I guess I just don't get it.

My politics puzzle some and anger others. Apparently I am some sort of Uncle Tom's Log Cabin Republican. As a gay man, I guess I am required by some contract I do not remember signing to focus the entirety of my political energy towards the legalization of gay marriage. I am not allowed to consider fiscal policy, foreign policy, or any other policy above gay marriage. Excuse me for thinking that terrorism and the social security crisis are a little more important than legalizing something I don't really need anyway.

We need to disengage!

In regards to my own debt woes, Jonathan aptly pointed out that I should consider the disastrous tax effects of the upcoming Clinton II administration (does it bother anyone else that her presidency would mean that two families occupied the White House for a quarter century?). Tim, chimed in noting that we have to find some way to pay for the war (the legality or illegality of which I am not prepared to discuss).

And while the cost of the war is considerable and causes me great worry (not least of all because of the proposal to impose a War Surtax), but there is an even bigger monkey on our fiscal backs: The elderly.

Robert J. Samuelson in the Washington Post today notes that

From 2000 to 2030, the 65-and-over population will roughly double, from 35 million to 72 million, or from about 12 percent of the population to nearly 20 percent. Spending on Social Security, Medicare and Medicaid -- three big programs that serve the elderly -- already represents more than 40 percent of the federal budget. In 2006, these three programs cost $1.1 trillion, more than twice defense spending. Left on automatic pilot, these programs are plausibly projected to grow to about 75 percent of the present budget by 2030. [emphasis added]

So forget about the paltry War on Terror, our War on Death is costing us more than twice as much, and it is exepected only to get more expensive. Add to that the drive for Universal Health Care, and we can expect those elderly to live even longer. Once the Death tax comes back, these longer living seniors are going to use up their estates instead of leave it to us younger, better looking descendants. The picture is dire indeed.

Analogizing from our dear Speaker's remarks regarding the war on terror, we have only three choices to avoid these staggering deficits:

1. Institute a draft. It is politically inviable to force people to be nursing home attendants. I have always opposed this measure
2. Tax our people to support this program, so the true cost hits home. I always and with all my might oppose any tax increases whatsoever
3. End our engagement with the War on Death because it is too costly.

As I am sure you can guess, I support the third option with regard to Social Security just like Nanny Pelosi supports it with regard to the war. We must systematically stop spending money on extending the lives of these far less productive members of our society. No more Social Security (you didn't save to eat in your retirement, too bad!), nor more Medicare or Medicaid (you are old and about to die anyway).*

Oh you aren't willing to do that to save on our deficit problems? Then please don't use the rhetoric of the fiscal conservative as a rationale to end the war.

*Please note: my actual suggestions for Social Security are not so draconian as those above, but I suggest them to make a point.

Note further: I do actually see the distinction between funding a campaign that creates death and has little to do with national interests anymore and a program that purportedly enhances the quality of life of certain citizens of this country. But you will forgive me if I am a little resentful at the prospect spending most of my working career funding the retirement of a generation that perfected the art of living beyond their means. I'll gladly stop whining once I am allowed opt out, which I promptly will.

Highbrow?

I never thought of my blog as highbrow--sure I have a PG-13 policy, but have you seen what passes for PG-13 these days?

Nonetheless, I appreciate the compliment from a reader, even if I don't think I really deserve it (I happen to like underwear ads too--a lot!).

Just for fun: here's Giuliani Girl v. Obama Girl. The tune is rather catchy.



My favorite lyric:" I knew Reagan and you're no Reagan." Of course Obama ain't either.

(For Tim:) I'm Not Buying Free Health Care

Looks like this election cycle, health care is going to be the primary domestic issue. It is one that gets at the very core of what is just and what is American. it is an issue that almost everyone has a strong opinion on, but (unlike say, abortion) one where there is room for dialogue. For those reasons, I am writing what may turn out to be the first in several posts that seriously contemplate the issue of universal health care. So there is no confusion: I'm against it.

Whether we have a public or a private health care system (or a mixture) is basically a question of equity versus efficiency. One can ration health care (and one must, because it is a scarce resource) any number of ways, but the two ways most prevalent are by need or by value.

