Paul Krugman: A Socialist Plot

Paul Krugman attempts to "dispel the fog of obfuscation right-wingers use to obscure the true nature of their position on children’s health":

A Socialist Plot, by Paul Krugman, Commentary, NY Times: Suppose, for a moment, that the Heritage Foundation were to put out a press release attacking the liberal view that even children whose parents could afford to send them to private school should be entitled to free government-run education.

They’d have a point: many American families with middle-class incomes do send their kids to school at public expense, so taxpayers without school-age children subsidize families that do. And the effect is to displace the private sector: if public schools weren’t available, many families would pay for private schools instead.

So let’s end this un-American system and make education what it should be — a matter of individual responsibility and private enterprise. Oh, and we shouldn’t have any government mandates that force children to get educated, either. As a Republican presidential candidate might say, the future of America’s education system lies in free-market solutions, not socialist models.

O.K., in case you’re wondering, I haven’t lost my mind, I’m drawing an analogy. The real Heritage press release, titled “The Middle-Class Welfare Kid Next Door,” is an attack on proposals to expand the State Children’s Health Insurance Program. ... And Rudy Giuliani’s call for “free-market solutions, not socialist models” was about health care, not education...

The truth is that there’s no difference in principle between saying that every American child is entitled to an education and saying that every American child is entitled to adequate health care. It’s just a matter of historical accident that we think of access to free K-12 education as a basic right, but consider having the government pay children’s medical bills “welfare,“ with all the negative connotations that go with that term.

And conservative opposition to giving every child in this country access to health care is, in a fundamental sense, un-American.

Here’s what I mean: The great majority of Americans believe that everyone is entitled to a chance to make the most of his or her life. Even conservatives usually claim to believe that...

But a child who doesn’t receive adequate health care, like a child who doesn’t receive an adequate education, doesn’t have the same ... chances in life as children who get both these things. And insurance is crucial to receiving adequate health care...

So how can conservatives defend the indefensible, and oppose giving children the health care they need? By trying the old welfare queen in her Cadillac strategy (albeit without the racial innuendo that made it so effective when Reagan used it). That is, to divert public sympathy from people who really need help, they’re trying to change the subject to the supposedly undeserving recipients of government aid. Hence the emphasis on the evils of “middle-class welfare.”

Proponents of an expansion of children’s health care have, as they should, responded to this strategy with facts and figures. Congressional Budget Office estimates show that S-chip expansion would, in fact, primarily benefit those who need it most: the great majority of children receiving coverage under an expanded program would otherwise have been uninsured.

But the more fundamental response should be, so what?

We offer free education, and don’t worry about middle-class families getting benefits they don’t need, because that’s the only way to ensure that every child gets an education — and giving every child a fair chance is the American way. And we should guarantee health care to every child, for the same reason.

_________________________
Previous (8/24) column: Paul Krugman: Seeking Willie Horton
Next (8/31) column: Paul Krugman: Katrina All the Time

Comments

[evagrius]

Considering that the U.S. federal government hasn't signed the U.N. Convention on the Rights of Children, ( the U.S. and Somalia are the only ones mentioned by Wikipedia not to have signed the convention),it isn't surprising that providing health care for all children is not considered to be a societal obligation.

[Jim Harrison]

This piece should remind us why it is a bad idea to means test Medicare and Social Security.

[Bruce Wilder]

I wish someone had suggested means-testing Iraq, before we did it.

What we could do, if we could get back that trillion . . .

[Bruce Wilder]

Many of the big-bang child health care interventions are things like vaccines, which are cheap, cheap, cheap, to do en masse. And, measured in meaningful benefit terms, like years of expected healthy life, the payoffs are also often high.

[DJM]

a must watch video;
http://www.huffingtonpost.com/bill-maher/what-i-did-on-my-summer-v_b_61551.html
What I Did on My Summer Vacation
Posted August 23, 2007
He has some great lines and one of them starts; "...A great Republican canard ever since Reagan has been ....there is no such thing as collective civic responsibility, It's your money, don't let the government go picking in your pocket, as if we don't all drive the same highways and breathe the same air and eat the same poisonous food from China...."

[Sarah]

Just let a thoroughly drug-resistant strain of TB get loose (as it's close to doing right now in Russia) and we'll see just how committed those free-market true-believers are to their ideology. Unfortunately, a lot of the rest of us get to die really ugly, slow, painful deaths thanks to their proselytizing success...

[BJ Feng]

Nice try Paul, but at least you got the title right. To begin, it is perfectly reasonable for a society to determine the level of social services it provides to all of its citizens. Just because society decides to provide free K-12 education doesn't mean it has to provide free health care or college level education for that matter.

Secondly, there is a push for private sector education through the use of vouchers because of poor public sector performance.

Finally, there is no reason to extend the State Health Children's Program to the middle class other than to prepare the populace for the complete socialization of health care.

[Erik]

"Considering that the U.S. federal government hasn't signed the U.N. Convention on the Rights of Children, ( the U.S. and Somalia are the only ones mentioned by Wikipedia not to have signed the convention),it isn't surprising that providing health care for all children is not considered to be a societal obligation."

That's not really true. What the US is saying is that they are not ready - at this point - to force unrelated people, at the barrel of a gun, to pay for other people's healthcare. In europe and most other places we have no qualms about such things because it is the essence of our political system. But deeming something a societal responsibility does not HAVE to include threats of violence, jsut because it is the way the UN prefer it to be done.

[notsneaky]

Ay, ay, this is one of the New Paul Krugmans that makes me miss the Old Paul Krugmans. It's probably very true that "it’s just a matter of historical accident that we think of access to free K-12 education as a basic right, but consider having the government pay children’s medical bills “welfare,“ " But the fact that it's an accident doesn't really get at how each of these goods should be provided nor whether it really should be considered a "right". There's a pretty basic difference between education and health care. If left to the free market one of these goods is likely to end up inefficient, under provided, unequally distributed and socially sub optimal, while for the other it's a pretty good bet that a free market would do a half way decent job. Health care provision and the insurance markets that go along with it are very likely to be subject to the usual problems of asymmetric information like moral hazard and adverse selection which will lead to prices and premiums which leave a lot of deserving people without access. On the other hand the best argument one can make for public provision of education is that there's some externalities involved but every serious study that has looked into this has found that these are fairly small and that education is not really a "public good". Add to that the obvious fact that the presently government provided provision of education is very very unjust and unequal and the conclusion is obvious. The government should get OUT of provision of universal education and INTO provision of universal health care (or health care insurance). I don't care what historical accidents have to say about it.

[anne]

"Ay, ay, this is one of the New Paul Krugmans that makes me miss the Old Paul Krugmans."

Ay, that must be the Paul Krugmans who write just this way continually whether on health or racial or ethnic prejudice. That must be the Krugmans who have written dozens of columns on health care when others have turned away and the Krugmans who have written on the way in which race and ethnicity are used to subvert health care programs such as Medicare.

Ay, I miss the Krugmans of, say, last week and the week before and before, who writes just like same way and just these same topics.

[anne]

There was a time and could be such a time again when free education was provided in a number of wonderful public college and universities. There was free education through New York public universities, no tuition at California public universities. Nominal cost for the wonderful public universities of Texas and North Carolina.

I would much like to begin a federal-state revenue sharing program to foster a return to minimal cost higher public education.

says...

notsqueaky...
I agree with you, except of course that universal education is definitely a good thing. The way it is done in the US is abonominable.

[reason]

That was me, by the way.

Clearly - notice of course the distinction between "universal education" and "provision of universal education".

[btgraff]

"Secondly, there is a push for private sector education through the use of vouchers because of poor public sector performance"

funny how every other industrialised country can make public education work, but the US can't - but it is not surprising given that edcuation is largely funded through property taxes - which leads to a wide variation in funding (and therefore quality)...

if vouchers are so great, why not give every parent a voucher to pay for health insurance for their kids!

[bailey]

Is it possible for PK to tiptoe any more carefully around writing "ANYTHING" that might call the slightest attention to the power struggle we're watching drive our monetary policy?

[robertdfeinman]

Once again the left loses the argument before it starts by allowing the right to frame the issue. Krugman chose the word "socialist" purposely, but didn't go on to explain the misuse.

Socialism is government ownership of the means of production.

