Tag Archives: Republicans

One Reason Our Democracy Is In Trouble

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A recent paper by three political scientists argues that American voters don’t nicely divide between liberals and conservatives. There are also populists and libertarians. In order to understand the American electorate, therefore, we need two dimensions, not one. This observation isn’t new, but it’s worth keeping in mind when thinking about our dysfunctional political system.

Instead of the standard left/right dimension, we need a left/right social dimension and a left/right economic dimension. Polling data indicates that the electorate is rather evenly distributed between four ideological tendencies:

04edsall-chart-popup

At the lower left, liberals are liberal on both social and economic issues. That’s the official Democratic party position. At the upper right, conservatives are conservative on both social and economic issues. That’s the official Republican position (although “conservative” is a misnomer for today’s Republican Party).

Meanwhile, populists are liberal on economic issues and conservative on social issues, while libertarians are the opposite of populists, being conservative on economic issues and liberal on social ones.

On a social issue like gay marriage, for example, liberals and libertarians tend to be in favor of it. I mean, who cares if gay people get married? Well, populists (say, a truck driver who belongs to the Teamsters) and the conservatives at the Republican National Committee aren’t happy about it.

On an economic issue like the minimum wage, however, liberals and populists like the idea that people with jobs should have a relatively decent standard of living. Conservatives and libertarians, on the other hand, think it’s wrong to force business owners to pay their employees an artificially high wage.

The authors of the article identify a fifth group, the moderates in the middle, whose ideology isn’t especially liberal or conservative. They represent some of the infamous “swing” voters who don’t know who to vote for (Obama, Romney, who can decide?).

What the diagram shows, however, is that the populists and libertarians will also tend to swing between the two major parties, since their views don’t match up nicely with either the liberal/liberal Democratic candidates or the conservative/conservative Republican ones.

It may also be the case that the moderates, populists and libertarians will tend to avoid voting altogether, since the major candidates don’t fully represent their views.

Would it be better if there were four major parties instead of two? That might result in more people voting, which is supposedly a good thing in a democracy. But that would seem to require making our political system more representative, for example, by moving away from winner-take-all and allowing minority parties to gain more power. The authors of the paper don’t expect much to change any time soon:

There is no great mystery as to why American political parties can’t get beyond the left-right divide. Parties are by nature risk-adverse organizations … tightly moored to the status quo. Only under the most extreme circumstances—for parties, that means repeated losses at the polls—do they adopt changes in their electoral strategy. Thus, as long as both parties can plausibly convince themselves that their ideological appeals are not responsible for their electoral defeats, they will avoid making any fundamental changes in their basic strategies.

At the same time, … neither Republicans nor Democrats will be able cultivate a majority by only focusing on their core ideological supporters. There are simply not enough additional conservative and liberal votes to be harvested to produce an electoral majority. So, for the time being, both parties are caught in fundamental dilemma—they lack the incentive to move beyond their ideological anchors and yet they cannot become a majority party by becoming more closely tied to these anchors. They are thus set adrift in a sea of future uncertainty.

I read about this paper in an article in the New York Times. The author of the Times article is mainly interested in the idea of a middle-of-the-road third party. I think a middle-of-the-road third party might satisfy fewer people than the two we already have.

Finally, the Perfect Healthcare System!

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Breaking news from Washington:

House of Representatives Republican leaders ripped the Affordable Care Act, known as Obamacare, and Majority Whip Kevin McCarthy, R-Calif., urged a “patient-driven health care system, not a government-driven health care system.”

So, House Speaker John Boehner, R-Ohio, was asked at a news conference, what does that mean?

“Well,” he said, “When you look at “Obamacare,” what you see is a government-centered health care delivery system. That’s not what the American people want.

“The American people want to be able to pick their own type of health insurance; they want to be able to pick their own doctor; they want to be able to pick their own hospital. That’s what a patient-centered health care system looks like.”

Asked if that was likely to come to a vote next year, Boehner said, “We’ll see.”

Finally, no more in-network-out-of-network! No more we-don’t-accept-Blue-Cross-Medicare-or-Medicaid! No more United-Healthcare-is-no-longer-offered-by-your-company! No more if-I-get-this-job-I’ll-get-health-insurance! No more reasonable-and-customary-charges!