Universal health care systems ostensibly are about allocating according to need. For instance, a person poor enough to be unable to afford health care may get a deadly, though curable, disease and need a doctor's attention more than a rich person who is getting surgery to correct annoying but not debilitating knee problems. Public health care systems would likely choose the more serious disease over the less serious knee trouble. It seems unfair to many if not most people that the rich person gets his knee problem fixed while the poor person dies. In a need based rationing system, the person who needs the health care most gets it, regardless of ability to pay. If you want to see this, you don't have to go to Cuba, your local emergency room is a perfect example.

Then there is rationing by value, the way a free market system works (which incidentally is not the system we currently have in health care in the United States: government regulation and what may be anti-competitive practices in the insurance industry [I don't know for sure if there are anti-competitive practices, but the current outcomes seem consistent with a lack of competition] distort the market a great deal). In a value system, the person who values the Doctor's time more, as evidenced by a willingness to forgo alternatives (i.e. pay for the health care instead of something else), gets the health care. A market is established and suddenly providers have a profit incentive to be more efficient, to provide both better and faster health care than competitors. Better health care attracts more customers, and faster health care allows providers to service more customers. This is efficiency. Don't forget rich people get cancer just like poor ones (though I do not foreclose the idea that some ailments affect poor people disproportionately, but the treatments developed for different, but perhaps similar "rich people diseases" would be useful and effective in treating "poor people diseases").

Which do we value more? I value efficiency, or more precisely I value EFFECTIVENESS; even if it means that Diamond Jim Millionaire sees the doctor before I do, I'm happy to reap the downstream effects of richer people spending on health care once I do see the doctor. However, I won't deny the sense of injustice that I (yes, even I) felt in the film John Q when that cute little boy couldn't get a heart transplant just because his father was poor. So I am keenly aware of this tension between equity and efficiency, but my argument is summed up thusly: if you focus entirely on equity you lose the great benefits of efficiency (effectiveness).

Now, you may be thinking, "That parenthetical about health care in United States not being a free market was a useful dodge," but actually it wasn't. It was an attempt to establish common ground. I know there are problems with health care; however, I don't think our problems are so much a market failure, but are instead the result of a hindered market. Nonetheless (and here's why it's not a dodge) even if out market is imperfect, it more closely matches the kind of value based health care I was talking about. You have doctors competing for customers who can pay(because they are insured) and becoming more efficient for all (even the uninsured consumers who end up in the emergency room).

Now my argument is premised on the assumption that value based health care results in more efficient health care than does need based health care. Sure I can draw all the analogies I want to justify this (computers, education, almost anything!), but in order to honestly deal with this assumption I have to look at the health care industry itself. Primarily, I will examine the quality of health care in the U.S. compared to other countries, focusing primarily on effectiveness. From this I make the inference that we have a higher quality of health care (FOR THOSE WHO GET IT) because our value based system is more efficient. If that is not rigorous enough for please tell me what would be and I will try to comply in the future.

Generally speaking the quality of health care in the untied states (FOR THOSE WHO GET IT) is respected worldwide [Right Column, Page 11] (though things can always improve!). This study suggests that in the Untied states the quality of health care exceeds that of other countries [see charts, pages 3, 4, 5, 12]. (this naturally excludes emergency rooms where the care is rationed based on need--emergency rooms are required by law to see any patient regardless of ability to pay). Americans seems satisfied with their health care: The chart on page 93 indicates that 72% of patients think hospitals are doing a good job, and 84% were satisfied with their last visit to the doctor. Notice also that the lowest area of satisfaction cited has to with insurance.

Even articles critical of the U.S. Health Care System seems to show that we have a high quality (effectiveness) even if we are dissatisfied with other aspects of out health care system:

The U.S. system ranked first on effectiveness but ranked last on other dimensions of quality (Figure ES-1). It performed particularly poorly in terms of providing care equitably, safely, efficiently, or in a patient-centered manner.

We seem to be doing pretty well on innovation too. According to this article that appeared in that not-so-fervent protector of markets, the New York Times (I had to link to a blog post to link to the text of the article--NYTimes makes you pay for certain archives):

When it comes to medical innovation, the United States is the world leader. In the last 10 years, for instance, 12 Nobel Prizes in medicine have gone to American-born scientists working in the United States, 3 have gone to foreign-born scientists working in the United States, and just 7 have gone to researchers outside the country.

