Tag: health care
The Los Angeles Times has given good consideration the prospects of taxing soda to pay for rising healthcare costs. An op-ed in October made the case for such a tax, and a front-page story last Sunday detailed the proposal’s murder by the beverage industry.
A few weeks after hearing testimony that a penny-an-ounce tax on soda could reduce consumption by 23%, Rep. Linda Sanchez proposed the tax to colleagues on the House Ways and Means committee to a favorable reception. Beverage industry lobbyists went to work, raising questions about the science and, significantly, bringing minority groups that they had long supported out in opposition to the tax, saying that it would affect minority consumers disproportionately. (It would cost minority consumers more, but these are people with higher rates of diabetes — Sanchez herself was recently diagnosed with gestational diabetes).
As dog ever bites man, lobbying scares Democrats:
By the time the Democratic caucus held its next closed-door meeting in early summer, the atmosphere had changed, Sanchez said — an assessment shared by Pascrell and some committee staffers.
Democratic Rep. John Lewis, the civil rights pioneer who represents Atlanta, the corporate headquarters of Coca-Cola, argued that the soda tax could lead to taxes on other foods, raising prices for hard-pressed consumers during a severe recession. If you begin taxing one sugar product, where do you draw the line?, he asked.
Rep. Ron Kind (D-Wis.), who represents a rural district where dairy farming is widespread, said he became concerned about the fairness of targeting one industry. Kind had heard from local Pepsi and Coke distributors, and he and other members also received letters from the National Milk Producers Assn. concerned that the proposed tax could apply to chocolate milk.
“We went from having real interest in this idea to it just falling off the table,” Sanchez said. “It was my perception that opposition increased as members began hearing from local businesses” that were part of the beverage industry coalition.
Michelle Obama debuted today her Healthy Food Campaign. The most regulation proposed inside it would grant principals the ability to ban unhealthy foods in schools, which is good, but altogether too localized. A soda tax would have discouraged consumption of a product and would reigned in the externalization of its costs.
The Los Angeles Times features waiters who work at Los Angeles’s two notable south-of-Mulholland delis: Langer’s and Canter’s. Canter’s is the Hollywood deli, set in a neighborhood full of young writers and actors, up all night, and host to The Kibitz Room (where Boots recently brought Edmund Welles). Langer’s, The Restaurant Saved By The Red Line, sits in “transitional” MacArthur Park, an easy lunch destination for downtown office workers who can ride the subway or get curbside to-go using their cell phones.
And Langer’s — as the Times notes 20 grafs in — is union.
Eva Francois began serving at Canter’s 17 years ago. The nighttime shift allowed her to spend days with her young son, but once he grew older, she was able to work days. A co-worker who served at both delis suggested lunch shifts at Langer’s, an extra job she has been working the last eight years. Like many dual-deli waiters, Francois takes the health benefits at Langer’s — a union shop.
Good on them for spelling out the difference. What the article neglects to mention–though the story’s in the archives–is that a little less than twenty years ago, Canter’s was union too. As I understand it, the original owners passed management to their children, who overturned a longtime arrangement with labor. A decertification campaign bitterly divided the staff. The former bass player in my band was a union organizer who worked closely with one of the shop stewards who manned that picket line (at a different job, years later). So we were not about to play The Kibitz Room.
In 1995, Senator Joseph Lieberman gave an address at Yale University to a small crowd. I don’t remember what he was speaking about, but I do remember joining with a few friends to disrupt the speech. About six of us, from either Guerilla Theater or the Radical Student Front, marched into the room during the middle of speech and walked back and forth with picket signs until his aides hustled us out of the room and told us that whatever our complaints, the Senator’s record showed that he was a friend of progress in America. Maybe he had been. I hadn’t known the guy’s roll calls up and down. But you don’t get a pass for voting for gay teen suicide.
Lieberman had recently joined forces with the charming Jesse Helms to strip federal funding from schools that counseled gay teenage students that it was okay to be gay. I don’t remember the exact wording of our signs, but we made the connection that teen suicide rates were highest among gay teens and that Lieberman’s actions were boosting the numbers. We weren’t subtle.
Today, Lieberman threatens to filibuster the public option. I really wish we’d pied the fucker.
Vaguely argued prediction.
As evidence of the link between health care and racial attitudes, we analyzed survey data gathered in late 2008. … We find an extraordinarily strong correlation between racial resentment of blacks and opposition to health care reform.
No such relationship between racial attitudes and opinions on health care existed in the mid-1990s during the Clinton effort.
