Hardly a week ever goes by when I am not alerted to the increasingly absurd cruelty of the social welfare services of the UK. I’ve lived in economically below-average, minority-populated parts of the US, off and on, and the US has a bad reputation for social welfare—mostly due to its absence—but in all that time, I never heard of the kind of sheer, deliberate twist-the-knife cruelty that is apparently daily life for some of the UK’s most vulnerable citizens. I’m starting to think that no welfare is better than evil welfare. Which I suppose was the entire point of the exercise.
The very same people who advocated for this cruelty and have had years to make it worse are the people now in charge of making Brexit happen in the UK. And everyone knows they’re making a mess of it—predictably, with the same twist-the-knife cruelty that is certainly no ward against incompetence. As I have written before, even if they were to run the Brexit show well, what they want from Brexit contains no redeeming value whatsoever. They’re still proud of their austerity and are only at best grudgingly willing to restrain it when it looks like they might lose a critical handful of voters here and there. Yes, even such a debased character as the British Tory voter can show rue where his drivers, on their own, cannot. The British Tory voter, however, will still let his leaders guide him into the sewage lagoon of the tax paradise which they are chomping at the bit to build.
A Brexit with less dislocation was possible, give or take an Irish peace accord or two. That Brexit requires a Britain that did not stake its economic foundation on being local banker to a currency union it didn’t join. This would require a Britain that, long before the Brexit referendum, had not gone down the neoliberal route in the first place, had not succumbed to the ideology of austerity, and had not perfected welfare cruelty.
But therein lies the paradox of Brexit. Brexit was only going to come after a referendum for it. But the conditions to reach the “Yes” vote are precisely these conditions of frustrated failure, if you are inclined, as many are, to see the phenomenon fundamentally through an economic-stress lens. In a non-austerian, non-neoliberal political alternate history—one that, I emphasize, has always mostly been within the UK’s power to execute, despite EU membership—a “Yes” vote would probably have been unachievable. That is why you could never really have a good Brexit, and why, when Brexit really takes place for good, a possible future Corbyn government is going to be left holding a nasty bag of failure that will likely preclude any major reforms in a left-wing direction.
From a progressive/left-wing/whatever perspective, from the perspective of a humane political economy, the flaw in anti-EU/pro-Brexit thinking is one of “dictionary-definition” conservatism. I was mostly opposed to the pro-globalization policies for goods and capital on the whole. But now that it has occurred, it’s a reactionary mistake to attempt to roll it back, rather than assess where the world is now and consider new ways of creating a humane economy in the future. That reactionary mistake plays into the hands of the Rees-Moggs and Boris Johnsons of the world, and worse.
(YES THIS IS A MANDOS POST; MANDOS ALERT MANDOS ALERT MANDOS ALERT)
I mostly concur with Yves Smith’s assessment of the on-going, cruel tragicomedy that is Brexit. However, she points out a Twitter thread that has been making the rounds, and it is interesting. It concurs with everything I have read about grassroots Brexitism:
Been conversing (on and offline) with grassroots Brexitists again. Really struck by their intense lack of interest in the details of how to make it happen – verging on hostility to it, as if the search for practical steps to make it work is a trap (1/9)
However, Prof. Finlayson analyzes this in terms of Utopianism, which is not entirely wrong:
I think that’s one more piece of evidence for the fact that Brexitism is a species of Utopian ideology, for which the belief in its happening is more important than its actually happening (2/9)
And while it’s not entirely wrong, I think it’s incomplete. I’ve written before about the Brexit phenomenon here before (and pretty much everything I said there has been borne out, not to toot my own horn too much), and one of the factors here is the role of the managerial/technocratic class. I interpret the hostility towards the details that Brexiters seem to exhibit (“Don’t talk down Brexit!!!”) partly in terms of something else. What grassroots Brexiters want is to force the managerial class, the people with the technical skills in government administration, to implement something (whatever it is) that the managerial class visibly doesn’t like and doesn’t agree with, and to do it enthusiastically as a duty to the Brexit-voting public. In any discussion, people arguing for the Remain side are therefore seen as proxies or stand-ins for that class, even if they themselves aren’t necessarily responsible for the implementation. Therefore, the Remainers demand for detail is seen as shirking, i.e. a threatened refusal to accept the legitimacy of the Brexit vote, because it is the Remainers’/managerial class’ job to come up with the details for whatever policy course is chosen especially via referendum.
