Conservative Economists on the Ryan Plan
From TPM, an overview of conservative economists’ assessment of the Ryan plan. Their bottom line is not that different from Krugman’s — the plan is neither serious nor courageous. Here’s a taste:
“It doesn’t address in any serious or courageous way the issue of the near and medium-term deficit,” David Stockman told me in a Thursday phone interview. “I think the biggest problem is revenues. It is simply unrealistic to say that raising revenue isn’t part of the solution. It’s a measure of how far off the deep end Republicans have gone with this religious catechism about taxes.” Stockman, who directed Ronald Reagan’s Office of Management and Budget, approves of Ryan’s entitlement proposals, but breaks faith over taxes and the GOP’s unwillingness to slash defense spending. And he laughs off the notion that the plan will do anything about unemployment, let alone dramatically reduce it, which Ryan and his plan claim it will. “This isn’t 1980. It’s not morning again in America. it’s late afternoon, or possibly even sunset.”
On this score, Doug Holtz-Eakin — a former McCain and George W. Bush economic adviser — told Huffington Post Ryan’s plan is “implausibly optimistic.”
I had intended to avoid commenting any further on this topic, but this post is so absolutely completely disingenuous that I have to respond.
To be sure, there are some ACTUAL conservative criticisms of Ryan’s budget being offered. I linked to David Brooks and Reihan Salam last week; here’s NY Times Ross Douthat’s column today: http://www.nytimes.com/2011/04/11/opinion/11douthat.html?ref=opinion#
It should not be surprising that conservatives are tweaking and critiquing the plan; that’s what conservatives do. However, they are all clear that Ryan’s proposal deserves credit and represents a significant victory – the debate has been won by and shifted to the right.
Now to the so-called “conservative” critics linked to this story. There are TWO essentially quotes in the source story: one from David Stockman, once Reagan’s OMB Director, the other to McCain’s economic advisor, the brilliant Douglas Holtz-Eakin.
Holt-Eakin has criticized Ryan’s ASSUMPTIONS, but he actually SUPPORTS Ryan and agrees with the effect of his proposals. Here is a link to his ACTUAL statement in National Review last week. I think if you read it, you would hardly come away with believing that he is a Ryan critic. http://www.nationalreview.com/corner/264040/economics-ryan-budget-douglas-holtz-eakin
Finally, calling David Stockman a “conservative” is a little bit like calling Dick Morris a Democratic political operative. He is, of course, liberals’ favorite kind of “conservative”, i.e. one who worked for a Republican in the past but who has come to see the light and forsworn his evil ways. He is hardly taken as a conservative heavy-weight, even in his Reagan days.
I have come to resign myself to the fact that dotCommonweal is not that interested in fair and objective analysis, but rather proof-texting a decidedly partisan point of view. And that’s fine, such as it is. But I would kindly ask the contributors to at least make an attempt at some intellectual rigor when it comes down to it. Because this kind of lazy ad-linking is really unbecoming this publication.
Mr. Landry: You’re too good for this lot. Maybe you should take your on-target comments to a blog that would lap it up!
@Jeff Landry (10:52 am) As you know from the thread sparked by Prof. Penalver’s (how do I type a tilde here?) post last week, I had plenty (perhaps too much) to say about Rep. Ryan’s proposal. I also quoted and linked to several reactions—conservative, liberal and moderate—to the proposal. In addition, I believe I linked to some liberal proposals, and tossed out my own ideas, for dealing with the federal government’s long-term fiscal health. You and several other commenters also made multiple contributions to that thread. All in all, I thought there was a fair amount of analysis, both “fair and objective” as well as partisan and subjective, in that thread.
I expect bloggers at Commonweal to express a point of view. I expect the same from bloggers elsewhere—whether liberal, moderate, conservative, religious, secular or otherwise. Part of what I enjoy about dotCommonweal, as well as other blogs I follow, is the conversation that follows from commenters which, at its best, enlarges and deepens the issues raised by the original poster. At its worst, of course, it descends into name-calling and “flame wars”.
Since last week’s conversation here at dotCommonweal about the Ryan plan focused mainly on reactions, pro and con, to the plan, its policy proposals, its assumptions and calculations, perhaps this week we could begin to reflect on Rep. Ryan’s proposals in the light of Catholic social teaching and theology.
For myself, it’s striking how little resonance with such fundamental Catholic Christian notions as “the dignity and equality of the human person”, “the preferential option for the poor”, “community and participation”, “human rights and responsibilities”, “the dignity of work and the rights of workers”, and “care for God’s creation” Rep. Ryan’s proposal seems to have. What do others think? And why?
@ Ms. Steinfels – Is that a not-too-subtle invitation to cease commenting here? I’m a bit confused; I thought liberals and progressives were committed to open and free debate?
@ Luke Hill – I agree with your desire for such a dialogue, but I think it absolutely crucial that the terms of such a dialogue occur on a respectful, honest platform. The “views” linked to in the original post are not that. You cannot have a dialogue when you engage in this sort of thing. As for your desire to examine the proposal in light of CST and your views that the plan falls short of that, the problem I see is that some of the terms you use are somewhat vaguely defined, and, moreover, I’m not sure either side has a proposal that would measure up. I could argue, of course, that maximizing consumer power and choice is supportive of the “dignity and equality of the human person”, and that unless something is down to trim entitlement programs, there would be such a disastrous economic consequence that there would be nothing left for a preferential option for anything! I think you would like some of Douthat’s recommendations re: inequality and wage stagnation (albeit they are conservative proposals). I would be interested in your reaction to that.
I rereference Cathiolic Moral Theologian blog that strives to be above the liberal/conservative divide that is often complained of here.
The capital sins today from the Apostolic signatura Bishop include accumulating excessive wealth, increasing poverty and increasing the disparity between rich and poor.
The poster there post there posits this is THE moral issue of the day.
Alawys the question: how much does our (political) ideo;ogy inform our values today?
Here’s the view of Gary Becker, a conservative economist not included in the TPM “overview,” regarding the Ryan Roadmap:
“the Roadmap contains excellent proposals that, if enacted, would greatly improve the long-term budgetary situation of the federal government of the United States, and the long-run prospects for the American economy.”
http://www.becker-posner-blog.com/2011/04/paul-ryans-roadmap-for-americas-budgetary-future-becker.html
BTW, Tyler Cowen, an economist who was treated as an authority in the TPM review, has an interesting link about the anger of redistributionists. The paper Cowen refers to is by a conservative law professor (they do exist) and the comments on the Cowen website (pro and con) are interesting:
“redistributionists and anti-capitalists expressed lower overall happiness, less happy marriages, and lower satisfaction with their financial situations and with their jobs or housework.”
http://marginalrevolution.com/marginalrevolution/2011/04/sentences-to-make-you-angry-or-not.html
The study is not conclusive, of course, but as long as we are exploring the views of conservative economists it’s worth mentioning there’s lots to discover on Cowen’s website — more than is dreamed of in TPM’s philosophy.
“I have come to resign myself to the fact that dotCommonweal is not that interested in fair and objective analysis, but rather proof-texting a decidedly partisan point of view. And that’s fine, such as it is. But I would kindly ask the contributors to at least make an attempt at some intellectual rigor when it comes down to it. Because this kind of lazy ad-linking is really unbecoming this publication.”
Jeff –
If you’re as smart as you seem to think you are, you should be up to learning that insults such as the above never incline listeners to take a speaker seriously.
Perhaps if you let that lesson sink in, people might take your “arguments” more seriously. Insult is not evidence, and negative rhetoric is self-defeating.
@Jeff Landry (11:36 am) Thanks for your response. As I said before, I view a contributor’s original post as, in effect, an invitation to conversation and reflection. I’m dating myself here, but that dynamic was part of what made William F. Buckley’s “Firing Line” an interesting, and often informative, TV show. YMMV.
I read Douthat’s column and I take his concern for what he calls “working-class opportunity” as being at least in part informed by his Catholicism and the influence of the Church’s social teaching. (Obviously an assumption on my part, but one I’m happy to make.)
As for Douthat’s proposals, off the top of my head I would endorse:
*(even further) cuts to farm subsidies (particularly those aimed at corn, soy and meat production);
*repealing tax expenditures that benefit primarily the rich;
*his concern that “at least in its initial draft, too much of the budget’s austerity is borne by downscale Americans”;
*his opposition to repealing the ACA without putting in place a replacement law that accomplishes similar objectives;
*cutting oil and gas subsidies and tax credits (I’d consider subsidies for renewable energy development, though at a fraction of the revenue raised by the oil & gas cuts);
*his implied support for a fairer tax code that has fewer tax loopholes;
*his preference (or so it seems to me) for cutting corporate welfare before cutting Medicaid.
@Bob Nunz (11:42 am) Thank-you for your post. An overriding fear I have about Rep. Ryan’s proposal, one that Mr. Douthat seems to share (at least in part), is that the proposal would increase poverty and increase the disparity between rich and poor.
I enjoyed Tom Scocca’s response to David Brooks’s take: “The Ryan proposal ‘has moved us off Unreality Island,’ Brooks writes. Provided, that is, that you ignore the fact that it won’t work and the fact that no one will vote for it.”
@Luke Hill: Thanks for your response. Douthat, Reihan Salam, Douglas Holtz-Eakin, and (sometimes) David Brooks represent to me the most creative policy thinkers and commentators on the right today. All have their critiques of Ryan, as do I, but I think some of this must be chalked up to the divide between Ryan’s political instincts and the more wonkish commentators. But the politics of it aren’t all bad. As Brooks said on the Newshour Friday, Ryan has succeeded in sketching in broad detail for the American people what kind of government they can afford on the current fiscal reality. As Brooks said, most Americans want more government than their willing to pay for, so he’s succeeded in setting up the Democrats to have to argue for increasing taxes as well as cutting spending, a fight that most Democrats do not relish.
