Political Life’s Mysteries
A bunch of people gather to listen to some dull moralist talk (wikimedia)
Julian Sanchez has a post bemoaning “the depressing rarity with which people actually understand the views of people with different ideologies.” It got me thinking.
My personal feeling, the longer I spend in DC and working in the political domain, is that I get better and better at understanding other people’s ideologies. I also feel that people writing about politics often caricature opponents’ views as part of a rhetorical strategy. But I’ve been back-and-forth on the main issues long enough that I’m pretty sure I could switch this blog’s point of view and do a credible job of offering critiques-from-the-right of the progressive liberal health reform movement and the progressive liberal approach to domestic policy generally. One happy consequence of this is that I find the stubborn persistence of principled disagreement less mystifying than I once did, and have a greater appreciation for what I now think of as a certain irreducibly Kierkegaardian element to ideological commitment that, in turn, helps explain why so many “normal” people have such fuzzy political views.
At the same time, I’ve come to be increasingly baffled by the high degree cynicism and immorality displayed in big-time politics. For example, Senators who genuinely do believe that carbon dioxide emissions are contributing to a global climate crisis seem to think nothing of nevertheless taking actions that endanger the welfare of billions of people on the grounds that acting otherwise would be politically problematic in their state. In other words, they don’t want to do the right thing because their self-interest points them toward doing something bad. But it’s impossible to imagine these same Senators stabbing a homeless person in a dark DC alley to steal his shoes. And what’s more, the entire political class would be (rightly!) shocked and appalled by the specter of a Senator murdering someone for personal gain. Yet it’s actually taken for granted that “my selfish desires dictate that I do x” constitutes a legitimate reason to do the wrong thing on important legislation.
Making it all the odder, the level of self-interest at stake isn’t all that high. Selling the public good down the river to bolster your re-election chances isn’t like stealing a loaf of bread to feed your starving children. The welfare rolls are hardly stocked with the names of former members of congress. Indeed, it’s not even clear that voting “the wrong way” poses particularly serious threats to one’s re-election. But even if it did, one might assume that people who bother to dedicating their lives to securing vast political power did so because they actually wanted to accomplish something and get in the history books, perhaps, as one of the big heroes of their era. Nobody ever writes a biography about the guy who did a good job of reconciling his party’s ideological base with the parochial interests of local businesses and his campaign contributors.
Meanwhile, political argument is actually dominated to an odd degree by fake-technical discussions about how “people think that x but really it’s y” or “a could achieve b if only he did c” with very little attention given to the crucial moral and ethical dimensions of political disputes and political action.
124 Responses to “Political Life’s Mysteries”
Register
RSSLogin
Topic Cloud
ArchivesBlog RollAbout Matt YglesiasContact Me
Donate
August 19th, 2009 at 2:36 pm
1) Give the clusterfuck with the swine flu vaccine, Let the Republicans sabotage Healthcare Reform in September –then blame them when 100,000 healthy Americans die from swine flu in December.
2) Then in February when the hospitals look like that Atlanta battle scene in Gone With the Wind, reintroduce the issue as a National Security Measure. Just in time for the election.
Bring out your Dead.
http://www.nola.com/health/index.ssf/2009/08/swine_flu_vaccine_factory_logj.html
http://www.nola.com/health/index.ssf/2009/08/swine_flu_vaccine_factory_logj.html
August 19th, 2009 at 2:36 pm
I would actually like to hear what political scientists have to say about this.
But my gut feeling tells me that human beings — in and out of politics — are driven
- only a little by ideology
- slightly more by rationally calculated self-interest
but to a huge extent by what they think they are expected to do in a given situation.
August 19th, 2009 at 2:37 pm
The real questions for me – and I think for the republic – are 1) whether the level of cynicism and self-interest displayed by our political elite is qualitatively greater than that in other democracies and 2) what is says about us that self-interested elected officials have so many destructive attitudes they feel they have to cater to.
August 19th, 2009 at 2:38 pm
You seem to be forgetting the self-importance dynamic. It’s the same one that informs the keyboard warriors who earnestly believe in the cause of the wars they foment, yet would never think of signing up themselves for battle. They truly believe in their own importance beyond any kind of rationality. I think this is a similar dynamic to what’s happening with Senators. They are able to rationalize their opposition to measures they otherwise believe in because they truly also believe that their presence is critical. The fact that their presence is not critical outside of doing something important does not come into focus at all. They could give you a million reasons why the destruction of our climate isn’t as important as the million things they can do for the broader cause by being in their position of political power.
It’s not rational. But I also think that if they believed that they were fighting for a fundamental truth or principle, something critical, they might be willing to put that position at stake. Unfortunately, the mechanisms of political power push them away from hardly ever seeing the world in these terms, and institutions like the Senate work hard to convince them of their grandiosity.
August 19th, 2009 at 2:38 pm
I’m pretty sure I could switch this blog’s point of view and do a credible job of offering critiques-from-the-right of the progressive liberal health reform movement and the progressive liberal approach to domestic policy generally.
Persuasive critiques? You could, without breaking a sweat, peddle the standard boilerplate about lower-taxes and government-is-the-problem. If there are non-moronic critiques-from-the-right of the progressive liberal health reform movement, though, I have yet to read them.
August 19th, 2009 at 2:40 pm
I watched Network last night. It explains it all beautifully.
August 19th, 2009 at 2:40 pm
Ted: Speaking as a political scientist, I think it depends on who you ask. Self-interest is usually part of the calculus, but what I find alarming is work by Larry Bartels that suggests that the opinions of the bottom 80% of a member of congress’s district has virtually no effect on the voting behavior of the member – especially for Republicans.
August 19th, 2009 at 2:40 pm
…crucial moral and ethical dimensions of political disputes and political action.
To many political practitioners, and many fans, there are none.
What are the ‘crucial moral and ethical dimensions’ of, say, Texas or Tampa Bay pipping the Red Sox for the AL wild card?
We could with fairness replace ‘E pluribus unum’ with ‘Just win, baby’ — no one actually believes the first, and it’s in Latin to boot.
August 19th, 2009 at 2:40 pm
I understand your bafflement. I’ve been trying to figure this out myself. One thing I’ve found that offers some glimmer of an answer is a paper by Persson and Tabellini titled “The size and scope of government:
Comparative politics with rational politicians”
It can be found here:
http://didattica.unibocconi.it/mypage/upload/48805_20081009_050832_THE_SIZE_AND_SCOPE_OF_GOVERNMENT_COMPARATIVE_POLITICS_WITH_RATIONAL_POLITICIANS.PDF
Persson and Tabellini are very highly regarded in their field and Persson advises the Nobel committee in respect to the award of the prize for economics.
The abstract of the article follows:
We try to demonstrate how economists may engage in research on comparative politics, relating the size and composition of government spending to the political system. A Downsian model of electoral competition and forward-looking voting indicates that majoritarian Ð as opposed to proportional Ð elections increase competition between parties by focusing it into some key marginal districts. This leads to less public goods, less rents for politicians, more redistribution and larger government. A model of legislative bargaining and backward-looking voting indicates that presidential Ð as opposed to parliamentary Ð regimes increase competition between both politicians and voters. This leads to less public goods, less rents for politicians, less redistribution, and smaller government. We confront these predictions with cross-country data from around 1990,
controlling for economic and social determinants of government spending. We Þnd strong and robust support for the prediction that the size of government is smaller under
presidential regimes, and weaker support for the prediction that majoritarian elections are associated with less public goods.
August 19th, 2009 at 2:40 pm
Who was it — was it MY or someone else? — who was observing the other day that Congressmen decide where to stand in a relativistic way.
Enzi always wants to be two steps to the right of Grassley, who wants to be two steps to the right of Snowe, and three to the right of Baucus. And to some extent, it wouldn’t matter where they were absolutely standing, as long as the relative positions felt right. I’m paraphrasing someone, but I forget who.
August 19th, 2009 at 2:44 pm
Of course they do. They just don’t write it that way. Instead they make up imaginary principles and create elaborate justifications after the fact in an attempt to lionize their heroes and discredit their critics.
That’s the main role of the chattering class. I guess it’s true what they say about a man understanding something when his salary depends on not understanding it…
August 19th, 2009 at 2:45 pm
But even if it did, one might assume that people who bother to dedicating their lives to securing vast political power did so because they actually wanted to accomplish something
Why would you think they want to accomplish anything other than personal power, possibly followed by a lucrative lobbying contract upon retirement?
August 19th, 2009 at 2:47 pm
What I find alarming is work by Larry Bartels that suggests that the opinions of the bottom 80% of a member of congress’s district has virtually no effect on the voting behavior of the member – especially for Republicans.
@7: When you say bottom 80%, do you mean by income?
To me, this is extremely intuitive. People want to be well-regarded by their peers. They don’t think of the masses as their peers. They want to do something that will be lauded by the people forming (educated / wealthy) opinion. Dems and Reps probably differ a little in the relative weight they give to education vs. wealth … but there’s fair amount of overlap in those criteria anyway, so it may not matter much.