What we have are government-administered, communal, social welfare programs. The government doesn't own anything except some office furniture and the buildings to house the processing staff.

The government collects the funds via general or dedicated taxes. Puts them in dedicated accounts and then disburses them according to rules established by congress. It performs a clerical task, that's all. In fact much of the paper work from Social Security and Medicare is already farmed out to specialist paper-pushing firms.

The people of the US, democratically, have decided that they want communal, risk sharing, programs. They also want to see these programs expanded. Why the right can't accept that the people get to chose what they spend their money on in a democracy is the nub of the issue.

The only possible explanation is that the right doesn't favor democracy. Their actions tend to confirm this, They elect autocratic leaders and the more autocratic the better.

So rather than letting the term "socialism" slide we need to push back with charges of anti-democratic behavior.

[evagrius]

"That's not really true. What the US is saying is that they are not ready - at this point - to force unrelated people, at the barrel of a gun, to pay for other people's healthcare. In europe and most other places we have no qualms about such things because it is the essence of our political system. But deeming something a societal responsibility does not HAVE to include threats of violence, jsut because it is the way the UN prefer it to be done."

You mean the political system in Europe is based on the gun and the U.S. isn't?
Have you studied U.S. history? Quite a bit of guns involved.

And what does this have to do with providing health care?

[im1dc]

To: robertdfeinman, et.al.

Subject: Carlos Slim Helú, The World's Richest Man

Mexico’s Plutocracy Thrives on Robber-Baron Concessions

This Editorial follows up an earlier discussion between Warren Buffett's Value Theory of Investing versus Carlos Slim's amassed wealth via the Mexican Govt's largesse.

link: http://www.nytimes.com/2007/08/27/opinion/27mon4.html

I was right about Slim.

[manapp99]

notsneaky has it exactly correct. If anything the failures of the public education system point to exactly why we should NOT allow public involvement in health care. Nobody can screw up our health care delivery system better than the government. Just look at Europe and Canada and witness how they are shifting back to private health care more and more. In fact more European countries are pulling back from socialism in many areas as is evidenced by the recent elections of conservative leaning leaders in France and Germany. I would be all for a program that begins to take education out of the public realm and into the free market. Oh yeah, there already is such a program, vouchers.

[anne]

Public education has of course been a splendid success instrumental, overwhelmingly instrumental, for middle class development of this country. From the thousands of wonderful neighborhood elementary schools to hundreds of public universities, American education has been a wonder through all the problems with schools in poorer and less integrated or segrated communities for generations.

The idea of terrible American public schools is comically but perversely absurd.

[Jay Dubb]

Interesting. From what I've read of most of the 'universal healthcare' proposals, even those just for children, the families of "the rich" are often exempted (they have to find and pay for their own).

To maintain his example, I presume Mr. Krugman will fight against those that want to exempt "the rich" from government-paid healthcare plans. After all, we don't ban 'rich' children from public schools.

So what *is* at the heart of these healthcare proposals that would ban 'rich' children from the government-paid healthcare plan?

[anne]

"On the other hand the best argument one can make for public provision of education is that there's some externalities involved but every serious study that has looked into this has found that these are fairly small and that education is not really a 'public good.'"

Yes; study on study, especially serious study has seriously shown in study that education is a "public bad." Remind me though where those serious studies on education being a "public bad" are.

[Barry]

Erik: "...to force unrelated people, at the barrel of a gun, ..."

O noes!!111! Not teh Gun!1111!!!

The US government forces a lot of stuff at the barrel of a gun, just in case you haven't noticed. For example, we're now entering year 5 of a war which a majority of Americans don't want, but whose elected representatives seem to be deeply in love with. At hundreds of billions of dollars per year that we know of.

[kharris]

BJ Feng,

Krugman isn't arguing that societies shouldn't "determine the level of social services it provides to all of its citizens." He is arguing that it should. If you are, too, then you agree on that point. Suggesting otherwise is misleading. The point on which you disagree is, apparently, the level.

Krugman is aware of the school voucher issue. The school voucher issue does not change the fact that public education is available, in theory at least, to every child in the US, so this is not a very useful critique of what Krugman actually wrote.

The claim that "there is no reason to extend the State Health Children's Program to the middle class other than to prepare the populace for the complete socialization of health care" is mere hyperbole. One the one hand, there could be other reasons. On the other, Krugman is not arguing for provision of S-chip to the middle class as a matter of priciple. His point is that some of the standard arguments against a higher funding level for S-chip don't hold up to scrutiny. If some middle class families get lucky as a result, so be it. Just to clue you in, hyperbole is not all that effective because it is generally quite transparent. It is, for instance, entirely possible to think on reasons for extending S-chip that are not driven by political considerations like creating a path to (fully) socialize medicine. One reason to extend the program, for instance, would be to assure coverage for children who currently receive inadequate health care. These programs cannot do a good job of discriminating between needy and non-needy without going to great expense, so we are faced with choosing between spending on the core job of the program - providing health care to children - or spending money on greater adminitrative efforts so as to save money on medical care for children. The line between spending on core program goals and on administration always has to be set at some point. Your assertion ignores that choice to indulge in Chicken-Little claims of creeping socialism.

[Bruce Webb]

rdf:
"Socialism is government ownership of the means of production."

Nope, nope, nope. That is closer to a definition of communism as it developed late in the 19th centruy. The history of the socialistic movement did not revolve around state control, certainly not in the days of the Age of Reaction, that is roughly Europe before 1848 when 'democracy' was quite literally a dirty word, not least in Britain. Socialism in the form of the trade union movement, cooperatives and the franchise was always about worker control of the means of production first, then participation in government, then perhaps control of government. But I can't see that it was ever about turning over the means of production to the kings and property owners that made up the typical government of the day.

And indeed even communism as originally conceived did not perceive long time government control of the means of production. Instead the state would "wither away"
http://en.wikipedia.org/wiki/Stateless_communism

[Peter Schaeffer]

Parents who can pay for their children's health care, should. No one has a right to be a burden on society, particularly those with plenty of money.

Of course, the children of the affluent are eligible for free public education. Why not offer them free food, free housing, free clothes, free vacations, etc. while we are at it?

Why not make everything free and set taxes at 100%?

Every country that has tried this approach has been a great success.

[phastphil]

So - I send my child off to school and they become ill because their classmate's parents can't afford Health Insurance coverage - How secure are my family and I?

Here in Oregon our former governor John Kitzhaber has been making the same public school/health care argument for a couple years now. Check it out at: Archimedes Movement

[btgraff]

"Just look at Europe and Canada and witness how they are shifting back to private health care more and more."

speaking as a canadian, that is news to me. the political right has been pushing privatisation, along with the medical profession itself, but so far very little has happened - ironically, the only province where there is a 2-tier system developing is Quebec, which is normally the most "socialistic" province.

Prime Minister Harper has had to back-track from making any attempt at increasing the role of the private sector - he has a minority govenment - the other parties won't let him do anything and he has stopped trying because it is politically unpopular. Even Alberta, which was threatening to increase the role of private clinics etc., backed off a few years ago despite indications from premier Klein that he was going to make some radical changes.

[Lee A. Arnold]

Round and round it goes. The truth doesn't matter to some people.

Socializing health care could be a very good idea, because it will provide a baseline of coverage for everyone while reducing the overhead costs of the system. So it can save both time and money, and save distress for lots of people -- all of which will increase welfare and productivity.

The downsides could be political control of funding, which would lead to rationing, and also reduced innovation resulting from reduced profits. I think these objections can be dealt with.

The Republicans (helped by the health insurance industry, on this issue) are going to use "Markets are good, and tax cuts are even better!" as one of the core principles underlying their coming rhetoric. A alternative version of this (we see it here) is "No slide into socialism!"

(Their other core rhetorical principles will be: "George Bush is not a true conservative!" --a.k.a. The Big Divorce--, and: "No matter how much of a idiotic flip-flopper our new candidate is, the Democrats are worse!")

It's time for people who want to save this country from its slide into infamy to start formulating the rhetoric of a SERIOUS GENERAL DEFENSE of non-market institutions that are TARGETED TO SPECIFIC social problems. It has to be done by sound bites.

They save money. They cover everybody. They can be kept transparent.

It's not government control of everything else. --That has never happened, in a democracy.

And the negative: You prefer the present system, where the Republicans bail-out Wall Street every 5 years, while most everybody else gets screwed?

