care system. On my amateur reading, taking the bill, the argument for it, the experience of other nations on these difficult problems, I expect that the defects will not be satisfactorily repaired. They will remain as very real difficulties for millions. Moreover, certain aspects of the bill, in my judgment, will do grave and lasting injury to justice in health care. I think, finally, that the idea of this bill as a revenue generator for the government is positively insulting.

Thus my opposition to it. Another proposal, another "scoring," according to what resources I possess, to decide what I think of it.

I have no problem with you opposing a bill because you think it will lead to worse consequences. I might disagree with your logic, but you may disagree with mine. With MikeT, I think I have a disagreement in principle. I'm not as acquainted with your arguments on this particular topic, but I assume you are of good will and we agree principle.

I think one of the major Moral problems with Goverment Healthcare is the utilitarianism logic used by certain supporters, it the way they measure Humans purely through Economic terms.

Ezekiel J. Emanuel (Rahm Emanuel's brother) says

The complete lives system discriminates against older people. Age-based allocation is ageism. Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years. Treating 65-year-olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.

His idea is that Younger people contribute more economically to society so its ok to Discriminate based on age, older people or Retires are no longer Economic Contributors or there overall signifince is at a minimum. Now the problem arises hear when we see that this would entail supplying less medical care to old people (who are sick more frequently than the young) because of finite supplys. But in this situation the suffering and pain of these people becomes secondery to there economic worth, they become nothing more than Stastics and costs it leads to a indifference to people after a certain age. If an old lady needs arthritis medcine and a young economically viable man needs a operation then the costs and money will be directed to him over her and this will happen on mass scale, if drugs intended to numb pain for the Elderly are seen as to costly for the overall system they'll just have to suffer. I find this something quite Dehumanising about this entire thought process, an Objectification of people that I see as dangerous and will eventually lead to the rise of euthanasia and other such processes.

I find it hard to see how a system like this can be seen as moral.

It is important to keep in mind that the same Tradition which - indeed the very same Pope who - gave us Rerum Novarum, also gave us Quod Apostolica Muneris.

Ben, I think that you have laid out a relatively fair description of the supposed social justice plea. Let me comment on it.

a good social justice catholic would say that good of health care is created by God for the benefit of all of his children, and if one of his children is prevented from participating in this good at at least some very basic level then his health care has been stolen from him.

It can't have been stolen from him before some doctor, nurse, or scientist actually developed and made that care, could it? So this "right to" that you speak of must somehow pass through the hands of other humans before it becomes a real right instead of just steam and smoke in the mouth. But as soon as you say that God "created it" by enabling other humans to make it with their effort and intelligence, you have already allowed that this benifice "health care" is something really in private hands before the state has a right to re-distribute it, and that means that, at least in first instance, it is a God-given right and obligation for those private individuals to decide how they are going to distribute that good He has put in their hands.

at least some very basic level

What if someone says: yes, at the basic level that $100 per month of insurance will buy. Whatever that covers, that is what they have a right to. (Which is, by the way, about $95 per month value than would have been around some 200 years ago: did the poor have the same "right to at least some basic level" that our current poor have a right to? Why not? How can our current poor have a greater God-given right than the poor of old?) The point is, there is no clear basis for a governmentally enforced decision upon private citizens holding their privately developed benifice (yes, out of God-given resources) to set the level by fiat at point X rather than at point Y. What criterion descends to us from on high which says what "basic level" the poor have a right to?

has been stolen from him

There is a big difference between man A using God-given resources, developing a modest surplus of a good, wheat, and decide that his storage warehouse is a better social use for the next 4 months for that surplus, until next spring when it can be planted, than giving it to a neer do well B who will be just as hungry/cold /stupid/wasteful next week as this week, on the one hand,
and A taking a good given to B by a friend and deciding "I want that, so I'll take it." The latter rightly goes by the name stealing. If you call the former stealing, you have damaged the ability to speak together to any use.

healthcare is a basic right of all based upon their dignity as children of God

Whoa, let's not equivocate here. You said above that a basic level of healthcare is a right, not generic "healthcare." Please remember to always use "basic level" whenever the phrase includes "right to", and we'll get along fine.

his right is unalienable by bad behavior

Actually, this right may be alienable in part by his own actions, just like the right to life, liberty, and personal property, the right to health care can indeed be circumscribed and penalized on account of his actions.

I'm not as acquainted with your arguments on this particular topic . . .

. . . for the perfectly legitimate reason that I haven't made many. Indeed, in this post I began with some assumptions that (I think) we can all work from to understand ourselves, and each other, better. So, to return to my post:

Resolved, that this health care reform bill is a very considerable step away from rule-by-the-many and towards rule-by-the-few -- both on the level of state-capitalism, where we have established near-monopolies, and on the level of bureaucratization, hard on the heels of which will surely follow corruption on a vast scale. We have further "managerialized," if you'll forgive a jargon term, our society.

Maximos answers this by adverting to (a) the long legacy of plutocratic forms in American history, stretching back 150 years at least, (b) the staleness of conservative-libertarian arguments, (c) the prospective implausibility of "it can always get worse" as a electoral appeal. To my mind, neither (a), (b), nor (c) is, strictly speaking, an answer to my resolution.

I am interested in hearing how M.Z. answers my resolution, though.

Zippy -- thanks for the link to that less well known Leo XIII encyclical.