I would look at this in a more favorable way. To me, this suggests that we don’t need to match the contributions of the insurance companies. We just need to create a climate of opinion that will make members of Congress feel publicly humiliated if they fail to do the right thing. They need to realize that their adult children are going to be reading facebook comments, and watching youtube clips, that make fun of their parents. Seriously.
August 19th, 2009 at 2:47 pm
Here you go:
1) President Obama is a nazi who wants to kill old people and babies using rich people’s money, because. . .
2) Liberals want to sell out America to al-Qaeda and institute Sharia law while SIMULTANEOUSLY turning this country over to the gay rights movement
3) The rapture will be happening any day now, so why bother trying to fix things anyway?
Did I miss anything?
August 19th, 2009 at 2:47 pm
Sorry — forgot to italicize the quote from #7. Hope that was clear anyway.
August 19th, 2009 at 2:51 pm
What I mean to imply is we can wring our hands about “the depressing rarity with which people actually understand the views of people with different ideologies” but in the real world, right now, there are two sides: the side of people who want health care reform, and the side of people who think illness is caused by evil spirits that live in the flouride of our water supply. The latter group is impossible to understand because there is no rationalizing nonsense, and they can not understand other people because. . . if they could understand stuff they wouldn’t believe what they believe in the first place.
August 19th, 2009 at 2:54 pm
At the same time, I’ve come to be increasingly baffled by the high degree cynicism and immorality displayed in big-time politics. For example, Senators who genuinely do believe that carbon dioxide emissions are contributing to a global climate crisis seem to think nothing of nevertheless taking actions that endanger the welfare of billions of people on the grounds that acting otherwise would be politically problematic in their state.
“Politically problematic in their states” sometimes means the same thing as “opposed by the majority of their constituents”. And strangely enough, some elected officials in our representative democracy actually do think that it is an important part of their job in Washington to represent the will of their constituents. Some might even say that is what they are paid salaries to do.
It also turns out some lawyers actually think that their job consists in advancing the interests of their clients, given that is what their clients are paying them for, rather than to serve the abstract interests of Society or Humanity or something else. Some people working in the business world have also been known to work on behalf of those who pay their salaries.
When I was a college professor, I used to take it that my obligation to my students, who were paying me to educate them, was to satisfy the students’ own educational needs and desires, rather than pack their heads full of whatever content might be most socially beneficial. From time to time, I would hear that the school, or the State of New Hampshire, or the United States of America, wanted me to fashion the students into “good citizens” or something like that. But I always felt that choosing a moral vocation in life was the students’ business.
August 19th, 2009 at 2:56 pm
I’m struck by how much political discussion is dominated by fake ignorance & error – fake in the sense of willed & motivated – behind which lies so much cynicism & immorality.
August 19th, 2009 at 2:56 pm
I won’t pretend to be an expert, but I have just enough reading to potentially answer that question. You’re effectively correct about ideology, although there is still debate over whether individuals are driven by, say, core values instead. As for self-interest, one of the more robust findings in political science is that self-interest doesn’t tend to drive as much behavior/opinion as we might think. The economic type of interest that drive electoral behavior, for instance, is not pocket-book economics (am I better off than I was four years ago) but sociotropic (how is the nation’s economy doing). You could probably break down your “human beings” though; there is a slice of the populace who knows rather a lot about politics and tends to act based on ideology . And there is a far larger slice that doesn’t pay all that much attention and is less ideologically driven, if they are driven at all by an ideology.
August 19th, 2009 at 2:59 pm
This is sort of beside the point of the original post, but Matt, could you say more about what you mean by “a certain irreducibly Kierkegaardian element to ideological commitment that, in turn, helps explain why so many “normal” people have such fuzzy political views”?
What do you mean by Kierkegaardian? And how does ideological commitment help explain fuzzy political views?
I’d like to know more about that.
August 19th, 2009 at 2:59 pm
@19: Interesting. And “sociotropic” sounds like a useful word.
August 19th, 2009 at 3:00 pm
Compare
with
Accepting one and being befuddled by the other requires, I think, a lot of work to be done by “genuinely do believe.”
August 19th, 2009 at 3:04 pm
The key point to understand is that humans arrive at political opinions via emotions – not reason. Reason comes into play as explanation or persuasion.
Some people are more optimistic than most and some are subject to depression, everyone has a personality type.
Everyone also has a “worldview” personality type. The key component wrt politics is how one catagorizes his “group”. If his group is pretty much all humans, he is leftwing. If his group is limited to class, ethnicity, etc., he is rightwing. Of course, this is a continuum.
This is why changing someone’s views is so difficult. The change has to come from an emotional experience, e.g., Dick Cheney’s acceptance of lesbianism.
At least, that is my position today. And it will take an emotional experience to convince me otherwise.
August 19th, 2009 at 3:04 pm
I’ve had several biographies — plus an airport named after me!
August 19th, 2009 at 3:06 pm
And strangely enough, some elected officials in our representative democracy actually do think that it is an important part of their job in Washington to represent the will of their constituents. Some might even say that is what they are paid salaries to do.
This would imply that any Senator from the south up until the 1970s would consider it an important part of their job to represent white supremacy and racism, and actively keep any legislation that would lead to less racism from passing, because of the wishes of their constituents. Maybe you actually believe that, I don’t know. It seems to be an absolutely morally repugnant view to me.
Now, obviously that’s not the exact same thing as being in favor of cap-and-trade. But anyone who actually believes that global warming will have dramatic, world-changing consequences if left unchecked and yet votes to do nothing about it to protect the coal industry in their state isn’t all that far from that scenario. I think Matt’s point is that yes, they do actually believe that, but that their moral prerogative takes a backseat to, well, whatever’s put in its place. Apparently pleasing whoever donated the most to them, it seems these days.
August 19th, 2009 at 3:07 pm
The image of someone who gets elected Senator, does the right thing even though it costs him PAC money and the next election, and is fine with that assumes a Senator who isn’t pathalogically insecure. According to David Brooks that’s not the case:
But so, a lot of them spend so much time needing people’s love and yet they are shooting upwards their whole life, they’re not that great in normal human relationships. And so, they’re like freaks, they don’t know how to, they’re lonely. They reach out. I’ve spoken to a lot of young women who are Senate staffers and they’ll have these middle age guys who are sort of in the middle of a mid-life crisis. Emotionally needy, they don’t know how to do it and sort of like these St. Bernards drooling everywhere.
This is from the interview where Brooks says he sat through an entire dinner with a Republican Senator’s hand on his inner thigh. People that needy aren’t going to get validation through their own knowledge that they did the right thing; they need validation through outside approval in the form of winning elections, getting PAC money, getting choice lobbying jobs after they retire, etc.
August 19th, 2009 at 3:07 pm
Murdering one man is a crime. Murdering millions is politics.
August 19th, 2009 at 3:07 pm
Great post.
I don’t get the Kierkegaard part. Can somebody explain that?
August 19th, 2009 at 3:08 pm
I’m with Paulk at #4…I think a large part of the reluctance of a politician to endanger his/her reelection is an exaggerated view of his/her self-importance to the welfare of his/her constituency.
August 19th, 2009 at 3:08 pm
@20: I think I see what Matt is getting at by invoking Kierkegaard. He means that at some point, people just decide to commit themselves to a particular political orientation. And the rational explanations for their attitude come afterward. Because you can always generate rational-sounding explanations, whichever ideology you’ve decided to defend.
And this helps explain why most people have fuzzy political views. They can be committed to a particular “posture” without necessarily bothering to harmonize their different assumptions in a rational way. Because rational explanations are — and always are — an afterthought.
August 19th, 2009 at 3:12 pm
a certain irreducibly Kierkegaardian element to ideological commitment
Could someone please translate this to English?
I also feel that people writing about politics often caricature opponents’ views as part of a rhetorical strategy. But I’ve been back-and-forth on the main issues long enough that I’m pretty sure I could switch this blog’s point of view and do a credible job of offering critiques-from-the-right of the progressive liberal health reform movement and the progressive liberal approach to domestic policy generally.
Since Matthew is one of the many who “often caricature[s] opponents’ views” as part of his “rhetorical strategy”, I wonder whether he could actually produce real critiques from the right or whether he would just offer characatures of such critiques.
August 19th, 2009 at 3:13 pm
If there are non-moronic critiques-from-the-right of the progressive liberal health reform movement, though, I have yet to read them.
I have what I think is a very reasonable objection to health-care reform in its current form; that is, the entire attempt to “bend the curve,” if successful, would reduce health-care innovation in the long run and would essentially deprive people of potential cures. That is, of course, if the public plan persists and eventually emerges as the dominant carrier, sort of like a single-payer-by-stealth. Right now the U.S. is half the world’s pharma market; if the Europeans are watching, they should be nervous about any American attempt to seriously reduce costs, because right now they are free-riding (the sort of prices at which pharma is sold in Europe and Canada in no way covers full tort-risk and R&D and marketing costs; the Europeans are essentially being subsidized innovation-wise).
A very much real-life example would be the slow progress in tropical-disease drugs, because the countries that benefit most from innovation here are the ones least able to pay for it. Just look at Massachusetts, which is now attempting “outcome-based” pricing.
