November 25, 2003

Medicare etc.

This is in response to David Remer’s article arguing for the institution Medicare and progressive social programs—that piece in turn was a rebuttal of Dustin Frelich’s thoughts on the current Medicare debate.

The most controversial clause of the Medicare bill allows private managed health care into the Medicare system, starting on a trial-basis in 2010 in six cities. The Democrats are ideologically opposed to this, but have offered no viable alternative of their own. Their main argument is that private health care companies will hand-pick healthy seniors to keep premiums low. But if I’m a healthy senior, wouldn’t I want that alternative? What’s wrong with healthier seniors paying lower premiums?

But David’s article makes some other broad ideological sweeps which I want to rebut.

This is not to say that social programs don't come without opportunity costs. But free enterprise is not without its costs in greed, class segregation, and tiering of society.

Marxism was founded on the premise that there are two classes in society - the capitalists and the workers - and that the capitalists live and grow wealthy by exploiting the workers. Thus, wealth must be "fairly redistributed" by a "central authority". Any sane reading of history will show that this premise was fundamentally flawed, seeing as how people living under communist governments have fared. The ultimate proof of this is current-day America. The segregated society that Marx predicted would be the ultimate outcome of capitalism has not emerged. "Workers Unite!" rings hollow, and even a little funny here, because the "workers" enjoy a relatively affluent middle class lifestyle.

Canada has a health care system that recognizes the immorality of being a wealthy nation and leaving 40 plus million of its citizens without health care, experiencing pain and suffering and shorter lives all because they can't afford the free enterprise health care.

Actually, Canada is free-loading on the U.S. The Candadian government has achieved this "miracle" by simply putting a cap on prices of drugs sold there. Drug prices are high in the U.S. because drug companies need to recover the costs of R&D for new drugs, and the U.S. is about the only place left where they can actually set their own prices. In effect, the American drug-buying public is underwriting the costs of pharmeceutical research and development for the rest of the planet, Canada included. All this, while they parade their healthcare "achievements".

A janitor should be entitled to a decent wage that provides home ownership, a reliable vehicle, health insurance, a retirement plan, and the ability to save for his/her children's educational choices and assistance in getting their start in life as productive adults. For without that janitor, our nation would collapse. Without that clerk, that secretary, that server at Luby's, that maid at the hotel, free enterprise would grind to a halt in a heck of a hurry.

Good ol' Marx, once again. A janitor (nor anyone else) is not entitled to home ownership, a reliable vehicle, health insurance, etc. He is entitled to be given a fair chance to earn all of those things. He is entitled to the pursuit of happiness, not to happiness. As for how dependent the nation is on said janitor, here's a thought experiment: scenario 1 - all janitors quit; scenario 2 - the CEOs of the top 100 corporations quit. Draw your own conclusions.
Posted by Vivek at November 25, 2003 12:58 AM

Comments
Comment #4028

Vivek, You ask, What is wrong with healthier seniors paying lower premiums? First, as the baby boom generation retires, millions of them won’t be able to afford lower premiums or higher premiums. Millions of them started their working careers earning $.50 an hour and will have ended their careers earning $6 to $8 per hour. What do you propose to do with them? Should they just be denied health care which the free enterprise system has priced out of reach for 44 million Americans already? Should they suffer and die alone in cardboard boxes or sent to “charitable” death houses to wait for death?

You state: The segregated society that Marx predicted would be the ultimate outcome of capitalism has not emerged.

We have millions of families whose parents both have to work, and 100’s of thousands of single parent families, whose kids have no supervision for a couple hours after school. Then you have those who can afford nannies, after school day care, or private tutorage, etc., etc. We have 44 million Americans who cannot afford health care insurance nor to pay for health care out of their earnings. Then we have millions more who can easily afford it. We have many millions of Americans who can afford to speculate in the markets and invest generous sums into interest bearing and dividend producing investment strategies to self insure against bad times or unforeseen adversities. We have many more millions of citizens who can barely meet middle class living standards paycheck to paycheck.

