Byzantine Structures and the Splitting of Hairs

It is my firm conviction, firming up as this campaign year proceeds, that the fundamental problem in US health care -- one which none of the mainstream reformers ever address -- is the ubiquitous assumption that there are and as a matter of fitness there ought to be four distinct parties to a health care transaction.

Routine medical transactions in the US involve (a) an employee [if it is a covered family member of an employee this is a five-party model], (b) employer, (c) a health insurer whose direct relationship is with that employer not with the patient, and (d) the actual care provider, who is looking to that insurer for payment.

This byzantine structure is a legacy of the wage-price controls the feds imposed on the economy during WW2. Anything can be justified when there's a war on, right? but it had lasting effects. We ought to rethink the thing from its foundations.

In the meantime, we have the sort of insane debates we've seen recently.

Is Obama 'getting all Henry VIII' on the Catholic Church?

Not really. Nobody is going to have to put his head on the chopping block, a la Thomas More.

But consider ... the Church controls a variety of entities, notably hospitals, many of which compete with various secular entities in the business world, and it has through these entities a lot of employees, including many non-believers, whom it insures in accord with the four-party model above. It wants examption from the general requirement of insurance insofar as such insurance will cover matters prohibited by Catholic doctrine.

The administration says, 'okay, here's a compromise. We won't require that the Church provide or pay for these services. But we will require that your insurers do so.'

Now, I'm sorry, but that sounds like the splitting of hairs. Given the four-party structure, there is ony a difference in verbiage between the following two propositions:

1) You, as an employer, are required to insure your employees as to health services A, B, and C, even though you object on grounds of conscience to C.

2) You, as an employer, are required to insure your employees as to health services A and B -- we will allow you an exemption from providing C -- but we will require that insurer to pay for C anyway.

I agree with all parties in this exchange -- there is nothing to be gained but confusion by pretending that the difference between (1) and (2) is a difference of principle.

The problem, here, though, is that we take for granted the central role of the insurance industry, and of employment, and this warps all our other thinking and makes absurdities seem plausible. As John Stewart said on The Daily Show recently, if a Church or anyone else simply gave its employees cash the question wouldn't arise.  That's the great thing about cash -- it's the universal medium of exchange. What bills you pay, pills you buy, with the cash your employer has just given you isn't any of said employers' concern.

Furthermore (and given my libertarian sympathies I hate bringing this up, but for purposes of completeness I must) -- even if the government by force of law coerces employers into paying more money to a specific set of workers, as it does every time the minimum wage is raised for example, we would not generally assume that the coerced employer has anything to say about how the 'extra' money was to be spent -- on birth control pills, on Viagra, on sex toys, or even (another subject of some religions' scruples) on firearms. That becomes the employees' concern. There is no accomodation.

Were the US government to order all hospitals to increase the pay of their employees by x%, rather than imposing an insurance mandate that would cost the hospitals x% ... there would be various arguments you could make about that order of course. But the employees would be free to buy birth control pills (or Viagra) with that new x% and no one would say a word about religious "accomodation."

The whole issue of a religious 'accomodation' only arises -- and thus the hair-splitting between propositions (1) and (2) above only becomes possible -- because we're saddled ourselves with this four party paradigm.


This is all one of many many good reasons to get rid of that!

Gary Weiss versus us Crackpots

 I admire Gary Weiss and I have indicated as much on this blog. I've even been the target of criticism because his critics think I'm a crony of his.  I'm proud to have taken a little heat for so good a reason.
Anyway, I do think Weiss has written insightfully about a wide range of issues and I have learnt a lot from his efforts.

I say all that as preface to this: Gary has unfortunately decided to stigmatize the Ron Paul campaign for president as a uniquely "crackpot" effort. I have to publicly take issue with him there. It is just about the least cracked thing happening within either of the two major parties at the national level just now. Like the US dollar among the other major currencies of our time -- the Paul campaign is the cleanest shirt in a pile of dirty laundry.

I wrote Weiss via the comment section of his blog about these views.  I'll reproduce that comment here, with minor cosmetic changes, below:

"I have to tell you Gary, Ron Paul is the only candidate (including the incumbent) who makes any sense to me these days at all.

"I won't defend everything that's appeared in his newsletters, etc. But he is bringing into the mainstream issues, like the dysfunctional nature of fiat money and central banking, and the uncounted costs of foreign adventurism, that we desperately need to have brought into said mainstream.

"As to the civil rights statutes, I agree with Paul that the use of the 'interstate commerce' clause in this sense was an almost absurd stretch of the reasonably plain meaning of the founding document. To say that the Supreme Court approved of this stretch, so it must be constitutional, is inadequate as a matter of logic. For decades the Supreme Court had approved of the notion of 'separate but equal' too. Sometimes the Supreme Court errs and its errors require resistance.