Now, one could devise a number of rationalizations to express the idea that innovation would not be reduced in such a system, but I have thought carefully about it, and have deemed the risk to great; if a liberal Democrat gets control of the tempering, we might very well end up with a system where a dominant public entity severely restricts medical expenditures, just through market dominance.
Let’s why, say, the attempt to tie pricing to Medicare-rates is no asinine; because Medicare in no way accounts for full costs of treatment.
On this point, I am irrevocably resolved, and frankly, pretty much every single liberal counterpoint to this has seemed like to me very unconvincing and more than a little intellectually dishonest. You either are able to significant cut into costs and profits, or you are not. And to claim that somehow you can tighten the screws on drug companies and innovative medical centers and at the time expect them to maintain the same level of R&D outlay is, frankly, deliberately misleading.
August 19th, 2009 at 3:13 pm
But I’ve been back-and-forth on the main issues long enough that I’m pretty sure I could switch this blog’s point of view and do a credible job of offering critiques-from-the-right of the progressive liberal health reform movement and the progressive liberal approach to domestic policy generally.
As a thought experiment, it might be nice for you (and other “liberal” bloggers) to do this once in a while. I can’t find *anything* in the way of right-wing commentary out there that isn’t intellectually dishonest and/or out-and-out whacko.
August 19th, 2009 at 3:14 pm
one might assume that people who bother to dedicating their lives to securing vast political power did so because they actually wanted to accomplish something and get in the history books, perhaps, as one of the big heroes of their era.
Really? You sure about that? When was the last time you read a biography about a Congressman who has never held or run for higher office?
I don’t read many biographies in general, but I don’t think there are that many such biographies out there. Congress is actually pretty low-status. (Or Congress as a whole is high-status but individual Congressmen aren’t, or Congress occupies a unique status that doesn’t compare well to others, or something). People who primarily want to make the world a better place either don’t go to Congress, or they don’t stop at Congress, or they plan to move on to higher office but get stymied and disillusioned and give up – at which point they lose that idealism they used to have.
For career Congressmen, the goal is power, and doing something maybe good with that power would be a pleasant bonus. And one way to get that power is to be the dealmaker, the centrist who could go either way and therefore is courted by both sides. Other ways including becoming a literal or figurative elder statesman, or gaining authority within a political party. The “centrist broker” strategy, however, is potentially quicker and easier.
August 19th, 2009 at 3:17 pm
Myles: Good points. However, keep in mind that government currently funds an enormous chunk of pharma and biotech R&D. There’s no reason why funding couldn’t be extended as part of the plan. As for drug expenditures: Look at Medicare Part D. Unlike surgeons and the like, drug companies actually do quite well out of government-run single-payer in the US, such as it is.
Also, for single-payer that fosters innovation and, well, pays providers plenty while keeping costs under rein, see Canada. There’s a difference between controlling costs and starving the healthcare industry. As to starving the health insurance industry, here’s my intellectually honest two cents:
I don’t give a fuck.
August 19th, 2009 at 3:20 pm
This is from the interview where Brooks says he sat through an entire dinner with a Republican Senator’s hand on his inner thigh.
That was hilarious. I bet it was Larry Craig and why didn’t Brooks just discretely push the hand away? He didn’t want to lose a source?
August 19th, 2009 at 3:21 pm
Yet it’s actually taken for granted that “my selfish desires dictate that I do x” constitutes a legitimate reason to do the wrong thing on important legislation.
The reason this goes over so well is related to an important ambiguity in representative gov’t. It’s not totally clear what representatives are supposed to be doing. 1) There are people who think that they’re supposed to represent the opinions of folks in North Dakota. 2) Others would say — do what’s actually in the best interest of folks in North Dakota. 3) Others would say, do what’s best for the country (and, whenever the two things don’t conflict, the world).
Like MY, I take it for granted that the last of these answers, (3), has the strongest moral claim. But I think a lot of Americans have a vague idea that our system is based on (1). In which case, doing whatever is immediately popular in ND would actually be the moral course of action for a Congressman. That ambiguity ends up opening a huge loophole for cynicism.
August 19th, 2009 at 3:22 pm
Let me rephrase that. Simply speaking, at this point in time, the science of medical is essentially one dependent on continual innovation, whether in drugs or medical equipment. The nature of such things are that they would be monstrously expensive at first, and only cheaper much later on as it becomes more widely adopted and the technology is refined.
And frankly, given that the United States, not Europe or Canada, is responsible for most of the world’s medical innovations (another out-sized pharmaceutical power, Switzerland, incidentally has among the highest healthcare costs in Europe), I would think that the system in the United States, imperfect as it may be, is in the long-term, more conducive to human health and treatment.
Any attempt to cut down on costs is essentially a trade-off between present and future utility. At what point are sacrificing improvements in healthy technology for future generations for a marginally better system, essentially one of better organization rather than technological innovation, for the present generation. That is the moral question one has to answer.
August 19th, 2009 at 3:25 pm
Successful politicians understand it’s all a game and they like playing it. While there might be slightly less genuine comity than in some past periods where violent opponents on the floor would kick back in the office and share glassfuls of bourbon and branch still for the most part the policy differences might be based upon deep beliefs but deep beliefs aren’t all that important. It’s all just a game.
Do we really want a Senator beating another half to death with a cane on the floor?
If on the other hand if a few tens of thousands are tortured to death or hundreds of thousands starved or bombed to death because of politics if you happen to be one of the unfortunates the whole it’s a game idea seem a little callous. Sure, but they don’t count. Little statistics in some history book. Senator Smith’s name will live on for a long time, at least in his home town. Because he played the game well.
August 19th, 2009 at 3:26 pm
Aside from the white supremacy point 25 made, more generally I’d observe that a republic is based on the idea that people elect their leaders because they trust their leaders to make the right decision, not because their leader buys their votes off with promises to defend this or that interest.
In a republic, you get a say in who does the job, and you’re supposed to vote for someone that you will support regardless of how they decide, because you have to concede from the outset that the person you elect, once in office, will always have more and better information than you, and will be in a better position to make a wise decision because he has made his job to think about these problems 24/7, and not just reflect the wishes of whatever the Rage Machine emails him that hour. Yeah this requires a lot of trust on the part of the people, but I think the founders just sort of assumed that people would simply vote for the people they naturally allied themselves with in commerce/society/church etc, and that these bonds would be sufficient to allay people’s concerns (”I don’t like my senator for giving the darkies the vote, but I the man is my dentist/deacon/son’s boss and know him to be honest, so I’m satisifed he’s making the best decision.”)
Of course, now we just vote for whatever schlub promises panem or marriage amendments; politicians themselves are just ciphers for whatever the people want, which I think is profoundly against the vision of the founders.
August 19th, 2009 at 3:34 pm
Due to PUBLIC spending on biomedical research (and, presumably unlike you, I speak from actual knowledge a a trained life scientist.) Drug company development is 1) completely dependent on basic science done at public expense, 2) dwarfed by their spending on marketing and 3) heavily focused on development of me-too drugs.
And anyway, for-profit health INSURANCE has fuck-all to do with any of the above. Like everybody who spouts this favorite right-wing talking point, you have no idea what you’re talking about.
August 19th, 2009 at 3:34 pm
Myles: Good points. However, keep in mind that government currently funds an enormous chunk of pharma and biotech R&D. There’s no reason why funding couldn’t be extended as part of the plan. As for drug expenditures: Look at Medicare Part D. Unlike surgeons and the like, drug companies actually do quite well out of government-run single-payer in the US, such as it is.
Also, for single-payer that fosters innovation and, well, pays providers plenty while keeping costs under rein, see Canada.
The problem isn’t so much R&D itself (it constitutes a sizable minority of costs, but not the majority), but rather the whole infrastructure the drug companies have built up in the prior decades. It takes money to maintain. And frankly, I would estimate class-action tort risks (or insurance premia) are probably even more costly than R&D (see Vioxx). You can’t actually do very much about torts, because well, even if you eliminate a sizable portion of tort payouts, the would still be many cases where there is genuine harm being done upon users, and the drug companies have to compensate accordingly.
There is no way you can starve the best very much. And the funny thing about the Part D is, it was exactly liberals like Yglesias and liberal Democrats who were so trenchantly opposed about the giveaway to drug companies, where was necessary.
You see where the risks lie: had Part D been a liberal-Democrat program, I suspect there would be a fair bit of an attempt to starve the beast.
And about Canada; it is highly plausible, but quite honestly I don’t think it is at all relevant because the domineering majority of health-technology innovations is American; that is to say, you wouldn’t have been able to reliably ascertain whether or not Canadian system fosters innovation even if you want to.
August 19th, 2009 at 3:35 pm
I actually think this was David Simon’s point with “The Wire”: Humans create institutions as a way to legitimize immoral acts. Your experience with government tracks perfectly with my (limited) experience in the corporate world, and I’m guessing most “public servants” are really just in it for the job perks.
August 19th, 2009 at 3:39 pm
And anyway, for-profit health INSURANCE has fuck-all to do with any of the above.