The American people will be able to choose whatever doctor they want and any kind of health care insurance they want. It won’t matter if you’re homeless, you’ll be able to go to the best doctors on Park Avenue. If you stock shelves at Walmart, you’ll be able to get high-quality care at the Mayo Clinic. If your company offers health insurance plans A, B and C, you’ll be able to choose D.

It won’t make any difference to anyone how much doctors, hospitals or insurance companies charge, because the Republicans now have a plan, the ideal plan that nobody else had the courage or insight to propose. In retrospect, however, it’s clearly the only way to guarantee everyone’s right to whatever health care they want without interfering with the free market: 

Every American citizen will have an unlimited supply of money to spend on healthcare! It’s the MONEY IS NO OBJECT plan! (MINO, for short.)

It’s the perfect “conservative” free-market solution, since everything for sale in the healthcare marketplace will be as good as free for consumers, while providers will retain the right to make as much money as possible.

(Note: Aside from replacing the words “government-centered” with “patient-centered”, details of the plan are, to be polite, “sketchy”.)

Meanwhile, here on Earth, there is an informative article in a recent New York Review of Books called “Obamacare: How It Should Be Fixed”. It’s by Arnold Relman, Professor Emeritus at Harvard Medical School. Unfortunately, you have to pay to read the whole thing (after MINO is in effect, we’ll all be able to afford it). But Dr. Relman concludes that our best hope of getting a high-quality, affordable health care system would be a single-payer system built on Accountable Care Organizations, i.e. private medical groups that would be paid by the government, not for every service performed, but for their patients’ overall care:

The only type of ACO [Affordable Care Organization] that has been proven to satisfy patients and physicians is multispecialty group practice. According to the American Medical Group Association, there are now well over 430 such group practices and their number is increasing rapidly as more physicians seek group employment….

Data from the Medical Group Management Association indicate that average staff earnings in groups are fully competitive with earnings in solo or small partnership practice, particularly if the generous fringe benefits that groups usually offer are also considered (for example, office expenses, malpractice insurance, paid vacation, pension plans). And judging from their low turnover rate, physicians who choose employment in successful, well-managed groups are usually satisfied with their job.

However, only a few medical groups currently avoid the inflationary incentives of fee-for-service by contracting with insurance plans that pay them on a per capita basis for comprehensive care of some or all of their patients; and even fewer pay their medical staff by salary….

… I have described in detail how a single-payer system sponsored by the federal government would function when coupled with a reorganized medical care system based on independent multispecialty group practices with salaried physicians. Replacement of all public and private insurance and elimination of itemized bills with a public tax-funded system that simply paid medical groups per capita for comprehensive care would avoid much of the expense and many of the other problems with the current system. The enormous savings could ensure adequate compensation for all the facilities and physicians needed for universal care.

The loss of jobs in the eliminated private insurance industry would probably be more than compensated by increased employment in a greatly expanded public-payer system, and by the new jobs created by the emerging business opportunities created when employers no longer need to pay the health costs of their employees. Government would be able to contain the rise in total health expenditures by its power to set prices and determine the level of taxation required to fund the system, but it need not micromanage medical care. Medical decisions should remain in the hands of physicians and their patients, where they belong.

Most important, this revolution in our health care system would make universal access to good care affordable. It is a revolution that seems inevitable, even though it is not yet on the political horizon.

I’d say it’s far, far beyond the horizon, but at least it’s on planet Earth. Meanwhile, we’ve got the ACA, which is significantly better than what we’ve had.

In Case You’re Concerned About Health Insurance Cancelations

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It’s the media’s current ACA crisis. In other words, a lot of sound and fury, signifying very little.

The policies being canceled are those that don’t meet the ACA’s new minimum standards. All policy holders will be able to sign up for better policies. That’s the basic story. This short article in the New York Times explains what happened at a House committee hearing today:

Republicans were apparently furious that government would dare intrude on an insurance company’s freedom to offer a terrible product to desperate people.

http://takingnote.blogs.nytimes.com/2013/10/30/the-uproar-over-insurance-cancellation-letters/

It’s worth reading, if only for its humor value.