Zippy -- thanks for the link to that less well known Leo XIII encyclical.
Oh it is awesome, and must-reading alongside the more popular Rerum Novarum from the very same Pope. Here is a taste of it:
Surely these [Socialists] are they who, as the sacred Scriptures testify, "Defile the flesh, despise dominion and blaspheme majesty."(2) They leave nothing untouched or whole which by both human and divine laws has been wisely decreed for the health and beauty of life. They refuse obedience to the higher powers, to whom, according to the admonition of the Apostle, every soul ought to be subject, and who derive the right of governing from God; and they proclaim the absolute equality of all men in rights and duties. They debase the natural union of man and woman, which is held sacred even among barbarous peoples; and its bond, by which the family is chiefly held together, they weaken, or even deliver up to lust. Lured, in fine, by the greed of present goods, which is "the root of all evils, which some coveting have erred from the faith,"(3) they assail the right of property sanctioned by natural law; and by a scheme of horrible wickedness, while they seem desirous of caring for the needs and satisfying the desires of all men, they strive to seize and hold in common whatever has been acquired either by title of lawful inheritance, or by labor of brain and hands, or by thrift in one's mode of life.
But the boldness of these bad men, which day by day more and more threatens civil society with destruction, and strikes the souls of all with anxiety and fear, finds its cause and origin in those poisonous doctrines which, spread abroad in former times among the people, like evil seed bore in due time such fatal fruit. For you know, venerable brethren, that that most deadly war which from the sixteenth century down has been waged by innovators against the Catholic faith, and which has grown in intensity up to today, had for its object to subvert all revelation, and overthrow the supernatural order, that thus the way might be opened for the discoveries, or rather the hallucinations, of reason alone. This kind of error, which falsely usurps to itself the name of reason, as it lures and whets the natural appetite that is in man of excelling, and gives loose rein to unlawful desires of every kind, has easily penetrated not only the minds of a great multitude of men but to a wide extent civil society, also. Hence, by a new species of impiety, unheard of even among the heathen nations, states have been constituted without any count at all of God or of the order established by him; it has been given out that public authority neither derives its principles, nor its majesty, nor its power of governing from God, but rather from the multitude, which, thinking itself absolved from all divine sanction, bows only to such laws as it shall have made at its own will. The supernatural truths of faith having been assailed and cast out as though hostile to reason, the very Author and Redeemer of the human race has been slowly and little by little banished from the universities, the lyceums and gymnasia-in a word, from every public institution.
For, while the socialists would destroy the "right" of property, alleging it to be a human invention altogether opposed to the inborn equality of man, and, claiming a community of goods, argue that poverty should not be peaceably endured, and that the property and privileges of the rich may be rightly invaded, the Church, with much greater wisdom and good sense, recognizes the inequality among men, who are born with different powers of body and mind, inequality in actual possession, also, and holds that the right of property and of ownership, which springs from nature itself, must not be touched and stands inviolate.

To my mind, neither (a), (b), nor (c) is, strictly speaking, an answer to my resolution.

What do you mean by the term, 'answer'? - a decisive demonstration that this legislation is not, in point of fact, a movement such as you describe? Not only have I not attempted such a demonstration, I would not, given the principles I have already declared. What I have provided, rather, is an explanation of the why of such things as this legislation. "Because they hate our freedoms" is as silly an explanation here as it is with respect to terrorist activities, inasmuch as the term 'freedom' is a mystification covering a dense of skein of discrete freedoms and unfreedoms, justified and unjustified, warranted and unwarranted, false and true. We have, as a collectivity, taken this step for certain reasons, and that step has assumed a given form for certain reasons; and I am filled with a vague sense of dread that so many wish to oppose things, even when defining them correctly, without endeavouring to understand why they have happened.

Conservatives will not silence the clamour of the suffering, nor its political salience, however much they may avow their abhorrence of that clamour, and assert their lack of sympathy for its subjects; and when that clamour is answered, the form of the answer will be dictated by the forms of our governance, which are managerial.

For the record, I am not asserting that "it could always be worse" is a worthless electoral appeal; to the contrary, it seems always to be implicit in our discourse. Rather, I am claiming that the health care version of "let them eat cake" is not going to persuade the suffering and deprived to still their tongues and die quietly out of the sight and hearing or unsympathetic conservatives. If this much is not self-evident, then conservatives deserve the long defeat and doom which await them.

His idea is that Younger people contribute more economically to society so its ok to Discriminate based on age, older people or Retires are no longer Economic Contributors

And Zippy mentions 2 of Leo's encyclicals. I would like to intertwine these comments: Pope Leo was elected at the ripe old (very old considering the times) age of 78. They say he was elected as a caretaker pope so they could re-do the election in a couple years at greater leisure (I don't know, I was fishing at the time). Anyway, this very old caretaker pope lasted 25 years in office, and put out great encyclicals like the ones Zippy brings up. So much for older people not contributing "value".

What I have provided, rather, is an explanation of the why of such things as this legislation.

And I have stated my sympathy for that explanation. But all you can say is, in effect, "yeah you're pretty much right about this bill but more importantly LOOK AT WHAT THE LOATHSOME CONSERVATIVES ARE SAYING!" They're saying what they've been saying on these topics for 30 years or more, as are the liberals. The urgency of these antique disputes eludes me.

The kind of answer that I'm looking for -- particularly from a supporter of the legislation -- is "no, actually this bill is an instance of rule-by-the-many for X, Y and Z reasons" or "well medicine is one area where we must have planners" or . . . something else that I have not anticipated. That I might genuinely seek a conversation somewhat aloof from those antique disputes mentioned above at least could be a possibility, no?

I'm having trouble seeing where the differentiation is coming. My thoughts immediately come to Max Weber. I have no trouble seeing how bureaucratization consolidates power. I'm not seeing how that is a feature of the political though. Certainly communist states have invested greatly in bureaucracy. Our bureaucracies have tended to be more invested in our corporations. Each of our Fortune 100s' revenues exceed the GDP of the median world's country, ~$25B. The Fortune 500 account for 73% of our GDP. Rather than signaling a change, I think we are speaking more or rearranging the chairs. On the other hand, I don't see how we escape bureaucracy and then, if we do, how it will benefit us.

On the poli sci end, I'm going to go further than Maximos and go to Jefferson. We have had two party rule since then. They have been the king makers. Before LaFollette's reforms, the parties were more explicitly all powerful. I think we are mythologizing when we think of citizen leaders. They have all come from the elite. Over the past 30 years, we've almost managed to have the stability of a hereditary monarch: Bush, Clinton, Bush, H. Clinton. Well, we escaped the last one, but I have little doubt she would have won had she gotten the nomination.

So to answer your question, I think managerial state is here to stay.

Zippy,

Pacem In Terris pretty clearly establishes the State's role in health care. When Leo was writing, there was a greater push toward outright communism. After WWII, the Church made its peace with Democratic Socialism.