It appears to me that the next salvo in this debate (which I think again Ryan and the GOP have succeeded so far in co-opting from the Democrats) is going to be taxes. And that excites me because I think there is broad bi-partisan consensus that the tax code simply has to be simplified and made more user-friendly. Both parties deserve blame for the atrocity they have wrought on the tax code. I think both sides recognize that while rates will be slightly higher, the tax base will also have to be broadened, so the number of people who find themselves “rich” in the words of Pres. Obama might be surprising because simply increasing the rates on the super-rich, laudably as it might be, won’t wring out enough revenue. I think the Republicans win that one too; Tom Coburn is taking on Grover Norquist and providing some needed cover to Republicans.
@Ann – Again, I’m not interested in a tit-for-tat with you about my “name-calling” because I think its in the eye of the beholder. My only point is that the title of this post and the story linked in the post are misleading in some fairly fundamental ways. And I just don’t think its fair to suggest that these “conservative” critics are dumping on Ryan. If you don’t want to take my arguments seriously, that’s fine by me, but I submit to you that whatever side of teh debate we’re on, we have to be fair and accurate in representing the arguments, and the TPM story, as well as the title of this post, do not do that.
“An overriding fear I have about Rep. Ryan’s proposal, one that Mr. Douthat seems to share (at least in part), is that the proposal would increase poverty and increase the disparity between rich and poor.”
As, apparently, does the CBO.
Here’s a viewpoint I hadn’t seen before on the federal government’s fiscal future (from Austin Frakt at The Incidental Economist— http://theincidentaleconomist.com/wordpress/did-we-ask/ ): using the CBO’s baseline projection of “federal primary budget as a percent of GDP after passage of health reform”, he shows a graph with balanced federal budgets (excluding interest on debt) for the next two generations, beginning about 5 years from now.
“I have come to resign myself to the fact that dotCommonweal is not that interested in fair and objective analysis
Jeff ==
The name-calling here is not “in the eye of the beholder” as you claim in a subsequent post. To refer to “dotCommonweal” is to refer at last to most of the people on the blog, and to say that we are “not interested in fair” analysis is to say we are unjust. Now it might be a fact that we are unjust, or some of us are, but the fact remains: to call us “unjust” is name-calling. It’s insulting, and insult are not evidence.
Don’t fool yourself. If you want to be taken seriously cut out the insults.
@Ann – I think based on the constructive back and forth I’ve had with Luke Hill and a few other commentators, I’ll assume my arguments are taken somewhat seriously. If you’d like, I’ll re-write the paragraph to which you object to make it clear that I think Mr. Penalver’s post is misleading when you look at the actual comments in the source story. Of course I do not mean to suggest that all users of dotCommonweal are being unfair or misleading.
I would also note Ann that you haven’t yet chosen to respond to a single argument or critique I’ve suggested, nor shown me how my criticisms of some of the coverage of Ryan’s plan are baseless, which leads me to believe you’re more worried about the substance of my point of view rather than the way it is expressed.
First of all, why all the thin-skinned derisive comments from our dotCommonweal politburo? There’s enough room in the sandbox of ideas for everyone, isn’t there? Let’s play nice.
Actually, Ryan may in the long run be just what working and middle class advocates need to energize their political counter-attack. Ryan is, after all, from Wisconsin, ground zero of the liberal and labor resurgence.
Destroying Medicare by turning it into a voucher system? Really???
How fast do you think it will take the health insurance industry blood-thirsty sharks to figure out that they can make $billions by cutting grandmas off from their health insurance after they pocket the vouchers? No health insurance company will ever insure the poor and middle class elderly because they are a too much of a ‘health risk’ for really big medical expenses. Get real!
As a health professional, believe me, the best thing that ever happened to the elderly regarding their health care access, despite all its problems, was, and IS, Medicare.
If anything, the Ryan proposals should make like shooting-fish-in-a-barrel for us liberals, politically speaking! I can just imagine the soon-to-be Madame Speaker (Again!) Nancy Pelosi dancing the “Tarantella” all over Ryan’s face. Thank you, God, for all these tax cuts-for-the-rich grubbing Republicans!
Paul Krugman, of NY Times and Princeton fame, my Nobel economic evangelist of choice, framed the Ryan proposals best: “Republicans have once again gone all in for voodoo economics – the claim, refuted by experience, that tax cuts pay for themselves.”
Everyone really should re-read Krugman’s op-ed: Ludicrous and Cruel, NYT, 4/8/11. I take the liberty of reprinting his conclusion here:
“[So] the pundits who praised this [Ryan's] proposal when it was released were punked. The G.O.P. budget plan isn’t a good-faith effort to put America’s fiscal house in order; it’s voodoo economics, with an extra dose of fantasy, and a large helping of mean-spiritedness.”
If Democratic liberals and progressives can’t win the next election on this issue alone, we should get out of politics.
@Jeff Landry (12:29 pm) One of the frustrating aspects of this debate (for this liberal at least) is statements like “both parties deserve blame for the atrocity they have wrought on the tax code”. Here’s why.
From the liberal perspective, Ronald Reagan’s 1981 tax cuts blew a hole in the deficit because at the tax rates Reagan inherited, large tax cuts don’t (or at least didn’t in real life) decrease deficits by stimulating growth that more than makes up for the lost revenue from the tax cuts. Democrats then worked with Reagan to increase taxes several times in the rest of his administration to repair (partially) the damage done. Most notable of these efforts were the 1983 Social Security fix and the 1986 Bradley-Gephardt reform of the tax code.
When President H.W. Bush agreed to raise taxes, Democrats (led by Senate Majority Leader Mitchell) agreed to spending cuts to pass the 1991 budget. That budget, along with the 1993 budget/tax increase passed under Clinton without a single Republican vote, led to the budget surpluses of the late 1990s.
President W. Bush then passed two massive tax cuts (2001 and 2003), a major health care reform (Medicare Part D), and for the first time in history, committed the US to war without even seeking, let alone securing, a tax increase to pay for the war (or for Medicare Part D).
By contrast, President Obama’s major health care reform initiative in the last Congress was the Affordable Care Act which reduces the federal deficit slightly in its first 10 years and more steeply in the following 10 years.
Both times in the past generation that Democrats have acted unilaterally to restore fiscal balance, Republicans have successfully used that against them in the following election. When Republicans controlled both the Congress and the White House, they have not acted to restore fiscal balance; to the contrary they’ve added enormously to the federal debt.
I go on at some length about this, not to attack you, but to provide some perspective on how it looks from the “other side of the table” (to coin a phrase). The fact that Ryan’s numbers don’t appear to add up (we’ll know better once he’s drafted an actual bill and had it scored by the CBO) just reminds Democrats of the way the numbers didn’t add up under W. Bush either. The fact that he proposes repealing the ACA—which would increase deficits—and does not propose replacing it sets alarm bells ringing for liberals (and many deficit hawks) as well.
@Jeff Landry (11:36 am) Sorry to be going out of order here, but I appreciate that you gave an initial response to my request that we look at all this in the light of Church teaching. Here are some of my thoughts along those lines:
*Dignity & Equality of the Human Person—By repealing the ACA and not replacing it, Ryan would effectively take health insurance away from 30 million people. By abolishing Medicare arbitrarily (for those under currently under age 55), and by replacing it with a voucher of decreasing value as time passes, Ryan would—for what appear to be crass political reasons—create a generational inequality that does not now exist. Jeff, your argument that “maximizing consumer power and choice is supportive of the “dignity and equality of the human person” brings to mind Anatole France’s famous line: “The law, in its infinite majesty, forbids the rich as well as the poor to sleep under bridges, to beg in the streets and to steal bread”. In this case we might add that Ryan’s proposal, in its infinite majesty, allows the poor as well as the rich to buy expensive health care treatments that could prolong their life and health for decades”.
*Option For the Poor—Again, it’s probably best to wait until it’s an actual bill, but at this time it appears the most glaring failure of Ryan’s proposal, in terms of Church teaching, is the way it not only does not have an “option for the poor” but in the way it actively targets the poor (now, and the middle class eventually) for most of its spending cuts in order to pay for tax cuts that will primarily flow to the rich.
I could go on, but I’ve probably already said too much, and anyway, these are the two main points that struck me. Again, I welcome your further thoughts Jeff, as well as contributions from anyone else.
Regarding criticizing the forums you choose to write in, it makes no sense to me. I have recently written a fair amount on the First Things blogs, and in almost all of what I say there, I am in disagreement with the contributors and most of the other commenters. I don’t hesitate to criticize the contributors and what I believe their biases to be, but I wouldn’t criticize First Things itself on First Things. It is what it is, and if I ever find it so objectionable that I feel the need to try to get the contributors to change the nature of the forum itself, I’ll just stop writing there.
We are all so convinced of our own views that we find it difficult to believe those who disagree with us do so in good faith. How can they possibly believe what they are saying??? But aside certain strategists and politicians who really are engaging “spin” or are just downright lying to shape things to their advantages, I think most people honestly believe the arguments they make. So I think it is unwarranted to accuse people here of not being “fair and balanced.” People are here to express their viewpoints, to try to achieve some kind of objective coverage of the news.