To B Or Not To B

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That is a question. If Hamlet were with us today, would he ask himself: “To blog or not to blog?”

That’s what I asked myself this morning. Whether I should put this blog on hold.

But how can I save the world (one blog post at a time) or find out what I think if I don’t speak whereof I can?

Especially today, after a respected reader shared this letter to the editor:

When seniors started enrolling in the new Medicare system, hardly anyone touched a computer, there was no internet, or broadband connection. The system worked. Today, the same tools are available to us as were available then: applications, telephone, person-to-person help. The preferred method of access is the Internet, but the Internet is really just a way to get one into the system. The media is spending way too much time complaining about the method by which people sign up. They should be pointing out that millions of people who have not had access to health coverage will now have it. We need more stories about people with sick children who can now get coverage, not how much trouble people are having logging in to a web site. (BTW, just to see how it would work, I went to healthcare.gov and created an account. No problems. Maybe they kick in when you try to actually sign up for something.) 

I hate the media.

Me too, much of the time.

Now, in this autumn of our discontent, everyone with access to a media bullhorn should keep in mind that large information technology projects almost always have problems, especially when a “drop-dead date” is involved. The Republicans will “investigate”, silly people on TV and the radio will say stupid things (except in Afghanistan), columnists will draw the wrong conclusions, but the problems will be fixed, millions of people will benefit and, as someone said the other day, the ACA isn’t just a website.

We should also remember that most people sign up for things as the deadline approaches, and in this case the deadline (March 31, 2014) isn’t “drop-dead” at all – it’s a soft deadline that can be delayed a while, if necessary.

On the even brighter side, healthcare.gov is getting all kinds of free publicity! Let’s hope everyone spells the name right – although that’s not required these days (“did you mean healthcare.gov?”).

For the icing on the cake, take a look at how Republican politicians defended the problem-plagued rollout of the Medicare prescription drug benefit eight years ago, when one of their own was in the White House:

http://thinkprogress.org/health/2013/10/24/2828261/hearing-post/

“The empty vessel makes the greatest sound.” (Henry V, act 4, scene 4)

The Big Website Foul-Up (It Takes A Village)

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Major problems with the new ACA website healthcare.gov are being reported and criticized throughout the media. It’s a great story, definitely worth reporting and much easier to write about than the complexities of the new law and how it will affect millions of people.

Fortunately, states that chose to create their own websites, like California and New York, are doing better, one likely reason being that their software requirements were easier to implement. It’s states with Republican governors or legislatures that didn’t create their own websites, like Texas, Florida and New Jersey, that are especially suffering. Although there are other ways to sign up for ACA-generated health insurance (by phone, and even in person), it’s still a problem for many people who live in those Republican-governed states.

Still, it’s an especially poignant example of how Republicans often put politics above principle or pragmatism. One would think that politicians who consistently criticize the Federal government (except for the Defense Department, etc.) wouldn’t depend on a Federal website delivering health insurance to their citizens, but go figure.

It’s also a great example of how large computer projects usually fail to meet deadlines, and how corporations that sell things to the government almost always find a way to make a whole lot of money. “We will deliver X by Y for $Z” repeatedly turns into “we will deliver X- by Y+ for $Z++”. Everyone involved usually has an excuse – it’s often the fault of those other guys – but whatever happens always results from a team effort.

For more on the software development aspect of the situation, here’s an honest, accurate appraisal from someone who has clearly been in similar situations:

In fact, we software developers suck at estimating how long it will take to build a web application (it’s time that we admit that). So, if we suck at it, imagine how poorly our managers who have never written a line of code suck at it when they pull estimates out of their asses to impose on their development teams and report to their bosses.

The whole article is worth reading, although I’ll add that these problems aren’t limited to web applications, many people who give optimistic estimates have done plenty of coding, and the people doing the requirements aren’t always the most blameworthy. Software developers frequently slow down the requirements-writing process by failing to give feedback, asking for repeated clarifications, arguing about which features are necessary and failing to move forward when progress could be made. In addition, there may be good reasons to roll out software that isn’t ready (sometimes, something is better than nothing). It really is a team effort.

http://www.dailykos.com/story/2013/10/17/1248260/-A-software-developer-s-view-on-the-HealthCare-gov-glitches#