[robertdfeinman]

Bruce Webb:
I don't know what your debating the definition does to further the argument. But my point is that whatever the right says the social service programs that people want are government-administered, not government owned.

As for the definition of "socialism" - it seems to be in the eye of the beholder. All the more reason to not let the right use it as a negative label.

From dictionary.com:
"a theory or system of social organization that advocates the vesting of the ownership and control of the means of production and distribution, of capital, land, etc., in the community as a whole."

From American Heritage Dictionary:
"Any of various theories or systems of social organization in which the means of producing and distributing goods is owned collectively or by a centralized government that often plans and controls the economy."

The right means sense two and this is what needs to be countered.

[evagrius]

"Of course, the children of the affluent are eligible for free public education. Why not offer them free food, free housing, free clothes, free vacations, etc. while we are at it?"

Considering that some of the affluent have figured out ways to not pay taxes, this has already occured.

says...

Aha! Everyone's a little bit right! Even me!!

Of course each child should be guaranteed a quality education K thru 12. Hope we get back to doing it.

Should SCHIPS be extended to the middle class, of course not. Should it be extended to cover children that are not covered and at poverty level cannot afford it. Of course it should. There is no excuse for an American child to go without healthcare because their parent is unemployed or among the working poor.

As to college education Anne, there was never a "free" education, it was being paid for out of taxes. But there shouldn't be free higher education because not everyone should attend college.

But Anne and others have a very valid point...there is no excuse for the cost of higher education to be so high. No excuse at all at state supported universities. None.

Krugman is just arguing we should have Universal Medical care for every American citizen and I can't disagree with him.

I must have missed the part where France, Germany and others are getting rid of their systems that deliver better health care and going to our system that charges twice as much for half the result.

As to making the vouchers argument saying public education is failing, its the same as the current theory of government, starve it for proper funding, put incompetents in charge, misdirect it, use countermanding directives, provide half the staff needed to fulfill your directives....then step back and say, see....I told you government was the problem.

[manapp99]

The last entity you want to be a customer of is one in which there is little to no accountability. The various governents that we live under (local, state, federal) are the worst at effective, efficient management. When you have to turn to an orginization that has no competition, customer service suffers. They do not have to be effective as they are not threatened with the loss of business. The federal government is famous for it wasteful ways. I cannot wait until some clerk decides that my hip replacement surgery can wait another year due to a backlog of more important surgical procedures. Never mind that my inability to walk without pain affects my ability to make a living and support my family. We will end up with a system like the schools where you pay for the public one through taxes, but if you want real results on your timeline you will get to pay again for private care. Even if the system goes public, will they outlaw private care? If not, where do you think the better doctors will practice?

[someofparts]

Making an entitlement universal makes it more popular and harder to reverse.

[evagrius]

I'd like to know what the definition of "middle-class" is.

There are Medicaid programs in some states that allow eligibility for a family of 4 to earn 200% above the federal poverty limit- that's about $40K a year. That's pretty close to the median income of most American families, last I read.

So- is fully extending this coverage to families 200% of the FPL extending it to "middle-class" families?

( Don't forget- the rules require that a child that can be covered by employee provided insurance is not eligible- even if the family can't afford the premium).

I think the definition of "middle-class" is fairly useless these days.

[Lee A. Arnold]

manapp99, You are applying the argument that democracy can't work, as opposed to the fact that it hasn't been working too well.

Democracy can be made to work, and "transparency" is the key. People should demand information about what is happening -- continuous information, and in comprehensible formats.

There aren't only TWO main institutions, market and government. There is a THIRD institution: free passage of ideas and information. That's why Jefferson insisted upon the First Amendment. It isn't merely a "freedom," it's the only way democracy will work. If people are disengaged -- from the school board, from healthcare provision -- markets can't cure the problems either. Or can cure them, only for people with the money.

But the size-distribution of wealth and income is NOT cured by markets -- in fact, markets appear to be making it a little worse. See a picture of this at around minutes 3:00 to 5:00 of

http://youtube.com/watch?v=SA1f2MefsMM

And globalization (which on other accounts, we prefer,) isn't helping.

So we are going to always have people who can't afford basic services. And, it turns out, costs can be reduced for everyone else too, with universal coverage.

(Better doctors, by the way, don't necessarily practice where they can make the most money. That has never been true.)

"Democracy doesn't work" could well be the 4th core principle of Republican rhetoric. Remarkable how far a self-fulfilling contradiction can travel!

[manapp99]

Lee, in a perfect, hell even a good, world maybe. I can only go on experience. My experience of watching the government waste and lack of concern to it's customer base has been less than encouraging. You say it can work. The problem is that it may not work. I do not want to find out. Mend it don't end it is my (stolen from Jessie Jackson) motto with health care. Lets try to fix the current free market system first. How about tort reform, multi-state markets, choice in group plans (as opposed to the current one size fits all) allowing small business to form large groups etc. If we go to a universal care system and it is a nightmare we will be stuck. Government will never relinquish control once they have it.

[kthomas]

Like a great man once said, "Children are not rugged individualists."

A healthy society will make for a healthy nation.

The Haves just don't want to share.

[manapp99]

Liberal tripe kthomas. Everyone wants a healty society, We just differ on the best way to get there.

says...

A single payer system is not socialized medecine. Its publicly paid using a private delivery system.

As to the argument "I cannot wait until some clerk decides that my hip replacement surgery can wait another year due to a backlog of more important surgical procedures." Who do you think is deciding when or if you receive that treatment now? A clerk of a company with a vested interest in denying you coverage.

As to the bunk about waits...the French don't have any longer wait than we do, or the Germans, or anyone else under single payer. Socialized medecine as in the UK is another story.
"
There are Medicaid programs in some states that allow eligibility for a family of 4 to earn 200% above the federal poverty limit"

Correct and unfortunate. Pol's buying votes and well meaning busybodies perverting a needed and well intentioned program.

An abhorrence of Civic responsibility is the mark of a declining society.

[Lee A. Arnold]

manapp99, The general trend in the U.S. for thirty-odd years has been to make markets freer, and that hasn't worked either. Income is down, unemployment may be higher than the official stats, the size-distribution of income is polarizing more, and now globalism is giving much more competition from people whose healthcare is assured -- you already know the litany.

Reaganism is a myth that was kept alive -- from its beginning! -- by enormous government debt and a clever and continuous series of investment finance bubbles. The growth for most has merely been trickle-off, from a stunning redistribution upwards.

There are three main institutions: markets, government, ideas. Markets and government are slightly secondary to the free discussion of ideas. If the people determine that their universal healthcare system needs changes, or should be ended in some areas, or expanded in other areas, it will eventually happen. There are many examples of democratic governments relinquishing control. But you have to make it all work -- it isn't just handed to you.

[Lee A. Arnold]

God I was hoping for one of the usual suspects to jump on my assertion that only the Republicans have been bailing-out the investment finance markets over the last thirty-odd years... I was hoping for a fresh example of the 3rd core principle of Republican rhetoric, "No matter how much of a idiotic flip-flopper our new candidate is, the Democrats are worse!" ...But of course, the Dems have had a huge stake in the serial bubbles in finance, and bailing out their crooked friends, all to maintain the illusion that Reaganoidism works...

says...

Erik,
It never was your money. The current system requires hundreds of thousands of attorneys using government, what you call coercion, primarily in order to maintain your income and wealth, along with that of others who overwhelmingly tend to rationalize much the way you do.

Declaring one resource distribution system "natural" and another "coercive" is the height of intellectual self-deception, childish arrogance and moral cowardice. Re-education camps will be too good for many of your kind.

[worker]

Funny analogy to the governments abysmal track record in managing public schools- preaching to the left wing choir on this one. God I hope that someday the tireless civil servants who are bringing us (rather I should say, you poor people) the Baltimore City School system [fill in any major urban] will be rewarded with administering my (theoretical) childrens healthcare.

Is it socially worse to limit a new healthcare entitlement, or to choose (as Krugman's people do) to sacrifice a children's education in order to pay off some teachers union supporters? Or is that the goal of Krugman's gov't healthcare dream will become- a system where a corrupt, overpaid, systemically incompetent, group of government workers remake healthcare for their benefit. Screw the patient, as long as we can turn another sector into dues paying government workers.