Pacem In Terris pretty clearly establishes the State's role in health care.
It clearly establishes that health care is one of many legitimate things for the State to be concerned about, sure. Not that that has ever been in doubt, as far as I know.

I've heard that some socialists try to claim that their heresy has been declared no longer a heresy through some development of doctrine, but I've never personally seen a credible attempt to make that case. I don't ordinarily read fruitcakery from the liberation theology wing of Catholicism though.

I have done no reading in LT, so I can't competently address it. Pope Benedict XVI as Cardinal Ratzinger wrote in the book Without Roots:

In many respects, democratic socialism was and is close to Catholic social doctrine, and has in any case made a remarkable contribution to the formation of a social consciousness.

As you aware, he is not a lover of LT.

well medicine is one area where we must have planners

If you compared health insurance to a power grid, the status quo is something like everyone in the suburbs gets reliable power, the people who live in the city get power about half the time, and people in rural areas live without electricity. So building a network with a good deal more consistency is like establishing a public utility, a company that has a near-monopoly, is heavily planned and regulated, and has stable and unspectacular profit margins.

Got anything Magisterial, to at least give me something to look at?

Now we're getting somewhere.

One commenter has told me that rule-by-the-few is here to stay, meaning perhaps that it is idle to argue against it; and another has as good as told me that rule-by-the-few, far from simply being a fact to face, is a positive good in some areas, including health care.

Now I happen to think the managerial state is here to stay as well. I might have a more pronounced sense that the managerial experience is near the sunset of its days than my interlocutors, but we can agree that it is for now a fact to face.

Set all that aside. Return to the language of justice. Let's consider two questions: (a) has the establishment of the managerial state comprised an advance for justice? and (b) should we on those grounds continue to favor the replacement of democratic or self-governing or rule-by-the-many forms with managerial, plutocratic, rule-by-the-few forms?

(Incidentally, it is fascinating how the language of justice is so vital for liberals in certain contexts, but makes them deeply uncomfortable in others. I have my suspicions, of course, for why this is so; but maybe the liberals themselves have better explanations. Also, let me emphasize what is clear to me at least about these different linguistic frameworks, "rights" vs. "justice": they do point to much deeper differences than mere semantics. They point to different ways of understanding the nature and destiny of mankind.)

The wicked enjoy the same protection under our laws as the innocent. "He was a drug dealer" is not a positive defense in court against the charge of murder. Scott Roeder was prosecuted for the murder of the thoroughly wicked George Tiller.

I don't know whether you evaded what I said because you don't understand it or because you don't want to deal with it, but your response here has nothing to do with what you originally said or my response.

You asked me why the drug dealer still has a right to police protection.

I responded by pointing out that a legal, positive right to police protection has not only never been recognized by our political or legal system (and arguably any major philosopher or legal theorist), but that the courts have formally ruled that there is no such right, even under the 9th amendment.

Technically, you don't even have a right to court protection because you have legal right to demand access to a grand jury and a state prosecutor and the courts no longer provide a mechanism by which a citizen may initiate criminal proceedings. Tiller's murder trial would be entirely at the mercy of the system, not a legal right.

He doesn't. The dying cancer patient does have a claim on society for morphine (or whatever prescribed treatment for pain) so that they may not suffer any greater than need be. Doing so is a recognition of their dignity, regardless of how the cancer arose.

Ah, so we tell people they can live however they want and then society will comfort them with free drugs and treatments as they suffer the physical damage they inflicted on themselves.

You really seem to have embraced this idea of a parasitic relationship. Sometimes (oftentimes even) a parent does not force their child to bear the brunt of the consequences of their actions. They do this because they believe the child will be better off for having done that. Society does this well. God does this. There is a point where bearing the burden of choice goes from proper social order to sadistic. I'm not telling you where that line is here, but there is a such a line. When the desire for recrimination overpowers the desire to even protect the innocent, I think that line has clearly been crossed (like those opposed in principle to the government temporarily taking over the credit markets). If the idea that someone, somewhere might get inordinate benefit from a health care scheme (not necessarily this one) even though everyone else is better off with it is seen as a compelling argument against that system, I think that line has been crossed.

A lot of people do have a parasitic relationship with the system. A lot more will have one if so enabled by liberal politicians.

I have no problem with the federal government providing a safety net like Medicaid on the condition that it is empowered to do things like deny welfare benefits and bill back patients who have a parasitic relationship. As I have said here, the left (and that includes you) don't want to recognize that your class model is broken as there are four classes, not three: upper, middle, lower and under. The underclass cannot and will not behave according to mainstream norms without a sizable stick in the hand of the one offering it a carrot.

As long as there is the ability to shelter the homeless, feed the hungry, and clothe the naked, it should be done. How is always a question, but the need to do so is not one, at least for a Christian.

You are ignoring the clear scriptural mandates on this like when Paul tells young widows that they must remarry rather than be a burden to the Church, that those who won't work shouldn't eat, to say nothing of Paul's teaching that those who intentionally persist in sin have no right to be a member of the Church. The scriptural teachings are clearly in favor of denying such generosity toward those whose circumstances are imposed upon them by a defiant, unrepentant behavior which is specifically what I referenced in saying a "single mom who won't stop having kids out of wedlock." In fact, your willingness to take the money of those who have tried to live right and give it to those who are unwilling to stop living such sinful, destructive lifestyles only serves to build up contempt for the Gospel on the grounds that it will be perceived as a weak-minded, sentimental, effeminate message that demands nothing of anyone except those trying to make a way for themselves in this world.

Here, by the way, is yet another example of where rule-by-the-many has been replaced by rule-by-the-few in health care, and it will result in manifest injury to justice:

http://www.investors.com/NewsAndAnalysis/Article.aspx?id=528337

With MikeT, I think I have a disagreement in principle.

In principle, I reject the socialization of individual moral duty. I recognize an individual moral duty to help the poor. I do not recognize a collective, societal form of that. I only recognize a duty by society to not hinder the individual in his or her performance of that duty.