Yes it does, if you have been at all hearing some liberals enthuse about a) importing “cheaper” (more like artificially cheap) drugs from Canada, and more importantly,
b) letting Medicare and other public program use their “price power” to “negotiate lower prices” from pharma companies.
Which is, actually, where some liberals seem to intend for any public health programs to head, in the long run.
I can’t imagine how this would not qualify as “tightening the screws on pharma.”
August 19th, 2009 at 3:40 pm
@43: You know, I would add academia to the list. Every institution develops a set of mores that encourages its employees to serve the interest of the institution rather than the interests of society at large.
August 19th, 2009 at 3:43 pm
More importantly, a single-payer, or a dominant-public-insurer or essentially single-payer by stealth, could only rationally, in the long run, try to use it enormous pricing power in the long run to reduce drug costs; the temptation is, alas, too great for any politician to resist. It is very humanly understandable, of course; but in my mind at least it is not optimal.
August 19th, 2009 at 3:43 pm
Myles, you know absolutely nothing about how the pharma industry works. As I said, 90% of their “innovation” is finding me-too drugs so they can keep overcharging after patents expire. And they spend far more on marketing than on research. Repeating right-wing bullshit over and over doesn’t make it less ignorant.
August 19th, 2009 at 3:43 pm
I would add, just to punctuate this point, that if you “distrust politicians” maybe a republic isn’t the right kind of government for you. A central conceit of the US constitution is:
* Only members of congress should have a say in what laws are passed
* Practically speaking, very few people have a competent opinion of what laws should be passed
* The only thing everyone has a say in is who belongs in the congress
(the definition of “everyone” has undergone a lot of drift since the 1780s, granted)
If you don’t agree with all of this, maybe a parliamentary democracy is more your style. Or some kind of open-source government.
August 19th, 2009 at 3:45 pm
And frankly, I would estimate class-action tort risks (or insurance premia) are probably even more costly than R&D (see Vioxx). You can’t actually do very much about torts, because well, even if you eliminate a sizable portion of tort payouts, the would still be many cases where there is genuine harm being done upon users, and the drug companies have to compensate accordingly.
The foregoing paragraph is total bullshit that even a cursory Google search will debunk. The “malpractice costs are a kind of significant factor in the American healthcare system” meme is on a level with “death panels” or “Obama is a secret Muslim.”
August 19th, 2009 at 3:46 pm
Ted has a pretty strong point on 37.
As a political scientist (for what it’s worth), I would suggest that in response to Matt, a member of Congress would give you some version of this story:
1) I do the “right” thing; I lose reelection. Now I have no influence, and thus can do no more “right” things as a person of power. Moreover, the bill (in almost every case) passed or failed regardless of my vote. What did that accomplish?
2) I do the “self-interested” thing; I win relection. Now I have X more years to do the right thing, whenever that day arrives.
Of course, for many, that day of reckoning never arrive, and the logic doesn’t stand up if it doesn’t. But I would aruge this way of thinking allows most MOC to accept that self-interest and morality are, in some pragmatic sense, reinforcing. It may not be true, of course, but it lets them sleep at night, or least create a pleasing illusion that beats back guilt.
August 19th, 2009 at 3:46 pm
Required reading for Myles and other purveyors of this kind of nonsense.
August 19th, 2009 at 3:48 pm
@28 chrismealy: If I understand Matt’s reference correctly, read the Wikipedia entry for Kierkegaard’s thoughts on passion. Simplest sentence to get: “The desire to live, and to live in the right way, for the right reasons, and with the right desires, is a holy and sacred force.”
Consider: the libertarian critique of regulators is at least in part based on the idea that nobody individually or in a small group is smart enough or wise enough to regulate well and deliver positive outcomes. Persons make bad decisions; people make good ones. So what we need is to allow the market to run free because regulators will make worse decisions than the market will.
I agree with the premise: if you rely on the wisdom of certain regulators, you’re in trouble. But I disagree with the conclusion, and I think the evidence backs me up on this. Too little regulation leads to too much poverty, too much boardroom dirty dealing, etc. So what we need is not regulators but rules. It’s then up to individuals to enforce those rules, but they’re not making up the rules, and if they fail to enforce them, they face penalties.
However, I also oppose mandatory sentencing laws because they don’t allow judges to consider the facts of individual cases. It’s how you end up with a scenario like this (hypothetical) one: after two convictions and trying but failing to get a job, someone takes a bike and tries to sell it to help pay for a cast for his child’s broken arm. He is caught, and because of three strikes rules, that person is now in jail for life.
I want the judge to look at the individual facts and decide. But of course, that means that I’m allowing a regulator rather than the rules to decide the outcome. And while one is business activity and the other is criminal justice, if you look at the full social system, you end up recognizing that these things are really continuations of one another. The only way to justify my diverging views, really, is to state that this is about big-question passions or principles or ideological predispositions about what is right and wrong, rather than about big-question notions of the mechanisms that work or do not, about whether rules or regulators are better at creating appropriate outcomes.
August 19th, 2009 at 3:48 pm
I have what I think is a very reasonable objection to health-care reform in its current form; that is, the entire attempt to “bend the curve,” if successful, would reduce health-care innovation in the long run and would essentially deprive people of potential cures. That is, of course, if the public plan persists and eventually emerges as the dominant carrier, sort of like a single-payer-by-stealth. Right now the U.S. is half the world’s pharma market; if the Europeans are watching, they should be nervous about any American attempt to seriously reduce costs, because right now they are free-riding (the sort of prices at which pharma is sold in Europe and Canada in no way covers full tort-risk and R&D and marketing costs; the Europeans are essentially being subsidized innovation-wise).
Reasonable objections, but not persuasive, to my mind. I don’t think that the degree health-care innovation we see in the US, as compared to other Western countries, is worth the cost. I would rather have the degree of health care innovation produced by, say, Great Britain and pay British health care costs (say, 50% of the US). The 50% of costs saved could be reinvested in other productive endeavors that would produce greater benefits for us in the long term than the massive investment in an inefficient health care system.
Moreover, I think the free rider problem you identify cuts against the current system, not in favor of it. I don’t like the the Euros free riding on our high cost health care system – and if cut those costs, perhaps the Euros will pay a fairer share of health care innovation.
August 19th, 2009 at 3:57 pm
“For example, Senators who genuinely do believe that carbon dioxide emissions are contributing to a global climate crisis seem to think nothing of nevertheless taking actions that endanger the welfare of billions of people on the grounds that acting otherwise would be politically problematic in their state.”
Ummm, I hate to sound condescending, but are you just realizing this *now*? How many senators do you really think believe the world is 6,000 years old, or ever did? That is why the far right “base”, especially the evangelibans, is so pathetic. Even their elected officials think they’re nuts.
August 19th, 2009 at 4:01 pm
Moreover, I think the free rider problem you identify cuts against the current system, not in favor of it. I don’t like the the Euros free riding on our high cost health care system – and if cut those costs, perhaps the Euros will pay a fairer share of health care innovation.
I don’t think I am one to bet the future magnitude of health innovation (remember, this is geometric, not arithmetic, growth) on the Europeans stepping up to the plate, especially if they haven’t done so already. This isn’t exactly a game you can afford losing, because just Americans as well as Europeans need the innovation to keep going.
August 19th, 2009 at 4:04 pm
As I said, 90% of their “innovation” is finding me-too drugs so they can keep overcharging after patents expire. And they spend far more on marketing than on research.
Whatever your point is, unless you can prove to me that pharma companies would cut down only on marketing and other “ancillary” costs when you tighten the screws on their margins, and not at all on R&D, then I have no option but to regard your argument is invalid.
August 19th, 2009 at 4:05 pm
“Political Parties are comprised of:
1) Policies
2) Interest Groups
3) Ideologies
4) Cultural views”
There have always been coalitions in party politics that include strange bedfellows.I often get asked how I can be a libertarian and a Democrat. From my point of view, I’m like Edmund Burke, who was a Whig. I can understand people saying that they can’t understand Conservative/Republican critiques of the Health Care Plan put forward by most of this group, and also saying that some Conservatives/Republicans are arguing in bad faith. But if you can’t imagine arguments against a plan that you agree with from Republican/Conservative point of view, that reflects negatively upon the depth of your understanding and knowledge of the issues. You need to have a robust critique of your own views.
Since I’m a Democrat, I support the plan. In other words, I believe in a certain level of party loyalty. I also support the plan because it covers more people, addresses insurers dropping coverage, etc. It’s better than what we have. But I can certainly imagine many of the cost cutting measures not working out, and the plan costing more than anticipated.
Also, I would prefer either my own Milton Friedman plan ( which covers everybody, by the way ) or some version of single payer than what we have now, which I consider to be an inefficient mess. From a political point of view, I understand how we got into this mess, and I would rather that we make small changes for the better than no changes, but it’s still a mess.
One final point: I’m a Democrat because I want universal health coverage. I don’t believe that the GOP does. However, I don’t understand why people can’t have honest disagreements on how to do that in the US.