The problem is that the managerial classes/technocrats in question do not believe that they can deliver a good Brexit and do not want to, and even if they go to work every day to produce the policy and administration required to do it, they are only going to do it on a work-to-rule basis. Work-to-rule is an effective labour disruption strategy—and the managerial classes are expected to do labour on someone else’s behalf in this instance, obviously—because it turns out that a lot of jobs really require the worker not only to be there and do the work in the job description, but to give an additional surplus of energy and attention for the enterprise to produce a good outcome.
Now in all probability, in particular due to the conditions under which Brexit has been unleashed, it is impossible to deliver a “good” Brexit even with the most enthusiastic of technocratic staff. But that is not the real demand—rather, the demand is that the technocratic class visibly demonstrate that it shares the identity markers and self-image of certain large sectors of British society, instead of appearing wholly alienated. However, if the technocrats genuinely don’t believe that there can be a good Brexit, that puts everyone in an impossible position: If technocrats impertinently ask the pro-Brexit public what they really expect is to signal that they are shirking their duty to come up with those ideas and that they really aren’t “of the people” (keeping in mind that enthusiastic pro-Remain positions also represent a wide grassroots in British society!). The reality of the situation is that there simply are no good ways to go about doing this, under the schedule of Article 50 and particularly under the political dysfunction of the British Tories and pro-Brexit vested interests.
I haven’t written much about tomorrow’s German elections because from an immediate geopolitical standpoint, they don’t necessarily mean that much. Merkel will remain in power most likely, although the coalition math may not work out so easily or comfortably, with the worst case scenario being a return to elections. The constellation of parties that form the coalition are likely to be ones even more hostile to Greece and to reform in favour of southern European economies. This is partly because Merkel’s party itself has done its utmost to project the idea into the German consciousness that the problem with southern economies is not liquidity but rather corruption and inflexible employment laws (keep in mind that German employment law is itself much, much less flexible than that of any developed English-speaking country, as far as I know).
One remarkable feature of this election is the very likely entry of the Alternative für Deutschland (AfD; “Alternative for Germany”) party into the German parliament. This will be the first time in a long time that an openly national-exclusionary party will be represented in the Bundestag, and it is very likely a result of the same forces that kept Merkel in power. Remember that most non-German commentators were thinking of Merkel’s refugee stopgap (it was never a genuine, willing opening regardless of propaganda — but rather a way to deal with an emergency that European treaties had not foreseen) as political suicide, because most non-German commentators don’t read German and have less familiarity with German political culture than they do the far more legible (to anglophones) French political culture, for example.
In reality, Merkel’s choices in the refugee crisis cemented her popularity with a large portion of the German electorate while deeply alienating another portion, roughly corresponding to the old West/East divide that a lot of Germans like to pretend has been magically overcome. Overall, Merkel is seen as having made a difficult decision to deal with the immediate situation caused largely by the collapse of Syria, and then to make a series of complex, morally complicated decisions to stem the flow with minimal direct use of German or EU-based force, such as the Turkey deal and the more recent Libya deal. Especially in the time of Donald Trump, Merkel revealed qualities that a lot of the German electorate values — being capable of making “Solomonic” decisions that preserve key German interests, most importantly the external trade surplus and internal banking stability, while even managing to help a few people and keeping German hands at least cosmetically clean.
As for the alienated portion of the population (link in German), some of whom are now willing to vote for a party that more than hints that it wants to take back German regret for the Holocaust (via carefully chosen code words of course), they presently confirm what we know about present-day right-wing populism, and are therefore more “legible” to analysis along the lines of other countries than the rest of the German political spectrum. For one thing, they are largely not in relative terms poor or unemployed, although they may feel more precarious than before. The German SPD, another social-democratic European party in crisis, attempted to run a traditional campaign based on redistribution and better social services and does not appear to have made much headway against the AfD, because AfD voters are not concerned about this. Rather, they are focused on the belief that they would be even better off if there weren’t any refugees, and they largely belong to the part of the population that expects to have control over the racial and cultural composition of their neighbourhood and has a deep-seated emotional preference for homogeneity, which they justify post hoc.
Assuming poll results are true, one challenge for the stability German society with regards to forces like the AfD will be to find a way to politically cordon off this persistent segment of voters from most forms of political influence, a challenge assisted by Germany’s proportional representation system, as well as to deal with the real challenges of immigrant economic integration posted by recent and on-going geopolitical events. That, of course, in addition to the upcoming difficulty in squaring the circle of a trade surplus inside the Eurozone without fiscal transfers, which is a whole other story and will rear its ugly head doubtless in the next and future Bundestag mandates.