I wish before proposing new entitlements, the craven pols were forced to actually fix their last great idea.

[Lee A. Arnold]

Maybe we need a 5th Republican core point: "It's broken, so it can't be fixed." That would logically subsume "Democracy doesn't work," although it loses some of that tangy hypocrisy.

[Lee A. Arnold]

manapp99, Is "tort reform," as a cure for anything, a canard? Every study that isn't from a political thinktank or insurance P.R. firm shows that large awards are unusual, and that they SHOULD have no effect on rates. Meanwhile only a small fraction of medical mishaps become legal malpractice claims. For business at large, insofar as there are expanded bases of liability, tort claims are a natural result of a more complex society having increased social and environmental transactions costs. In this sense, tort awards are a natural way to "get the prices right," not wrong. That part should be welcomed by all libertarians. Of course, if your insurance carrier is also playing the mortgage market, you could have problems... On the other hand, universal coverage can greatly reduce claims (will someone please check on what the Canadians and French do,) so you can expect the attorneys to screech the most...

[kthomas]

manapp99, would you like some wine to go with my tripe? I would recommend the Cab. Blanc. I am told that washes the tripe down fully, with neary an aftertaste. Quite fresh.

[Bruce Webb]

rdf

Maybe it is not too important in the scheme of things.

But you made the following assertion; "Krugman chose the word "socialist" purposely, but didn't go on to explain the misuse." Well I don't believe it was particularly a misuse. Oddly enough I too consulted the American Heritage Dictionary, and prior to my post. I just highlighted a slightly different word.

"means of producing and distributing goods is owned collectively OR by a centralized government"

And even your dictionary.com definition says "in the community as a whole". Now while the organizing structure of "community as a whole" might typically be governmental or quasi-governmental, it doesn't have to be, instead you could set it up along Cooperative principles, in fact any Condo board or subdivision HOA delivers a subset of organized services without in any way losing its non-governmental status.

Your statement explicitly limited 'socialism' to 'state socialism' which in turn gets equated to 'government central planning' or more prosaically 'bureaucrat deciding on your health care' or in other words feeding the prejudices of certain of the posters here.

I want to defend and advocate social solutions to social problems and believe that governments can (and despite what some commenters say) and does deliver those solutions in a more efficient way than simple markets. That is I want to defend 'socialism' and 'government' without conceding to the Hayekians their position that any amount of government intervention leads to centralized government control.

Single payer can be set up on a socialist basis without transforming it into a Canadian style Governmental Health Service. There is no reason why health care insurance can't be delivered by non-profit regional Cooperatives or by organizations modeled on Unions. That is an important point and one I think that was endangered by your formulation.

[robertdfeinman]

I hate to intrude with some facts, but we do have a government-administered universal health care system, Medicare. Here's how those in it feel about it:
The Medicare Contractor Provider Satisfaction Survey (MCPSS), conducted by CMS for the second year, is designed to garner objective, quantifiable data on provider satisfaction with the fee-for-service contractors that process and pay Medicare claims. Sixty-five percent of those who were surveyed responded. The survey revealed that for the second consecutive year, 85 percent of respondents rated their contractors between 4 and 6 on a 6-point scale.

Note you can go to essentially any doctor you wish (some opt out, but very few) and Medicare doesn't say what care you can have, only what they will pay for. This is to limit quacks and unproven treatments. Private insurance companies do the same thing with even more constraints.

85% satisfaction sounds pretty high to me. So can we stop all the totally unfounded claims about the evils of government-administered health plans now? By the way the VA had similar high scores until the Bush admin cut its funding and sent thousands of serious wounded soldiers into the system.

[Nate]

Robert: Lets remember that we are not looking at two independent identically distributed populations when comparing those on Medicare with the rest of the US population.
"Satisfaction" can be measured by a binary variable dependent on whether U(R) - E(U(R)) is positive or negative. U(R) being the utility received, and E(U(R)) being the preconceived expectations one has of utility to be received. E(U(R)) of the Medicare population does not equal the E(U(R)) of the rest of the population.
When you are spending someone else's money, you are going to have a lower E(U(R)).

[anne]

"When you are spending someone else's money, you are going to have a lower E(U(R))."

So, whose money are my grandparents spending after paying for Medicare insurance all those years? So, whoe money are my parents getting for the health care insurance they have and the Medicare they will have because they are paying for future Pedicare provision?

Whose money goes for Social Security payments? Whose money are my grandparents getting for the Social Security payments they made for so mnay working years?

[anne]

"When you are spending someone else's money, you are going to have a lower E(U(R))."

Imagine, all those Medicare recipients getting someone's else money after decades of working and paying for Medicare. What nonsense.

[Arne (not anne)]

"funny how every other industrialised country can make public education work, but the US can't"

Why do people accept this assertion? It is no more accurate than that SS is going broke.

Although there is always room for improvement, I believe that my school district is providing a better education for more people with fewer dollars per student now than it did thirty years ago when I was the student.

[Nate]

Anne, yes some of the money spent can be traced back to money they were coerced into saving, but Medicare is very much a program in which those that make enough income to not qualify for Medicare, subsidize the medical costs of the rest of the population.

[calmo]

Arne, (and not anybody else), do you figure this is a nasty fib then...that US public education is (gasp!!) getting left behind the international standard(s)?
Should we, emboldened with our newly revived confidence in our respectable education, accept your denial of these international and possibly terrorizing claims or view your personal claims with some reservations?

[anne]

Medicare is not means-tested, nor is Social Security. These are insurance programs that workers pay for over the decades. But, immediately with the words "coerced savings" I understand the position being taken. Oh well.

[Jazgar]

Dear nutters, universal health care IS coming, and once the American people get it the only only way you'll be able to take it away is to pry it from their cold, dead fingers. Let's face it, the whole privatize everything philosophy simply hasn't worked out in the REAL world. We've gotten screwed by energy companies, insurance companies, big pharma, charter schools, Chinese imports, E.coli, Halliburton, coal mine owners, Detroit. No trabaja, homes. Most corporations simply don't make good citizens. There simply isn't any incentive without regulation and enforcement. The invisible hand is invisible for the same reason the Easter bunny is. Can you guess? Personal responsibility means exactly 1 thing: "C Ya, wouldn't wanna B Ya!" Cast adrift without a paddle. Which might be fine for you rich dudes with a 60' yacht, but most of us can't even afford a dinghy.

If it means I don't have to worry about going broke because I got cancer then, yeah, I want me some of that "socialized medicine". And if that means we have to sacrifice a bit on efficiency (efficiency to what, btw, drive us all to bankruptcy?) then so be it.

[Arne (not anne)]

@Nate

You are mixing up the question of whether we do well enough with what we put into education with whether we could get more out of education (by putting more into it).

[Patricia Shannon]

Some people must have missed the news that the U.S. ranks just 42nd in life expectancy?
http://www.msnbc.msn.com/id/20228552/

As for the theoretical wait for a hip replacement, most people w/o health insurance have to wait forever, or at least until they are eligible for Medicare, for a hip replacement, because they just can't afford it. I couldn't afford to get my cataracts fixed when I was working as a waitress a couple of years ago. Even at poverty-level income, I was not eligible for Medicaid in the state of Georgia. What the state of Georgia did for me was to give me applications for a couple of charities that help people with vision problems.

I also learned that when a person becomes eligible for federal disability payments, they do not become eligible for Medicare for two years (unless they have ALS)! So, someone with diabetes may not be able to afford proper medication or medical care, and instead of being able to possibly work part-time (legal for the disabled), may end up dead or on dialysis.

I know a man, legally blind from RTP, who got an eye infection. He couldn't afford the full prescription of antibiotics, so he was taking a half dose. That encourages the development of antibiotic-resistant bacteria, endangering all of us.

If you want your comments to make sense, get a job at Waffle House, and try to live on that for awhile, and find out what reality is. Read "Nickel and Dimed: On (Not) Getting By in America" by Barbara Ehrenreich.

[Peter Schaeffer]

Anne,

“The idea of terrible American public schools is comically but perversely absurd”

Wow, I thought America ranked rather low compared to other industrialized countries on standardized exams. I guess I was wrong… Not.

In real life, America’s urban public schools combine fantastically high funding with levels of performance that are unimaginably low.