August 19th, 2009 at 4:07 pm
As for the overall critique of Myles’s logic, instead of simply pointing out the many factual errors that undercut it:
Myles, your argument is that Europe, Canada, and indeed the rest of the world are subsidized by the absurd costs we pay for insurance. We’ll assume for the purposes of argument that this is true; that every other country except us pays far less for healthcare because they get the drugs we pay to have developed for less.
The implication of this is that the massive problems in our system: the millions uninsured, the thousands that die every year because they couldn’t afford a doctor until it was too late, the hundreds of thousands of medical bankruptcies that destroy people’s lives – it is necessary that we suffer all this so that new treatments can be developed. That because we have no way of making other countries pay “their fair share” our country and many of the people in it must suffer things that every other modern country would consider unconscionable.
And what is our reward for this suffering? New and better treatments that, of course, only the privileged and those in other countries can afford. A necessary implication of the defense of the status quo is that the people here who don’t have health care still won’t have it in the future, and that in fact it’s entirely possible that a larger percentage won’t have it in the future.
Now, researchers could focus their efforts on making existing drugs cheaper, so that more people can afford them. You’re not suggesting that they do this, nor would they under your plan. You’re suggesting they continue to develop mostly new and better treatments, most of which will be expensive, and many of which will benefit only those able to afford them. Which, given the current trends of income inequality and insurance, will be fewer and fewer people over time.
This is fundamentally the problem with your argument. It holds as its premise that it is better to help a small number of elite people than a much larger number of the downtrodden, and that this must happen even if it continues the disasterous status quo and pushes us down the road to financial insolvency. I consider that a profoundly immoral premise.
August 19th, 2009 at 4:09 pm
Moreover, I think the free rider problem you identify cuts against the current system, not in favor of it. I don’t like the the Euros free riding on our high cost health care system – and if cut those costs, perhaps the Euros will pay a fairer share of health care innovation.
An additional note: for the Europeans to stop free-riding on health technology innovation, it would mean for them to adopt an more American health-care system and market. Which is to say, it would nullify a great deal of the worth of American reform.
August 19th, 2009 at 4:12 pm
Myles doesn’t have an “argument”, he, like many health care reform opponents, is just recycling blatantly dishonest pharma propaganda because it suits his purpose. When someone is reduced to demanding “proof” of counterfactuals, you know he’s got nothing.
August 19th, 2009 at 4:19 pm
for the Europeans to stop free-riding on health technology innovation
One thing I think is very crucial to point out here. They don’t have to free-ride on health technology innovation to get better results. If they simply decided to limit all approved health care to anything available in 2009, or even 2000 or 1990, from now on, and use nothing that was developed by American companies, they would on average still receive far better health care than we do. This is because what we’re talking about is wealthy people with great insurance having a small percentage higher chance of living with a very expensive new treatment versus millions dying far earlier than they should because of no care whatsoever. If we had a basic standard of available regular preventative care in this country (which is quite cheap), I could see your point. But we don’t. Not even close. And until we get that, I have a very hard time caring about future innovation that only those who already have fine care will get to use.
August 19th, 2009 at 4:25 pm
Politicians do things for power? Imagine that!
This is why we are silly to allow government to be involved in anything which could be handled in the private sector, and for the things we must turn to government to do, we must be prepared for some level of failure.
I find it scary that many people are arguing to have their health care controlled by a government that, until fairly recently, felt that embryonic stem cells should not be used for research, and that global warming was fake.
And even if a politician gets into politics for altruistic reasons, power corrupts.
Moreover, to become a successful politician, you have to be a bit of an egotistical maniac.
August 19th, 2009 at 4:28 pm
I find it scary that many people are arguing to have their health care controlled by a government that, until fairly recently, felt that embryonic stem cells should not be used for research, and that global warming was fake.
And I find it hilariously amusing that you can with a straight face argue that because Republicans have such insane values and lack of respect for reality and run government so poorly, that government should not do anything. Which inevitably leads to the conclusion that one should vote for Republicans, who more or less explicitly run on the platform of not allowing the government to do anything. It’s really quite something how that line of reasoning works, isn’t it?
And of course, had the private sector dealt with this issue, we wouldn’t be having this debate. The only reason reform is on the table is because of the utter failure of the private sector in this area after having 60 years of reform attempts to figure out they should get their act together.
August 19th, 2009 at 4:31 pm
You make the assumption that are current method of doing things is the only way and the best way. I don’t see how Americans subsudizing drug research for the rest of the world good for American’s long term interest or the world’s long term interest.
August 19th, 2009 at 4:32 pm
Because ultra-wealthy people and corporations, of course, never do anything for power.
Idiot.
August 19th, 2009 at 4:32 pm
“Too little regulation leads to too much poverty, too much boardroom dirty dealing, etc. So what we need is not regulators but rules. It’s then up to individuals to enforce those rules, but they’re not making up the rules, and if they fail to enforce them, they face penalties.”
Not all regulations are equal though. Research studies on cross-country comparisons of “Economic Freedom” show that regulations that assure stable property rights and non-inflationary currency are positively correlated with economic growth. Regulations that damage property rights, lead to inflation, reduce trade opportunities, and create a marketplace for government corruption are negatively correlated with economic growth.
August 19th, 2009 at 4:36 pm
Research studies on cross-country comparisons of “Economic Freedom” show that regulations that assure stable property rights and non-inflationary currency are positively correlated with economic growth. Regulations that damage property rights, lead to inflation, reduce trade opportunities, and create a marketplace for government corruption are negatively correlated with economic growth.
Ah, yes. I recall reading a detailed study conducted on the topic by the The John Galt Institute for the Perpetuation of Libertarian Bullshit.
August 19th, 2009 at 4:43 pm
Now, researchers could focus their efforts on making existing drugs cheaper, so that more people can afford them. You’re not suggesting that they do this, nor would they under your plan. You’re suggesting they continue to develop mostly new and better treatments, most of which will be expensive, and many of which will benefit only those able to afford them…
…It holds as its premise that it is better to help a small number of elite people than a much larger number of the downtrodden, and that this must happen even if it continues the disasterous status quo and pushes us down the road to financial insolvency.
Well, a couple things. One, it is the natural tendency of technology, no matter how expensive and complicated initially, to become more and more affordable over time. Cases in point: DVD players, television, computers, air travel, maritime travel, and closer to home, CAT scans and other assorted technologies.
Additionally, a great deal of medical innovation builds on past experiences; evolution, not revolution. Which means, by necessity, the refinements in technology would make existing technology more accessible and thus affordable.
You posit a false dichotomy between superior technology helping a small elite or less advanced technology helping the masses. That is not so. It is the nature of all significant innovation to be initially rare, difficult, complicated, unpredictable, and thus expensive. Only through continual development, which is to say, continual innovation, are costs reduced. Indeed, your assertion about researchers not focusing on perfecting and make more accessible existing technology is puzzling; that is a part of innovation.. Without new and innovative practices and technologies, they cannot perfect existing technologies; between the two there is no dichotomy but interdependence.
August 19th, 2009 at 4:49 pm
You implicitly assume that ideology should lead to principled disagreement and preclude cynicism and immorality. In reality, the causation is the reverse: cynicism and immorality — basic to human nature — lead to what you incorrectly perceive as the drivers: ideology and principled disageement.
As to the cause of cynicism and immorality, look to the seven deadly sins: Lust, Gluttony, Greed, Sloth, Wrath, Envy, and Pride. They cover most of the angles in the current policy debates, including the one abouth health care.
August 19th, 2009 at 4:50 pm
If they simply decided to limit all approved health care to anything available in 2009, or even 2000 or 1990, from now on, and use nothing that was developed by American companies, they would on average still receive far better health care than we do.
That’s a rather fatuous exercise, isn’t it? A health-care with any sort of intention toward that scenario would not survive beyond the immediate following election. It is a nice mental exercise, but a completely useless, but for the Europeans to not free-ride on American technologies would, frankly, be the death sentence for socialized health-care. So, they wouldn’t still receive better-on-average health-care, because the system would not continue to exist.
If you want to do reductio ad absurdum, I am here to help you.
August 19th, 2009 at 4:57 pm
Myles– if I understand your argument, you believe we should agree to continue overpaying for drugs, subsidizing the rest of the world’s healthcare, in order to facilitate R&D. Does this arrangement not strike you as baroque, inefficient and unfair (both in privileging drug company shareholders, who get their cut before R&D, and in unduly penalizing American taxpayers)?
August 19th, 2009 at 4:57 pm
@Myles,
“I’ve got a pill to make your dick bigger, and if you’re old and fat and rich and white I can keep you alive for thirty extra fucking years!”
If the pharma companies don’t want to invest in R&D because they’re only going to be able to push a 150% markup instead of a 600%, fuck ‘em. Nationalize the industry, eliminate the patent rights, and let ‘em go sell staplers or plasma TVs or whatever.
August 19th, 2009 at 4:58 pm
Without new and innovative practices and technologies, they cannot perfect existing technologies; between the two there is no dichotomy but interdependence.
This is a valid point, though I think you underestimate the degree to which it is a balance that can be thrown off-course by outside priorities.