I have said here that I favor abolishing all of these programs and instituting a $1:$1 tax credit system by which the middle and upper class may take all of this burden to support the needy on themselves. If Warren Buffet wishes to spend $1B of his income directly paying off the debts of indigent patients, then the state has a moral duty to lessen his tax burden to enable this generosity. Most of what the state does cannot be considered a moral good remotely on par with this sort of act. Likewise, if my wife and I take it upon ourselves to relieve Medicare of the obligation to pay for my grandmother's next eye surgery, then society owes it to us to relieve us of that share of our tax burden.

I also take the view that the left, and that includes a number of W4 commenters, have an inconsistent view here toward the medical profession. If a hospital has a moral duty to anyone who shows up at the ER, then so does a law firm, especially the expensive ones, to any poor client who needs representation. Yet, I don't see any popular willingness to impose such a legal burden on lawyers, despite the fact that their profession is as expensive to the public as the medical profession and the benefits they often provide to the public dubious by comparison.

Good link, Paul. Excellent example.

Given that I've written rather vanilla catholic social thought, I'm going to skip the Scriptural cites with which you should be well familiar. You are only going to convince yourself here if you think you can cite Scripture as an authority that society in its institutions should disregard the poor. I think Scripture is perspicuous on this matter, and I'm comfortable having you be one of the few people that disagrees with it.

I don't know whether you evaded what I said because you don't understand it or because you don't want to deal with it
You seem to have misunderstood my point in that matter. I have to accept some fault for apparently communicating it poorly. Most work under the belief that right that human rights are universal. This means that the status of wicked or righteous doesn't mean a person stops enjoying those rights. Most rights are defined universally.

Ah, so we tell people they can live however they want and then society will comfort them with free drugs and treatments as they suffer the physical damage they inflicted on themselves.
I can live that. I hope I receive the same measure when I die.

I have no problem with the federal government providing a safety net like Medicaid on the condition that it is empowered to do things like deny welfare benefits and bill back patients who have a parasitic relationship.
That is well and good. Reducing it to brass tacks, it just means you have no objection to charity being provided that you would be willing to give were you able. Unfortunately, any social system with the least bit of complexity will involve cases where someone disagrees. (There were people bellyaching locally that a family was chosen for "Extreme Makeover: Home Edition" because they felt the family didn't deserve it.) More significant is your willingness to tolerate being found wrong. Saying you support government when it agrees with you is like saying you support having sex freely when there's no chance to contract an STD, not too significant.

As I have said here, the left (and that includes you) don't want to recognize that your class model is broken as there are four classes, not three: upper, middle, lower and under.
You have understand my writing well up to this point and you haven't here as well. I actually subscribe to two classes: the bourgeoisie and the proletariat. You seem to be moving into Sailer territory. You might even be one of his disciples. Even if you subscribe to the notion that there are some classes, races, or ethnic groups that are incapable of self provision, something with which I emphatically do not subscribe, your obligation to support does not go away.

But all you can say is, in effect, "yeah you're pretty much right about this bill but more importantly LOOK AT WHAT THE LOATHSOME CONSERVATIVES ARE SAYING!" They're saying what they've been saying on these topics for 30 years or more, as are the liberals. The urgency of these antique disputes eludes me.

Well, when a conservative avows a lack of sympathy for those who suffer in marginality owing to the structures of our health care system, I do think it, well, that word you used to describe my sentiments about the matter; and this is why these ostensibly "antique" disputations are of relevance: because the prevalence of such sentiments on the right are indicative of a failure to reckon with the nature of this problem as it manifests itself in our society. Playing the Three Monkeys with respect to the problems in our health care system, essentially demanding that the entire political question vanish from before us, as though the mere wishing will cause it to be so, is the sheerest irrealism. Many conservatives may protest that they lack sympathy for the plight of the uninsured, those subject to rescissions, and so forth, and they may, as have some of the teapeople, denigrate the suffering, to their faces, as communists, moochers, the unproductive, and other phrases uncomfortably close to "useless eaters", but all such talk, quite apart from my estimation of its ethical worth, is politically useless - worse than useless, actually: it is an objective detriment to conservative success in the political arena. Most Americans, either now, or at some time in the future, will recoil from such sentiments and their social implications, and, for want of an alternative from the right, assume that the left is the only source of viable solutions; you cannot defeat something with nothing, or something amounting to, "I don't care." Now, I'm all for a conservatism of pessimism, even of despair with respect to certain matters; and if one wishes to concede utter and irrevocable defeat on a given policy matter, acknowledging that, at this moment of history, in the actual world, it is impossible to achieve X, he should give rein to his despair quietly, perhaps listening to a good requiem and imagining it a lamentation for his nation and his political hopes; what he should not do is engage in voluble rhetorical foot-stamping about how dreadful things have become, how hopeless it all is, how benighted the majority who do not perceive things as he does, without offering a credible alternative. If one is going to protest, one should have in mind at least some sketch of an alternative, some basis for arguing that while A is horrible, and will engender consequences M through Y, Z is preferable, and will engender consequences B through L. And this is precisely what altogether too many conservatives are not doing, preferring to state, in so many ways, that this is a pseudo-problem that should just go away, that the people who regard it as a problem are wicked, and so forth. Saying those things which Maximos regards as loathsome may be satisfying, and may well reflect some deep philosophical argument, but saying those things is the equivalent of foot-stamping, and does nothing to develop a viable conservative alternative to the new status quo.

As for the question of rule-by-the-many and rule-by-the-few, the matter is more nuanced, more fine-grained than the binary. It must be inquired who are the few and the many in any given scenario. For example, one of the cardinal failings of this legislation is that it, so far from weakening the state-level monopolies of the health insurers, strengthens them, neither removing their anti-trust exemptions nor subjecting them to meaningful competition, which might only come were they subjected to interstate competition. That's a limpid case of augmenting the rule of the few, and weakening the rule of the many, I should think. And yet, merely permitting interstate competition in the issuance of insurance policies is no panacea, and the case of banking regulation demonstrates why it is no panacea: the individual states have vested interests in obtaining a comparative advantage over the other states, in terms of the employment, and tax revenues, that can be lured via slacker regulation, and there is nothing in the nature of the case, unlike banking, that will insure that this process results in the provision of superior insurance policies and customer service. The race to the bottom in state banking and credit card regulation is perfectly analogous to insurance, yet another instance of an industry with vast asymmetries of power and information. The case of international financial regulation offers another analogy; globalized finance certain entails some measure of global regulatory oversight, but it is well nigh impossible to achieve this effectively because of the comparative advantage problem: if London punishes its parasites, perhaps they will decamp to Berlin and Frankfurt.