Indeed almost all dissatisfaction and criticism of health care in the United States that I could find had to do with ACCESS not QUALITY. The only problem is if you just mandate access and fix prices, as in a single payer system, you reduce incentives to invest in innovation and maintain quality. we lose that edge. "But wait one second, Pinky," I hear you say in your skeptical of the market tone of voice, "isn't a lot of the fantastic medical research in the United States funded by public money such as grants?" Yes, but remember, the grant provides only the cost of research the incentive is in the patent which will bring you profit. (Sometimes just glory, but I'll bet most of the time profit is quite enough incentive!).

What about U.S. life expectancy? It seems true that the U.S. population consistently has a shorter life expectancy compared to other developed countries. If health care is all about prolonging life, then surely this fact indicts my premise that U.S. health care is more effective, right? Wrong. Sure health care quality and effectiveness will have an impact on life expectancy at the margins, but we cannot forget all the other things that contribute to a national population's average life expectancy. Perhaps things like crime, suicide, auto accidents have something to do with it. Then there's population size, geographical diversity and racial composition (yes different races have different life expectancies!). And let's not forget the big one: LIFESTYLE. The fact that our diabetes rates are rising is not because our hospitals suck, it's because we are fat and lazy. Universal health care is not going to change that.

People are so eager to get to a fairer system they forget that the quality of health care in this country is at an amazing level. It find it not only intellectually unpersuasive but also dishonest when people try to portray American health care quality as substandard (often ignoring the difference between emergency and nonemergency care--I cannot stress that point enough--or including access, a real problem, as a measure of quality) in an effort to bring us efficiency folks into the equity side. The problem is not the quality of what we get; the problem is who gets it (or more accurately who doesn't).

So what do I suggest instead? I'll probably develop this in a later post, but a deregulation of the insurance industry might be a start. Similarly, if you MUST have the government subsidize health care, you should do it in a way that keeps competition. I support school vouchers, so maybe health vouchers would be a way to go.

Look for Part 2 where I discuss the economics of 2 tiered systems (the more likely result in this country anyway), and why they are just as bad (even in France!).

I still feel sorry for Tyler

I have gotten a lot of comments about my Tyler Whitney post, and I thought I should address some things publicly, rather than let them get lost in the comments. Also, it's clear that I am in the minority, so I want to better explain myself (not defensively, but just so everyone knows exactly where I am coming from).

First, I am not sure Tancredo is the most hostile to gays candidate (hostile to immigrants certainly, but we aren't talking about a story exposing Tancredo of employing an undocumented gardener). He opposes gay marriage using the same tired procreation argument, and doesn't vote for any pro-gay federal legislation (there could be a legitimate federalism reason for this, though I doubt it). Now, do I think Tancredo would make even a passable president? No. I'd vote for Obama over him (A Hills v. Tom race might send me to a third party again). Tancredo is certainly not a gay-friendly politician, but I'm just not sure a gay kid working for him is exactly like a back kid working for George Wallace.

Secondly, It's true that I may have glossed over Tyler's own exercise of extremely poor judgment. Perhaps some of the things he did were awful. Apart from various connections a la six degrees from Kevin Bacon, the only thing I can find that Tyler actually SAID or DID was hold a sign that was is in extremely poor taste. (You'll notice that some of the more outrageous things in the article are attributed to associates, but the author is obviously making an attempt to connect them to Tyler). For that, he deserves to be outed? If you think so, I am afraid we are going to have to agree to disagree.

Third, do I want to give him a free pass? No, had the story been that in addition to working for Tancredo, Tyler had been convicted of a hate-based assault against gays, my opinion would be different. Matt is quite right to point out the personal responsibility aspects of this situation, and I have to agree with Matt up to a point. I'm just concerned that this punishment is not commensurate. Basically, from what I can tell, Tyler's sins are: holding incorrect beliefs, expressing them in poor taste, and having acquaintances who are even more evil. If that's all he did, sure he should be called out, but there's no reason he should be called out in such a way that I should ever have heard about it. (Please ignore the fact that even by trying to take his side, I am continuing to call attention to Tyler's situation, making his outing even more widespread). It seems like instead of washing his mouth out with soap, we are throwing acid in his eyes.