Evagrius,

“Considering that some of the affluent have figured out ways to not pay taxes, this has already occurred”

If you think dodging taxes is easy… I suggest you try. Actually, don’t for your sake. However, even if a person avoids taxes they still have to earn the money.

I won’t defend the Bush tax cuts nor the current treatment of carried interest or other tax foibles as well. However, the average tax rate on the top 1% or 0.1% is far above zero. Check out “NEW STUDY FINDS "DRAMATIC" REDUCTION SINCE 1960 IN THE PROGRESSIVITY OF THE FEDERAL TAX SYSTEM” (http://www.cbpp.org/3-29-07tax.htm). The effective tax rate on the top 1% appears to be around 30% (down from 45% in 1960).

Btgraff,

“funny how every other industrialised country can make public education work, but the US can't”

Wow is this far off. France’s public schools in the suburban slums are shockingly bad. Ask some French people. The UK’s urban public schools are scarcely better. Sweden now has dismal public schools in many areas. What is the common theme? Diversity doesn’t come free.

As for the US, our awful public schools are lavishly funded with and without property taxes. Back in 2005, Washington, DC was spending $17,809 per student, for what might be the worst public school system in the world. Actually, that is not true. Camden, New Jersey spends even more and is allegedly even worse. See “Public Education Finances 2005” (http://ftp2.census.gov/govs/school/05f33pub.pdf).

[Patricia Shannon]

For those who want to do away with the (admittedly not perfect) public school system, what country, does things they way you advocate, and what are the results?

[anne]

"France’s public schools in the suburban slums are shockingly bad. Ask some French people. The UK’s urban public schools are scarcely better. Sweden now has dismal public schools in many areas. What is the common theme? Diversity doesn’t come free."

Ah, diversity is the supposed problem. I never would have guessed. France, UK, Sweden, OMG!

[robertdfeinman]

As new people show up on various sites they tend to bring up the same issues or viewpoints again and again.

Those of us with enough patience and a good supply of bookmarks can whip together a reply once again. This gets tiresome after awhile. I think what is needed is some set of prewritten answers. Call it the anti-libertarian FAQ. Perhaps Mark Thoma would like to moderate it or host it on his site. He can even decide what goes into it.

What brings this to mind is the off topic rants about the quality and/or expense of public education. This has been treated before...

I'll just make one point about the cost. Many school districts are now taking on social service functions and this adds to the apparent cost of education. These include free meals (including in the summer), drug counseling and treatment programs, and extensive special education services. Many districts also have to deal with large immigrant populations many of whom don't speak English. This means ESL programs as well as outreach to the parents. NYC has a program to translate school documents into five languages (soon to be expanded) and currently employs 40 people.

The US does poorly by international measures when national averages are used, but if you separate out the "two Americas" you'll find that the top group still leads the world by most measures.

[demisod]

Re: Schools

Perhaps "slums," not "public," is the key word here. Well-funded public schools in good neighborhoods have a quite good track record. And at least part of the reason for lower U.S. scores is that a higher percentage of U.S. students take the tests.

[calmo]

So Robert, are you advocating an elitist view of education --like an edited version of this blog so that we can weed out the "tiresome" newcomers (I'd count you one btw --not always tiresome but relatively new...and include you.)?
That "top group", would that include or exclude recent immigrants whose scholastic abilities were instrumental in determining their status as Americans?
Is this business, public education, only about the technical caliber of the individual product or should we have a broader, more social evaluation?
I hesitate to leave this adjudication in merely technical hands, you?

[Icarus]

Anne...

The US is not failing children in either education, or health care. This is an irresponsible idea.

If children are being 'failed', it is by their parents. While a good society has a certain amount of redistribution required, in order to better maximize total output and productivity, the responsibility of the welfare of children belongs to the individuals who bring them into this planet.

[RW]

The authority with which those who despise public schooling trot out their putative facts and spurious analyses never ceases to astonish me. I suggest those who think they know and understand the current state of public education in the US and believe its comparative status internationally sucks should take "A Test Everyone Will Fail" at http://tinyurl.com/ytlrnn (no it's not some test of 19th century, 5th grade knowledge) and then quit inflicting your terrible, tendentious ignorance on the rest of us.

Ditto for universal health care frankly: the US model is dysfunctional, broken or punitive and I have no interest in the apparently more bureaucratized Canadian and English systems; I do hear the French system is excellent and remarkably consistent with the theme of choice so beloved by US chest thumpers -- let's talk about that.

[ilsm]

The posts about the government messing things up are correct.

Look at the military. We spend 4% of GDP ad really waste it.

We prop up corrupt incompetents in places like Iraq and Vietnam with our treasure and kids' lives.

What waste. But armies, according to Hitler are to be used. So better find some tinhorn incompetent to support to use our army.

If you do not use it you will lose it.

ANd while your at it include the con artists in the MBS's debacle too.

Cannot let good millionaires go broke.

If we did there may be plenty of money to pay for kids' health care.

And scare us about SS going less than surplus in 2017. We should raise taxes now so the rich don't have to buy t bills to run the government.

"Military madness is ruining my country......... Neil Young

[Sonia]

Back on the SCHIP topic. The S in SCHIP stands for state and since state matching is required it is unlikely that many states will expand eligiblity greatly beyond current levels. According to the Kaiser Family Foundation in 2006 91 percent of kids in SCHIP were in families below 200% of poverty (about $41,000 for a family of four). However to the extent that states expand coverage well beyond 200% of poverty it could ameliorate some of the stagnation in real income for moderate income families. An important factor in the errosion of real wages for moderate income families has been the increase in employer health costs. Providing health insurance for moderate income children through SCHIP
is one way to reduce the pressure on moderate earner wages.

[german_reader]

@manapp99...

"Just look at Europe and Canada and witness how they are shifting back to private health care more and more. In fact more European countries are pulling back from socialism in many areas as is evidenced by the recent elections of conservative leaning leaders in France and Germany."

Your statement is complete nonsense.

First of all conservative ( mainstream conservatism ) in Europe doesn't mean the same as in the United States. Our Conservatives would be anywhere in the middle of the political spectrum in the United States. Even a majority of the conservatives normally want public solutions in central areas of the society like education, health care or pensions. The discussion is about the details of organization, not about public or private in general.

Most European health care systems already combine public and private solutions, giving people the freedom of choice. The main difference to the United States is, that government control is more intense for private insurances and that health care - public or private - is affordable for nearly everybody.

The majority of the population is well aware, that public solutions are often the best way to provide basic services to all citizens at a reasonable price. The trend goes towards more public involvement in the society not against it. The main reason people vote conservative in Europe is, that they hope a conservative government will offer better protection against the winds of globalization than the more internationally oriented left.

A majority voted left during the last election in Germany. But the moderate left SPD didn't want a coalition with the outer-left Linkspartei, which has reputation problems, because it includes some influential members from the former EastGerman communist SED. And the new leader of the Linkspartei Oskar Lafontaine is a former leader of the SPD, who left the party after some quarrel. That's the main reason we have a great coalition now. And Sarkozy in France stands for a strong government, which intervenes into the economy. As far as I know he has no intentions to privatize core parts of health care.

The United States are often seen in Europe as a rich society, which fails to guarantee all of its citizens basic social standards, that are self-evident in other parts of the developed world. And just like in the United States government decisions in Europe don't always reflect the will of the population. Rich lobbies are often successful in manipulating political decisions in their own interest. Many "free-market" reforms here in Europe are refused by a vast majority of the population. And as far as I know a majority of Americans wants unviversal health care and a more balanced policy in other areas of the society.

[Icarus]

German Reader...

Lets see what happens once nations like Sweden open themselves up even further to immigrants, and, the crime rates in cities like Malmo continue to increase. The solidarity of social welfare will erode, the financing of it will fray, and the idea of a central government guaranteeing anything, outside of protection and roadworks, will begin to fracture.

Sure, a majority of americans want univeral healthcare, free college tuition, and, the occasional lottery victory. It doesn't make it logical.

[anne]

"Lets see what happens once nations like Sweden open themselves up even further to immigrants, and, the crime rates in cities like Malmo continue to increase."

Notice the prejudice, notice the intimidation; the pattern is always the same, always crazed prejudicial intimidation.