I know that on the left-wing side of the aisle, there are some people who support the idea in itself of the UK leaving the European Union and agree with Corbyn-Labour’s original pro-Brexit stand. There are some theoretical arguments in its favour that boil down to how you interpret EU law on nationalizations — I have heard arguments both for and against the idea that the EU is a practical barrier to re-nationalizing privatized British public enterprises.
But whatever the case may be, Real Existing Brexit is another story, and there’s currently every reason to believe that Theresa May’s version of Brexit is going to be an epic mess. There are ways to do Brexit “well,” and all of them start from a clear-eyed view of what it means to leave the EU and the groundwork that needs to be done to prepare for departure. That groundwork involves, among other things, ending austerity (which the UK can mostly do as it is not a Eurozone country) to make the investments in infrastructure and human capital to create greater within-border self-sufficiency and leverage for making favorable future trade deals, if desired. This preparation would have needed to start a few years before any kind of referendum.
But what the UK is getting is Tory-Brexit, the Brexit of right-wing fantasists dreaming of tax arbitrage and empire. Tory-Brexit may, in the worst case scenario, kick off with a hellish traffic jam at Dover and Calais. And the mess it may create may well propel a Corbyn-led Labour party to a Parliamentary majority. But if that happens, Corbyn will be left with not only a mess on his hands, but a lot of constraints.
Because, you see, without having done the necessary groundwork, Britain will be very much a trade-dependent country. Corbyn would not have a big “honeymoon” and may not have much time before the public would expect him to “turn things around.” And unfortunately, that will involve establishing new trade relations, but under highly unfavorable conditions.
If you catch my drift, I’m saying that what a potential Corbyn government might have to go through in the future is the sort of dilemma that plagued Syriza and Alexis Tsipras in Greece. And you probably remember how popular that was around these parts. No bargaining chips, but a desperate need to create relations.
Note that I am not arguing that Brexit shouldn’t happen — it should, in some form, because that is the only way to resolve one of the problems that lead to, well, Brexit-scenarios. That problem is that people don’t really get what they voted in favour of. They need to start experiencing the outcomes of their collective choices. It’s too bad for the many UK residents voted against Brexit, but that’s how representative democracy works. The best-case scenario for Britain would probably be some kind of Norway-style solution, but, again, that is not easy to organize, and it requires crossing what appear to be many red lines for Tory-Brexit hardliners.
(POST BY MANDOS – was posted early quite by accident, postscripts below basically with how I planned to conclude)
L’affaire Damore
The whole kerfuffle about the Damore manifesto at Google and James Damore’s subsequent firing led to the dredging up of old debates about the sources of underrepresentation particularly in technological professions such as software engineering. The basic idea is quite old: Merely, that the current structure of society, as reflected in by group access to well-paying professional positions (substitute for historical versions: land, money), is obviously the outcome of the “natural,” “biological” difference between those population groups, in this case, gender.
Biological sex has been viewed as one of the intractable differences in terms of career representation in technical fields for some time now, holding especially for programming. The negative reaction to the Damore manifesto (including his firing), which consisted primarily of polite, “geekified” versions of old internet arguments defending sexism, is viewed as denial of the underlying facts that drive the apparent intractability of this difference.
The logic behind the claim is an enormous act of begging the question. Social change is slow and difficult — even the legal architecture that prevented women from living independent lives took a long time to change. Diversity advocates’ underlying claim has always been that rectifying differences in the economic success of identity groups requires change greater than that of mere legal emancipation, but instead deeper changes in employment practices and cultural representation. To claim that women are underrepresented in technology because of biological differences is to dismiss the idea that culture matters: It is using the outcome as the evidence, a fallacy.
Instead, the evidence to justify tech employment differences in biological terms is a red herring, and l’affaire Damore is simply a reflection of the fact that Big Tech is little more than a series of entrenched, possibly natural monopolies.
The reality of programming jobs
Let’s start with the brass tacks. Even in Big Tech like Google, most programming jobs do not really require either very high intelligence, particularly as expressed in mathematical ability as is the implicit argument, or even most of the curriculum of university four-year computer science undergraduate programs to be successful. Competent programming in itself is not a high-intelligence skill. The basic skills can be learned by a committed but average person in the way that singing in a community choir can be learned by a committed but average person. Indeed, the analogy stretches farther: For most large scale projects, beyond basic programming skills, one typically requires good organization, collaboration, architecture, standards, respect for requirements and so on to succeed. A full SATB choir is much the same, it requires some skill, but more importantly, it requires the ability of the signers to integrate the content of different musical scores into a single melody. A singer who is too “primadonna” and does not have the social cognition to fit her voice into the choir can make a near-professional school or community choir sound like beginners. It is no accident that even in the open source/free software community, a great deal of emphasis is placed on version control and design process in order to produce the fairly sophisticated software on your typical Linux desktop.