So interstate competition, while potentially valuable, is not a panacea considered in itself. It would be necessary to couple it with national-level regulation of minimum policy forms and content, and so forth, and it would also be necessary to employ anti-trust regulations to insure against the emergence of a handful of mega-insurers, after the failed pattern of our banking system. But in that case, you'd have the many allying with a different set of the few in order to forestall the abuses of another set of the few, which is a fairly well-established pattern in Western political economy since the Renaissance, with the nascent bourgeoisie allying with monarchs, many claiming (mythical) divine rights, in order to escape the authority of local nobility and guilds. And that raises the question of subsidiarity.

What subsidiarity requires in the case of health care policy is not immediately evident, and the establishment of a rough range of policy outcomes consistent with this principle would require a great deal of intellectual labour, I think. The entire point of the principle is to establish the correct balance, prudentially, for any given society, of the few and the many, and their respective degrees of authority and effective power; critically, therefore, it depends upon prior consensus as to the nature of the objectives of social policy. Health insurance provision necessitates risk-pooling, manifestly, but on what scale? - state-level, with competing insurers, unlike the present? National-level, with interstate competition, guarded against the emergence of an insurance analogue to JP Morgan or BoA? What level of risk-pooling suffices to realize the benefits of risk-pooling for any given population? Who should be included in the risk-pooling, and who excluded, if anyone at all should be excluded? Absent prior consensus on these points, one cannot answer the questions about subsidiarity, which is to say, the questions about balancing the few and the many.

I'm far from convinced, mind you all, that these matters must be redressed at the national level; addressing them at that level, in certain respects, is not necessarily inconsistent with subsidiarity - that is contingent upon whether, given our other systemic elements, that is the appropriate level. Conservatives, however, cannot consistently protest national-level solutions, or "solutions", while allowing at least some of the forms and circumstances which suggest national level solutions, or "solutions".

You seem to have misunderstood my point in that matter. I have to accept some fault for apparently communicating it poorly. Most work under the belief that right that human rights are universal. This means that the status of wicked or righteous doesn't mean a person stops enjoying those rights. Most rights are defined universally.

You are still evading my point which is that the drug dealer has never had a legal right to police protection precisely because the system has never recognized such a right, nor has even any prominent legal theorist with whom I'm familiar. Even access to the courts for criminal proceedings is a privilege, not a human right, as the right to bring charges in modern societies is not only not regarded as a right, but as a prerogative of the state prosecutor.

To be blunt, since you seem to need me to be blunt here: your entire point about the protection of the drug dealer from his rivals is invalid. Categorically, invalid. The system recognizes absolutely no legal right in the drug dealer to police protection or judicial action against his assailant. It even has gone so far as to formally state that such a right does not exist.

Why does this matter? Because you used this line of thought as a counter-point against me, and I just proved that your argument is legally specious.

I can live that. I hope I receive the same measure when I die.

Perhaps you can. A great many of your fellow citizens cannot. Your wholesale rejection of the idea of even hearing them out and compromising with their honest disagreement with this process is unacceptable.

That is well and good. Reducing it to brass tacks, it just means you have no objection to charity being provided that you would be willing to give were you able. Unfortunately, any social system with the least bit of complexity will involve cases where someone disagrees. (There were people bellyaching locally that a family was chosen for "Extreme Makeover: Home Edition" because they felt the family didn't deserve it.) More significant is your willingness to tolerate being found wrong.

I am pragmatic and willing to compromise in principle, something I cannot say of most leftists, especially ones like Al here who push the envelope whenever they can get a chance. I fail to see anything immoral with the state saving irresponsible person's life and then setting them up with a payment plan or something to repay society over many years for the price they have imposed on it. Without any penalties, people can and will abuse the system.

You have understand my writing well up to this point and you haven't here as well. I actually subscribe to two classes: the bourgeoisie and the proletariat.

Ah, so you are a Marxist. How does it feel to be part of an intellectual movement whose theory of economic value was successfully debunked in 2 pages of a science fiction novel (Starship Troopers by Robert Heinlein)?

Even if you subscribe to the notion that there are some classes, races, or ethnic groups that are incapable of self provision, something with which I emphatically do not subscribe, your obligation to support does not go away.

I do not believe they are incapable of self-provision. I believe they simply choose to not join society in a productive way. Therefore in all things, from housing them, to feeding them, to providing for their health care, society can freely relax under the words of Paul: "they that won't work will not eat."

Even Lenin went so far as to quote that verse from the Bible and said it is fundamental to the theory of Communism.

Furthermore, there are bad assumptions that you and Maximos are making here. Him to a lesser extent than you. The medical profession is beset with a vast array of obfuscations and distortions which prevent the efficient care for the majority of society.

You refuse to accept the fact that the current system has no possible reformable point in which your desired outcome can be achieved. It is hopeless, it is doomed to failure to keep adding kludges onto it in the hopes that you will finally make it work.

You can pride yourself and your movement on historic changes, but they will be made meaningless. The Republicans will not be any better. Don't bother bring them up, they're just a distraction and one which I have no interesting in defending.

Until a systematic effort to undo those distortions and obfuscations is made, you are just adding more cards onto the house of cards. The left doesn't have the will to do that because it will mean ramming through changes which will actually force a true market in health care where patients can compare prices, can get predictable rates and where all customers start with a basic equality by sheer fact of there being no presumption of a mediator between buyer and seller bring undo force to bear on either side.

The average American is going to have to get accustomed to the idea that real insurance is like auto insurance: it covers disasters, not tune ups. Up until now, most of us with health insurance have gotten spoiled by the idea of paying a cheap copay for a doctor's visit. That has to change, among other things. Unfortunately, legislators won't have the stones to stand up to the American people and tell the masses the hard facts.

