Dining With the Enemy

In this age of political polarization and partisan rancor, I often worry about the fact that I have no real Republican friends.  I did have one.  But when he began spouting Tea Party craziness seemingly overnight, we briefly dialogued and haven't seen each other since.  One wonders whether such profound disagreement on the very nature of society, and such unwillingness to understand the other side, can be overcome by old bonds.

Yet this sort of dialogue almost seems like the one thing that really matters anymore.  Large portions of the population have completely tuned out of all major media and are getting their news and views exclusive from a handful of right wing media sources which arguably cannot even really be considered to present actual journalism.  But if we aren't engaging these people, how else to bring reason back into politics?

Mark Kleiman (heroically!) sat down with a couple.

I just had dinner with.... an old and trusted friend with a sophisticated knowledge of public policy [and] a relative stranger with limited information – both of whom plan to vote for Carly Fiorina over Barbara Boxer this fall. For each of them, the Access to Care Act is an important reason. Their concerns were opposite; the stranger loves Medicare and fears that ACA will cut into Medicare spending, the friend has caught Peterson-itis and is convinced that Medicare is going to eat the GDP, and hates ACA for not cutting Medicare enough.

Similarly, the stranger thinks that extending the Social Security retirement age would be a crime, while the friend regards it as an obvious response to increased longevity.

The fact that they were voting for Fionina for opposite reasons didn’t bother either of them; the stranger has decided that all incumbents ought to replaced, and indeed offered John Boehner’s proposal to raise the retirement age as a reason to vote against Boxer. (All this while railing against “socialism.”)

Anecdote isn’t data, but the hint here is that the Repubilican strategy of obstruction plus obfuscation is, so far, working pretty well.

I can see this happening because while they both professed to care greatly about the ACA, it was really just a sort of partisan bludgeon: the opposition to Boxer stems more from a larger disgust with what she represents on many levels. So the obstructionist strategy creates a scenario in which everything the Democrats do is terrible and almost fascist (“ram it down our throats”). So the good in even something as conservative as the ACA – similar to historical Republican proposals – is denied out of hand, and fodder for further political anger.


The alternative would have been to work out a bi-partisan agreement, and been more honest about elements of legislation that their ideology is actually comfortable with (“government keeping its hands off medicare”). But that would have cost political capital. Republicans would have had to tone down their rhetoric considerably, and admit that they too believe in some government, some of the time. Of course, the right-wing media-fueled tea party has largely tied them into this sort of craziness, but at some point you need to have principles.

Insurance Pools and Information

Reihan Salaam is a rarity it seems these days: a reasonable conservative who is both knowledgeable about the context of his opinions and willing to engage issues in an intellectually honest capacity.  I've long wanted to find more right-wing thinkers like him to defray my somewhat tendentious reliance on liberal thinkers for political and cultural analysis.  I say somewhat tendentious because, to be fair, conservatism has taken the express train to crazyville lately.

So I was delighted to see that he's blogging at National Review, with comments (although there don't appear to be many!), and that from the looks of things he's providing some quite interesting and reasonable writing.  In a great little posting on what the increasing availability of medical predictors in patients might mean for the entire enterprise of health insurance.  He quotes fellow conservative Mankiw:

If insurance companies do not use these markers, perhaps because of regulation, will the availability of these tests cause the markets for life insurance and annuities to unravel because of increased adverse selection?

Then, economist Stephen Cecchetti:

To understand the problem, think about a simple case in which there are only two kinds of people, those with high and low expected future medical-care-costs lives. Imagine that the insurance company can’t distinguish the two types, so it charges all comers the average cost across the entire population.  For the healthy people, the cost of the insurance will look very high, so they won’t buy it.  That means that the only people who will buy the insurance are the unhealthy.  Realising this, the insurance company will have to raise their price further to compensate for the fact that only the high cost people are willing to buy insurance.  This is the classic “lemons” problem that causes markets to fail and was first described by George Akerlof. 

Salan takes this predicament seriously, avoiding any knee-jerk reaction that ideological pre-disposition might suggest. 

Agree or disagree, it is an excellent and insightful discussion of the underlying issues shaping the private insurance market of the future.

I agree that this is fascinating. Insurance pools rely on a diffusion of risk. But what happens when that risk is removed? Sure, we'll all still face accidents. But I imagine most health costs that are in theory predictable, and do not involve broken limbs or infectious diseases.