See Martin Gilens’s book “Why Americans Hate Welfare” for a good analysis of how this worked with welfare. There too, the association was not originally there: the right managed to yoke existing racism to welfare in order to piggyback on existing resentment among whites. The result was that, as more people came to associate welfare with blacks, antipathy to the program rose. So too here: just yoke healthcare to providing services to blacks (or the pro-black policies of a black president) and voila, instant white opposition.
Yes this is the laziest post ever.
By now everyone has heard about Rep. Joe Wilson’s cri de coeur during Obama’s health care speech last week. He was furious that Obama would dare to deny that his health care plan might cover illegal immigrants. (The next day Sens. Conrad and Baucus announced plans to strengthen bans against illegal immigrant participation, thereby retroactively validating Wilson.)
That anger seems a pretty clear example of the loyalty phenomena studied by Enzo Luttmer (PDF):
I show that self-reported attitudes toward welfare spending are determined not only by financial self-interest but also by interpersonal preferences. These interpersonal preferences are characterized by a negative exposure effect—individuals decrease their support for welfare as the welfare recipiency rate in their community rises—and racial group loyalty—individuals increase their support for welfare spending as the share of local recipients from their own racial group rises. These findings help to explain why levels of welfare benefits are relatively low in racially heterogeneous states.
In other words, if you see benefits going to members of your own race, you support welfare more than average. If you see benefits going to members of another race, you support it less than average.
Illegal immigrants are only the current racial bugbear of much of the right. If it wasn’t them, you can be sure we’d be hearing fear about benefits being sucked up by some other unworthy group. My taxes going to pay for those people. Never mind that in fact it’d be more likely the other way around—immigrant taxes would pay for old white people:
According to a July article in the American Journal of Public Health, immigrants typically arrive in America during their prime working years and tend to be younger and healthier than the rest of the U.S. population. As a result, health-care expenditures for the average immigrant are 55 percent lower than for a native-born American citizen with similar characteristics. With the ratio of seniors to workers projected to increase by 67 percent between 2010 and 2030, it stands to reason that including the relatively healthy, relatively employable and largely uninsured illegal population in some sort of universal health-care system would be a boon rather than a burden.
Reactions like these are why I think I have to part with Josh K-sky on the desirability of ingroup loyalty as a moral principle, at least when it comes to those invoked in politics. A feeling of belonging may be important for mobilization, but the moral appeals of liberal politics rarely depend on it. I’d say it’s the difference between what you feel (solidarity) and the morals you invoke in your rhetoric. There’s plenty of “we are as good as you” or “we deserve the same justice as you.” Not so much “stick with your own.” Not constructively, anyway.
I suppose there might be some. But I don’t think it’s wrong to be reflexively suspicious of anybody who comes making those sorts of appeals. Highly suspicious.
Part of the problem I think I may be having with Haidt’s framework is that he seems to be conflating “moral judgments” with “things people care about.” Take, for example, this bit on bumper stickers Josh K-sky linked to in a comment:
The soft-spoken psychologist is acutely annoyed by certain smug slogans that adorn the cars of fellow liberals: “Support our troops: Bring them home” and “Dissent is the highest form of patriotism.”
“No conservative reads those bumper stickers and thinks, ‘Hmm — so liberals are patriotic!’” he says, in a sarcastic tone of voice that jarringly contrasts with his usual subdued sincerity. “We liberals are universalists and humanists; it’s not part of our morality to highly value nations. So to claim dissent is patriotic — or that we’re supporting the troops, when in fact we’re opposing the war — is disingenuous.
“It just pisses people off.”
The University of Virginia scholar views such slogans as clumsy attempts to insist we all share the same values. In his view, these catch phrases are not only insincere — they’re also fundamentally wrong.
But “Dissent is the highest form of patriotism” isn’t an attempt to insist we all share the same moral values. It’s an attempt to recapture the concept of patriotism in a liberal, nonmoralistic context. To put it another way, just because I don’t believe love of country is a moral imperative doesn’t mean I don’t love my country. When Haidt insists that I’d be insincere to say so, it pisses me off.
This is how liberals conceive of identity and solidarity in a diverse society, too: I value my group, or my heritage, without appealing to it as a font of rectitude.
Yesterday, several dozen people in my Facebook feed changed their status updates to read:
No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree, please post this as your status for the next 24 hours.