Liberals remain in power via support of the underclass, i.e., those for whom they have engendered a state of dependency. Those dependents who feed from the tit of the government will always vote themselves a bigger tit. Following that, it is in the interest of the liberal elite in power to enlarge that tit, as that is how they remain in control. This whole thing, really, is all about power.

Liberals of this sort have an intense, unquenchable desire to be in charge, since it is they who will bring about the new age of economic harmony. Ideology always results in tyranny, and tyranny always resorts to violence -- either physical, or violence to conscience. We are currently seeing the latter; not sure if we can stop the juggernaut before we start seeing the former. I hope so, but I'm not sanguine. My gut feeling is that we have taken it up the pooper, with nary a jar of Vaseline in sight.

M.Z. --

Most work under the belief ... that human rights are universal. This means that the status of wicked or righteous doesn't mean a person stops enjoying those rights. Most rights are defined universally.

Which is precisely why I argued upthread that the language of rights is inadequate and even positively mischievous in the context of health care. Even with all our enormous technical advances, doctors still cannot probably diagnose problems, treatments fail for mysterious reasons, awful misfortunes befalls normal folks. It is pernicious to promise, as proponents of socialized health care are wont to, a universal right to good health that must be discharged by the state lest a terrible injustice be committed.

I don't have much to dispute in Maximos' gloss on the rule-by-the-few / rule-by-the-man framework. I'll constrain myself to saying what I said to M.Z., above:

This bill is proposed to repair certain defects of justice in our health care system. On my amateur reading, taking the bill, the arguments for it, the experience of other nations on these difficult problems, I expect that the defects will not be satisfactorily repaired. They will remain as very real difficulties for millions. Moreover, certain aspects* of the bill, in my judgment, will do grave and lasting injury to justice in health care. I think, finally, that the idea of this bill as a revenue generator for the government is positively insulting.

Thus my opposition to it. Another proposal, another "scoring," according to what resources I possess, to decide what I think of it.


___________________
* To which we can now add the reckless animus against doctor-owned hospitals (i.e., form of worker cooperative), an animus that (naturally) benefits the established corporations.

Even with all our enormous technical advances, doctors still cannot probably diagnose problems, treatments fail for mysterious reasons, awful misfortunes befalls normal folks. It is pernicious to promise, as proponents of socialized health care are wont to, a universal right to good health that must be discharged by the state lest a terrible injustice be committed.

I don't see how this is a fault with socialized medicine. (I would not call Obamacare socialist BTW.) Medicine and treatment ought to be free (libre, not gratis) goods. That is all a right to health care means. The cause for the State to intervene is that medicine and treatment are not free presently (libre again). Among wage earners, health care is only obtainable for all practical purposes through their employers, and then it is dependent upon the generosity of the employer. The only private, individual market that exists is for those relatively young and healthy or wealthy.

"I would not call Obamacare socialist BTW."

Funny, because Al Sharpton does. And he ought to know.

Paul,

I think you more accurately stated some of the things which I have been trying to argue, though I am skeptical still of the justice case of, for example, a meth addict demanding coverage for their health problems as I don't believe it is morally licit for individual liberty to exist without full responsibility for one's choices.

I think it is particularly strange that doctors are singled out here. Why not lawyers? Why is the left not positively disgusted at the expenses imposed on the common man by involvement in the legal system? Unlike doctor and hospital visits which frequently yield positive (if costly) benefits to health, most legal battles yield neither justice nor benefits to the common. I know very few people who have ever been unable to get relief for their health care needs, but I know at least a few middle class individuals who have been almost destroyed by legal battles which went on... and on... and on... while the lawyers profited handsomely.

Were I to be cynical about it, I would write it off as due to the fact that one of the critical bases of financial support in the Democratic Party is the legal profession...

Medicine and treatment ought to be free (libre, not gratis) goods.

Then so should all goods and labor. Of course, you won't do that because you're a hypocrite.

**Sorry, I spoke out of turn. I should give you a chance to advocate the socialization of all production and labor before calling you a hypocrite.

That you choose Sharpton as an authority does not compel me to do so.

Then so should all goods and labor. Of course, you won't do that because you're a hypocrite.
I support free (libre) labor. I'm assuming you don't support slavery or indentured servitude either.

M.Z. --

I emphatically don't think the "fault," as you put it, is isolated exclusively to health care. I think the philosophical language of universal "rights," vouchsafed against the community and secured by the state, is on balance a mischievous one. The other day an acquaintance told me in no uncertain terms that he thinks there is a "right" to good coffee every morning. He persisted even when I demurred with a remark like, "well, I'd love good coffee every morning, but I don't think we can treat as a right we are entitled to."

As for medicine being free, on one definition the idea is impossible. Medicine is in most cases quite expensive. Demand for it is theoretically unlimited. Reflect on what infinity tends to do to a plotted supply-demand-price curve. Thus to talk of medicine being free is to elide the fact that the payment must be socialized.

Now, that may be necessary and wise. But we're not going to get far if the terms of our debate are so slippery.

Sorry, I spoke out of turn. I should give [MZ] a chance to advocate the socialization of all production and labor before calling [him] a hypocrite.
If I understand MZ correctly he is using "free" not to mean available to everyone without cost, but rather available to everyone at all. A plutocratic quasi-monopoly on health care - which is the pre-Obamacare state of things - is like a plutocratic monopoly on food, or on air.

I don't think the point is completely without merit[*]; but I will further point out that Obamacare is among other things an intensification of the plutocratic and monopolistic attributes of the health care system.

[*] There are complications. Some aspects of health care, such as boob jobs or whatever, are clearly luxuries like caviar or whatever. Nobody will die from eating inexpensive food rather than caviar, but there are some extraordinarily expensive health care measures that some people will die without; so the correspondence is far from perfect. Furthermore, there is the fact that no patient can be refused health care, so what seems to be meant here is available without resort to emergency rooms and bankruptcy. But still, I think a legitimate point is being made.

"That you choose Sharpton as an authority does not compel me to do so."

I don't claim him as an authority. I'm just glad that unlike many on the left, he's at least honest enough to admit what it is that he supports.

I think Paul makes a good point that - in a different manner from food or air - health care is something for which there is a potentially infinite appetite: not infinite in the sense of mere greed or conscupiscience, but infinite in the sense of needing more of it to stave off death.