Someone asked about the 2012 budget and CST. Here is a draft on the idea from Stephen Schneck at Catholic University.
http://ipr.cua.edu/blogs/post.cfm/a-savvy-and-compassionate-budget-balanced-by-2030
@Luke Hill – A fruitful few replies again! I hear you on the tax things. I think the big picture concern for me as this debate concerns CST is that I believe we are reaching a crucial crossroads with respect to the evolution of the American welfare state (an imprecise term I admit) in which we need to re-think the expectations we have. I think the best analysis/argument for this is the linked article by Yuval Levin (another creative thinker I neglected to mention). I think he argues somewhat persuasively for this require re-imagining. What excites me about Ryan’s proposal is that it is the only such proposal thus far (until perhaps tomorrow) that seeks to shape this re-imagining, imperfect and political as it is. Obviously as I ‘ve stated countless times already, I think at the end of the day we end up with a grand compromise, and whether that compromise skews more left or right of center is really what the debate is about. BUT, if all CST as articulated by my liberal Catholic friends, is going to do in this debate is mimic the worst talking points of the Democratic party rather than engaging in this creative re-imagining, then I think CST has reached a critical terminus in its ability to capture the hearts and minds of its own followers, let alone the larger public debates. It is simply not enough to say “let’s go get all the rich people’s money”. That is not intended as an ideological statement, nor to suggest that tax rates should not be increased. But so far, I am yearning for a creative Catholic thinker to engage the larger debate re: the welfare state in a way that doesn’t simply fall into the old and familar political trench warfare.
@David Nickol – Perhaps I was unclear in my first post. I am not criticizing dotCommonweal for being dotCommonweal. I am fully aware that Commonweal has a decided editorial point of view, as does First Things. I have no problem with that. But, just because you have a decided editorial point of view does not mean that you should abandon fair and accurate representations of arguments with which you are disagreeing. And Mr. Penalver’s post is, by any fair reading, a misrepresentation certainly of the “conservative” view of Mr. Ryan’s budget proposal, and of the individual viewpoints of the at least one of the persons quoted in the TPM story. So my criticism is not intended (at least in the first instance) at Commonweal for being “liberal”; my criticism is that in its coverage and “official” commentary on Ryan’s budget, it is shaping a critique that I think is somewhat disingenuous by cherry-picking quotes and giving snippets of commentary that I just don’t think accurately and fairly represent certain arguments.
@Margaret Steinfels (3:14 pm) Thanks for this link. I recall using either the Times’ budget calculator or a similar program (perhaps both) a few months ago and being pleasantly surprised by how relatively easy it was (in theory!) to balance the budget over time: some defense cuts (which, since our defense spending exceeds that of the next 10 largest military budgets—and some of those countries are our allies) which still keep the US as the largest military power in the world, returning to (or at least approaching) Clinton-era income tax rates, closing some corporate tax loopholes and tax expenditures.
(Of course, in the real world every proposed change is an uphill struggle. Alas.)
Jeff –
I don’t argue with name callers. The very fact that they call names shows they have poor judgment, at least about how people react, and how people react to others is a huge factor in economics especially. It’s a pity. Sometimes conservatives do have some worthwhile things to say. In fact, In some ways I’m quite conservative myself.
JEff ==
P. S. The reason I’m wrangling with you is because, without the tiresome negative stuff some of your posts might be interesting.
David Stockman? Seriously? A conservative? Just because of past associations, he’s no conservative. He’s not even a very good economist, but at least he’s right in his predictions as often as Paul Krugman – which is to say almost never.
I, too, got a chuckle from the suggestion that David Stockman is a conservative.
The arc of the moral universe is long, but it bends toward liberty.
Jeff,
The principal problem in this discussion is how we use plurals. Your umbrage is provoked because you take “conservative economists” to mean all conservative economists, while TPM used the phrase “conservative economists” to refer to three conservative economists. You may be justified since Mr Penaver’s seems to be reading it as an all inclusive plural, but his remarks are so brief it is hard to be sure.
But I do not think Holtz-Eakin’s position is anywhere obvious. As near as I can tell, he defends Ryan’s unemployment numbers by saying they “are based entirely — I repeat: ENTIRELY — on the Congressional Budget Office’s economic assumptions and baseline projections.” But this is in response to Krugman’s remarks about a graph from Ryan that compares the CBO’s projections with Ryan’s numbers, with no hint as to why there are differences when the assumptions are the same. And elsewhere H-E. calls the report on which Ryan bases his numbers “implausibly optimistic”, but seems to be defending those assumptions as if they were the same as the CBO’s. Clearly, I am missing something, which is why I say there is not much that is obvious about H-E’s position. He supports Ryan’s plan, but not his projections which are based on implausible assumptions that are the same as the assumptions of the CBO yet yield different projections?
None of these little points says much of anything about the issues I care about. Will reforming Medicare make people healthier? Or will it just “save” money by letting people be sicker? While economic issues are important, the real values here are health and security, and the discussion of economics has to be subservient to those values. Ryan has it upside down, or so it seems to me.
While economic issues are important, the real values here are health and security, and the discussion of economics has to be subservient to those values.
That’s a completely meaningless distinction in a system that spends astronomical sums — enough to save many thousands of lives elsewhere in the world — on incredibly sophisticated technology, in a losing proposition to forestall an old person’s natural death by months, weeks or days. You simply cannot talk about economics and values separately.
How much of your grandchildren’s future are you willing to steal in order to forestall your own death by one year? Three weeks? 48 hours? You simply cannot go on forever in a cost-free fantasy land.
Thank God we finally have a least one politician willing to act like an adult. Rep. Ryan is an inspiration and bona fide hero.
perhaps this week we could begin to reflect on Rep. Ryan’s proposals in the light of Catholic social teaching
Only if we first reflect on the status quo in the light of Catholic social teaching — e.g., the morality of stealing from future generations to buy luxury RVs for middle-class retirees and forestall their natural demise by a few days; the morality of stealing resources from the productive economy and handing them over to corrupt politicians and bureaucrats to waste; the fact that we condemn the poor to an atheistic government school monopoly that wastes staggering sums while accomplishing nothing; the fact that the one non-negotiable for Democrat politicians is their unyielding fealty to the abortion industry (“The cuts will be hard for us to swallow, but we won’t bend on Title X”).
@j.a.m (8:44 am) If you’d like to reflect on the status quo in the light of Cathlic social teaching, please do.
I, for one, would find your reflections more helpful if you would clarify and define some of your terms. For example, what sectors of the economy are included in (or excluded from) your definition of the “productive economy”? What are some examples of behavior that, in your definition, consists of “stealing from future generations”?
As for the public schools, I think we American Catholics can take justifiable pride in our contributions over the past two centuries towards ensuring that the public schools are not a vehicle for state religious indoctrination. I would also note that the public schools are, by and large, the only schools that take all comers—rich and poor, of whatever race, religion or creed, or whatever physical, mental or emotional ability or disability.
Oops, that should be @j.a.m (8:00 am), sorry.
“Will reforming Medicare make people healthier? Or will it just “save” money by letting people be sicker? While economic issues are important, the real values here are health and security, and the discussion of economics has to be subservient to those values. Ryan has it upside down, or so it seems to me.”
I just don’t frame the question as one of “economics versus values”. If you asked Paul Ryan, or at least took him at his word, his plan IS based on values because at the rate of projected growth of Medicare, it will blow such a massive hole in the budget that everyone, rich, poor, old, young, healthy and sick, will be left holding the bag. Change simply is not an option. We are about to hear the Pres. say the same thing, if the reports in the papers are accurate. Medicare is the problem pure and simple. The question is non-ideological: how do you control the costs of healthcare and enable old people to have access to some healthcare. The answers so far have been ideological. Ryan proposes treating healthcare as a good, i.e. lets subject health care to market forces, provide meaningful competition among private insurers and give some means-tested assistance to consumers, i.e empower the consumers. The left has said, no healthcare is a right and old people have earned the right to have their healthcare paid for. Their solution to controlling costs is to empower government. That’s the basic argument. I personally, based on my own experience and, yes, values prefer a free market, consumer-driven reform approach (I’m also no where near retirement nor receiving Medicare, and am used to making HSA contributions, etc.). But I think framing the debate as “if you’re for the Ryan approach, you’re not acting on any kind of values but just economics (which many take to be synonymous with greed) isn’t helpful. Ryan’s plan seeks to, yes, trim the plan but also to ensure that is available to the neediest and most deserving versus the status quo, which is unsustainable. My concern is that I don’t see many progressive Catholics acknowledging that unavoidable fact. IF CST is going to be synonymous with New Deal welfare programs, then CST (at least as interpreted by progressive Catholics) is in just as much trouble as the New Deal welfare programs, because change is afoot.
I did mean to add in response to Jim (11:34 pm) that I DO think there is a certain empiricism at play in policy analysis that would pit values or morality against utilitarian motives, but I think such empiricism is bi-partisan and not only one side. Part of that is the product of higher education, in my opinion, particularly in the elite schools that simply shuns any discussions other than utilitarian-based analysis.
@Jeff Landry (10:05 am) Good morning. A couple of reactions to your post.
1 – “Medicare is the problem pure and simple.” Actually the cost of healthcare is the “problem pure and simple”. I think you suggest something like that in your next sentence where you write “how to you control the costs of health care and enable old people to have access to some healthcare”. I would amend that sentence to delete “old” and replace it with “all”, and then we would, I hope, have general agreement on the framing of the question.
2 – If we agree that controlling health care costs is a central issue both for the US government’s budget and for our economy as a whole, then based on what I’ve read so far (and again, it’s early days and Ryan’s proposal is not yet a bill that can be more properly evaluated), Ryan’s proposal repeals (and does not replace) the (multiple) cost control measures in the ACA, and shifts the risk of high health care costs from the society as a whole (through Medicare) to individuals—provided those individuals are under the age of 55 this year.
Without even getting to questions of ideology, it seems to me—and to a number of more knowledgeable commentators from across the political spectrum—that Ryan’s proposal is likely to eventually (10+ years from now) to reduce the % of health care expenditures paid for through Medicare and Medicaid, but does little to reduce the growth of health care expenditures overall. In addition, from a Catholic perspective, it appears that Ryan’s plan suffers from what we might call an “option for the well-off and healthy” as opposed to an “option for the poor”.