Because I’m an asshole, I changed mine to read “No one should die, etc.” My favorite variation was “Everybody should get sick go broke die,” and J.H.P. babelfished in with “Nobody must die because they cannot allow well-taken care of doctor, and nobody must break because patients obtain. If you agree, you satisfy fix this like its state for the rest of the day.” In Soviet Russia, Facebook updates you!
What have we really done when we “donate” our status update to a cause? While certainly tempting, I think it’s wrong to say we’ve done nothing — at the very least, we’ve taken a public stand, we’ve added our number to a count — and yet it’s very hard to pin exactly what the something we’ve done is.
It’s a question, I think, that takes us to the heart of digital identity. What is at stake in this sort of signaling behavior? What status does your status update have?
It’s easy to be crabby about this sort of thing. My friend V. complained that “if you care so deeply about the health care issue you should do something more than put a blurb on your FB page about it”, to which one of her friends responded:
Because the politicians seem to have forgotten their promises (as usual) at a critical moment in the debate, any action that helps remind people this is a topic worthy of attention and solidarity is one I consider worth pursuing.
This is a typical defense of decentralized activism: any little thing helps. I heard it a lot in response to my Whole Foods boycott-bashing. And I was guilty of it myself in this blog’s very comments. Let’s be clear about at least one thing: there’s plenty of things you can do on your own that, while nice, aren’t the slightest bit helpful. And the vague hope that one action will beget another, while not wrong, is almost always unfalsifiable. So let’s evaluate digital activism for what it is, not for what it might inspire.
Additionally, though it’s hard to make an argument that slacktivism will change the world, the arguments in favor of more accepted forms of politics, such as voting, aren’t a hell of a lot stronger. Short of owning an insurance company, a news network, or a United States Senator, there’s no guaranteed method for effective participation in politics. So why not take this one seriously?
I’ve noticed that liberal-sentimented people of a certain caste get unbearably twitchy around collective action. Raised on 1984 and Brave New World, we’re reflexively suspicious of lock-step action and automatic agreement. We overestimate our own agency and indulge in a fatuous civics of individuality. As a result, we can be very bad at politics.
So status-update “signaling” resists that tendency (though it also brings it out in assholes like me). It’s less than collective action, but I think it can be understood as cultivating solidarity, a precondition for successful collective action. It’s an emotional warm-up.
It still leaves the question, “what is to be done?” But by allowing it to be asked in (otherwise creepy) unison, I think it makes the question less academic.
In this week’s New Yorker, James Surowiecki argues that one of the obstacles to public acceptance of health-care reform is a bias in favor of the status quo:
But the public’s skittishness about overhauling the system also reflects something else: the deep-seated psychological biases that make people resistant to change. Most of us, for instance, are prey to the so-called “endowment effect”: the mere fact that you own something leads you to overvalue it.
And then later:
Compounding the endowment effect is what economists dub the “status quo bias.” Myriad studies have shown that, even if you set ownership aside, most people are inclined to keep things as they are: when it comes to things like 401(k)s, for instance, people tend to adopt whatever their company’s default option is, and with things like asset allocation or insurance plans people tend to stick with whatever they start with. Just designating an option as the status quo makes people rate it more highly. Some of this may be the result of simple inertia, but our hesitancy to change is also driven by our aversion to loss.
I believe it. But I think Surowiecki overlooks several critical elements of what’s going on right now.
First, people aren’t being asked to give up what they have now in favor of a defined Public Health Reform Policy X. They’re being asked to contemplate giving up what they have now in favor of a pig in a poke. There are four versions of health reform already in Congress with a fifth yet to be written, and while the four in existence are broadly similar, who the hell knows what will come out of the Senate Finance Committee or what the final bill will look like? It could be anything from a strong public-option plan to one that offers mandates without price protections.
Of course Democrats knew that this was a risk, which was why most of them wanted to have draft bills on the table before they left for August vacation. But even if they’d accomplished that much, they’d still have faced a second unacknowledged problem: nearly all the versions of health reform currently under serious consideration go farther than the plan Obama campaigned on.
It was Clinton and Edwards, not Obama, who offered plans with universal coverage mandates like the ones in all the bills that have been written. Obama only proposed to mandate coverage for all children and attacked the Clinton/Edwards universal mandate idea, a line of attack Paul Krugman warned against in this now eerily-prescient column. It was Clinton and Edwards, not Obama, who offered a strong public insurance option. Obama’s plan included something called an “exchange” (from the Roll Call link above):
Obama’s system, called the National Health Insurance Exchange, would point consumers to a plan that best suits them. It would “act as a watchdog and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible,” according to Obama’s campaign Web site.