[anne]

http://www.ailf.org/ipc/special_report/pr_feb07.html

February 27, 2007

The Myth of Immigrant Criminality and the Paradox of Assimilation: Incarceration Rates among Native and Foreign-Born Men
By Ruben G. Rumbaut and Walter A. Ewing

....

http://www.nber.org/papers/w13229

July, 2007

Why are Immigrants' Incarceration Rates so Low? Evidence on Selective Immigration, Deterrence, and Deportation
By Kristin F. Butcher, Anne Morrison Piehl

[JRossi]

As a family doctor I have seen innumerable cases in which poor children have suffered because of lack of insurance. Chronic and recurrent ear infections are big offenders. The ear infections can lead to hearing loss. Also learning and emotional disorders, which obviously have a tremendous impact on learning ability, are neglected. Is this due to parental disorganization or finances? Probably some of each. Free vaccines are often covered by the state (at least in MN and OR)and usually get taken care of at the public health dept, even for the uninsured.

[Patricia Shannon]

Icarus, do you really think that saying "the responsibility of the welfare of children belongs to the individuals who bring them into this planet" is going to make a difference in the life of a single child? In some cases, parents are negligent. But most doing the best they know how to do and can afford. Do you really think it is the best interest of our country to throw children on the scrap heap because their parents are incapable or uncaring?

Did you go to public schools? If so, people like me, w/o children, helped pay the taxes for your schooling. I don't begrudge that, because it ultimately is for the good of my county, myself, and the world.

I know from experience, that if I saw you being mugged, you think I should help you, at least to the extent of calling the police. But what reason can you give me for doing so that would fit into the philosophy that you advocate? I have come to the point that I simply don't care at all about people like you.

[DJM]

I wonder if private schools were to become the norm here how many free or low cost variations of "Maddrassas" would pop up (not just one perverted religion but many) for those who cannot afford the better/more expensive schools...and as we all know now, that eventually affects the world not just a few poor children. (yeah sweetie, dinosaurs and people were here together)
Sorry, I know it sounds hateful too, but I have begun to see the nuts in the wings taking a bigger and bigger role in religions.

[BJ Feng]

Most people just want a good education for their children and understand that a Maddrassas type school focused on non-scientific religious studies would do their children more harm than good. Wackos can already send their children to these type of schools, or home school them (not all home schoolers are wackos, probably very few are) so I doubt there would be much of an increase.

Why is there opposition to vouchers? I've said before the greatest benefit of private schooling, which vouchers would stimulate, is the competition it provides. Private schools will and are forcing public schools to do better or face closure. Likewise, poor private schools must improve or close. Who better to judge the quality of education than the parents and children going to those schools and living in a particular school district? What about personal choice and freedom to decide? Vouchers also cost the State less to boot! I don't understand the opposition. Good public schools will not close, rather they will force private schools to do even better or close. What are the negatives here?

[kthomas]

BJ, the onus is on you to PROVE that a voucher system actually works. Your abolsute belief in it is absolutely sketchy.

Cite one example where vouchers are making improvements or stop sounding like Gover "Drown-the-Government-in-a-Bathtub" Norquist.

[Lafayette]

Krugman: But a child who doesn’t receive adequate health care, like a child who doesn’t receive an adequate education, doesn’t have the same ... chances in life as children who get both these things.

Spot on. Except this bit:

And insurance is crucial to receiving adequate health care...

Private insurance is not crucial since it will maintain the excessive cost of Health Care. Wait till "national health coverage" does come and we'll see the "deductibles" for those who will benefit with extended coverage that they do not have today. Given HC prices today, those deductibles will prove dissuasive to the poor.

These deductibles will entice the the poor (and even many from the middle-class) to stay away from Health Care for everything that is not absolutely necessary, given the high cost of HC services.

For national Health Care to work, coverage must be universal and almost totally paid by out of government funding -- meaning that mandated GP and specialist pricing must be established for those who do not have company programs. (To avoid abuse, these lower charges could have a percentage deductible.)

But, the monkey wrench in the works here is that in proposing such, many companies will be enticed to drop present company programs and let people adopt the national health schemes, which will be obviously cheaper.

America is unable to make Health Care more fair -- and call it European-style effective coverage -- as well as maintain the exorbitant pricing of services that are prevalent today.

It just can't be done AND be effective. Pricing is the stumbling block.

In passing, it should be noted that the high cost of Health Care in America has to be paid by someone. And since companies recuperate HC-insurance cost in their product/service pricing, it is an indirect tax on all consumers -- even the unemployed who do not benefit from it, but purchase goods and services that include inherent HC-costs.

This makes it uniformly unfair. Just one more thing to add to the unfairness pile which seems to grow daily.

[german_reader]

@Icarus

I'am not aware what health care has to do with immigration. And I'am not aware why it's a reason to deny universal health care to native Americans. The United States are an absolute negative exception among developed countries in regard to their social policy - which includes health care - and their crime policy ( imprisonment rate, death penalty ).

Explicit immigration countries such as Australia or Canada have universal health care solutions and I don't see, that they collapse because of it. Many countries in the world prove the possibility of universal health care at a reasonable price and many, like Germany or Japan, have a higher share of older people, who need most health care.

The idea, that the country, which pretends to be the richest in the world and which already has by far the highest health care costs, cannot afford universal health care, is not very convincing. And the view, universal health care should be avoided, because it could be misused by poor people, is a really stupid. The US health care system is already misused - by rich insurances and overpaid doctors. Giving some of this money to those, who really need it, seems a fair policy to me.

It's true, some European nations are ethnically more homogeneous than the United States. But that's not the case for all. France, the United Kingdom or the Netherlands have high rates of immigrants and the number of people with an immigration background ( immigrants or children of at least one immigrated parent ) in Germany is 15.3 million, 18.6% of the population ( 82.4 million ). The correspondent number for the United States is in the range of 50 million, a similar share of the population as in Germany. And the inflow of immigrants to the the EU is higher than to the United States. If we can pay universal health care, you're able to do the same.

Your opinion, that immigrants are the main responsibles for crime is pure racism. I don't deny, that some groups of immigrants are more criminal than the rest of the population. But this can be explained. Immigrants have on average a higher share of young males than the native population and they are in most cases on the lowest ranks of the society. If you'd say that young males, especially poor young males, have a higher risk to become criminal than the rest of the population, this would be true. Limiting it to immigrants is insincere. Most immigrants are honorable, hard working people. And you should not forget, immigrants can commit "crimes" like illegal residence, native citizens can't. This also pushes up crime rates.

And size, another argument you brought on this website, doesn't matter. Germany is five times larger than the Netherlands, ten times larger than Austria ( Sweden ), fiveteen times larger than Denmark and twenty times larger than Ireland, but the crime rates are very much the same. We have much lower crime rates than the US and we reach this with much lower imprisonment and less draconian penalties . To assume, this has nothing to do with the social policy of a country, is superficial.

[reason]

With regard to vouchers, I like them in principle but I see BIG practical problems (ideas needed). The big practical problems are:
1. Ghettoisation - the danger of the community being divided into communities that hardly interact with one another.
2. By enabling a full range of private supplementary payments, there is a strong danger that the basic voucher education will become woefully insufficient. (This is a political danger, particularly in the US which funds education locally and often insufficiently anyway).

Compare this with say Germany where I am, where even most millionaires send their children to public schools (my daughters mix with them).

[Ganga Prasad Rao]

It is refreshing that Krugman has the gumption to stand up to the American Right and point out in his string of articles on health care, how tenuous and ridiculous the American system of health insurance is. I don't claim to have read all of them, the facts are more to the contrary. Yet, it was his latest piece 'Every child has the right to healthcare' (A Socialist Plot) that spurred me to pen a couple of thoughts.

First, the more I read on healthcare, especially Krugman's, the more I am convinced that those who passionately argue for 'free market solutions' in health insurance do so not because they believe in its miraculous 'invisible hand', but because a free market policy, more often than not, permits exploitation of planned and past policy mistakes and loopholes, and plays in to the designs of the fat cats in the insurance and legal professions. A 'free market policy' built on the edifice of regulations under previous administrations whose electoral campaigns were funded by lawyers and health insurance firms isn't likely to stand the test of economic efficiency. So, the next time, someone propounds free markets from a high pulpit, I'd take it with a grain of salt. Perhaps his intentions are not so noble. (God help innocent academics who play in to the hands of power mongers on Capitol Hill!)