3 – Thanks for sharing your own experience with health care, and how that experience intersects with your values and ideology. Here’s a part of my experience (although my values and ideology pre-dated this experience).
Eight years ago, a week before starting a summer vacation and feeling fine, I went for a routine checkup with my cardiologist. (I’ve inherited a genetic cardiac disorder from my father’s side of the family. Note—a pre-existing condition of the type that, pre-ACA, insurers would use to deny coverage. Fortunately for me, my wife’s job provides excellent health care benefits.)
After reading the results of the echocardiogram and examining me, the doctor, “I can’t let you drive out of here. I’ve called an ambulance to take you to the hospital, and I’ve spoken with a colleague of mine who’s in the operating room today who will put in a pacemaker/defibrillator.”
Turns out my heart was beating irregularly, with as long as 3.5 seconds between beats, a condition that can lead to sudden blackouts—not desirable when driving down the highway to work. Since that day I’ve had the pacemaker to make sure that doesn’t happen (with battery changes every few years).
I apologize for the length, but here’s the point. My situation is an example of why giving people vouchers to buy health care in a market doesn’t work, or at least doesn’t work well. Many sellers, many buyers, equal information are the basic conditions for a functioning market in classical economics. That didn’t apply in my case (shopping around for a discount pacemaker installation wasn’t an option, and I wouldn’t have had the knowledge base to make a “rational choice” if it were) and doesn’t apply for many people—particularly the old, the young and the disabled.
4 – As for the current path of rising health care expenditures being “unsustainable”, I think progressives of all stripes, including Catholics, would say we not only agree, but that we’ve put forward and enacted a partial solution: the Affordable Care Act. It’s far from perfect but it’s a major step in the right direction on controlling costs (unlike the last major health care reform enacted by conservatives, i.e., Medicare Part D).
Again, I look forward to Chairman Ryan drawing up a bill, having it scored by the CBO and the Joint Taxation Committee, and debated thoroughly so that we all can see what a conservative plan looks like. (An aside: one source of frustration for progressives these days is the feeling that when we adopt conservative ideas—like the individual mandate for health care, like cap & trade for environmental legislation—conservatives “move the goalposts” and suddenly oppose what had been their own ideas. But that’s a conversation for another day. Sorry.)
5 – I think most progressive Catholics would agree with you that Catholic social teaching is not synonymous with New Deal programs, or with Great Society programs either. It goes far beyond the limits of those programs—as one would expect from a worldwide church that is several times older than the United States. For us Catholics, regardless of all the changes going on around us, the universal truths of our faith, and the social teachings that flow from it, remain the same. The challenge we face is how best to apply those teachings in our society.
In conclusion, regardless of the ideology of Rep. Ryan’s proposal, we Catholics all have a responsibility to evaluate it in light of the Church’s teachings. Since these are prudential judgments we’re making, it’s to be expected that we’ll come to varying conclusions. I remain deeply concerned that Brother Ryan’s plan will fail some of the basic “tests” of Church teaching (e.g., the option for the poor, the dignity and equality of the human person).
I will repeat, economics has to be subservient to values. Any economic goal has to be aimed at preserving or increasing what is of value. That includes the long term preservation of health care as well as the immediate needs of individuals. The current system is full of iniquities, but a system that will fix the economics but not help people be healthier is no fix.
Ryan’s plan for privatizing Medicare has defined contributions (=$) instead of defined benefits (=health). This is not the way to build a system whose object is health. If your object is not health, and you willingly would allow people to die rather than be a drain on society, those values should be discussed. Or have I misunderstood j.a.m.’s position?
Personally I do not see why a private insurance plan that looks a lot like the much reviled “Obamacare” is suddenly acceptable to Republicans. I have my doubts about the “savings” generated by replacing Medicare with that kind of plan, and I doubt that free market principles are appropriate without intensive education so that informed choices can be made. But even if you do not care about those issues, how will adding layers of insurance company bureaucracy help cut costs? Unless we are paying for death panels who ration lifegiving treatments, where is the savings?
Here’s Ezra Klein’s latest column about Ryan’s proposal— http://www.washingtonpost.com/blogs/ezra-klein/post/column-ryans-bad-joke/2011/04/12/AFyvg2PD_blog.html .
Here’s the opening: “Just over a year ago, I wrote a column praising Rep. Paul Ryan’s Roadmap. I called its ambition “welcome, and all too rare.” I said its dismissal of the status quo was “a point in its favor.” When the inevitable backlash came, I defended Ryan against accusations that he was a fraud, and that technical mistakes in his tax projections should be taken as evidence of dishonesty. I also, for the record, like Ryan personally, and appreciate his policy-oriented approach to politics.
So I believe I have some credibility when I say that the budget Ryan released last week is not courageous or serious or significant. It’s a joke, and a bad one.”
For those who don’t know, Klein’s a liberal, but is (I believe) generally respected across the ideological spectrum for his knowledge of and reporting on health care issues.
Rick Santorum cuts to the chase, removing all need to consider the opinions of experts of any stripe. God disapproves of health care reform, doncha know.
Well obviously there’s a ton packed into the last 2 posts.
@Jim (11:50) – I understand your argument, and I just think you’re setting up a false choice between “values” and “economics”. My problem with such a false dichotomy is that it prevents any reasonable debate as long as “good” is on side (values) and bad/greed/heartlessness is on the other (economics). And as I have objected before, I do not think that setting up such a Manichean divide is either fair to the other side nor accurate of their intentions. Nor, might I add, is it how actual legislation and policy get drafted, as Luke Hill points out. We all begin with larger values at play, but must apply those to concrete circumstances- and that is politics. Thus, it is fine to say we should make all people healthier. But, you cannot simply say “everyone is entitled to as much healthcare as they need/want/feel they need/want” for 2 reasons: 1) it is financially unsustainable and 2) the American electorate (most of them) don’t support that position. Thus you have to craft legislation that is both financially responsible (financial responsibility is a good value, too) and that you can actually pass in 2 houses of Congress.
@Luke Hill – re: health costs again. I think we’re just going to have to reasonably agree to disagree on how much ACA controls costs. The central premise on bending the cost curve is the excise tax that must be passed by Congress in 2014 or some such thing, and the establishment of an independent board to oversee the program and cut out the must-ballyhooed “fraud, waste, and abuse”. Now to me, adding yet another layer of government bureaucratic oversight to an already badly bureaucratic system is essentially moving money from one pocket to another. I’d much rather, again, trim the system, make a few minor, targeted changes that have a bigger impact (i.e. universalize the tax credit for health care currently only available to employers), and empower the acutal users to make the choices. ACA does very little, from my reading, to actually monkey with broken system, and its proposed changes are still a ways off, require future Congresses to make politically difficult choices that the current Congress and President clearly dont want to make and essentially amount to some window-dressing promises to lower costs in the future.
Now, it seems to me a broad consensus is emerging, left and right, that Ryan’s budget re; the issue of cost controls is severely limited. I would agree with that. But I think the overall impulse is correct: we MUST shift some of the costs from society as a whole to individual consumers of health care. It is very easy to be in favor of lush healthcare for all when you’re not paying for it, and that is a fundamental driver of the skyrocketing health care costs. I had this conversation the other day with my doctor (a moderate Democrat): he emphasized that people simply demand too much health care, largely because they are innoculated from bearing most of the costs. Ryan would shift some of that burden, but also ensure that the neediest, those most deserving of help, will actually have it, a point I’ve made previously yet ignored. Means-testing!
Re: CST and the welfare state. I found your comments re: the universal truths and history of the Church very interesting from this perspective: replace economics with something like abortion, and you sound exactly like a conservative pro-lifer. We seem to bend the teaching to whatever the issue du jour is. On things like abortion or homosexuality, some progressives harp about how Church teaching has to meet the needs and times and is immensely nuanced, yet when it comes to economics, its clear the Church’s teaching is dead against Paul Ryan’s budget. I don’t know what the solution is for that, but I still sense we’re all too inclined to sink into proof-texting our positions with CST (again everyone seems to do it). This returns to my first point, but I just don’t see the debates as so fundamental, i.e. good vs. evil, moral vs. immoral. We have to have fundamental changes to our government budgets – that is an unavoidable and unassailable fact. What seems lost in that is that unless we make these changes, there will be a LOT more poor people, and a LOT less resources to care for them.
@ Luke Hill (11:58) – I like and respect Klein. But his main beef with Ryan is over ACA. And I do agree with him and other critics that the huge hole in Ryan’s plan is repeal of ACA with no replacement (yet). BUT, so long as polls continue to show such high percentages of disapproval for ACA, there is simply no political downside to Ryan attacking ACA and not offering a proposal. After all, this is the exact same game the Democrats are betting on in their calculations: the numbers opposing the kinds of entitlement cuts Ryan has proposed are simply so high that the smart political move is to attack them but not offer your own proposals. So the boogeyman here is politics, as Klein seems to admit in this post in response to the ever-charming Krugman: http://www.washingtonpost.com/blogs/ezra-klein/post/why-i-defended-paul-ryan/2011/04/12/AFFIlfQD_blog.html
I see that the President is going to be presenting his own deficit-reduction plan tomorrow, apparently to be based largely on the recommendations of the deficit-reduction commission. I also see that there is now a bipartisan Gang of Six in the Senate that is coming up with a plan that may have some of the same contours. Perhaps there is hope for a bipartisan consensus after all.
http://www.washingtonpost.com/business/economy/obama_turns_to_his_bipartisan_deficit_commissions_blueprint_for_reducing_debt/2011/04/11/AF7azCND_story.html?wprss=rss_business
@Jeff Landry (12:25 pm) Thanks for your response. I’ll respond in three parts:
1 – ACA and cost controls. Here’s what Ezra Klein writes in his column today on that issue: “The Affordable Care Act, as (former CBO Director) Reischauer says, isn’t perfect. You can argue whether its cost controls are a five or a six, but not that they’re a 10 (on a scale of 1 to 10). Nevertheless, it’s built atop a theory that actually makes sense, because it focuses on making medical care cheaper rather than changing who pays for insurance.