Personally, I never understood how that was supposed to work.
Finally, the centerpiece of Obama’s domestic agenda during the campaign was never health care at all. It was a tax cut. He already enacted that cut as part of the stimulus bill, though no one seems to be aware of it so he’s getting no credit for it.
So, to review: on top of status quo bias we have an undefined alternative, the fact that that alternative will nearly certainly not be what people voted for, and the fact that most people don’t know that the main domestic policy priority they thought they were voting for has already been accomplished.
I’m glad things have moved in the direction they have. When it came down to Clinton and Obama I voted for Obama, but nearly entirely because of Iraq. I recognized that Clinton’s health care proposals were better, and I think it’s great that Congress is moving much closer to her ideas. I also don’t have any amazing insights about how things should have been done better or could be done better in the months to come.
I guess I’m just getting a little bit tired of the howls of betrayal coming from certain quarters. There is no question that President Obama has so far failed to deliver on some of his campaign promises (notably, to undo Don’t Ask Don’t Tell and to do something meaningful about our history of torture). But on health care Democrats have the chance to enact a better policy than we actually voted for.
In the New York Times, David Leonhardt asks why we don’t treat fat people like we treat smokers, asking them to bear the brunt of their cost to society. It’s an inane and offensive argument on many levels. For example:
Cosgrove mentioned to me an idea that some economists favor: charging higher health-insurance premiums to anyone with a certain body-mass index. Harsh? Yes. Fair? You can see the argument. And yet it turns out that the obese already do pay something resembling their fair share of medical costs, albeit in an indirect way. Overweight workers are paid less than similarly qualified, thinner colleagues, according to research by Jay Bhattacharya and M. Kate Bundorf of Stanford. The cause isn’t entirely clear. But the size of the wage difference is roughly similar to the size of the difference in their medical costs.
Bigotry results in a wage penalty for being overweight (as it does in similar penalties for being short, or female)–and Leonhardt thinks public policy should follow from it.
The comparison to smoking is valuable, but Leonhardt gets it wrong by confusing a debilitating condition with a behavior that causes it. Cigarette taxes, whatever else they are, are not a punitive tax on people with lung cancer. So why would a smart public policy penalize, as Leonhardt proposes, “anyone with a higher body-mass index?”
Towards the end of the article, Leonhardt offers that the problem may have a social element:
The solutions to these problems are beyond the control of any individual. They involve a different sort of responsibility: civic — even political — responsibility. They depend on the kind of collective action that helped cut smoking rates nearly in half. Anyone who smoked in an elementary-school hallway today would be thrown out of the building. But if you served an obesity-inducing, federally financed meal to a kindergartner, you would fit right in. Taxes on tobacco, meanwhile, have skyrocketed. A modest tax on sodas — one of the few proposals in the various health-reform bills aimed at health, rather than health care — has struggled to get through Congress.
Again, smoking rates weren’t cut in half by ostracizing people with lung cancer, and obesity shouldn’t be attacked by shunning the fat. Most importantly, it would help to stop subsidizing the production of cheap, unhealthy food. A proposed California cigarette tax would raise revenue to fight cancer, and the costs of obesity could be fought with a soda or snack tax.
And fat people will continue to walk the earth–mostly-healthy-eating, occasionally-snacking people who remain fat. Public policy shouldn’t be designed to punish them.
Advanced reading: “Fat rights are where gay rights were at 30 or 40 years ago,” Paul Campos at Lawyers, Guns and Money.
Libertarian, anti-union body-purity obsessive Whole Foods founder John Mackey, who has laughed himself all the way to the bank on the endive cash of soi-disant liberals, announced his opposition to health care reform in the Wall Street Journal this week. His article has prompted a convulsion of “Boycott Whole Foods!” across my Facebook feed, and blog posts like Why a Whole Foods Boycott Might Actually Work to Spur Real Health Care Reform at OpenLeft. I take the rousing keywords “Might” and “Actually” to mean that author doesn’t, at heart, think anyone should take this idea too seriously. The rest of the post is in keeping with this, with a lot of “my impression is” and “if such a plan works”.
This enthusiasm will soon wash away into the great ocean of ADD outrage, but since such a boycott has been encouraged by people who ought to know better, like the great Russell Mokhiber, I’ll address some of its flaws.