My second point concerns the debate between 'equality of outcome' vs 'equality of opportunity'. On paper and all else equal, I too would pitch in for equality of opportunity over equality of outcome. After all, why should the world wait for late-night party buffs, junk food lovers and slap-stick comedy watchers when there are those who toil overnight to bring out a research paper or work two jobs to make ends meet? I agree that we should not be either surprised or concerned when outcomes differ wildly within a target group. But it is important to understand the reasons behind why outcomes vary as they do. Is the variation in program success on account of personal or community traits, genetic proclivities, or is it attributable to the design and implementation of the policy? Are we mis-attributing 'outcome failure' on account of inefficient policy design to 'personal'/'community' causes? (or the other way around?). Perhaps public and private policies are designed to exploit these natural or artificial correlations? Perhaps Government policies do not take cognizance of personal traits, community practices (Sweets, savories and 'panak' for an early harvest festival in India are not exactly what the doctor ordered for the Indian community in Boston!), and genetic proclivities that private insurance programs do, bringing about an 'arbitrage opportunity' for those who juggle policy renewals and coverage against the market movements of health care industry ETFs and ETNs?

Is there an ETF of health care law firms that I can 'invest' in?

[Patricia Shannon]

BJ Feng says...
Why is there opposition to vouchers? I've said before the greatest benefit of private schooling, which vouchers would stimulate, is the competition it provides. Private schools will and are forcing public schools to do better or face closure. Likewise, poor private schools must improve or close. Who better to judge the quality of education than the parents and children going to those schools and living in a particular school district? What about personal choice and freedom to decide? Vouchers also cost the State less to boot! I don't understand the opposition. Good public schools will not close, rather they will force private schools to do even better or close. What are the negatives here?
==========================
The problem with vouchers is that private schools can cherry-pick the best students. People who run private schools have admitted they can't do better than public schools if they have to admit all students. The public schools would be left with a higher percentage of problem students, whether behaviour problems or learning disabled, so they would look bad. (Learning disablilities can cause behaviour problems in young people who are bored and/or frustrated.) But it is not in our best interest to neglect the problem children, for doing so would lead to higher social problems in the future.

It seems to me that one thing that could be tried in the higher grades is to allow young people to drop out for a year or two, as long as they are in the work force, and see what kind of jobs are available to them w/o an education. Then it should be possible to continue their education.

We also need more help for children who have fallen behind for whatever reason. Head Start should be available to all children below a certain income level. When I was out of work in 1990-1992, I did voluntary tutoring at a middle school in a poor part of town. One boy could not seem to learn percentages. I discovered it was because he couldn't divide large numbers. He could multiply large numbers likety-split. Unlike his teachers, I felt that was a good sign he was capable of learning to divide. Working with him individually, I discovered that he couldn't do long division because he didn't know how to borrow in subtraction. Within an hour, he was subtracting and borrowing with no problem. He looked awed. Unfortunately, it was at the end of the school year, but I hope that he had learned the lesson that he is capable, and was able to proceed. He was a very bright young man, a fast learner, and it is utterly stupid that people like him are being wasted. (BTW, for those who care about such things, he was Afro-American, and I am Euro-American).

[Icarus]

Patricia Shannon...

"In some cases, parents are negligent. But most doing the best they know how to do and can afford. Do you really think it is the best interest of our country to throw children on the scrap heap because their parents are incapable or uncaring?"

The first issue is 'responsibility'. Who's is it? My point was that the welfare of a child ulimately belongs to the parent that brings them into the planet. It is their choice to do so. Setting up an incentive system where a person can have a child, and, expect the social system to finance it, due to a collective responsibility, is, effectively irresponsible.

Every child born into poverty, every child born into a broken home...every child unplanned, with parents who don't have the time and means to raise them properly...every single one is a shame, no doubt. The solution isn't to fathom a social welfare system which finances everything; that will never be possible. The solution is to continue to spread, ever forcefully, the need for family planning, lest the cycle of poverty replicates.

There will always be a modicum of social welfare for chidren; you've mentioned public education, and, there's of course health care for children. But, both systems are inadequate for the poor, and will always be. The reason isn't improper financing...the reasons begin and end with the way those children are raised. Children learn at home, their discipline comes from the house; their values, lanuage skills, propensity for obesity, concentration levels, focus, and curiosity, come from the relationships they have at home.
A school could never replace all that. No social policy can render differences equal. There will never be equality of opportunity, or equality of results, simply because children born into nurturing, disciplined environments will always succeed at greater rates than the others.

Our society is best served when we create the right incentive system for better social welfare...as it is, our schools have turned into soup-kitchens for improperly fed children, and, a quasi-effective disciplinary structure for children not getting discipling at home. What more? We'll teach the the birds and the bees...maybe even hygiene...and what else? Seems like we can bypass the parent altogether. What a brave new world.

[Icarus]

German Reader...

I was not trying to make a connection between immigration and crime. My comment was about a relatively homogenous society (Sweden), and, its commitment to the welfare state once that homogenization is fractured. Of course, it's tough to compare a nation the size of a large metropolitan area in the US, to a country of 300 million.

Saying "Sweden", or "Ireland" does it right, is akin to saying that Orange County (california), or San Diego have great standards of living, proving that the US way of life works.

It's much more difficult to measure apples to apples. Find me an immigrant nation (recent immigration...not the visigoths or ostragoths), of great size (even germany's 80 million is small), which handles universal healthcare properly.

But, yes...the US, Germany, and the UK have had very different histories since WW2. Labour power in the US isn't quite as strong as Germany, and this configuration of class power in the US has lead to very intriguing results. We have a strong capitalist class, with great resilience, who will sacrifice its labour class quickly (maybe the most efficient fat-trimming in the world). Industries can come and go (I'm speaking in terms of decade to decade), cities can rise and fall, and the onus of social protection falls on the individual here. It is, in effect, the land of individualism. This is a nation where every person, equipped with their nike shoes, ipod, and other accoutrements of consumption, can create their semiotically controlled persona. The rebel, the pimp, the king, the good samartian, whatever. We dress the part here, and play the role well.

Germany is much different. If Volkswagon sets up a plant in Slovenia, you may get people to go on strike. In the US, we can be in the midst of an illegal war (really, a state terrorist attack), and, its citizenry prefer american idol.
Most Europeans travel to other nations, speak another language besides their mother tongue, and, have some clue beyond entertainment-news. Not so true in the US. The land of the free and the home of the brave is a land of 'People' Magazine, and Sportscenter.

In this vein, it's no wonder the working class in the US has no capacity for class consciousness. I think its laziness...or, a technology utility trap. There's Playstation in the ghettos...we've apparently reduced the cost of Televisions and Video Games to such a low level, the cost of great utility per hour is incredibly low. Given that, why learn algebra?

It's tough to compare Germany and the US. Two very different histories, two very diffent levels of individualization, two very different ethics of consumption and waste.
And, I wonder if the immigrants from Turkey compare to the immigration the US gets from its southern neighbors, in terms of levels of education, and barriers to assimilation. I'll have to read more on that...

[anne]

"Of course, it's tough to compare a nation the size of a large metropolitan area in the US, to a country of 300 million."

Of course, it's tough to compare the European Union, which is larger than the US, to a country of only 300 million. The US is too small then to extend health care insurance to the 45 million who have no health care insurance.

[german_reader]

@Icarus,

I accept that you didn't want to tie immigration and crime.

On your other arguments I must contradict. The number of immigrants for Germany I quoted ( from the federal agency of statistics ) are first generation immigrants or children of first generation immigrants and many come from countries like Turkey, Russia or Marocco, so they are comparable to immigrants from let's say Mexico. Most of them are concentrated in WestGermany and Berlin ( population 69.1 million ). The share of immigrants in WestGermany is significantly higher than the 18.6% for Germany as a whole. We have high immigration and our societies ( European ) are not as homogeneous as you believe ( Don't tell our conservatives: Germany is an immigration country. ).

Germany may not be as large as the United States, but it is a larger country by world standards ( 14th out of 221 ). If you don't accept Germany I could hint at Japan, but it's indeed less heterogeneous than the US. Or as "anne" says the EU or the Euro-area ( better choice, because the EU includes countries that are much poorer Portugal, Greece, Poland... than any part of the US ).