The law has three big ideas for controlling costs: First, pay doctors for quality rather than volume; second, vastly increase the amount of information available about which treatments work best and when; and third, pay providers more to keep people out of the hospital than to treat them once they get in it. If any or all of these strategies work, costs will go down, but not because the premiums seniors pay have gone up.
And the law takes the next step by including some big ideas for how to spread cost controls through the health system: a board of experts empowered to reform Medicare even when Congress is paralyzed or worrying about other things; exchanges where people can easily compare insurers based on cost and quality (the same model Ryan uses in Medicare, incidentally); and electronic medical records that give doctors easy access to the latest information about drugs and treatments.”
As best I can tell, none of these potentially cost-saving measures require future Congressional action. I know I’m repeating myself, but on the issue of taking action to control health care costs, and doing so in a fiscally responsible manner, the Democrats’ major initiative in the past decade was the ACA; the Republicans’ major initiative was Medicare Part D—which adds to federal deficits and doesn’t control costs. (If Chairman Ryan is looking for bipartisan support for his plan, some acknowledgment of that record would likely be helpful.)
2 – Rep. Ryan’s Proposal and Cost-Shifting. Again from Ezra Klein’s column today: “(Alice) Rivlin’s worry is that Ryan’s plan won’t control costs so much as shift them to seniors. And the CBO agrees with her. It concluded that Ryan’s privatization plan would actually add to Medicare’s costs. In 2030, traditional Medicare insurance, CBO estimates, would only cost 60 percent as much as the private options Ryan is offering. But under Ryan’s plan, seniors would pay two-thirds of the cost, while under traditional Medicare, they’d pay only 25 percent.
That’s not cost control. That’s cost-shifting. And even assuming Congress would turn a deaf ear to the cries of seniors, it wouldn’t solve our nation’s fiscal problems. It would just shunt them off the federal budget and onto family budgets, and make them worse.”
Note the 2030 estimates from the CBO—under Medicare seniors would pay 25% of their health care costs (more than enough, I would argue, for most people to be well aware of those costs). Under the voucher system with which Ryan replaces Medicare seniors would pay about 67% of their health care costs.
Also, by repealing the ACA, Ryan creates 30 million people without health insurance by 2020 or so. I’ve seen no evidence that his plan contains elements to correct that situation. Furthermore, most health policy analysts agree, I believe, that the result of “blockgranting” Medicaid would be less access (not more) to health care for impoverished elderly, disabled and young Americans.
3 – Catholic social teaching. I’ll take your observation that I “sound exactly like a conservative pro-lifer” in the spirit I think it was offered, and accept it as a compliment. Taking the universal principles of Church teaching and using one’s prudential judgment to apply them to concrete social realities is something I learned from the great wave of documents from Vatican II and the following generation of church leaders (e.g., papal encyclicals, letters from national bishops’ conferences (especially our own), pastoral letters by individual bishops). I’m still grateful to them.
Please understand that I’m not saying “the Church’s teaching is dead against Paul Ryan’s budget”. Partly that’s because Ryan hasn’t written a budget yet, nor has he had its impact reviewed by independent analysts (like the CBO and JCT). Mostly it’s because I meant what I said about prudential judgment and faithful Catholics legitimately arriving at differing conclusions. (I’m still looking for a defense of Ryan’s proposal that uses the perspective of Catholic social teaching. Perhaps he’ll offer one himself in the coming months in Commonweal or First Things or another forum.)
A word about a language problem in this discussion –
I think that the phrase “a preferential option for the poor” is very indefinite and can be interpreted a meaning that the poor “have to come first*. I don’t think that’s what the good Lord meant — He said to love our neighbors as ourselves. Period.
However, it sometimes happens in the U.S. that lower middle class working people who are on the edge of poverty end up paying taxes for health care for the poor when they cannot afford such health care for themselves and their own families. They resent that bitterly, and who can blame them.
I don’t know what phrase would better describe our obligations to the poor, but I do think the one above could be improved.
“But, you cannot simply say “everyone is entitled to as much healthcare as they need/want/feel they need/want” for 2 reasons: 1) it is financially unsustainable ”
Jeff –
Canada has had universal health care for years, and at the moment its economy is doing better than the U. S. economy. Other nations, less well off, e.g., Cuba, have universal health care. If I”m not mistaken Germany has had it since Bismarck.
Whether we can all have “all we want” is another question. But surely routine care and catastropic coverage is affordable, if we assign our spending wisely. I agree that keeping a person in a persistent coma with no hope of surviving is beyond our means. But those are exceptions, not the rule.
Yes, terminal care needs to be considered, and it isn’t a pleasant topic.
Ann,
Santorum would say our neighbors to the north are just like a bunch of crackheads, and a national disappointment to God to boot. He’s no Augustine, but he does love extended metaphor:
“Think about how they view you. They view you no different than the drug dealer views the little kid in the school yard. They want to get you hooked, they want to get you dependent. They want to get you relying upon them for your wellbeing. And once they’ve satisfied you, giving them that drug, that narcotic, then you’ll be reliant on them and, by the way, you’ll also be less than what God created you to be.”
@Luke: Klein linked to this helpful summary of the Bowles-Simpson provisions re: health care costs: http://theincidentaleconomist.com/wordpress/fiscal-commission-on-health-policy/
As you can see, the second proposal is: It moves to accelerate several aspects of the ACA that could slow health care cost inflation. It addresses the tax preference of employer paid health insurance in 2014, instead of waiting until 2018 to do so via the excise tax on high cost health insurance plans. It expands the focus of the Independent Payment Advisory Board (IPAB), most notably by ending the hospital exemption of the board’s work from 2014-2021.
Which is the piece I am referring to. But this is all getting very interesting because you’re beginning to hear progressive grumbling about the reports that Pres. Obama will largely endorse Bowles-Simpson (a fairly centrist platform). Krugman is predictably up savaging both the president, Simpson, and the plan (what hasn’t he savaged?), and Klein is also posting about his misgivings. So I’m just not sure at this point what progressives want.
Re: your second point, at this point I concede that Ryan’s plan is pretty vague on health care. I think this is largely to do with the poltical nature of both the process and the document. This appears to be where Ryan has traded his wonky hat for his political hat, and is where most of his opponents are pressing the case. I guess the question remains whether this vagary reduces the plan to a “bad joke” to summarize Klein, or still merits, despite this, credit for beginning the conversation and setting up the basic framework. And as far as CST goes, at this point given the crumbling nature of the welfare state, I just think CST as it applies is giong to be very tentative and not simply allow Catholic Democrats to use it as a proof-text for their arguments. That said, conservative Catholics like myself still have to wrestle with the moral implications of the debate we’re presently driving.
@Ann – I think making cross-border comparisons of health care systems is incredibly difficult. First, what are the points of comparison? For example, while the US has significant health care delivery problems, it is still the envy of the world when it comes to innovation. Innovations are, of course, extremely expensive and risky. So there is a trade off between stripping the system of incentives to innovate and allowing more risk for break downs. So I’m always skeptical of the arguments to other country’s because most people around the world still come to the US for the best (and riskiest) health care treatment. Finally, would you really trade living in the US for Cuba?
“So I’m just not sure at this point what progressives want. ”
I should correct this sentence. Progressive know what they want, its just not clear they have the political clout to get it.
Ann’s coment on the preferential option made me think (in these days of widening gap) of Mario Cuomo’s comment in the NYT Magazine article last Sunday.
In comparing himself to Clinton and POTUS, he said, in his time, they thought about doing what they could for the poor without crushing the middle class; today and for some time, Dems think about doing what they can for the middle class without crushing the poor.
Jeff,
I think you have misunderstood and misrepresented my “argument.” Economics should be subservient to values; it is not a value unto itself. This is the opposite of setting up a dichotomy between values and economics, but an effort to align them/ Economic decisions reflect values as surely as any other decision.
So if conservatives want to protect their grandchildren’s inheritance, at the expense of the health of the grandparents, that is not a simply economic decision. It reflects values, that children’s money is more important than parent’s health. As long as conservatives discuss economics without addressing the underlying values, they distort the issues. We should be discussing values, not ‘unsustainability’ or ‘bankrupting.’
And no, I do not think you believe you support the positions of j.a.m., anymore than I think “progressives” have a position that can be summarized in an all inclusive fashion. But if you are going to insist on criticizing progressives for not having a coherent answer, I will criticize you for holding the positions of other conservatives, on the assumption that conservatives do have a common coherent answer.
“We should be discussing values, not ‘unsustainability’ or ‘bankrupting.’ ”
Ok then, Jim, then tell me what value is at play in keeping the current welfare programs in place without any changes? If not bankrupting future generations, then what is it? What word should I be using? And presumably the President tomorrow will speak about the (forgive the word) unsustainable federal debt; so what “value” would rather he replace the word “unsustainable” with? I do not follow your argument. Of course values are the highest priorities in our individual and communal lives, but values are expressed in the choices we make. So what value do you think is expressed in not addressing skyrocketing health care costs? I would add that 10% of the users of health care are responsible for 47% of its consumption, hence driving up costs. So what “values” should they live by? Values are expressed through the economic choices we make, and rational consumer choose to spend their dollars in ways they they think maximize their values. But we have to make rational choices based on sometimes competing values. Of course our grandparents health is important; but so is the future of our children. So I really see no other way around talking about economics.