A successful boycott isn’t just a punishment for a transgression. It requires a clear goal. The Forever 21 boycott, organized by immigrant-rights advocates in Los Angeles, sought the payment of hundreds of thousands of dollars in back wages to workers who made their products. The fair-trade Nike and Starbucks boycotts of the mid-to-late 90′s resulted in monitoring regimes and improved conditions for many of those companies’ suppliers in Southeast Asia and Central America.
A successful boycott needs to be run by an organization with resources to devote to it. The Forever 21 boycott was run out of the Garment Workers Center by labor organizers, immigrant advocates, student activists and the workers themselves. Famously, the grape boycott was run by the United FoodFarm Workers. A great deal of momentum was added by neighbor-to-neighbor conversations, but it wasn’t started by them.
What would be the goal of a health care reform Whole Foods boycott? To get John Mackey to renounce his editorial? Put down the Ayn Rand? Quit blogging? All are worthy as idle hopes. None would move health care reform a day closer.
What organization would run it? Please believe me when I tell you that Whole Foods is not afraid of your Twitter feed, especially because half of the retweeters will feel that they’ve done their part by spreading the news so it’s all right if they duck in for a quick Odawalla. You’ll need to plan direct actions, picket lines in the parking lot, leaflet drops. Is this how Organizing for America should spend its resources? Is it how you should spend yours?
There are plenty of reasons not to shop at Whole Foods, and I encourage everyone to choose not to shop there out of pique or thrift. There are plenty of good reasons to boycott Whole Foods, and if you want to help your local Whole Foods employees join the United Food and Commercial Workers, have at it!
But if health care reform is your goal, take a page from the crazies. They’re not showing up at meetings of the leading health care reform bloggers. They’re not boycotting Wal-Mart, even though that company has nominally joined the side of reform. They’re bring direct pressure on the decision-makers: their elected representatives.
Bonus: the trailer for Made In L.A., a documentary film about the Garment Workers Center and Forever 21.
Rather than confront the extreme right wing of the Republican Party — which is who constitutes the crowds at these town hall events — it might be more useful to target protests at the giant insurance companies and the huge campaign contributions they are handing out , especially to moderate Democrats. Compare the insurance companies’ big profits and outrageous corporate compensation to the tens of millions of Americans who can’t afford health insurance, who can’t get insurance because of pre-existing conditions, or who have policies that don’t cover the things they need. Then challenge the waffling blue-dog Democrats to answer a simple question: which side are you on?
The Los Angeles Times:
Hundreds of people spent the night outside the Forum in Inglewood in hopes of getting free medical and dental care.
More than 2,000 sought services on the first day of the medical clinic — and hundreds were turned away. People were lined up Tuesday night, hoping to get in. The MTA announced it was extending service of Line 115 because of “overwhelming demand” for service to the clinic, which runs for eight days.
The Remote Area Medical Foundation is a trailer-equipped service that has staged health clinics in rural parts of the United States, Mexico and South America. It brought its health camp to urban Los Angeles County on Tuesday to begin a stint that the group’s officials described as its first foray into a major urban setting.
We are all Appalachia now. This would recall the time that Hugo Chavez sent heating oil via CITGO to poor New England families, except that the Remote Area Medical Foundation isn’t twitting the United States government. They’re just going where the poor people are, which happens to be, as Steve Lopez had it, “in the land of palm-shaded mansions.”
No, they’re not trying to make a political point. Is anyone? Certainly not the Democratic representatives who have been eaten alive in town halls over the past few days. These displays yield nothing but the vague hope that the cradle-to-grave racist id of the GOP will fly its freak flag too proudly and drive a few snobs into the reform camp.
I’m not dismissive of all types of political theatre, just of this defensive, too-clever prayer for backlash. The town halls were supposed to be an argument over health care. They have become an argument over town halls. A victory at this point would be getting people to shut up and behave, and it would be a hollow, procedural victory.
So why not stage the town hall meetings in traveling health clinics?
This would put members of Congress in the enviable position of bringing their constituents services they actually need. People who actually need better health insurance would wedge their way into the debate, which is currently dominated by an appeal to those who already enjoy health insurance and seek reassurance that reform won’t hurt them.
In the current scenario, the teabaggers yell “Don’t Kill Trig,” Organizing for America yells back, “Let Him Speak!”, and the media calls a pox on both their houses. A debate in a health care context, on the other hand, would require opponents of reform to make their case in front of people whose lives are at stake.
And who knows? Someone might catch a richly deserved cold.
Video: Sarah Palin only got it two-thirds right. It’s not “Death Panels,” it’s “Death Star Panels”.