"Personally, in this case, though I object to the use of the commerce language as a blank check for Congressional power, I would be inclined to recognize a defense of necessity. The various branches of the govt of the US had to do something more to check the inertial force of our long history of racial separation and white domination than the formal declaration by the US Supreme Court in May 1954 of the end of Plessy could have accomplished. A recognition of this necessity need not and should not make us uncritical of the doctrinal particulars of such decisions as Heart of Atlanta, though. Here, too, Paul is serving a valuable purpose by his (relatively) straight thinking.

"The one change in federal policy now that could do the most for the improvement of race relations in America would be an end to the absurdities of the war on drugs. Guess who is the only candidate calling for that?"

I wrote those words prior to this Tuesday's developments in Iowa, and I ended by saying that I would be "delighted" by a Paul win there.  As indeed I would have been. In the first hour of Tuesday night's count, there was a neck-to-neck-to-neck three way tie. Only gradually did Paul fade a bit, becoming a backgrounded third to the true neck-to-neck drama of Romney versus Santorum. That is unfortunately, because it means this teaching moment, our opportunity to throw libertarian memes about in the mainstream, may already have ended.

I guess that's why they call them "moments"!

Same guy: Does it matter?

Here's a clip from YouTube that purports to deconstruct the "focus groups" that Fox has been usingYouTube.

It has gotten a lot of attention recently, beginning SFAIK on January 6 when Mickey Kaus mentioned it on Slate, thanking "emailer WB" for sending him the clip.

The link available via Slate no longer works for some reason, but the one above should.

Anyway, Luntz -- the pollster/market research maven responsible -- has replied that the guy singled out for the repeat appearance isn't a paid actor, and that he (FL) does make a practice of re-using people from earlier focus groups, with a 20% veterans to 80% newbies ratio.

Accepting that it is standard practice for Luntz, is it equally standard in the opinion-measuring industry in general to use 20% repeats? Why would that be a good idea? I have no ideas on the subject and am open to instruction.

The Marist Institute

Amongst prominent pollsters discussed in news accounts during election years, there is always the name of Lee Miringoff, identified as the founder of the Marist Institute for Public Opinion, at Marist College, in Poughkeepsie, New York.

I have done a certain amount of bragging over Miringoff's increasing prominence in recent years, because I was there at the founding. The "Institute" had its origin in 1978, which of course wasn't a presidential election year, it was the mid-term election of the Carter administration. The polling was an extra-credit project for a few of us under L.M.'s direction that fall.

So I've also experienced chagrin this week as the Marist Institute has come under a rather harsher spotlight than usual. Along with every other polling operation, Marist had Obama leading Clinton quite comfortably as New Hampshire Democrats headed for the polls Tuesday morning.

The combined wire services story that came out of that debacle and that ran in my local paper had a headline quite on point: "Big Loser in N.H. Race: The Pollsters."

But pollsters are human, and like all humans, can use a periodic lesson in humility. Consider (since this is Sunday) the wedding feast that Jesus describes according to Luke, chapter fourteen. Its a lot better to place yourself with due modesty at the bottom of the table than to place yourself at the front.

The Iowa Caucus

Despite my feeling of philosophical detachment, I admit I retain what one might call an anthropological interest in the internal politics of the two major parties of the U.S.

Allow me, then, a few words about the caucus this week, amidst all the noise of celebration and dismay.

On the Democratic side, the results amount to less than may meet the eye. Yes, they weakened Senator Clinton, because some of her appeal had been the sense of inevitability itself. And one can't keep the cloak of inevitability around one's shoulders while coming in third. In anything.

Still, its at most a flesh wound. She still has money, organization, a famous name, and the promise of reviving an era to which many Americans already look back with fondness.

If Edwards had come in first in Iowa, I would have written the above two paragraphs just as I have. But I would have added on to them, without scare quotes, something like this: "and she's also a woman, which gives her campaign a let's make history together appeal that Edwards frankly can't match -- her sex and her insider status together making for a formidable inside/outside combo."

But Edwards didn't come in first. Barack Obama did. And he can certainly match the "let's make history together" appeal, so in the present circumstances she can't count that as one of her assets.

Still, there are only three candidates who count right now on the Democratic side. The rest are dropping away. Triangular debates might be a better show than the over-crowded ones we've so far seen.

On the Republican side, I think the rise of Mike Huckabee is an amazing story, that might make the proper chronicler -- if there's a Theodore White at his side -- ecstatic.

But we should remember that the ethanol lobby has veto power over any Republican caucus efforts in Iowa, and we should inwardly congratulate Ron Paul and John McCain. Each took a principled stand against ethanol subsidies, and each effectively punted this caucus as a result. On to New Hampshire and the rest of the country, folks!