I don’t know what your last paragraph is referring to honestly. I am not aware of me referring to j.a.m’s arguments.
Again, once we get past the thin-skinned hurt feelings on both right and left, an interesting discussion emerges.
I’m still thinking about Jeff’s point that the problem is not Medicare, but health care costs.
Frankly, I think the solution to health care overall will require that smaller municipal entities (or states) offer rewards to hospitals and businesses that find creative ways to reduce health care costs. (Doctors in a nearby town have started a free clinic and donate time much like lawyers do pro bono work.)
I also think doctors need to stop offering the latest designer drugs from Big Pharma to patients who can be helped to better health in the long run with lifestyle changes and older drugs with proven track records. Ditto the new diagnostic gizmos that proves to be no more effective than the older gizmos (traditional v. digital mammography). And the frequency of screening for certain diseases after a certain age (cervical cancer) ought to be adjusted simply because threats from those diseases are lower.
As a 57-year-old, my concern about the way in which the entitlement problem–and it IS a problem, no doubt–will be solved lies in the what appears to be deep resentments of the GenXers and Millennials toward the Boomers (jam’s comments that we’re all up to our butts in debt and buying SUVs and motor homes is fairly typical of this resentment, never mind that most of us are caring for elderly parents on our own time as well as paying a fairly good percentage of the nation’s taxes, as its largest generation, to help take care of Gramma).
In my view, if we don’t get a handle on health care costs and stanch the generational resentments, I think we’re going to see a lot of sentiment going along the lines of “pull the plug on those aging hippie brats.”
On the other hand, the way the world is going, I don’t aspire to live past retirement. But that’s not a choice I get to make. It’s in God’s (and possibly Paul Ryan’s) hands.
Also, the costs of health care are not only driven by Big Pharma and the Diagnostic Gizmo Creators, but by the high costs of med school.
Might it not be smart to foot the bill for the next generation of doctors, let them graduate without all the debt–in exchange for their lowering the cost of their services? Or offering debt forgiveness for a certain number of years worked in a free elder clinic?
I don’t know, but I don’t think Ryan’s cut-cut-cut plan is terribly creative or will be very effective.
I don’t think Ryan’s cut-cut-cut plan is terribly creative
Bingo. Paul Ryan would be the first to say that politicians and bureaucrats are not terribly creative. That’s precisely why they should not control all the resources. People, on the other had, are endlessly creative. That’s why they should control their own resources.
Jim McK: We should be discussing values, not ‘unsustainability’ or ‘bankrupting.’
Write back after you’ve bankrupted yourself feeding the poor and are living in a cave.
Until then your logic is unavailing.
The only “option for the poor” that means anything is making them not poor.
And the only way to do that in a highly developed society is education and robust economic growth.
In that regard Paul Ryan has more practical ideas before lunch every day than somebody like Paul Krugman would have in a thousand lifetimes.
Jeff,
instead of discussing “unsustainability”, discuss how we can sustain the life of every living person. Obviously, in the long run, people will die, (life is not infinitely sustainable) so death has to be included in the plan. But starting from unsustainable (in an economic sense) is equivalent to throwing our hands up in the air and saying people are not worth it. Our commitment to caring for every person needs to be the basis for health care, not our commitment to being solvent. Being solvent is important only in order to provide health care. If you consider solvency a value in itself, to which health must be sacrificed, we should discuss that.
Ryan, by proposing a defined contribution system, is suggesting we reorder our support for health care to an economic end, rather than to the current defined benefit, health. I am objecting to that proposal not on economic grounds, but because it makes solvency the object of health care, and not health.
j.a.m. expressed this in stark terms earlier today “How much of your grandchildren’s future are you willing to steal in order to forestall your own death by one year?” He proposes an economic good as a substitute for life. Is that the conservative position? You seem to support a position at least similar when you center the argument on economics rather than life and health. (note, I do not think there is a conservative viewpoint, or a progressive viewpoint, but that seems to be your position when you critique progressives, so I am trying to adapt)
So let’s clarify the values we believe in. We can care for the health of all our people. Perhaps we cannot do it with our current system, but any alterations cannot assume that this is an impossible task. If you do assume that health care is unsustainable, say it up front: People will die because of the plan you propose. j.a.m. is at least honest about his position.
Write back after you’ve bankrupted yourself feeding the poor and are living in a cave.
Ok. What is your response now?
Luke Hill: I think we American Catholics can take justifiable pride in our contributions over the past two centuries towards ensuring that the public schools are not a vehicle for state religious indoctrination.
Government-run schools always have been vehicles for religious indoctrination. Prior to 1962, it was generically Christian or Judeo-Christian. Since that time, there has been scrupulous and intensive indoctrination in the official state ideology of atheistic humanism.
This sad state of affairs is nothing to be proud of. It is ludicrous to suppose that education can occur in an environment in which the most important questions are illegal.
Jim McK: Ok. What is your response now?
You bankrupted yourself feeding the poor, and still there are lots of starving people.
Obviously your strategy of bankruptcy isn’t a very effective way to realize your “values”.
Jim McK,
Economics is how we express value and values. Regardless of your squeamishness, the iron-clad fact of the matter is that the same $250k can feed thousands in a poor country, start a business that creates livelihoods for a number of families, educate a middle class family, or suspend Granny in a completely unnatural mechanized state for 12 months past her sell-by date.
You think you can cover your eyes and ears, and simply refuse to choose. Sorry, that’s absurd and not very grown up.
Luke Hill,
By “productive economy” I mean the one that allocates resources in a way that is most likely to provide goods and services people value.
(I do not mean the one in which politicians and bureaucrats plunder other people’s resources and squander them.)
By “stealing from future generations” I certainly mean borrowing, but also intergenerational transfer payments that are not strictly needs-based.
@j.a.m. (9:28 pm) Would you please elaborate on what specific elements in Chairman Ryan’s FY 2012 budget proposal you view as making an “option for the poor”? Are there any elements in the proposal that, in your view, are troublesome because of their failure to reflect an “option for the poor”?
(P.S. Sincere questions asked in a spirit of furthering the conversation, in case that’s not already clear.)
@j.a.m. (11:00 pm) It seems like we’re getting somewhat off topic here (probably my fault more than anyone else)—and the distinction may not matter to anyone but me—but there’s a difference (in my view) between a secular state that bars state action to promote one religion over another while allowing freedom of religion to its inhabitants (such as we have in the US), and an “official state ideology of atheistic humanism” in a state that uses the education system to indoctrinate its children in that ideology (e.g., the old Soviet Union would be an example, though I think they would have called it “socialism” rather than “humanism”).
@ j.a.m (12:14 am) Thanks for your response to my question, and your definitions.
Am I correct in assuming that your denunciation of “politicians and bureaucrats (who) plunder other people’s resources and squander them” would apply more generally to plunderers and squanderers (is that even a word?) in the private sector as well?
(If so, then I think we have some significant agreement on the importance of a productive economy, and within that agreement can legitimately debate questions such the most appropriate “mix” of, for example, public, private/for-profit and voluntary/non-profit sectors in creating and sustaining a productive economy.)
“instead of discussing “unsustainability”, discuss how we can sustain the life of every living person. Obviously, in the long run, people will die, (life is not infinitely sustainable) so death has to be included in the plan. But starting from unsustainable (in an economic sense) is equivalent to throwing our hands up in the air and saying people are not worth it. Our commitment to caring for every person needs to be the basis for health care, not our commitment to being solvent. ”
Jim McK – your pronouns “we” and “our” refer to whom, precisely? I agree that “we” (meaning the American people, the Christian community?) have a responsibility to care for the sick. But it’s not clear that *the federal government* is the only (some would say, proper, but I am not one of them), social structure by which we must do this good work. Nor is it clear that the government is engaging in responsible stewardship of its finite resources to spend most of them to the provision of health care.
Our Founding Fathers were pretty well-read in political philosophy, but I don’t know of any evidence that they intended the Constitution the crafted to encompass a mandate for the government to provide health care. Our country scraped by for nearly 200 years without our leaders discerning this mandate. This is not an argument that we should scrap government-funded health care; it’s an invitation to consider the proper role and scope of government.
Government should do what it is supposed to do. If funding or delivering health care impinges on its ability to do what it is supposed to do, it’s not wrong to ask whether government has strayed from its mission. That doesn’t absolve the larger society from its responsibility to care for one another. It may mean that we have to look at supplemental, or other, ways of providing that care.
Rep. Ryan, istm, is suggesting a supplemental mechanism: the marketplace.
Istm that one of the great services that Paul Ryan and the Tea Party are giving our country is a dawning realization that even government with its vast economic resources and its ability to make and enforce laws, may not be able to solve all of the issues of delivering health care.
@Jim Pauwels (9:15 am) Here’s the preamble to the Constitution (not because I assume you don’t know—quite the contrary—but so that we have it here for reference): “We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”
You’re quite right that there’s no “mandate for the government to provide health care” in the preamble, or elsewhere in the Constitution (as written or amended). (There are relatively few mandates in the US Constitution.) The constitution both limits governmental powers and creates them—and does so within the broad purposes summarized in the preamble.
We can debate whether it’s a good idea for the federal government to pass particular laws regarding the provision of health care, but I think we can all agree that the Congress has the power to enact laws regarding health care—and has done so in a variety of ways since the early days of the Republic.
With all due respect to Chairman Ryan and the Tea Party, they are (pardon the expression) late to the party. I think it’s been clear to the vast majority of Americans for some decades now that the federal government “may not be able to solve all of the issues of delivering health care.” (I know I’m repeating myself, but in the previous session of Congress, to their credit, the Democrats passed a health care reform law that expands access to health care and reduces the federal deficit. The last major health care reform passed by Republicans—Medicare Part D—continues to add to the deficit with each passing year.)