Fourth, you may think I am overreacting. "All that happened to him is that he was outed, and now he can live a more honest and fulfilling life. Plus now he doesn't have to go through the agony of doing it himself; the band-aid is already off," you may say. But it's more than that. At 18 he's finished in public policy. Pro-Gay groups (including also the libertarian leaning groups I align myself with) wont have him for what he did before he was outed. And conservatives won't have him because he's gay. Even if, as I expect (hope?), conservatives give up this anti-gay nonsense, Tyler will not be welcome as a reminder of the movement's dubious past. Furthermore, should Tyler see the light, any attempt to look rehabilitated ("I was a very misguided youth, and I deeply regret some of the things I have done") will be met with a jaundiced eye from both sides. This kid will be lucky if anyone from a city councilman up will talk to him again. That HAS to matter to him. People with only a passing, cocktail party interest in policy and politics do not go to work for congressmen running for president.

Finally, true confessions: the Tyler Whitney situation is scary to me because I see how EASILY I could have been him. I have said here before that back deep in the closet I associated with groups and supported politicians who could legitimately be criticized for being being anti-gay. I rationalized at the time "I support 75% of what they say, and I don't really care that much about social issues, anyway." (My current, continued affiliation with the GOP, certainly the more anti-gay party, is different. I no longer turn a blind eye to their anti-gay policies, and hope to help change the party from within). I am ashamed now of those affiliations and have severed them completely, but they still exist in my past. It grieves me to think that I contributed, even indirectly, to some of the pain and prejudice that I and many others are experiencing now.

Thankfully even at 18 I had the good sense to know that holding a sign in such poor taste would not only be ineffective for my cause, but could also come back to bite me. However, a few years ago I worked for a policy organization and wrote two op-eds. One was about education policy and the other was a criticism of a prominent leader in the gay community. Can you guess which one still shows up when I google my name? Though I was never mean spirited and tried to focus my criticism on legitimate problems, someone could construe the op-ed as anti-gay. (I remember at the time I wrote it, I had a paragraph along the lines of "even if he is right that XYZ," and was told to take it out, because it "ruined my argument and gave [the leader] too much ground.") I wouldn't say I am haunted by the op-ed the way I am some of my former affiliations, but I would prefer that it could recede back into history just so I don't have to deal with it if it ever does come up.


Update:
North Dallas Thirty found a few more folks who are, well, sympathetic to Tyler.

A response to a comment

Rather than let one conversation get lost in the comments section, I thought I'd create a new post to give it attention.

A reader (I like the idea of having readers!) asked me the following in a comment to this post, which I think is something of a response to this post:

I have a question ... and this is not meant to attack you in any way ... but on the matter of gun control, how do we define "arms" and determine who may possess them and in what ways they may be used? A nuclear bomb is a type of "arm." I definitely believe people should be able to bear arms, but where do we draw the line? Thanks for your response; I'm simply curious.

My response is probably unsatisfactory, but I will be honest (as I am shielded by the anonymity of the internet): the line drawing is tough. Certainly, when drafting the bill of rights, the writers did not conceive of the myriad of tools we humans would eventually devise in order to kill one another. Did the right to bear arms really only mean personal firearms such as rifle and pistols, or did it originally include the right to own a cannon? I'd be interested to know, but in the end I do not place much emphasis on original intent or textualism. Hopefully, as my link to the Becker-Posner blog might suggest, I am more of a legal pragmatist. With that in mind, let's see where it takes us.

As I hope is clear, I certainly support, indeed encourage, carrying a handgun for personal protection as well as protecting the home with a handgun, rifle, or shotgun. I don't see much of a distinction between a revolver and a 9mm semi-automatic. Nor is there much practical distinction between protecting your home or person with a handgun, a rifle or a shotgun. These weapons clearly fall along under "definite yes" column about the right to possess. Blah, blah, blah

On the other hand, should I have the right to possess a nuclear bomb? I don't want to say yes, but I don't want to say no either. I don't want to say yes because nuclear bombs are a weapon that has A LOT of collateral damage. If I set off a nuke to stop someone from beating me up, I have not only stopped the aggressor, but also killed hundreds or thousands of people. Silly example, but you get the idea. Certainly nukes are not in the weapon for personal protection category. But making "weapon for personal protection" the standard does not provide much more guidance.

I don't want to say no because of that bane of every law student, the slippery slope argument. How long would it take to move into the arena of the "definite yes" column from automatic weapons, and to automatic weapons from the type of heavy collateral risk weapons like a bomb? Further, I do not accept any national security/terrorism/24 argument for banning such weapons. The well funded and determined baddies are going to get their hands on what they want regardless of any possession laws.

Bottom line: I'm glad the line drawing is not my job.