The big problem is that your math doesn’t work out. Drug companies get paid when their treatment is approved, either by insurance companies or the government. And yet you’re honestly saying that the government, which is notorious for its lack of cost control on anything, is somehow going to have the fiscal responsibility to pay the drug companies noticably less money than the for-profit insurance companies which have legions of specialists whose entire job is to figure out how to pay them as little as possible and how to deny as much treatment as possible.
Am I supposed to believe that?
Here’s what really happens in most countries with single-payer or something like it. It provides a level of decent care, something that covers preventative treatment, minor injuries, common illnesses, etc. It can be more robust than that, but the point is that, yes, obviously it doesn’t cover everything. The government has an incentive to control costs, and the drug companies have incentives to make things cheaper because they know there’s a higher chance the government will approve it if it’s cheaper.
But you’re missing the one key element here that contradicts your claim: Private insurance also exists in these countries. Just about every country has optional, high-end, private insurance that many people get through their jobs. Just like here. That insurance covers the pricey treatments that the government won’t, and provides the money necessary to spur innovation.
What’s the difference between that system and ours? That in theirs, they have far, far fewer people dying and going bankrupt because they can’t get a decent care.
August 19th, 2009 at 5:01 pm
According to this article in the Atlantic, http://www.theatlantic.com/doc/200909/health-care
if one confiscated all the profits of the health insurance industry and all the profits of the top (I think it was 7)pharmaceutical companies you could pay for our health care system for about 11 days.
This tells me that more is wrong with health care than insurance company and pharma profits.
The article’s author seems to me to be on the right track.
August 19th, 2009 at 5:01 pm
A health-care with any sort of intention toward that scenario would not survive beyond the immediate following election.
In case you haven’t noticed, Britain’s Conservative party are ardent defenders of the NHS (going out of their way this election to try to say how they support it more than the liberals). And the NHS is pretty much the textbook definition of government rationing that won’t cover new things that are too expensive. It’s still wildly popular and no politician would suggest touching it.
August 19th, 2009 at 5:06 pm
if one confiscated all the profits of the health insurance industry and all the profits of the top (I think it was 7)pharmaceutical companies you could pay for our health care system for about 11 days.
Yeah, it’s just like Zeno’s paradox, innit? No one’s making any money and therefore healthcare is impossible! Seriously, what does the figure you cited have to do with anything?
August 19th, 2009 at 5:09 pm
The article’s author seems to me to be on the right track.
The article, which is entitled “How American Health Care Killed My Father”, by the author who believes that “it is a system that is not worth preserving in anything like its current form” and that “we will need to reduce, rather than expand, the role of insurance”. I’ve just read the first page so far, but yeah, he does seem on the right track. The employer-based insurance system is a complete mess and needs to be completely demolished for a single-payer system.
The unfortunate reality is that single-payer is not passable given the current 100 members of the Senate. So we take the shitty reform we get and hope to elect better people and do better in the future.
August 19th, 2009 at 5:26 pm
And yet you’re honestly saying that the government, which is notorious for its lack of cost control on anything, is somehow going to have the fiscal responsibility to pay the drug companies noticably less money than the for-profit insurance companies which have legions of specialists whose entire job is to figure out how to pay them as little as possible and how to deny as much treatment as possible.
Am I supposed to believe that?
Contrast differences between the prices paid by Canadian single-payer and American HMO’s for the same drugs. I should think the answer to your rhetorical question is, indeed, affirmative. Part D only got away with paying market rates between it was a Republican-instigated program; had it been a Democratic program, it would have been paying below market rates through its pricing power.
The government has an incentive to control costs, and the drug companies have incentives to make things cheaper because they know there’s a higher chance the government will approve it if it’s cheaper.
But you’re missing the one key element here that contradicts your claim: Private insurance also exists in these countries. Just about every country has optional, high-end, private insurance that many people get through their jobs. Just like here. That insurance covers the pricey treatments that the government won’t, and provides the money necessary to spur innovation.
The difficulty is fairly well-explained by, again, pricing power. Being the dominant insurer in those countries, the government essentially maintains a deadlock on most treatments. In a system where less than a quarter of the insured (the privately insured) are expected to shoulder essentially all the costs of broad-based innovation, said innovation must necessarily be more difficult. The critical mass does not exist.
In any case, your hypothesis is contradicted by reality; health-care innovation is much weaker in Europe than in America. If your hypothesis was correct, then that would not be so. But it is indeed so, thus the necessary conclusion is that (majority, dominant) single-payer retards health innovation. France has various supplementary private insurance in addition to the main, dominant public one, but it shows no signs of improved innovation.
I want to focus on this sentence: The government has an incentive to control costs, and the drug companies have incentives to make things cheaper because they know there’s a higher chance the government will approve it if it’s cheaper.
This is a classic fallacy. What makes drugs, from a cost-of-development perspective, cheaper? Innovation. The drug companies already have an enormous incentive to pursue that innovation, because the cheaper the drug is to development, the price being constant, the greater their profits (Profit = Revenue – Costs).
The only thing a government pricing mechanism would do in this case would be as a price ceiling beyond which it is reluctant to adopt certain innovations; that is, to set a cap on cost of treatment. Which is to say, the innovation could not progress to the initial stage, where costs > government price ceiling, without which it cold not progress to the next stage, where eventually costs < price ceiling. And the government insurer being the dominant market-maker, it would essentially prevent the particular innovation from going forward. I am aware of no continental European health market where a major, revolutionary treatment has been marketed exclusively at private insurers in the absence of government approval; in such cases the innovation would simply not materialize.
Indeed, in such cases, the tendency has been to restrict people’s choices to go to the private sector, out of concerns for “fairness”. In the U.K., patients have been refused treatment because they have ostensibly “jumped the queue” by purchasing private care. In Canada, the same inane mentality dominates.
In any case, you contradict yourself. You are making two irreconcilable claims here. One, that the gov’t could not restrict costs even if it wanted to; two, that gov’t cost controls will be sufficiently effective that “the drug companies have incentives to make things cheaper because they know there’s a higher chance the government will approve it if it’s cheaper.” It is either one or the other; I suspect you fall closer to the latter, but you are just using the former as a unpersuasive legerdemain.
August 19th, 2009 at 5:46 pm
Myles:
1) Pharma is by no means the whole of the healthcare system.
2) The healthcare market, especially with respect to provision of services, diagnostics, and preventative treatment overall, is woefully distorted by the vultures in this country who call themselves the private health insurance industry. They have created a messed-up system that has whacked-out stated charges for the provision of healthcare even on those occasions when they agree to pay at all. Other countries’ systems are much, much better at ensuring that providers get a bigger share of the healthcare dollar by controlling the costs of ensuring, and/or insuring, medical care.
That is all.
August 19th, 2009 at 6:21 pm
I think Matt’s point on “a certain irreducibly Kierkegaardian element to ideological commitment” is that it takes a “leap of faith” to choose one particular ideology rather than another. Had he taken a leap in another direction, Matt thinks he could just as easily have fought for the other side (without compromising reason), and people who haven’t leaped at all tend to have “fuzzier” political ideologies–for presumably “rational” reasons.
This is a kind of weird argument (very Yglesian, in a good way), and, I think, essentially wrong. I think rational processes from shared American/Western/human values naturally leads to much of progressive ideology, and it’s better to view the right as a regressive cultural movement cynically sponsored by self-interested rich people than as an internally consistent faith equal to all other internally consistent faiths. That is, in the big picture at least, the other side isn’t even arguing in good faith; their arguments are constructed for dishonest and yes, immoral and unethical
purposes.
August 19th, 2009 at 6:34 pm
@80: The faith analogy certainly breaks down at a certain point, and I don’t think MY means to advance a corrosive relativism where there’s *actually* no reason to prefer X over Y.
But there are a lot of cases where the difference between opinions boils down to a question of emphasis, and you have to make a choice between two valid concerns.
It’s true that the GOP has been amazingly dishonest and uninterested in constructive compromise in recent decades — so much that it’s hard to grant that they even have a real point of view sometimes. But though it’s hard to remember right now, we do need conservatives around to keep us honest. I just wish we had better people playing that role.
August 19th, 2009 at 6:43 pm
One happy consequence of this is that I find the stubborn persistence of principled disagreement less mystifying than I once did, and have a greater appreciation for what I now think of as a certain irreducibly Kierkegaardian element to ideological commitment that, in turn, helps explain why so many “normal” people have such fuzzy political views.
I would read anything more you had to say to expand on those comments. I think, if I get you, that I have been having similar thoughts myself of late.
August 19th, 2009 at 7:09 pm
> In any case, your hypothesis is contradicted by
> reality; health-care innovation is much weaker
>in Europe than in America.
Perhaps you could use your “reality mapping system” to plot out the location of the top 10 private pharma corporations in the world, their headquarters, and the location of their research labs. That might prove instructive to you.
All of which continues to be a blind, because while there is certainly personal and societal value in having 3 slightly different versions of the same cholesterol-lowering therapy there is no values in having 7, yet it is the race from 3 to 7 of the same drug with only a patentable variation that has occupied US pharma for the last 20 years. And note well that none of those drugs work as well as plain niacin – which is essentially free.