Fundamentally, this goes very deep, down to our assumptions about human agency. To what extent are we in control of our lives? Any insurance pool is weighted towards people at greater risk. So what about people who make poor decisions? One model is that they could have chosen otherwise, and so the consequences should be born entirely by them. If you eat too many Cheetos and get type II diabetes, you should pay for your own insulin (this is assuming no genetic pre-disposition to overeating is found). But another model says that we - our choices - are in large part socially determined. So it is through life experience, education, etc. that one individual is more likely to be susceptible to weight gain. That there are social predictors (demographics and social capital trends) for obesity is evidence that we are not all operating with the same level of human agency. How then is risk apportioned? Should one really be considered responsible (that is, should society *not* be responsible) for the burden of this disease?

And then there is the more morally simple question of those who indeed have a genetic (not social) predisposition to disease. Should they bear the burden alone? Society already makes many sacrifices for those we consider "deserving" of our help.

But health care, unlike say, car or fire insurance, has a number of different components. Driving or owning a house is generally egalitarian where risk is concerned. To the extent that insurers are able, they make adjustments. But for most people the difference is marginal (for those of us who don't live in fire-prone environments, or have clean driving records). But what's more, the stakes aren't nearly as high. Health care is infinitely more complex and for many people a matter of life and death, whereas auto or fire insurance is considerably less so.

In other areas of life, we just assume that society should guarantee a basic level of access no matter what - the alternative would be at best onerous, and at worst horrible. For instance public education, roads, parks, etc. are all things that we basically say, "OK, we'll just do this and everyone can have it." The idea that only certain individuals would be allowed to send their kids to school, have access to 911, drive across certain bridges, etc. is almost absurd (even though yes, this was certainly the case through much of American history).
So the discussion is complicated. There are competing interests and compromises to be made. But it is a discussion that, as Salan points out, will only become more critical as society becomes increasingly capable of delivering more useful information.

The Meaning of Government

A common complaint among people who resent taxation is that the government is "stealing" their money.  I wondered whether they would consider these people thieves:

• The members of the armed forces who risk their lives for us
• The police who protect our neighborhoods
• The firemen who literally have a pole next to their bed they can slide down to get to us faster
• The teachers who take all the kids in our neighborhood and help them to become intelligent and skilled citizens
• The highway workers who fix the holes in the roads we drive on
• The bus drivers who are there in case we don't feel like driving
• The inspectors that make sure our hamburger meat isn't tainted
• The geologists who monitor our volcanoes in case they feel like blowing 
• The lifeguards at our beaches
• The park rangers who protect our natural parks
• The judges that make sure we get a fair trial
• The public defendants that we are given by right
• The postal workers who brings mail to our door
• The librarians that make sure our neighbors stay well-informed
• The doctors in subsidized emergency rooms that will take us no matter what

In the words of Supreme Court Justice Oliver Wendell Holmes, Jr.:

"I like to pay taxes.  With them I buy civilization."

Closing the College Achievement Gap

There is an understanding implicit in the city college and state university systems, and to a lesser degree (through scholarships) at private universities, that diversity is good for higher education.  Not just racially, but in broader terms providing a hand up to those who are willing to put in the effort required to succeed.  This is no where more clear than the city college model, where almost anyone is accepted, and remedial courses and support is built in from day one.  While less so at the state university level (I don't believe they offer remedial courses), there is still a community ethos and more attempts are made to promote diversity - especially in the subsidized tuition.

We have known for a while now that disadvantaged students at these institutions are much more likely to fail, even despite attempts at support and intervention.  Some students are probably beyond help, whether due to financial, cognitive or emotional limitations that are too great.  But the degree to which the students "just aren't cut out for college" is over-assumed.  There are structural problems at the institutional level that, were they resolved, many more students would find success. 

To the degree to which adequate support is unavailable, these students are at the mercy of success in the classroom; whatever outside pressures come to bear, a failing grade is going to be the last thing many of them see before they return to the workforce, sans-degree.  This places the professor in the difficult position of handing out what, in essence, are college death-sentences.  It would make sense that this could result in grade inflation.  The logic is likely that, considering the hardship the student faces, there is a social injustice in giving them a failing grade.  If inflation is implemented, even marginally, that student might find a way to make it in the end.

Of course, at the system level, this can be pathological.  Standards are gradually reduced, which is unfair to all students.  Getting an inflated grade in one class might give the student a false sense of efficacy, setting them up for failure later on, in another class.  At city colleges, this pressure is lessened by the existence of extensive support: classes are far cheaper, night courses are widely available, failing students can be sent to a writing lab, or remedial courses.  At the state or private level, few of these options are going to exist, and failure will be quick.  However, admission at these institutions will have already removed at-risk students through stricter admissions.  At city college, as they accept anyone, the demand for support services is all the more crucial.