There are certainly technology jobs that require the higher “puzzle-solving” mathematical ability that people associate with success in IQ-testing frameworks. Areas such as advanced cryptography, compression, and parallel processing sometimes require this kind of reasoning, as well as even the content of graduate-level university algorithms classes. Suffice it to say that these form a small minority of tech employment at companies like Google. Even advanced computer security work only occasionally involves a small amount of this kind of thinking: What matters far more is the ability to understand and study the human factors and fallibility associated with security regimes. If gender disparities in programming jobs had been confined to those limited fields, a biological explanation would have held more water.
Many of these kinds of the skills required by the majority of programming jobs are quite easy to associate with stereotypical female characteristics. Many of us may have been raised by a mother who knits. If you have, you may realize that she had been forming fairly complex abstract patterns with her hands even as her attention may be focused elsewhere. Indeed, women have been writing knitting patterns that produce complex structures in an abstract “assembly language” for quite a long time. Numerous other stereotypes pertaining to female creative styles and diligence serve perfectly well to “justify” extensive female employment in software engineering. So the question remains: Why are they not employed in software engineering? Either female ability and inclination really is, in the majority, unsuited to technology jobs, because they are indeed mostly of the category that requires the intelligence that men have marginally more of, or the story I’ve told you so far is probably true, but some other factor intervenes, one that diversity attempts in the tech industry do not address.
The red herring of sex difference in intelligence
Pretty much everyone seriously discussing this topic acknowledges that all human characteristics stem from a combination of factors, including genetic. A starved child with the same genes as a well-nourished child is simply going to look different, although they will also look similar. However, the line between a “genetically-inherited” characteristic and “socially-determined” developmental factor is anything but clear. It’s increasingly clear that some characteristics can be set by the social conditions under which your mother was an unfertilized egg. Which happens when your grandmother was an embryo, the time when ovaries are stocked. Which means that your great-grandmother‘s social conditions may have some (still to be determined) inherited effect on your life today. And there are other potential variations of this situation.
Nevertheless, we know that some characteristics are inherited, and some are sex-linked. A male and female child raised in exactly the same conditions with the same genetics (other than sex-chromosomes) most probably will develop grossly different visible physical characteristics above and beyond the primary sexual characteristics of genitalia. No one questions this — except, of course, that even the categories of male and female are actually more fraught and complicated and ambiguous than previously considered, because biology is almost never “cut and dried.”
So where does this difference come from? Some biological differences are indeed incidental (rare is the gene that affects strictly one characteristic), but the high degree of physical sexual dimorphism is too systematic to deny the effect of selection pressure, particularly sexual selection. A “just-so” story in which male physical strength is connected to the differential ability of getting female reproductive attention is relatively plausible and seen throughout the animal kingdom even in the present day. Naturally, it applies the other way, and the characteristics that suggest female reproductive fitness are, yes, emphasized in females. You would therefore not be entirely remiss to imagine that this would apply to cognitive characteristics, particularly intelligence.
I will not do a rundown of the evidence on this topic, but instead refer you to, yes, Wikipedia, which has a discussion with references to both sides of this debate. What I will instead emphasize is that while some studies show statistically significant differences between the sexes, the effect sizes tend to be small and apply to (as mentioned many times in this debate) the margins. Furthermore, many of the effects seem to disappear depending on how you account for confounding factors. This is how you should understand situations like this: When, over the course of a number of studies, it becomes apparent that quibbles over confounds are deciding factors in the statistical significances of competing results, you should be skeptical of attempts to apply such results to other areas — they are almost certainly small contributors to the overall effect under discussion, such as women’s employment in technological fields. The area of biggest difference between the sexes seems to be in spatial inference, but as I mention above, the applicability of this to software engineering ability is questionable, and it’s independence from social factors also potentially doubtful, a criticism that applies to quite a lot of intelligence research overall, even if one accepts the existence of “classically” genetically heritable factors of general intelligence.