Sorry, Karl Marx was right on this point. And it is evident in the headlines of Great Britain and the U.S. on a regular basis. Example: Census exposes unequal Britain. Free enterprise is no more a panacea to creating equality than socialism is. My argument in my piece is for the mixed economy we now have and have had for 68 years. That mixed economy, a blend of socialism and free enterprise has made us the greatest nation in the world. If socialized programs in a mixed economy are so abhorrent, how have we become so great?

I did not say a janitor should be entitled to home ownership, I said a janitor should be entitled to a decent wage which can provide home ownership if he chooses. My point being that a full time worker should earn enough to afford a middle class lifestyle. If a janitor chooses to bet it away in Vegas then doing without homeownership is his choice and cross to bear.

It appears for some, the dollar should dicate the quality of life for humans, rather than humans using the dollar as a tool for elevating quality of life for themselves. As for medical care, hey, the argument made here appears to imply that if you can’t afford it, die, and make room for someone who can. I fail to see the compassionate conservative in this kind of argument.

Posted by: David R. Remer at November 25, 2003 12:20 PM
Comment #4030

Something struck me last night as I saw news coverage of Bush signing a $400+ billion defense bill. What exactly is the purpose of national defense? To protect the lives of our citizens, right? So why is it that the conservatives are so gung ho on saving the lives of Americans from terrorists like Osama bin Laden and Saddam Hussein yet they only begrudgingly try to save the lives of Americans from terrorists like heart disease, diabetes, and cancer? In any given year, thousands more die at the hands of insufficient medical care than die from terrorist attacks. Therefore, wouldn’t the laws of economics suggest that the greater marginal utility of federal dollars would be to on reallocate funds towards healthcare?

Posted by: blipsman at November 25, 2003 12:45 PM
Comment #4031

Vivek, I am in complete agreement with you on the Democrats ideological opposition to private plan competition with Medicare. I am not about to defend Democrats who want to socialize the medical system in the U.S. This is a path that will ruin the very intended purpose of Medicare much as the Welfare system ruined the goal of ending poverty.

That is why I argue for a centrist position where the socialized Medicare system reflects our society’s value for human life and dignity for those who through no fault of their own, cannot afford private health insurance. We also agree that the best medical care to be found will only come from a capitalist competitive medical industry.

I am impressed with the debate on this issue by all parties to it. It is helping me and I am sure, many readers, understand the complexity of the Medicare issue on many levels from the philosophical to the pragmatic. Thanks for another perspective and view on this. It is difficult to find this kind of focused rational debate on other blogger sites on the web.

Posted by: David R. Remer at November 25, 2003 12:48 PM
Comment #4032

Blipsman, your point reminds me of Economics 101. With limited resources and more demand than those resources can provide for, how are the priorities established and translated into what those limited resources shall be spent on? How the money is allocated directly reflects the priorities of the spender and indirectly reflects the value system that shapes the priorities.

Posted by: David R. Remer at November 25, 2003 12:53 PM
Comment #4033

The Janitors don’t have to quit. They get laid off by those people, who in turn claim greater profits despite losses in real productivity. It’s a simple matter of multiplication. Their fortunes rise on their stock options, which become more valuable when they beat the abstract Profits Earnings Ratio that Wall Street was predicting. Here’s the unfair thing: That Janitor has lost his ability to generate his paycheck. All the CEO would have lost is a marginal share of his profits.

Additionally, that Janitor’s service could have been valuable. One of todays bad habits in business is to lay off so many people that when crises or big opportunities come to pass, they don’t have the manpower to handle the problem or the possibility.

I mean, if the wiring in your building gets SNAFUed, you don’t want to learn at that point that your company downsized your electricians. You also don’t want to learn that somebody has a rush job that could make you oodles of money, and you don’t have enough workers. Sure you could outsource, but then you’re probably paying a premium for the convenience of not having to employ the people yourself.

Additionally, those CEOs are costing the company money. Options are not free. You are essentially using company money to pay for these people’s share of the company. That’s the issue with stock option expensing- in essence people are downsizing to take more money out of the company for themselves.

Instead of a symbiotic relationship, where the execs are paid appropriately, and paid for performance, and employees enjoy the benefits of a stable well-paid job for their performance as well, we have a system that is rigged to benefit the corporate leaders, even while they’re screwing up the business, and screwing over the custormer.