Matt Yglesias points out that there are many models that have shown great success in supporting students, and could theoretically be instituted at every level of academia.  He links to Monica Potts:

A new program at the University of North Carolina pairs low-income students with faculty and peer mentors, monitors their grades, and instills them with basic job-hunting skills like business etiquette. Graduation rates for program participants were 17 percent higher than for students in the control group. Low-income students simply need more resources, and that’s as true for students at the college level as it is for those in elementary and high school. The kinds of schools most likely to serve lower-income students, though, often have the fewest resources. And state-level higher-education funds are vulnerable as states shrink their costs in a difficult budgetary environment.

Yglesias writes:

It’s worth underscoring how perverse the allocation of resources inside American higher education is. We expend the most time, money, and effort on helping the set of high school graduates who need the least help, even though these very same people tend overwhelmingly to come from families who have the most resources (in terms of both money and social capital) with which to help them. It’s nuts.

An important thing to note here is that, assuming the students are academically equivalent, there are still going to be large disparities in student capital (human+social capital). This means anything from navigation of campus norms, peer-group isolation, parent support, financial issues, etc.

Then, in situations where the academic equivalence is not there (usually in city college), students are going to be taking remedial courses and in many cases the “tricks” that may have worked in high school just won’t cut it. These students face the double challenge of having to succeed in college-level courses that may rely on work that they aren’t ready for.

The solutions don’t seem to difficult – counseling, cohorts, etc. But they do require resources.
*One last thing to note: my wife taught English at a PA state university and had students from one of these low-income cohorts. The papers they turned in, while often slightly sub-par in grammar, etc., were generally heads and tails above the other students in terms of a sort of wisdom of life experience. Far from vacuous and cloistered, these students represented a form of striving that seemed invaluable.

These are exactly the sorts of voices that we need at the university level, and we should be giving them any support necessary to see them succeed academically.

Pro-Life, Animal Rights and Subjective Morality

Often times in ideological debate we make the mistake of trying to strengthen our argument by creating a false narrative for our opponent's character.  This is partially due to emotional frustration with the perceived consequences of their belief.  But it is also a cheap attempt to undermine their position by painting it as based upon character flaws. 

So the conservative is greedy and uncaring, so he opposes redistribution.  The environmentalist hates business, so wants more regulation.  The corporation doesn't care about anything but profit, and thus acts without moral consideration.  While there may be some truth to each of these claims, they have no direct bearing on a particular position's merits.  So a conservative may be charitable and compassionate, and still oppose progressive taxation.  An environmentalist may love business, and still want to regulate a particular business.  Etcetera.  While looking at an opponent's character may be useful in a sociological sense, it can be quite misleading and lead to irrational and unfair arguments.

One of the strongest cases of this is on the issue of abortion, specifically on the pro-life side. Understandably, because they believe that the fetus has all the special meaning of a birthed baby, abortion is in many ways no different than murder.  The more radical pro-life position is to indeed equate abortion with murder.  Yet it is not, necessarily murder at all.  If you do not attach the same meaning to the life of a fetus as you do the life of a birthed baby, then killing it is a very different act.  If one is not religious, and doesn't think there's anything wrong with killing a fetus because they don't consider it a meaningful life, then they are being entirely principled in supporting a woman's right to choose. It is perfectly congruent with leading a moral, compassionate and righteous life. So while your moral disagreement is perfectly legitimate, your narrative is false.

I think an illustrative example of this is the subject of animal rights. If you believe that animals are meaningful lives, in the sense that we ought not kill them for our own pleasure, then "murder" is being committed on a horrendous scale daily. But hunters and meat-eaters are not bad people - or even immoral. They simply have a different belief about the meaning of animal life - one that is perfectly reasonable within the bounds of modern attitudes. The "pro-choice" attitude among vegetarians would be that people ought to be allowed to make that determination for themselves, considering that the question of meaning and animal-rights, just like the question of meaning and fetuses, is reasonably debatable; There are very good reasons on both sides for making different, subjective decisions.

Ideology and Unemployment Insurance

Kevin Drum thinks that economics is inherently ideological.

Ideology is everywhere, and it's often strongest in the very places that pretend the hardest that they don't cater to it. Economics, unfortunately, is still an immature discipline, much more complex than something like chemistry or physics, and that mean that if you pick your assumptions carefully you can prove almost anything you want. And economists do.