Postscript I – inclination
It seems remarkable that despite the degree of “gross physical” sexual dimorphism among humans, the evidence does not really show up anywhere nearly as strongly in the characteristic of intelligence, despite its obvious importance to human survival. I can only suggest that the sex-differentiating pressure of sexual selection fails to apply to intelligence for reasons that have an easy “just-so” story: both males and females for most of human history had much less day-to-day differentiation in “survival labour” as they do in the very recent industrialized society, and they had no way of performing any sort of fine-grained intelligence test on mates, at least for the intelligence that relates to very abstract mathematical abilities.
But if general intelligence and even specific ability fails to explain the magnitude of the gap in software engineering employment, one could still argue, as Damore and his antecedents do, that there is some other tendency away from technological careers for women, and some tendency towards them by men. Many of this type of claim involves attributing to women personality traits like “neuroticism” and “gregariousness”, which are very old accusations indeed. However, the same considerations apply as they do to that of intelligence: how much of this gap can be explained by an evolutionary “just-so” story, and how much of an alleged personality gap can be explained instead by, well, the conditions of patriarchy. Feminists have argued for a long time that the greater presence in women of seemingly self-defeating personality traits is actually the result of very immediate psychological self-defense mechanisms from overt and subtle ills deeply embedded into patriarchal culture — among them, the need to pre-emptively appease a potential oppressor, a kind of psychological insurance policy created by immediate conditions rather than a genetically entrained cognitive difference. The arguments of Damore and his ilk usually fail to take into account these types of explanation for a sex-based personality gap — in fact, feminist arguments about “female” personality are disregarded to an extent that arguments for the social construction of intelligence differences are not.
And precisely how a biological personality or intelligence gap can be used as an explanation for employment and pay gaps in one particular type of industry when other high-status jobs (e.g., like it or not, the aggressively-competitive financial services industry) show greater increases in female employment is rather hard to discern. It requires that one attribute characteristics such as “status-seeking” as particularly necessary in software engineering employment in a way that is not necessary in other professions, something that really runs counter to the collaborative nature of successful software projects. Instead, feminists have long documented how girls are discouraged from even considering technology careers at a point well before the diversity efforts of large corporations actually take hold. Instead of engaging with these details, Damore and his antecedents fail even to mention them and the history of work on this type of topic, but yet demand respect for “conservative opinions”.
Postscript II – monopoly
As I said at the beginning of this post, a part of the instigation for Damore’s essay is justified in that the efforts of Big Tech to encourage diversity, including women’s representation, appear to have had little effect particularly on employment in companies like Google. The truth is, companies like Google have a large incentive for the appearance of encouraging diversity, but little for the actual practice of diversity, even if such would help them avoid debacles such as the failure of Google+, which was in many ways the result of a culture that failed to understand the human factors that apply to populations that are different from those who work at Google. (For example, early on, Google+ attempted to use “true names” filtering that expelled people whose real names look “fake” to someone who works at Google because of cultural difference — it’s very difficult to rectify this kind of error post hoc for a nascent social media entrant competing with an incumbent like Facebook.)
Why would this be so? Because these companies don’t really exist in competitive markets. Google’s attempt to “muscle in” on Facebook’s turf with Google+ was never really, despite the hype, about rectifying a gap in social media offerings that really threatened the survival of the company. Google has an entrenched near-monopoly in key aspects of internet architecture that is very hard to displace. Consequently, it can leave the potential gains from social diversity on the table without appearing to suffer overmuch. In the short-to-medium term, even for a company like Google, it is costlier to attempt rebuild internal culture, at the risk of alienating the incumbent constituency whose voice Damore made impolitely audible, than to spend a measly few hundred million on cosmetic diversity placebos. In reality, the material merits of improving the inclusion of underrepresented groups in “technological power” will only be seen when the vicious cycle that actively keeps them underrepresented is broken through broader cultural change, imposed somehow from without — and over and above the immediate economic incentives afforded to monopolies.
And that is not surprising — whoever imagined that a monopoly- or oligopoly-dominated society would lead to the optimal outcome for the most people?
(PLEASE CHECK THE BYLINE ABOVE. YES, IT’S MANDOS AGAIN.)
Single-payer is proposed by many as the most ideal way to reform the payment/insurance process for health care in the US, for reasons with which I mostly agree, based on personal experience. The Canadian experience is drawn up, again mostly appropriately, as part of the evidence-base for this view. But if one is going to use Canada as an example, it is important to understand, in some detail, how single-payer was accomplished and what lessons this has for the US.