When Adam Smith wrote of enlightened self-interest, he was not speaking of this system. We should pay CEOs because they do good for the company, not because of their potential. We don’t know what their potential or their level of competence is They should do good for the company, before the company does good for them. As for the employees, you should give them every reason to show up for work, every reason to devote their efforts and their loyalties to you, because if they don’t judge such a level of honest work to be in their interest, or if they are driven beyond the limits of their endurance or their sympathy for the company, you will have run your productive resource into the ground.

Unfortunately, though, many in the upper-class have bought into the Ayn Rand sort of unrestrained self-interest model of things, failing to take a more considered approach to the network of loyalties, resources and interests that is the real world. Extended to government it becomes nothing more than authoritarian support of such greed.

If there is one lesson that the past few years should teach, it is that race does not alway go to the swift. That is, the best man does not always win. Often, its a race to the bottom to see how many rules can be broken, bent or obliterated, so that one group can claim supremacy over the market. In the meantime, the working and middle classes are thinned, and the numbers of those who fall into poverty grow.

Recent improvements in the market are pointing to signs of hope, but that hope can only be held onto as long as the mistakes and the misdeeds that lead to our last economic collapse no longer trouble the system. My bet is, that those problems remain. And as long as they do, I cannot view the economic recovery with anything but skepticism.

Posted by: Steve Daugherty at November 25, 2003 02:54 PM
Comment #4056

“I did not say a janitor should be entitled to home ownership, I said a janitor should be entitled to a decent wage which can provide home ownership if he chooses. My point being that a full time worker should earn enough to afford a middle class lifestyle.”

Terms like ‘middle class’ are always relative. Everyone could be idle rich and unless they all had exactly the same amount of money there would still be a ‘middle class’. So do you have an absolute level of wealth in mind for a janitor? Or do you think that they should be toward the middle? If you believe the latter, who do you think ought to be in the lower relative wealth class?

Posted by: Sebastian Holsclaw at November 26, 2003 03:17 AM
Comment #4060

Sebastian, I agree middle class is a relative term. I defined it for my discussion in my original article.

Those full-time working adults not in the middle class would be those adults who choose another lifestyle other than middle class. Reclusive sustainable landowners, those who make imprudent choices about the spending of their 40 hour a week middle class pay, and those who through choices of their own, deprive themselves of a 40 hour week job; criminals, come to mind. And perhaps new employees with less than 2 years experience and time on the job. (2 years is arbitrary, could be 1 or 5, depending on a host of variables.

It will never be utopia. My point was there needs to be the political will to avoid the world embarassment of being the wealthiest nation on earth with headlines of retiring aging citizens dying for lack of health insurance or access to the American medical system in cardboard boxes in alleys. Senior citizens who worked all their lives in productive, necessary jobs that make the American economic giant what it is, regardless of whether their work was trash collector, doorman, waitress or CEO of Microsoft who was ripped off of all his investments and holdings illegally.

Posted by: David R. Remer at November 26, 2003 02:48 PM
Comment #4063

And couldn’t all that be handled by having Social Security ONLY if you were on the threshold of being poor? Couldn’t Medicare be ONLY for people who were on the threshold of being poor? Why do we have to have all these universal schemes which pay for the medicines of rich and middle class people who can do fine without being dependent on the government?

Posted by: Sebastian holsclaw at November 26, 2003 07:13 PM
Comment #4064

Sebastian, that is the most pertinent question I have read here, yet. What you suggest would appear to be the absolutely most sensible plan to be put forward. I don’t have an answer, but, I really appreciate carrying that question around with me as I read more about this subject.

My guess is that if everyone is going to pay in to the government to support Medicare, but, only the poorest and neediest receive the benefits, it fits the classical definition of socialized wealth redistribution. To appease those phobic of the word socialized, everyone gets to participate in the plan.

If of course everyone who does not need Medicare does not pay into the government to support it, the logical conclusion is there will be no such program, since the neediest cannot afford to support the very system designed to assist them with the finacial burdens of medical costs.

I believe it does come down to everyone pays a share, progressive share or flat share to be debated, so that we as a nation can demonsrate compassion for those who would otherwise die prematurely, many alone, and with great suffering in the absence of medical assistance in retirement years.