It seems to me that Rep. Ryan is not suggesting “the marketplace” as a mechanism for providing health care. Rather, he seems to be making the following proposals:
*that Americans currently 55 and over will have Medicare for the rest of their lives;
*that Medicare will be abolished for all younger Americans and replaced with a voucher system in which the voucher is projected to have declining value to the point where by 2030, voucher recipients would be responsible for 2/3 of their health care expenses (as opposed to 1/4 under Medicare).
*that one of the most cheapest parts of our health care system (Medicaid—which provides for the poor, the disabled, the very young and the very old) will be slashed;
*that the savings from these cuts will go largely to pay for tax cuts—the prime beneficiaries of which will be the wealthy and the well-off.
Again, Chairman Ryan has yet to do the work (which I’m sure he will) of turning his proposal into an actual budget. But based on the work he’s done so far, the heart of his health care reforms seems to be shifting costs off the federal government’s balance sheet and onto the balance sheets of individuals and families.
Would you agree—leaving aside the somewhat philosophical discussions about the Constitution and the marketplace—that the elements I summarized above are key parts of Chairman Ryan’s proposal?
@ Luke Hill (9:15) You say:
“the heart of his health care reforms seems to be shifting costs off the federal government’s balance sheet and onto the balance sheets of individuals and families.”
2 responses:
1) No plan (or rumors of a plan) that I have seen yet does anything different. From what I’m hearing, the President will also propose cuts to Medicare and Medicaid that will have the effect of shifting costs from the federal balance sheet to individuals/families.
2) Whats inherently wrong with asking or expecting people who can afford to to bear some of the burden? One problem I have with some of what you’ve written is you talk about people on Medicare as if they were all poor and destitute. That isn’t the case. This is what I like about Ryan’s proposal to introduce means-testing into the program. I think this also provides a response to your earlier query about what in Ryan’s budget is an “option for the poor”. Means-testing, i.e. targetting the benefits to those MOST in need, is such a proposal.
This second issue is primarily an ideological question, i.e. how much government dependency should we have? Democrats believe, as George Will has argued, that the more government dependency we have, the better it is. This is primarily premised on the idea that government will act as the great “leveller” in our society, so we should have as many people as possible, deserving or not, dependent on government transfers. Now of course the sticker shock for this kind of government is abated by shrinking the tax base to “the rich”.
Conservatives believe, on the other hand, that government dependency is the problem, not the solution. Of course there should be a social safety net for those most dependent and largely unable to care for themselves. But, conservatives believe that a “freer” society that rewards entrepreneurial risk-taking, but also tolerates greater risk of unequal outcomes, is preferable and, yes, more sustainable, than one more tightly controlled by government.
The facts, it seems to me, fall greater on the conservative side given the massive amount of government debt that is currently threatening to undo the entire welfare system we have developed.
@Jim McK – I’m afraid you’re vision of what the debate should be is somewhat incomprehensible to me. It seems to me that the current system we have is very BAD at distributing equal health outcomes as it is. So i’m not exactly sure how you design a system that delivers the outcomes you desire that also controls the costs of health care and doesn’t, yes, drive the economy into a ditch. Progressive CAtholics should acknowledge that a functioning economy is a just economy.
I’ve just read these two responses from 2 of my favorite commentators, Reihan Salam & Ross Douthat, basically summarizing the criticisms of Ryan and responding to them. I think they both basically summarize my position that Ryan’s budget is an imperfect, but politically savy document that has framed the debate so far and manages to make some fairly serious policy proposals that we need to consider. I think this paragraph from Douthat summarizes it best:
“But it’s important to look at the larger political context of the Ryan proposal as well as its specific content. We inhabit a moment when neither major party has been willing to level with the public about 1) the fiscal challenges facing the United States, and 2) the implications of its ideological stance for public policy over the coming decades. Eschewing tax increases and keeping government’s share of the economy around its post-WWII average, as conservatives want to do, will require a very substantial overhaul of the entitlement system — and yet Republican politicians spent the first two years of the Obama era demagoguing Democrats on entitlement cuts. Alternatively, keeping Medicare and Social Security in more or less their current form, as liberals prefer, will require a very substantial increase in middle-class taxes — and yet the president and his party have repeatedly suggested that the middle class can rest secure, because they’re only interested in raising taxes on the wealthy. We’ve had greater honesty from blue-ribbon panels, to be sure, but from the leaders of the two major parties, not so much. Indeed, President Obama very conspicuously distanced himself from his own deficit commission’s recommendations this winter, while offering only bland evasions in their stead.”
http://douthat.blogs.nytimes.com/2011/04/13/is-paul-ryans-budget-brave/?gwh=5AEC9BA57ABB4816E09C6C3355889127
http://www.nationalreview.com/agenda/264541/quick-note-chairman-ryan-and-his-critics-reihan-salam
@Jeff Landry (11:53 am) I don’t think I’ve written anything in which I “talk about people on Medicare as if they were all poor and destitute.” If I have somehow given that impression, I apologize and welcome to opportunity to clarify here that I’m well aware that Medicare is a health care program for people 65 and older. Medicaid is a program for the poor and disabled—the largest part of which (if I recall correctly) pays nursing home costs for destitute seniors. (And both program were created in 1965, primarily because the private health care market was not working for the elderly and the poor.)
Chairman Ryan’s proposal envisions large funding cuts (in the neighborhood of $3 trillion over 10 years) for Medicaid and other programs that benefit the poor. It also envisions large tax cuts (in the neighborhood of $3 trillion over 10 years), the bulk of which would flow to corporations and affluent individuals. It also assumes (but does not outline) spending cuts on everything except Social Security, Medicare and Medicaid that would shrink the federal government, including defense, back to the size it was (relative to GDP) in the Coolidge administration.
I’d be happy to have a debate about the proper role and size of government. However, it’s hard to get to that “ideological question” when Chairman Ryan and so many of his supporters can’t (or won’t or don’t) acknowledge the basic content of his proposal—or the basic realities of our current situation. It’s also hard when many conservatives do not acknowledge the fiscal consequences of the Affordable Care Act or Medicare Part D as part of the context for the current debate.
With all due respect to George Will, Democrats do not believe that “the more government dependency we have, the better it is”. Do Democrats generally favor a somewhat larger and more secure “safety net” than Republicans? Yes. But that’s very different from having an ideological commitment to the notion that “more government is better”. One of the asymmetries in American politics today is that there’s no left-wing equivalent of a Grover Norquist (who opposes all tax hikes at all times so as to constantly shrink the government).
Nor is there any organized effort on the left in favor of “shrinking the tax base to ‘the rich’”. On the contrary, there’s a lot of support on the left for allowing all the Bush tax cuts to expire in the next 2-5 years (just to cite one example). Please note as well that the context for this debate is a society in which the extremes of wealth and poverty are greater than they’ve been in 80 years, and the total tax burden (as % of income) on low income families is roughly the same as it is on affluent families.
You state that “the facts, it seems to me, fall greater on the conservative side given the massive amount of government debt that is currently threatening to undo the entire welfare system we have developed.” From a liberal perspective, it would help the conversation if you and other conservatives would first acknowledge that the majority of that debt is a result of the Reagan and Bush administrations.
I knew a priest who used to say “IYADWYAD, YADWYAD”—if you always do what you always did, you’ll always get what you always got. Chairman Ryan’s proposal as currently outlined looks like Republicans doing what they always did.
@Jeff Landry (12:05 pm) Thanks for this.
The points Douthat earns for chastising Republicans for spending “the first two years of the Obama era demagoguing Democrats on entitlement cuts” he loses (or at least some of them) by stating that “keeping Medicare and Social Security in more or less their current form, as liberals prefer, will require a very substantial increase in middle-class taxes”. Why?
Because Social Security is not the issue. (I’ve seen suggestions that Social Security could be fixed for the next 75 years simply by lifting the cap on wages and keeping benefits where they are.) By slipping Social Security back into the conversation, Douthat merely reinforces progressive (and moderate) fears that what conservatives want is to limit government to the roles in had in the 1920s and before.
Medicare is an issue primarily because health care expenditures are an issue. Health care expenditures are an issue 1) because of medical inflation, and 2) because of an aging population. Again, once Chairman Ryan has turned his proposal into a budget, and submitted it to the CBO and JCT for analysis, then we’ll see what effect it would (likely) have on medical inflation.
On a lighter note, there’s what Steve Benen, blogger for the Washington Monthly ( http://www.washingtonmonthly.com/ ) calls the “do nothing” plan to eliminate about 75% of the annual federal deficit in the next 5 years. “All” it requires is that Congress do nothing: allow the Bush tax cuts to expire as scheduled, allow the ACA to be implemented, stop passing an annual “doc fix” for doctors’ payments under Medicare. “All” is in quotes because it means offending a powerful and wealthy constituency (doctors), as well as raising income taxes for pretty much everyone, so it’s not likely to happen.
As Annie Lowery concludes in her piece at Slate ( http://www.slate.com/id/2291054/ ), “the do-nothing plan proves the point that the budget revolution does not need to be particularly revolutionary. Yes, the dollar figures are enormous, so big that it would appear to require “bold” plans that include massive new taxes or cruel new cuts. But, in fact, we don’t really need to end Social Security, sell Alaska, or ship the poor to Canada to get back in the black. We just need to stick to current law—particularly the tax and health care provisions—and then we can tinker our way toward a better, healthier economy.”
@ LUke Hill – I think perhaps its best we stop, because I think you take a big step back when you write:
“I knew a priest who used to say “IYADWYAD, YADWYAD”—if you always do what you always did, you’ll always get what you always got. Chairman Ryan’s proposal as currently outlined looks like Republicans doing what they always did.”