Cranky
August 19th, 2009 at 7:13 pm
@ Myles
- this really has nothing to do with the current reform. Even if the “worst” case – single payer, no private insurance worth speaking of left – eventually comes to pass in the distant future, people will still retain the ability to vote for or against higher spending on healthcare, under precisely the tradeoff you mention.
- Pharma spends around 20% on marketing. Surely, if the government were eventually, some day in the distant future, to become the only customer, and one who also cares mostly about price, some part of that 20% would no longer be necessary and could be moved to R&D.
- Your premise, while theoretically sound is wrong empirically. Europeans spend less on drugs but live longer and healthier anyway. Sure, you can tell yourself a little story about evil foreigners leeching off American efforts, but the far more plausible explanation is that there’s a lot of waste and inefficiency in the American healtcare system. That, quite simply, you can get more bang for your buck by setting some of the wrong incentives straight. And that looking for those would be a far more constructive use of your time, than worrying about some potential future scenario (single-payer) which then in turn might eventually reduce R&D spending, which then in turn might eventually hurt people.
(FWIW, compare the military. True, any reduction in overall defense spending might eventually endanger and kill American soldiers or even American civilians. Doesn’t mean we can’t cut that 120th jet or a carrier or get rid of some nukes.)
August 19th, 2009 at 7:22 pm
37 gave the best post in this thread.
Though I would add, taking Matt’s argument to the logical conclusion, representatives in Congress should only vote on what is based on the world’s best interest, and not give any extra consideration to the US best interests.
August 19th, 2009 at 8:17 pm
I think it is also important to keep in mind that John Bolton let slip that the Bush administration was using NSA intercepts for political purposes. Supposedly, per Bolton’s slip, only for matters related to the UN but even there the targets of the intercepts were American politicians who disagreed with Cheney. I find it hard to believe that those intercepts were actually limited to matters involving the UN, and I also find it hard to believe that they have magically evaporated now that the Bush/Cheney administration is over.
Cranky
August 19th, 2009 at 8:41 pm
I can’t envision any of my close friends murdering someone for personal gain, but I can conceive of at least some of them getting behind the wheel of a car plastered and mowing down some innocent pedestrian. The issue is that people are willing to take risks with the future because the future is not real yet. There are numerous examples– people who smoke, who overeat and don’t exercize. etc. and etc. Because the consequences of our present acts are generally probabilistic rather than hard-determined we are free to deny that the worst will actually happen.
August 19th, 2009 at 9:24 pm
I think rational processes from shared American/Western/human values naturally leads to much of progressive ideology, and it’s better to view the right as a regressive cultural movement cynically sponsored by self-interested rich people than as an internally consistent faith equal to all other internally consistent faiths.
Naturally leads to a classical liberal ideology, not what is called a “progressive” or liberal-Democrat ideology. A fair part of modern liberalism is just pure paternalistic and statist instinct, which is, of course, very much at odds with Western liberal thought.
If you want to see what the rational process from shared Western values genuinely should lead to, read Isaiah Berlin and understand his theory of negative and positive liberties, and why negative liberties are more important.
He was one of those men who personally experienced the evils of prizing positive over negative liberties (Soviet Russia).
And that looking for those would be a far more constructive use of your time, than worrying about some potential future scenario (single-payer) which then in turn might eventually reduce R&D spending, which then in turn might eventually hurt people.
(FWIW, compare the military. True, any reduction in overall defense spending might eventually endanger and kill American soldiers or even American civilians. Doesn’t mean we can’t cut that 120th jet or a carrier or get rid of some nukes.)
All good points, but the last analogy is inapt: defense spending (essentially production) in this case is quantitative (the nature of the aircraft does not change), whereas health-care innovation should be qualitative. A better analogy would be the trade-off between having the most advanced nuclear submarine in the world, or the second or third most-advanced.
August 19th, 2009 at 9:29 pm
But I think I have had my point; that there indeed are reasonable right-wing objections to the current health-care reform of potentially practical considerations.
August 19th, 2009 at 9:50 pm
Our health care system is in desperate need of reform. I was treated with all manner of drugs for “depression” for over a decade, then treated with drugs to mitigate the effects of those drugs, because psychiatrists don’t typically test for iron deficiency when facing an atypical depression, though the symptoms are exactly the same. When I think about how rapidly I improved after two weeks of dosing on iron supplements and vitamin c, I just wish I could beat the living crap out of someone who can be called “responsible”.
August 20th, 2009 at 1:37 am
Matt: “But it’s impossible to imagine these same Senators stabbing a homeless person in a dark DC alley to steal his shoes.”
Really? Not impossible for me at all. The only reason they don’t is because it’s too Mickey Mouse for them. They’d rather steal BILLIONS and ruin MILLIONS of lives rather than do penny-ante crime – unless of course there’s some money in it rather than just some cheap clothing.
August 20th, 2009 at 2:33 am
[...] Matt Yglesias points to an interesting phenomenon that is difficult to explain: the high degree cynicism and immorality displayed in big-time politics. For example, Senators who genuinely do believe that carbon dioxide emissions are contributing to a global climate crisis seem to think nothing of nevertheless taking actions that endanger the welfare of billions of people on the grounds that acting otherwise would be politically problematic in their state. In other words, they don’t want to do the right thing because their self-interest points them toward doing something bad. But it’s impossible to imagine these same Senators stabbing a homeless person in a dark DC alley to steal his shoes. And what’s more, the entire political class would be (rightly!) shocked and appalled by the specter of a Senator murdering someone for personal gain. Yet it’s actually taken for granted that “my selfish desires dictate that I do x” constitutes a legitimate reason to do the wrong thing on important legislation. […] [...]
August 20th, 2009 at 3:23 am
Matt, I hope you can write a similar post 20 years from now. Not from something repetitively ingrained, but rather drawn from a deep, ever replenishing well of general goodness.
I’d like to think so. You have chosen a difficult path, however. Stay vigilant, good sir, and may your well never run dry on your journey.
August 20th, 2009 at 4:41 am
In any case, your hypothesis is contradicted by reality; health-care innovation is much weaker in Europe than in America. If your hypothesis was correct, then that would not be so. But it is indeed so, thus the necessary conclusion is that (majority, dominant) single-payer retards health innovation. France has various supplementary private insurance in addition to the main, dominant public one, but it shows no signs of improved innovation.
First, you are wildly exaggerating the shortcomings of medical development in Europe. But, to the extent that you are correct, it is largely because America has much, much better universities than Europe, and as has already been explained to you, it is the universities and public research institutes that do the heavy lifting, not the pharmaceutical companies. Europe may indeed be doing some free riding but if so, it is far more on the American undergraduate with $200,000 in student loans and the American taxpayer at large than it is on American medical patients and American health insurance companies.
Indeed, in such cases, the tendency has been to restrict people’s choices to go to the private sector, out of concerns for “fairness”. In the U.K., patients have been refused treatment because they have ostensibly “jumped the queue” by purchasing private care. In Canada, the same inane mentality dominates.
As others have mentioned other places before me, it is very unfortunate that, for linguistic reasons, the two universal health care systems the average American is most exposed to — to the limited extent that is even true — are the Canadian and British systems, which are vastly more centralized, socialized, and directly government run than any others in the western world. They are sub-optimal in many ways and not good models for us, though their shortcomings are hugely exaggerated. They are also very different from the systems obtaining in continental European countries, which are what the commenter you replied do was attempting to describe in general terms. The phenomenon you are describing here is not a feature of most of these systems, certainly not in the country where I am living anyway.
August 20th, 2009 at 7:08 am
Myles,
I don’t know if you are still around, but you should consider a few points.
1) A lot of the expenses we would like to reduce in healthcare are unrelated to drugs. Your argument locks onto one potential downside of reform. There is no attempt to balance against the many many benefits. It suggests an ideology looking for a justification more than anything else.
2) Investment into drug research may be done better by the government than by private companies. I know you are not inclined to agree with this point, but you should consider it. Companies spend the majority of their money on advertising and layers of management. The R&D they actually do is directed towards life-style products and patent maintenance. I would guess that 10% of the cost of drug sold is allocated towards substantially helpful drug development. As a researcher I would, in general, prefer to be working in the private sector than for government subsidies, but it is possible that in this case the drug companies are simply too inefficient. At the very least, we should think about how we can improve the incentive structure here (how about less patent maintenance?).
August 20th, 2009 at 7:39 am
Myles,
The reason for American preeminence in medical innovation is the National Institutes of Health, the largest funder of medical research in the world.
Pharma claims to spend about $35B a year on research. We actually get more medical progress from a public dollar than from a private one. Projecting on population relative to the rest of the world we spend about $1T too much on medical care. Thinking we need to waste that much to get the results of private research is the most bizarre excuse for reasonable I can imagine.
August 20th, 2009 at 8:57 am
You write: “Yet it’s actually taken for granted that “my selfish desires dictate that I do x” constitutes a legitimate reason to do the wrong thing on important legislation.”