I should reiterate that I detest rights-talk in general and, while I acknowledge that it is possible to use rights-talk with unequivocal intent, it is virtually impossible, in our present culture, to use it without equivocal effect.

I support free (libre) labor. I'm assuming you don't support slavery or indentured servitude either.

I admit that I misread you there.

If I understand MZ correctly he is using "free" not to mean available to everyone without cost, but rather available to everyone at all. A plutocratic quasi-monopoly on health care - which is the pre-Obamacare state of things - is like a plutocratic monopoly on food, or on air.

I don't think the point is completely without merit[*]; but I will further point out that Obamacare is among other things an intensification of the plutocratic and monopolistic attributes of the health care system.

I just misread him. My brain didn't grok libre versus gratis at all. That's what I get for having to rely on caffeine and will power to make up for a lack of sleep.

As to your point about the intensification of those things, that is obviously correct. You don't make a system more just by giving a more prominent place at the table to the people who were making it unjust in the first place, even if they have to "make a few concessions."

Medicine and treatment ought to be free (libre, not gratis) goods.

So you support free markets in medicine and treatment? It just confuses me, because Obamacare isn't that at all.

I don't have much to dispute in Maximos' gloss on the rule-by-the-few / rule-by-the-man framework. I'll constrain myself to saying what I said to M.Z., above:

This bill is proposed to repair certain defects of justice in our health care system. On my amateur reading, taking the bill, the arguments for it, the experience of other nations on these difficult problems, I expect that the defects will not be satisfactorily repaired. They will remain as very real difficulties for millions. Moreover, certain aspects* of the bill, in my judgment, will do grave and lasting injury to justice in health care. I think, finally, that the idea of this bill as a revenue generator for the government is positively insulting.

None of which I've gainsaid, or had an interest in gainsaying. The information about physician-owned hospitals is dismaying, as I'm favourably disposed towards worker-owned economic entities - though I'd state that I'd prefer such hospitals to be non-profit, inasmuch as the respective motives of medicine and profit are in conflict often enough, if not all the time, to be problematic.

The gravamen of my arguments on the subject of health care policy and reform is simply that, before we determine what sort of health care system is consistent with the ethic of subsidiarity, in our circumstances, we must first settle the question of solidarity in health care, for the question of who gets covered is prior to the question of how they get covered, and by whom. Following the social doctrine of my Church, and the Catholic Church, I have a definite position on this, which I don't expect the non-Catholics and non-Orthodox to share. Fine. What follows is that my world-image is other than the world-image of the Protestants and libertarians and classical liberals and generic conservatives. Which, again, is fine. But the world-images are incommensurable, and I cannot be reproached for believing, and saying, that subsidiarity and solidarity go together, and that others are wrong for sundering them. After all, others are saying that I'm wrong to conjoin them.

I think Paul makes a good point that - in a different manner from food or air - health care is something for which there is a potentially infinite appetite: not infinite in the sense of mere greed or conscupiscience, but infinite in the sense of needing more of it to stave off death.

The problem scales both in individual need and the growth of the groups that need the most care. The left won't face the fact that years of abortion and other anti-family policies have left us with a terrible health care dilemma in that the percentage of elderly who will need health care has skyrocketed to a point where it is likely impossible for the rest of society to support it. When you combine those elderly with the underclass, the economics are daunting. I don't see how this is even workable without a faustian bargain that sacrifices the finances of the younger workers and diminishes their familial prospects even more.

though I'd state that I'd prefer such hospitals to be non-profit, inasmuch as the respective motives of medicine and profit are in conflict often enough, if not all the time, to be problematic.

Interesting. Do you feel the same about law firms?

I ask because there seems to be a curious silence on the part of many of the critics of a profit-driven, private medical system with regard to the state of the legal system. What I find particularly ironic is that we even call the venue of the legal profession the "justice system" and yet injustice is routinely done in many forms (not the least of which is the poor and middle class being bankrupted for nothing) with little effort to reform it.

The gravamen of my arguments on the subject of health care policy and reform is simply that, before we determine what sort of health care system is consistent with the ethic of subsidiarity, in our circumstances, we must first settle the question of solidarity in health care, for the question of who gets covered is prior to the question of how they get covered, and by whom.

Good questions. I would say that the answer to the question, Who gets covered? is "everyone." But then we are immediately pressed for more details. How much coverage should be guaranteed? What behaviors, if any (M.Z.'s dodges on Mike's points under this heading do not inspire confidence), can void that guarantee? How should the coverage be financed? Etc.

Incidentally --

I'd prefer such hospitals to be non-profit, inasmuch as the respective motives of medicine and profit are in conflict often enough, if not all the time, to be problematic.

I don't see much hope for the idea that being non-profit removes or even lessens the mercenary instinct in men deposed to cultivate and satisfy that instinct. Perhaps at the margins; but for myself, I would object to any intrinsic calculus tending to the view that a doctor operating a business for profit is more suspicious than one who operates his otherwise.

Perhaps you can reiterate Mike's points. Admittedly I have little concern for moral hazard, considering the concern to be more or less a red herring in the larger debate since it doesn't really effect cost or access for everyone else. At least all the empirical data show that our ability to health costs to influence behavior are minimal. Britain after all is far less robust than your typical supersized American.

The thing with hospitals is that they are natural monopolies. Building more of them tends to make things more expensive. It's in the part of the capitalist cycle where increased demand increases incremental costs. In mature markets, increased demand reduces incremental costs. In the case of surgery centers, they take a hospitals least expensive business thereby increasing the costs for other hospital services because general hospitals are capital intensive.

Admittedly I have little concern for moral hazard, considering the concern to be more or less a red herring in the larger debate since it doesn't really effect cost or access for everyone else.

By its very definition, moral hazard is an issue because you have to factor in what people will consume once they are insulated from the personal cost of consumption. Any increased consumption affects price in upward direction unless supply can scale accordingly both in availability and cost to provide.

Since we aren't churning out doctors like we are turning out undergrads in such eminently useful fields as the liberal arts, humanities, sociology and political science, that will have some interesting effects on price and availability.