I think you're in general much to sceptic against universal health care. The United States are a rich country and universal health care is with a probability cheaper - without quality loss - than the current system. So you can afford it. And it's not so as if the United States isn't able to install any other feature of a developed country in all regions of US, so why not health care?

On social policy: I think it's not only the amount of financial transfers which counts. It's the general feeling to be taken serious and to be treated as equal citizens. The lack of life perspective or the feeling of social exclusion is as dangerous as financial poverty. That can be addressed with social programs.

And yes, the history of the United States and Germany's/Europe's is much different. We have a much longer and painful experience, what it means, if a larger part of the society has the permanent feeling to be left behind. Don't repeat our mistakes. Build a fair country that cares for every one. Universal health care could be a part.

[calmo]

Thank you for joining us german_reader.

[anne]

Of course the reason for mentioning the dread awful horrible terrible threat to pristine Sweden from lack of proper racial and religious homogeneity was precisely to tie immigration to every possible evil. Of course, that was the purpose.

[anne]

The purpose of raving about homogeneity is just to rave about homogeneity, racially, religiously, by class, by culture, and on. When we are all sufficiently alike, how glorious we will be and therein resides America's problem; we are not homogeneous. We must all pray to the Gods of homogenity, and learn our algebra.

[Patricia Shannon]

Icarus says...
German Reader...

Labour power in the US isn't quite as strong as Germany, and this configuration of class power in the US has lead to very intriguing results. We have a strong capitalist class, with great resilience, who will sacrifice its labour class quickly (maybe the most efficient fat-trimming in the world). Industries can come and go (I'm speaking in terms of decade to decade), cities can rise and fall, and the onus of social protection falls on the individual here. It is, in effect, the land of individualism. This is a nation where every person, equipped with their nike shoes, ipod, and other accoutrements of consumption, can create their semiotically controlled persona. The rebel, the pimp, the king, the good samartian, whatever. We dress the part here, and play the role well.
============
We also have a much higher rate per capita of murders and prison population, and are 42nd in life expectancy.

I don't know where you live and work, but my experience is that non-conformity even of a harmless kind is likely to elicite criticism.

[Patricia Shannon]

german_reader

I'm glad you've joined us. It's good to have a first-hand viewpoint from another country.

[Icarus]

German Reader...

I'm not against universal health care, or, universal primary health care. I think we need to provide it for every person in the world.

What I do want to see is a cost-reduction for health servics. Spending 20% of GDP is ridiculous...and, the statistics suggest that we're (the US) only going to spend more.

What I would like to envision is something akin to the "Oregon Plan", which was presented by the state senate of Oregon in the early 1990s. They put together a committee of experts (professors in public health, medicine, economics, and other professionals, such as physicians and bureaucrats of all kinds), and, "ranked" the treated maladies in major health clinics/hospitals based on an an efficiency to treat matrix.

The basic idea was to logically rank the effectiveness of treatment. This is by no means easy, or, a-political.
The #1 malady on the list was Pneumonia. It's quite inexpensive to treat, but, very harmful to not treat, as the patient can die.

Like that, they got down to some 700 odd maladies, before drawing a cut off. I think the last one was some a-ceph-a-something, where an infant has some brain damage (usually due to a drug related pregnancy), and, can cost hundreds of thousands to keep alive for even a few months.

The Oregon Plan proposed to cover everyone in the state, for everything below the cut off line, which was based on the finances available. Universal Health Coverage within limits. This, I like.

Now, the down side is that a smoker, who's smoked for 30 years, who now needs a lung transplant, or lung cancer treatment, may be denied. They would do an assessment, and some would make it in, the others wouldn't.

Now, one can always get private insurance above and beyond what is publically provided. The assumption also is/was that you could not sue the public system (for punitive damages)...

This plan failed, as the Medicare/aid lobby saw it as a curbing of their health care rights. And, bamm...it was squashed.

In my view, until we (in the US), have a reasonable attitude towards death, keeping people healthy will continue to be hijacked by the fear of litigation, and the propensity to keep people alive at all costs.

If we continue with this rise in cost, the propensity to off-shore labour will only increase, lowering living standards for many.

[anne]

Please provide references to the Oregon Health Care Plan, which as far as I know has been in effect for Medicaid recipients. Where is the problem, if any? What does the plan have to do with Medicare? References, please.

[anne]

"This plan failed, as the Medicare/aid lobby saw it as a curbing of their health care rights. And, bamm...it was squashed."

I can find no reference to a failure of the Oregon Health Care Plan.

[BJ Feng]

"The problem with vouchers is that private schools can cherry-pick the best students. People who run private schools have admitted they can't do better than public schools if they have to admit all students. The public schools would be left with a higher percentage of problem students, whether behaviour problems or learning disabled, so they would look bad. (Learning disablilities can cause behaviour problems in young people who are bored and/or frustrated.) But it is not in our best interest to neglect the problem children, for doing so would lead to higher social problems in the future."

Excellent point. In my discussions with teachers, it seems there always is one or two people in class that are disruptive to everyone else's learning. The teachers are powerless to do anything. One teacher who sent a pupil to the principal for bad behavior was told later by the principal to "deal with him yourself". But the teacher lacks the tools to do anything about a disruptive student that refuses to behave.

Private schools simply kick out such students as they should. Perhaps we can increase the amount of the voucher given to problem students. That way, specialty schools can open up, offering a system that focuses on problem children with more resources to spend.

says...

anne...

"We must all pray to the Gods of homogenity, and learn our algebra."

No, we don't need either...all we "must" do is learn to live with socio-economic difference.

[anne]

Yes; and beg for charity. I understand modern conservatism completely, which is pre-modern conservatism, just as Charles Dickens understood. No matter, there is a change coming as conservatives show just who they are and who they have been which is just what is happening.

[Icarus]

anne...

Instead of begging for charity, you could always try teaching people to get a job. Even if they start at $7/hour (US low level wage), they can slowly build a good life. Is that too much to ask? Actual work...?

[german_reader]

@Icarus

The GDP share of health care costs in the US is 16%. But you're right, it's by far the highest in the world. All other industrialized nations pay less. And you should not forget, Germany and other rich nations such as Japan have much more people above the age of 65, who need more health care, than the US ( Germany +50%).

We manage not only to include nearly all of our citizens, but to pay much less than the US ( Germany 10.3% of the ( lower ) GDP, number three behind the US and Switzerland ( 11% )). The quality ( not the price ) of the German health care system is world class. It can compete with the US in terms of state of the art treatment. Waiting times are low and everybody gets the treatment he/she needs. Nobody must die, be chronical ill, be uninsured or go bankrupt because of health care.

And people have the freedom of choice. Germany has more than 200 health insurances, public and private. They offer different insurance packages at different prices, but everyone has the opportunity to find a health insurance, which fits his needs and all major risks are insured. Wealthy citizens can buy additional packages for "luxury" claims such as cosmetic surgery ( medically necessary cosmetic operations are paid by the standard insurance ) or a one bed room in the clinic ( standard is two to four ).

Our health care system is anything but the dark socialist dictatorship many Americans seem to have in mind ( Ok, pharma cooperations and doctors might think different ). The main difference to the US system is, that insurances and doctors are strictly supervised by the government for all medically necessary treatments and medication. Additional coverage can be negotiated without public control. Most people are satisfied with the standard treatments.

The German system is a bit like your proposal. Government defines - in cooperation with insurances, doctors, patient organizations and pharma companies - what's necessary and senseful and doctors or clinics get limited payments for all defined treatments and medications. The difference to your solution is that nobody must die or be ill because necessary treatments are not covered. Our system is generous enough to include "unnecessary" risks like smoking, sport or overweight.

The main criticism of the German system is its diversity. Private insurances tend to cherry pick the better risks ( the young, the wealthy ) leaving the rest for the public insurances. Our government tries to solve this problem by an obligatory financial transfer system between public and private insurances to limit the burdens for the public insurances. This creates superfluous bureaucracy and costs. And more than 200 insurances need more than 200 administrations. A reduction in the number of insurances could save money and make the system more effective.

I don't understand, why many Americans seem to fear universal health care so much. There are dozens of functioning models available and many industrialized countries manage to have quality universal health care at a reasonable price. Do Americans really distrust their fellow Americans so much that the anxieties about misuse are more important than the wish for a fair solution for all? Poor Americans!