I disagree; while I’ve said Ryan’s plan is imperfect and incomplete, I submit it envisions a different way of construing entitlements than what we have, and for that I think he deserves credit. But at this point, which is what I was coming back to write, I just don’t see progressive, Catholic or otherwise, really engaging with the fundamental problems of the budget in a way that suggests anything other than “cut out the waste, fraud, and abuse” and raise taxes. We need some fundamental reforms, and I just don’t see your side coming to realistic grips with that. Michael SEan Winters, for example, basically has a “come what may” attitude and that is naive. And so long as that is the case, and so long as CST remains (unfortunately) the idiom of progressive Catholics, I’m afraid CST will have very little impact of these debates, left or right. In effect I think progressives have ceded the heights.
@Jeff Landray (2:32 pm) I do want to give you credit for your willingness to state some of your disagreements with and concerns about Chairman Ryan’s plan, and also for discussing his plan in the light of Church teaching.
Speaking just for myself, I don’t view Catholic social teaching as “the idiom of progressive Catholics”. I view it as a framework developed by the whole Church and for use by the whole Church. Many of the key documents articulating and developing the Church’s teachings on social issues come from various popes over the past 120 years, from the most recent ecumenical council of bishops (Vatican II), and from national conferences of bishops (both in the US and around the world). One reason I find it helpful is precisely because it does not line up neatly with the partisan political divisions of contemporary American politics.
I don’t expect Catholic social teaching to have much impact on the national political debate. I do appreciate the opportunity a forum like dotCommonweal provides to use the Church’s teaching as a lens to examine these issues.
@Luke Hill (2:48) – I agree with, of course, that CST should be for the whole Church. I was speaking more practically in that CST is more usually invoked in economic debates by progressive Catholics than it is by conservative Catholics (at least with respect to economics, etc., just as the reverse is true on abortion, etc.). I just don’t see any progressive Catholic thinkers (or conservative for that matter) explicitly bringing CST to wrestle with the budget problems we are having. Most of them, as I said, seem to have a “do nothing” approach.
I just listened to the President. I’m sure you were pleased with the speech; he certainly laid down the liberal line and attempted to frame the debate from his perspective. he clearly said what he was against (which we knew all along), but his plan seems to amount to basically “VP Biden will let you know in early May”! Disappointing from that perspective. I expected a more robust endorsement of Bowles-Simpson. That he didn’t do that is disappointing because I think Bowles-Simpson is the basis of a REAL tax reform bill that broadens the tax base but also has some rate increases.
The text of President Obama’s speech today on deficit reduction, as prepared for delivery:
http://www.whitehouse.gov/blog/2011/04/09/president-obamas-statement-bipartisan-agreement-budget
@Jeff Landry- “i’m not exactly sure how you design a system that delivers the outcomes you desire that also controls the costs of health care and doesn’t, yes, drive the economy into a ditch. Progressive CAtholics should acknowledge that a functioning economy is a just economy.”
Is an economy that consigns people to die a functioning economy? My point is that a functioning economy is one that is committed to the good of the people in it. If economy is the standard, rather than a tool to achieve the society’s goals, it has stepped out of its role in service to the society. A society that forces its elderly to die does not have a functioning economy, no matter how efficient its markets are. If it chooses who lives based on wealth, it is even less functional.
Health care is expensive, but people generally choose to stay alive rather than stay wealthy. We are faced with that choice on a national level, and I have heard nothing that convinces me choosing death is the proper choice. A functioning economy is a nice thing to have, but you need a heart to live. (to quote a Springfield newspaper) As j.a.m. puts it “the iron-clad fact of the matter is that the same $250k can feed thousands in a poor country, start a business that creates livelihoods for a number of families, educate a middle class family, or suspend Granny in a completely unnatural mechanized state for 12 months past her sell-by date.” Do you have a living will so that you will not be suspended in a completely unnatural mechanized state past your sell-by date? Do you have instructions so that no one will give you a new heart when the sell-by date of your current one passes? If you do, then I respect your choice that a functioning economy has priority over your health.
But if you do not have those things, your demand for a functioning economy is hollow. It means you want the government to set limits on your life, rather than allow you to do it. You want the government to choose the economy over life. If that is your position, just be honest about it like j.a.m. The government should decide granny will die so that we can have a functioning economy.
Luke Hill: Am I correct in assuming that your denunciation of “politicians and bureaucrats (who) plunder other people’s resources and squander them” would apply more generally to plunderers and squanderers (is that even a word?) in the private sector as well?
No. When a private citizen misappropriates, he goes to jail and pays his debt to society. When a politician does it, he just accrues more power and goes for another spin of the vicious cycle. Further, the case of the politician is more egregious because, by definition, the misappropriation and misallocation of resources for purposes of partisan advantage harms the common good.
@Jim Pauwels, 9:15am “Government should do what it is supposed to do. If funding or delivering health care impinges on its ability to do what it is supposed to do, it’s not wrong to ask whether government has strayed from its mission.”
This is the point I am making. Values, not economy, are the basis for discussion. Don’t say “what the government is doing is unsustainable.” Say rather “Government should not be providing health care, so their effort should not be sustained.” That is a more honest conversation.
But if you believe government should provide health care, don’t say “what the government is doing is unsustainable.” In this case, government has an imperative to provide health care, and whether it is sustainable or not is irrelevant. We have to do it.
My problem with the Ryan plan is that it addresses the sustainability of the government’s health care program by getting the government out of its commitment to provide for our health. Instead the government is providing a presumably sustainable amount of funds that may or may not provide enough for our health care, but will support insurance companies. It is a change from a government that takes responsibility for its poor and elderly to one with no clear stake in our health.
@j.a.m. (9:57 pm) Thank-you for correcting my mistaken assumption that your denunciation of those who “plunder other people’s resources and squander them” applied equally to all.
Catholic social teaching hardly informs the current system — wherein corrupt politicians compete to deprive the poor and young, so that they may render superfluous largesse to relatively well off retirees who happen to vote.
Luke Hill, by all means, happy to clarify. I would hope we all hold public servants to a higher standard.
@Jim McK – I’m very sorry to say this (and i do not mean it as a personal attack in any way), but your framework for analysis (life vs. death; economy vs. values) just doesn’t make any sense to me, and I don’t find setting up such stark binary choices very useful in making the kinds of prudential judgments that are needed in setting policy goals and achieving political outcomes. One problem is that you speak of “health care” in such a broad swath; the American health care system is very good at some things and very bad at others. So to say the matter is just about “people dying” is so overly-broad it cannot serve as a useful basis for consideration. Yes, people die in a lot of different ways. One of best things about the American health care system is its innovation; thus, American doctors have made impressive victories in defeating various cancers, which were once death sentences. Again, I just don’t find your framework is working to help me assess some of these policy choices.
“This is the point I am making. Values, not economy, are the basis for discussion. Don’t say “what the government is doing is unsustainable.” Say rather “Government should not be providing health care, so their effort should not be sustained.” That is a more honest conversation.
“But if you believe government should provide health care, don’t say “what the government is doing is unsustainable.” In this case, government has an imperative to provide health care, and whether it is sustainable or not is irrelevant. We have to do it.”
Well … here is what I think, fwiw. I do think that “we” (meaning the American people, and especially the Christian community) have a duty to provide health care. It’s a human right. And I do take Jesus’ healing miracles as a kind of mandate to provide healing.
I don’t think it necessarily follows that the government *must* the vehicle, or even *must* be one of the vehicles, to deliver health care. In other words, I don’t see that delivery of health care to the general population is something that is intrinsic to governance.
But … having said that … I don’t have such a restrictive and narrow view of government that I would find it intrinsically *wrong* that the government fund or deliver health care services.
From a practical point of view, the two vehicles for health care delivery and funding seem to be the marketplace and the government. Both have advantages, both have drawbacks, and both have limitations and constraints. As a people, we need to find the right mixture of these two mechanisms.
Speaking of limitations and constraints: the government, like any other human organization, has economic constraints. It is imperative that we, the people, accord those constraints the respect they are due. The government, like any other human organization, will cease to function effectively, or even function at all, if those constraints aren’t respected. And it would be sinful of us to permit that to happen, because we are responsible for the effective functioning of our government, and just and effective government is a human right, just as health care is.
Ryan’s plan is far from perfect. It’s flaws have been documented in these discussions. It’s been suggested that its primary purpose is really as an internal Republican manifesto. I don’t doubt that’s at least somewhat true. I also view it as an “opening bid” in what I hope will develop into a negotiation with the other side. I hope that we will end up with a framework for health care delivery that will be both effective and sustainable.
But what are we negotiating? How can we proceed without some answer to that question?
The answer probably has little to do with economics, though economics is the way to achieve what we wish to accomplish.
Do we want a government that a> is committed to caring for the health of all its people; b> sees fiscal health as more important than individual health; or c> says health care is too expensive, so we are getting out of the business?
I do not understand why it is so hard to grasp this question. Or why it is so difficult to apply this to Ryan’s plan to change from defined benefit to defined contributions.
Once we decide those questions we can address issues like whether the mechanical means that keep granny alive are a part of health care.
just an example from Jim Pauwels:
“we are responsible for the effective functioning of our government, and just and effective government is a human right, just as health care is.”
Can a government that allows the poor and elderly to die prematurely be called “just and effective”? Justice and efficacy can only be judged if we have a definition of what government is supposed to do.
“Can a government that allows the poor and elderly to die prematurely be called “just and effective”? Justice and efficacy can only be judged if we have a definition of what government is supposed to do.”
Jim –
Now there’s a thread or two — or 10 or 20. And also there’s the rub.
Part of the question should also be: what *can* a government do? And that probably differs from nation to nation.
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