Posted by: David R. Remer at November 26, 2003 07:36 PM
Comment #4065

“I believe it does come down to everyone pays a share, progressive share or flat share to be debated, so that we as a nation can demonsrate compassion for those who would otherwise die prematurely, many alone, and with great suffering in the absence of medical assistance in retirement years.”

I am a sucker for the compassion argument in this debate. (I know it doesn’t seem like it because I look like I’m on the anti-compassion side). But I hate having something argued on one basis and implemented on another. If we want to argue that something is important to stop the poor from being in a horrible state, I would like to have all or nearly all of the program being defended on such a basis actually go to the poor. I’m against people starving. I’m against people dying of easily treatable diseases. I don’t want retirees to be homeless. But I don’t want to be paying rich and middle class people money in a program which is defended on the basis of being anti-poverty. Anti-poverty programs are not socialism. But universal government health care and universal government retirement is. I am completely for being compassionate to the truly poor, and the nice plus is we could even afford that. I am not for having an argument about poverty-reduction that turns into a program which covers rich people. I don’t like having my compassion exploited to universalize programs for people who don’t need it.

It is suggested in some circles that people won’t support programs unless they get a benefit out of it. I don’t buy that. Americans are very generous people as a whole. I suspect that they would be willing to back anti-poverty programs that were tailored to minimize an incentive to be dependent. In other words I think that people would be willing to contribute to a true safety net. I know I would.

Posted by: Sebastian Holsclaw at November 27, 2003 02:09 AM
Comment #4066

BTW, I think that most objections to ‘wealth redistribution’ is because the idea is closely akin to the idea that inequality of wealth is bad in and of itself. Keeping the poor from starving isn’t about unfairness or ‘equality’ it is about moral compassion. If people hear or suspect that you want to ‘redistribute wealth’ they suspect that you think there is something unfair about wealth. That doesn’t go over well in America, because we value the creation of wealth. But if you truly want to keep poor people from experiencing the worst parts of poverty, I’m with you and so is much of America. It comes down to absolute wealth vs. relative wealth. I think you will find that Americans are willing to enforce a minimum level of absolute wealth. In general we don’t care about relative wealth so long as the poorest are getting good food, good shelter, and nowadays good medical care. They won’t be getting the BEST food or shelter or medical care, but if you want to negotiate a minimum I suspect that would be quite possible.

Posted by: Sebastian Holsclaw at November 27, 2003 02:16 AM
Comment #4068

I agree Sebastian. Extremes to Demise had the central theme that free enterprise as an economic engine is vital to America’s economic, military, and diplomatic power.

And socialized programs that prevent retired or disabled seniors from dropping into poverty through programs like Medicare and Medicaid should be an obligation of the wealthiest nation on earth in my opinion.

But such simple solutions are always fallible and lack the wholistic approach to truly solve the problem. How can we keep seniors from falling into poverty after retirement on fixed incomes in the first place. Social security can be part of the answer, but, should, I agree be there for those whose life work did not afford them the opportunities to invest and save for a middle class retirement without having spent their working lives living close to poverty just to make the savings available. A wholistic approach also calls for the government setting minimum wage standards that will permit lower middle class persons to save at least for a lower middle class retirement, which of course, free enterprisers are opposed to in principle.

But, it is promising that a liberal and conservative can agree on a minimal safety net that prevents starvation, unnecessary suffering, and premature death where cost efficient care could prevent it. If only the solutions were as simple to reach as the agreement on the problem.

Posted by: David R. Remer at November 27, 2003 08:18 PM
Comment #4070

“A wholistic approach also calls for the government setting minimum wage standards that will permit lower middle class persons to save at least for a lower middle class retirement, which of course, free enterprisers are opposed to in principle.”

I can’t go with you there, but out of a different principle than the one you think. There is no free lunch. Everything including a minimum wage has a cost. The minimum wage cost is higher unemployment and a slower economy. That isn’t worth it. I would rather pay the cost directly and transparently in anti-poverty programs.