Perhaps at the margins; but for myself, I would object to any intrinsic calculus tending to the view that a doctor operating a business for profit is more suspicious than one who operates his otherwise.

Perhaps not any individual doctor himself, at least in the absence of any concrete evidence one way or the other; but as a matter of systemic, structural incentives, yes, there is a difference, and how could it be otherwise? Why do insurance companies reject certain classes of prospective customers, if not to achieve an MCR that will facilitate profits, and a more robust stock price? Similar incentives would be intrinsic to the for-profit entity, whether or not anyone acted on them regularly, or in discrete cases; what differs between the for-profit and non-profit models is that we more or less expect the principals of the former to maximize their takes - and in contemporary political economy, this almost always involves trimming and tunneling and the like below this level - while in the latter we're still scandalized when the principals reward themselves as though they were corporate executives with boards comprised of flunkies and yes-men. Expectations of compensation in the executive world are drastically out of whack, and restoring the sense that authority is accountability, responsibility, and service, and not power and peculation, will require more than admonitions. These latter fall on deaf ears in the New Economy.

what differs between the for-profit and non-profit models is that we more or less expect the principals of the former to maximize their takes . . . while in the latter we're still scandalized when the principals reward themselves as though they were corporate executives with boards comprised of flunkies and yes-men.

Outrage against the frauds and perfidies of "non-profit" labor cooperatives (i.e., labor unions), despite the fact that they, too, are decidedly organized to advance their members' interest, seems pretty muted these days, except among those loathsome conservatives.

If you're prepared to say that men banding together to advance their interest is inherently suspicious, that's fair. But it must apply more broadly than simply a narrowly-defined profit motive.

The mercenary motive in man embraces more than mere material accumulation.

Those same "non-profit" labor cooperatives also tend to have no qualms about outright seizing the wealth of their white collar neighbors, as witnessed by the SEIU's call for "pooling 401ks and IRAs. Even more muted is the outrage over the way that these people almost perfectly mirror, in a proletarian way, the rapacious behavior of the financial elites.

Outrage against the frauds and perfidies of "non-profit" labor cooperatives (i.e., labor unions), despite the fact that they, too, are decidedly organized to advance their members' interest, seems pretty muted these days, except among those loathsome conservatives.

Unfair. Conservatives are right to be outraged by the financial abuses of the unions, of which there are plenty; conservatives are wrong to be outraged by the existence of unions themselves, and the difference between these two positions is elided by virtually all of the conservative critics. Moreover, the outrage is due in part to the very set of expectations I mentioned above, expectations which are not present in the case of for-profit entities. While the mercenary impulse cannot be restricted to profit-taking, it is certainly the case that the excesses of that impulse in the for-profit sectors exceed, by orders of magnitude, the excesses among unions. SEIU and the UAW have nothing on the banksters, or the typical CEO gutting domestic operations and paying himself tens of millions for destroying Midwestern towns.

SEIU and the UAW have nothing on the banksters, or the typical CEO gutting domestic operations and paying himself tens of millions for destroying Midwestern towns.

So, is it fair to assume that you think the SEIU's goal of collectivizing 401ks and IRAs does not constitute a theft of the assets of millions of Americans from the ranks of the upper end of the working class to the lower end of the upper class?

**theft on par with those examples you cited.

Sorry, meant to complete that thought.

SEIU and the UAW have nothing on the banksters, or the typical CEO gutting domestic operations and paying himself tens of millions for destroying Midwestern towns.

No, but they have plenty on the doctor-owned hospitals, which was my comparison.

Has it happened? No. If it did, I'd look at the amount of wealth thus confiscated, compare it to the amount of wealth siphoned off and flat-out destroyed by the banksters, and make a comparison. In any event, I wouldn't support such a measure, and I resent the attempt to place a belief - namely, that such a maneuver would be licit - into my political consciousness. This placing of words in my mouth, or the generation of illicit inferences from things I've written, is what makes disputation here so unpleasant. Think that unions should exist, even if they've been abusive - which only entails that they should be cleaned out? I must support a multi-trillion-dollar wealth grab! Oppose factory farming? You must want billions to die! And on it goes.

Has it happened? No.
I resent the attempt to place a belief - namely, that such a maneuver would be licit - into my political consciousness. This placing of words in my mouth, or the generation of illicit inferences from things I've written, is what makes disputation here so unpleasant.

I simply wanted to know if it is fair to say that you believe that their stated goal is not, in its nature, a form of theft that is identical in rapacious intent to what the bankers accomplished. Based on your comment that they have nothing on those bankers, and my pointing out that the SEIU is attempting its own great robbery of the middle class, I thought I would ask...

As far as I am concerned, there is little difference between someone who attempts to rob and fails and one who successfully accomplishes the robbery insofar as the way they ought to be regarded by honest people.

M.Z. wrote, in an apparent attempt to reply to Mike T:

"You seem to be moving into Sailer territory. You might even be one of his disciples. Even if you subscribe to the notion that there are some classes, races, or ethnic groups that are incapable of self provision, something with which I emphatically do not subscribe, your obligation to support does not go away."

No, M.Z., the Sailer disciple around here would be...me.

Since you're apparently itching for an opportunity to point & sputter (as Sailer would say) about...RACISM!!!...you might want to check out my latest post.

;^)

No offense, but discussing racism with Sailer and his disciples is like discussing photosynthesis with a tree.

Step2 - do you think I'm a "racist?"

Cat got your tongue, Step2?

btw...supposing that a tree could talk, with whom would you rather discuss photosynthesis?

Steve,
I have to work on Saturdays, sorry for the delay. Like the song goes, everybody is a little bit racist, but some people emphasize it more than others. I certainly think you have a fetish about race and genetic determinism.

I certainly think you have a fetish about race and genetic determinism.
Hmm. Not my impression at all. My impression is that Steve likes to publish facts that other people won't publish because they are non-PC. But he's pretty doggone meticulous about making sure those facts are facts, at least from what I've seen.

If he has a 'fetish' I'd guess that it is one for non-PC facts. Not to mention great music.

Thanks, Zippy - you're more than kind.

Step2: wrong on every point. Not that you're trying.

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