I guess I’d say that it’s not just the politician’s beliefs or his selfish interest, it’s also those of his constituents. He may well believe that global warming is destroying the planet, but if a fairly significant number of voters in his state don’t believe it, what he personally believes really doesn’t matter. Maybe you can argue that he should be doing a better job of educating them, but until they get to a point where they see global warming as an immediate threat, rather than a distant one, and aren’t going to punish him for his vote it doesn’t matter. Politics in many cases is all he’s got, and he’s not going to endanger his meal ticket for a matter of principle.
August 20th, 2009 at 12:01 pm
Projecting on population relative to the rest of the world we spend about $1T too much on medical care. Thinking we need to waste that much to get the results of private research is the most bizarre excuse for reasonable I can imagine.
Incorrect. You are conflating the ability to do research (economic power) with headcount (population). Africa has a lot of headcount, but because of its economic and scientific weakness, it has almost no capacity to do pharma research. And so on and so forth.
A better comparison would have been to project American share of world health R&D against American share of world GDP.
August 20th, 2009 at 12:16 pm
It suggests an ideology looking for a justification more than anything else.
I will be perfectly at ease with any health-care system that does not a) attempt to squeeze pharma b) attempt to squeeze health-care equipment and technology makers and c) attempt to underpay specialists and private hospitals.
August 20th, 2009 at 12:18 pm
Whether it squeezes private insurers is not my concern, but rather my concern is that in reducing and squeezing the private market (public plan, etc.) it will be deleterious in the long term to innovators in equipment and pharma, as well as highly specialized hospital wards with absolute-leading-edge-of-the-world level of delivering complex health care.
August 20th, 2009 at 2:34 pm
The discussion seems to have veered off-topic, in many ways:
- Regarding the health care reform, the big item -which should be repeated over and over again – is the 20+% of your premium dollars which is eaten up by private insurance’s overhead, such as maintaining an administration denying insurance to the possibly sick, denying claims wherever possible, and just at random, CEO salaries,… compared to the < 3% in overhead lost by Medicare/Medical (including the fraud and abuse much liked by opponents of research). Most people seem not to know that only <80% of their premium dollar goes as payments for hospitals, doctors, drugs etc.
Much of the fight is over this percentage, which is a big number, so the insurance industry can easily spend $1.6 million a day to defeat any menace to their take).
The drug research talking point has already been rebutted by other commenters (actually new drugs come from public-funded NIH; me-too drugs, actually Europe does well in it).
- That normal people can get accustomed to commit terrible crimes has been well-known since studies of Nazi Germany and the Regime of the Colonels in Greece (1967-74). It is the ‘collegial’ environment.
Politicians are normally surrounded by others of similar background and ideological preference, and sycophantic aides, they meet lobbyists with talking points probably as often as common citizens… so selling out does not appear to be what it is in their minds. And it gets instant applause/approval/campaign contributions from some interest group. And their colleagues do it too. And, at first, you think you’ll take that contribution, but still vote for what you think is best. (And, of course, the victims are invisible; like, e.g., the increased infant mortality in Mississippi when gouverner Barbour made it more difficult to apply and get prenatal care for poor people in that state).
If you are a businessman, and have your colleagues and customers all read the Wall Street Journal, so you have to read it too, and at first, spout agreement so as not to loose some contract, but after a time, you might internalize what you have to say to be successful.
So much for this commenter’s pop psychology.
August 20th, 2009 at 9:06 pm
Well, American pharma companies spend more than twice as much on marketing than on the (vaunted) research. In a single-payer system most of the marketing costs would go away so obviously there can be cuts there.
August 21st, 2009 at 9:07 am
“Senators who genuinely do believe that carbon dioxide emissions are contributing to a global climate crisis “
They act as they do because they really don’t believe co2 is a problem. Look at the actions of all the prominent believers. They typically consume much more energy than average. If they truly believed, they would ACT accordingly.
As for the senators – you can’t BS a BSer
August 21st, 2009 at 9:15 am
[...] Matt Yglesias: [...]
August 21st, 2009 at 10:57 am
[...] Political Economy Matt Yglesias writes: [...]
August 21st, 2009 at 1:29 pm
The only good solution to this is to reduce the power that government and the state have, to reduce the opportunities for corruption by officials.
August 21st, 2009 at 4:56 pm
[...] Matt Yglesias: I’ve come to be increasingly baffled by the high degree cynicism and immorality displayed in [...]
August 21st, 2009 at 8:57 pm
I find it hard (maybe I shouldn’t here among those holier than Thou) to believe that no one understands, like any economic creature, politicians have desires and are placed in an environment where there are certain incentives to act in obtaining those desires. They crave raw power, they are NOT there to make our lives better, power to get money, prestige and supplicants at their desks.
Having prostrate ourselves for their hand-outs, they have every incentive to stay in power and lap up the rewards of office. Change their incentives.
Don Williams
Are you wishing for or predicting 100,000 deaths due to swine flu? Is swine flu a republican invention in your opinion? Do you predict that a government program passed by Labor Day would save their lives? Can you prove your case? I thought not, you dope.
August 22nd, 2009 at 2:36 am
[...] Matt Yglesias writes: [...]
August 22nd, 2009 at 9:04 pm
[...] Greed, and Power Matt Yglesias wonders why politicians are not more strongly motivated by higher ideals. Selling the public good [...]
August 23rd, 2009 at 2:28 pm
[...] identifying details because it’s apocryphal. But the point speaks to what I was saying about the role of morality in political action. Johnson is saying that while many Southern Democrats may have been hard-bitten white supremacists [...]
August 24th, 2009 at 1:34 pm
[...] blogger extraordinaire, Matthew Yglesias, is flabbergasted that politicians do what is in their best interest, even when it goes against their own [...]
August 24th, 2009 at 1:40 pm
Gee, Matt — I’m not sure you’ve said much to convince me that you’ve become any better at understanding other people’s ideologies. Or maybe your definition of ideology isn’t the same as mine, or of most other “normal people.”
We realize that the accumulation of power is the goal of all governments and all politicians, and that to think otherwise is fatally naive. And because of this, we distrust government and the motives of those in government, regardless of their party or ideological affiliation.
Ilya Somin, writing on the Volokh Conspiracy, does a good job of explaining why you shouldn’t be so baffled about the behavior of politicians.
August 24th, 2009 at 1:43 pm
This post is so cute.
August 24th, 2009 at 2:03 pm
And I truly can’t understand why you get paid to do this. That’s what baffles me.
August 24th, 2009 at 3:11 pm
Why?
Sweet Jesus are you really this stupid?
August 24th, 2009 at 4:24 pm
Voting as one’s constituents wish serves not only one’s self-interest in getting re-elected but the very purpose of a republican form of government. I think you’re essay misses that.
Politicians are representatives, proxies if you will, for their constituents; they are not elite rulers charged with doing the “greater good,” whatever that means.
August 24th, 2009 at 5:56 pm
[...] Matt Yglesias can’t figure out politicians these days. They seem, in some cases, to be straight out immoral people, passing legislation that they know will end up hurting lots of people. The real point that seems to get Yglesias, though, is that although Senators are perfectly willing to sell their constituents down the river for very small gains, they would not be willing (he thinks) to commit more basic immoral acts if the need or profit was high enough. He says: [...]
August 24th, 2009 at 6:16 pm
> But it’s impossible to imagine these same Senators stabbing a homeless person in a dark DC alley to steal his shoes.
Actually, that’s quite easy to imagine.
I suspect that DC’s homeless are safe from predatory congresscritters because:
(1) Said critters aren’t confident of surviving the confrontation
(2) Haven’t figured out what to do with the spoils.
> And what’s more, the entire political class would be (rightly!) shocked and appalled by the specter of a Senator murdering someone for personal gain.
Assumes facts not in evidence. In fact, is inconsistent with observed behavior.
August 24th, 2009 at 6:38 pm
How long does it take for a Democrat to decry the pit falls of democracy after his party takes power?
In the case of Yglesias; about 7 to 8 months.
August 24th, 2009 at 6:44 pm
Keep in mind that the US is now SECOND place in carbon emissions. Senators are not ‘endangering the lives of billions’ because they oppose the cap and trade boondoggle, and comparing that to stabbing a homeless person to death is the stupidest comparison I’ve heard since the early Bush years.
Cap and Trade is a fraud designed to make a few companies really, really rich at the expense of the tax payer. It will not reduce the likelihood of global warming which is already happening, or in reality reduce the world’s contribution of CO2.
Matt, you’re a smart guy but you originally supported the Iraq War and I see Cap & Trade as basically the same level of hubris. You should go back and read what you wrote and compare it to your support of this disastrous legislation.
August 25th, 2009 at 2:18 am
[...] Well yeah, it’s confusing, as Matt Yglesias notes: [...]
August 26th, 2009 at 1:49 am
For a guy who can throw off an oblique reference to Kierkegaard, you ought to be familiar with Burke’s contemplation of the problem of statesmanship versus faithful representation of parochial interests (and that to do either, one must first be in office). In which case you shouldn’t be quite so befuddled.
Oh, and discussing either of the above thinkers goes right over the head of at least 90% of the electorate. That too ought to tell you something – about yourself as much as them.
August 26th, 2009 at 12:59 pm
[...] wrote the other day about how over time I’ve “come to be increasingly baffled by the high degree cynicism and immorality [...]