I think your ‘whole problem’ approach tries to over-solve. Where do you get the idea that a huge percentage of middle class retirees are about to fall into poverty? Where do you get the idea that people are incapable of planning for their own retirement. I haven’t seen evidence of the huge systematic failure that you seem to posit. We could easily afford to keep the bottom fifth in food, shelter and damn good medical care. We can’t afford for the government to pay everyone at that same level.

Posted by: Sebastian Holsclaw at November 28, 2003 02:38 AM
Comment #4087

Look, with outrageous amounts of money and stock options being poured into executive and management sector pockets, I think this talk about the unprofitability of raising wages is rather hypocritical.

If they can find all that new money to pay themselves out of the corporate coffers, then it’s hardly the case that the company needs to depress worker wages to remain profitable.

Whatever happened to the good old American value of an honest days wage for an honest days work? Is it somehow un-American to pay them a wage that allows them to support themselves? I thought the whole point of having a work ethic is that you would enjoy the fruits of your labor.

No, what we do nowadays is we act like a bunch of scrooges, believing that if we keep our money to ourselves, somehow all the problems out there will get solved magically. A higher minimum wage means lower crime, healthier communities, and kids that are not too hungry to learn and think. If you want community and family values, then give the breadwinners of America the money to support their families.

Oh, by the way, most of the jobs that Bush is claiming are returning due to his policies.. they’re just about this level of pay. We can become like India or Egypt, with their PhDs driving cabs. I’m sure that’ll be good for the Corporate bottom line.

Posted by: Steve Daugherty at November 28, 2003 10:20 PM
Comment #4090

Sebastian, how would a conservative propose to keep those lower middle class families from dropping into poverty with escalations in medical insurance premiums, prescriptions, co-pays, and lowered caps?

I am talking about minimum wage providing a non-poverty level standard of living. And the only way that is going to happen is if minimum wages keep pace with inflation in the areas of housing, medical and insurance costs, food and transportation. All of which have been rising much faster than the overall inflation rate which includes a host of imported goods which hold the overall rate down.

You asked, “Where do you get the idea that a huge percentage of middle class retirees are about to fall into poverty?” It does not take much math expertise to realize that a fixed income faced with inflationary costs as mentioned above, lowers the standard of living significantly in just a decade. And our retiring seniors face as many as two to three decades of live after retirement, especially women.

You ask, “Where do you get the idea that people are incapable of planning for their own retirement?” How about the incredible rise in the retirement planners industry for one. How about the dozens and dozens of articles of fraud and mismanagement over the last month of mutual fund managers handling billions in 401K programs? How about the tech bubble that ruined the investments of 10’s of thousands of investors and caused significant losses for millions? How about the U.S. having one of the lowest savings rates among western cultures?

Can you compute compounded interest through multiple savings and investment instruments and assess the proper risk balance for your portfolio? If you can, your education significantly exceeds that of most middle and lower middle class retirees.

Posted by: David R. Remer at November 29, 2003 09:38 AM
Comment #4094

“I am talking about minimum wage providing a non-poverty level standard of living. And the only way that is going to happen is if minimum wages keep pace with inflation in the areas of housing, medical and insurance costs, food and transportation.”

You don’t keep people from being poor by raising the minimum wage. You keep people from being poor by helping them learn jobs which aren’t minimum wage. Raising the minimum wage to the levels you are talking about will just dramatically increase unemployment—defeating the whole purpose.

Posted by: Sebastian Holsclaw at November 29, 2003 06:14 PM
Comment #4104

Sebastian, here we must agree to disagree. Helping people learn new jobs which aren’t minimum wage in an environment where above minimum wage jobs are being lost in the millions and replaced by temporary and minimum wage jobs simply makes no sense to me.

To argue that raising the minimum wage to middle class levels would dramatically increase unemployment lacks, in my mind or education, any evidence or logic. Raising the minimum wage boosts the economy by increasing discretionary spending in much the same way the Bush tax cuts helped the economy by increasing consumer spending. Can’t have it both ways, if the Bush tax cuts helped the economy, then, so would raising the minimum wage.

Posted by: David R. Remer at December 1, 2003 07:50 AM
Comment #4117

You are suggesting permanent changes (higher minimum wages) to a temporary problem that will be made more likely with your changes. I’m suggesting a permanent attitude to foster both a growing economy, and a large class of people who can enjoy it.