He points to Mike Konczal who describes the bias built-in to economic theory:

Speaking as someone who has taken graduate coursework in “continental philosophy”, and been walked through the big hits of structural anthropology, Hegelian marxism and Freudian feminism, that graduate macroeconomics class was by far the most ideologically indoctrinating class I’ve ever seen. By a mile. There was like two weeks where the class just copied equations that said, if you speak math, “unemployment insurance makes people weak and slothful” over and over again. Hijacking poor Richard Bellman, the defining metaphor was the observation that if something is on an optimal path any subsection is also an optimal path, so government just needs to get out of the way as the macroeconomy is optimal absent absurdly defined shocks and our 9.6% unemployment is clearly optimal.

Arthur Laffer, darling of conservative economist, made a similarly ideological claim in a recent WSJ op-ed. He argued that unemployment insurance creates a disincentive to work, likening it to welfare. The problem is this ignores both the concept of unemployment insurance as just that - insurance. Highly skilled workers tend to be very specialized, and should not be expected to retrain in a new field just because of an economic downturn. What's more, they will only introduce more competition into the low-skill market. The idea of insurance is that we all pay into a pool so that during downturns, those of us unable to find employment will receive a sort of buffer until the economy picks up again. This is why it is called "insurance".

According to the theory, if the market for, say, heart surgeons takes a dive then offering unemployment insurance will disincentivize them to look for work. What they should be doing is taking a enormous pay-cut and applying at some low-skill job. But what if a new surgery position opens up? Should they just run out on their new employer? And do you really think that, in hard economic times, when jobs in their profession are hard to come by, they're simply going to not look for work, passing by possible (secure) job opportunities just so they can sit home and live off the maximum insurance payment - assuming that when it runs out they'll be able to find work easily?

It's all pretty ridiculous. I say this as an unemployed teacher who applies for every possible position available. I'd take anything in my profession at this point. If I thought there would never again be any teaching jobs I would face the reality and find a new line of work. But there will be (hopefully soon!), and applying at best buy isn't going to do me or any of the other low-skill workers any favors.

On a side note: many people are not quite aware of how unemployment insurance works.  You'll hear them - guiltily - justifying their acceptance of government checks by saying things like, "Well, it's my money.  I paid into it for years."  This is only partially true.  The structure of unemployment insurance system is a bit complicated, but suffice it to say that what one is paid has nothing to do with the total amount they have paid in.  While your payment rate is based on your previous year's income, the total payment is a fixed amount, regardless to any lifetime contribution to the pool. 

While working, your employer is the one who actually pays the state each month.  They are responsible for paying a set amount for each worker.  You could argue that this ultimately comes out of one's wages, but the amount is usually very small, with a monthly maximum (I believe) of around $50.  This means that the most an employer ever pays for a full time worker is $600 a year.  So if a hypothetical payment allocation of $6000 was made, one would of course have had to work for 10 years to pay in that amount to the system.

In essence, unemployment insurance is just that - insurance.  The model is that even during recessions, when unemployment might reach 5, 8, or even 10%, the other 90% is still paying into the pool, with the community-minded concept that we are all doing our part and if one of us faces difficulties we all - "have his back" so to speak.  This is no different than any other insurance model (healthcare, auto, etc.), where one might go a lifetime without needed open-heart surgery, God-forbid.  But in case we do, we're covered.

The Nihlism of Pain

I'm not sure how to start this off, but I wanted to say a few things about the experience of living with chronic pain.  One of the most jarring and confusing things about living with chronic pain is the extent to which one's daily rhythms and life habits are altered in ways that people who do not live with pain could not possibly understand.

Humans are social creatures.  We cannot help but identify and define ourselves by shared experiences with others, from the most specific ethnic eccentricities to the largest sort of intangible aspects of simply being human.  So a person in chronic pain, acutely aware of an absurd difference in daily experience, develops a sense of alienation.  More and more, the juxtaposition of personal experience begins to erode social bonds at the edges.  Things like walking or talking or sitting are sometimes difficult. 

So a fragile dance begins to pick up in rhythm.  The object of the game is to feel and appear normal.  When in public this is an utter necessity.  To the best of our ability, we all want to love and be loved.  Well, some of us do.  But society tends to shrink from suffering.  Nothing worse than to be shrunk from. 

That's less important.  The real trick is in maintaining personal integrity at home.  If a man's home is his castle, his body his temple, then chronic pain is like barbarians at the gate.  And they're sneaky.  Sometimes things look good - the sun is shining, the milk is flowing.  That's when they like to pop out!  Scabbards dangling, hatchets clanking, they throw you into the furnace.  It's hot in there.  You do things, say things you regret.

You recover, of course - you always do.  And hopefully the damage isn't too bad.  But a sense of impermanence sets in.  Life can begin to feel like a series of spinning plates.  Sure, you've got them all going now, the crowd is going wild - you're doing it, son, you're doing it!