Posted by: Sebastian Holslcaw at December 1, 2003 11:16 PM
Comment #4142

Sebastian, thank you for this challenging and very interesting debate. I appreciate your engaging in this discussion.

Things change, therefore, there are no permanent solutions. I agree with this. While you suggest a large class of people is a good thing, and I would not argue with that, I suggest that an even larger class of people who can enjoy it, everyone, who works a full time job providing a needed craft or service to keep the free enterprise system functioning and growing, should enjoy it.

It would not have been affordable or doable in the Hoover years, but, I believe it is today. So we may have to agree that we have different beliefs on this matter. Persuasion and dialectic can change a person’s thinking on a matter, but, I have yet to find a way to change anyone’s belief in something. I believe the wealthiest nation in the world should have the lowest rate of poverty, disease, suffering and premature death of any nation in the world. That is simply not the case, however, in America today, and I believe it should be.

Free enterprise purists, (I am not saying you are one) argue that, as M. Friedman followers have, that any attempt by the government to interfere with economic and market forces to resolve short term problems will only result in longer term problems brought about by the tampering. However, there is no mention, nor room, in such an argument for compassion, empathy and service to the people of the nation as a goal of government.

Which I believe is why charity support is such a band-aid fix purported by free market purists, as a means of trying to compensate for a completely dispassionate economic and political philosophy as espoused by Friedman followers.

Posted by: David R. Remer at December 2, 2003 12:29 PM
Comment #4195

I have a few comments to make.
First, two things to Vivek: What is wrong with healthy seniors paying less? nothing, except that it means unhealthy seniors pay higher premiums, then get stuck with copays that are exorbitant, and get thrown back to Medicare, all through no fault of their own.
I tried that thought experiment, and the only thing i could come up with was that the nation’s businesses really would grind to a halt if all janitors quit, while the same is not true for CEOs. In addition, if all janitors quit, not only would businesses become ridiculously inefficient, but schools, colleges, government offices, and courts would also cease to function well. Oh, and then we would be back to the health care issue with even more problems, because poor sanitation would lead to spread of disease.
Now, to Sebastian: please explain exactly who would do the innumerable jobs that require little or no training, but a lot of work? immigrants? wouldn’t that requirer a more open immigration policy, so that all of the workers who want to come here can?

Posted by: mdon at December 6, 2003 07:38 PM
Comment #4379

Sebastian, your whole idea of the economy is way too static. You have been taught to think in terms of the dividing of a pie.

But that’s innaccurate. In the real world the economic picture is more complex. The money we save in low wages bites us in the rear come tax time, because we are having to pay for these people to eat, and for these people to have heat and power in their homes.

These are people who would likely recycle what they earn back into the local economy, ensuring that losses would be paid back by revenues. In the meantime, we wouldn’t be paying to feed and keep these people warm, which means we would have more money to spend on things that benefit us.

Your system tends towards an unhealthy, unwise concentration of wealth, for no other reason than the fact that the people who make these decisions often decide to compensate themselves well, at the expense of the company.

When the companies collapse or report lower profits or losses, the people in charge often get to keep their gains, while the rest of the people in the system have lost an important part of their economic self-support. The result? A more dysfunctional economy, where people are turned into part of the problem, economically speaking, instead of part of the solution.

In the end, for all the conservative claims of class warfare on the part of the Democrats, it seems the ones initiating the conflict are the conservatives themselves. Why is it, that the rich see any advance in profit by the poor or the middle class as a threat to them? Why must wages be suppressed so ruthlessly while executive salaries have been allowed to spiral out of control? Why is minimum wage such a problem, and not the government having to foot the bill for the support of underpaid communities and workers? Why is it that workers get their jobs cut when things go wrong with the company, and not the people who made the bad decisions? And why is it no longer good enough that a company make a profit, but that it also has to meet some unrealistic goal set up by Wall Street?

Perhaps our economy would grow better, if companies were allowed to grow and operate more organically rather than be distorted and overheated by unsound expectations.

Posted by: Stephen Daugherty at December 13, 2003 01:38 PM