Canada has single-payer health care, but it did not come out of nowhere. It came from a left-wing government in the province of Saskatchewan, and it came after quite a dramatic fight, including a strike by medical doctors, who were its fiercest opponents.
The history of opposition to Saskatchewan was documented in a very detailed and high-quality MA thesis from 1963 by Ahmed Mohiddin Mohamed at the University of Saskatchewan, which, as far as I can tell, is the authoritative original history on opposition via media to the Saskatchewan single payer plan. Mr. Mohamed (I am unable to locate his present-day particulars or even if he is still alive) managed to get his hands on a treasure-trove of documents from various “players” not that long after the original events.
That opposition involved a great deal of media and propaganda, including astroturf organizations called “Keep Our Doctors” (KOD) committees. It is important to note that even if a lobby group is “astroturf” in the sense of being supported by vested interests, it is not the case that the people who run it, work for it, support it, etc., don’t have genuine beliefs in line with activities of the group. The KOD committees actually and genuinely originated with mothers, particularly rural mothers, who had the vaunted “personal relationship” with their local doctors and the ideological belief that their doctors would be justified in leaving Saskatchewan and abandoning their patients if they were forced into a monopsony. The song should be familiar to Americans — professional liberty and all that. Their local doctors convinced them that the Saskatchewan government would be responsible for denying them access to health care.
Of course, not only were they egged on by their own doctors, eventually medical organizations and ideological businessmen got into the game via their wives and organized province-wide KOD committees, radio propaganda, etc. The public focus and concern of all the protest and propaganda were very simple, as above: Professionals should have the right to choose their working conditions, and the pricing power that single-payer insurance gave government effectively made the government the dictator of doctors’ working conditions, and the ordinary Saskatchewan patient would suffer from this in various ways.
There is one important feature, however, of the anti-single-payer campaign: All the Saskatchewan government’s antagonists went out of their way to agree that people who could not afford access to medical care themselves, should still receive it. Their counterproposal was instead that there be voluntary regulated insurance, and the government would instead use its funds to pay the premiums of those who could not afford it. Doctors would charge patients directly — remember, we’re talking about a health care system that involved direct cash payments — and patients would submit the bills to the insurance agency, if they didn’t just want to pay the cost themselves. The medical associations agreed then only to charge poor patients what the insurer would pay out, so that poor patients would not have to swallow the costs.
The problems with this are obvious, of course. The Tommy Douglas government didn’t buy it, and proceeded to institute single-payer and break that doctors’ strike. The rest is Canadian history. But what is remarkable, and what I would like to emphasize, is that at no time did anyone make the public argument that the indigent should simply go without care.
In point of fact, the Canadian health care system still has ideological opponents in Canada, both among doctors and rich patients who think their wealth should allow them to skip the queues that do indeed sometimes result from the monopsony more easily than they do now (by going to the US). The difference is that it is still not possible in Canada to admit in public that you don’t think that those who can’t afford it shouldn’t have access to quality care. Almost all domestic Canadian attacks on single payer acknowledge the need for universal coverage, even if their proposed solutions won’t work as well as single payer.
That is a deep and fundamental difference with the United States of America and its health care debate. Admitting to a belief that someone should suffer medically for lack of funds does not put you beyond the pale of politics. I lived in the US during the Obamacare debate and had many acquaintances who expressed envy of the Canadian system under which I had lived my life previously; but I also had acquaintances who were willing to at least entertain the right-libertarian argument that property is an essential characteristic of being, and that to dilute my property for someone else‘s life — is a theft of my life. And they could make that argument in polite company and not be shunned.
To me, that is the most fundamental barrier preventing humane health insurance reform in the US. I find it difficult to believe that the US will achieve a single-payer health insurance system until nearly all opponents of single-payer, down to the college libertarian level, still feel obliged to make a halfway sincere-sounding argument that their preferred reform idea will pay for universal access to affordable care. From what I see in the health care debate in the US, that day is not here yet, although the discomfort that the Republicans have in trying to find a way to delete Obamacare suggests that some progess has been made; people are uncomfortable with taking away what has been given, and what has been given is at least some insurance for some of the uninsurable. But if arguing to leave some uninsured is socially acceptable, then that will usually be the path of least resistance.
That less death is better than more death and less suffering is better than more suffering is something that Ian has emphasized a number of times throughout the years, just to clear up the odd ethical confusion that people sometimes have. It sounds obvious, but it’s easy to get lost in the weeds, and there are moral orders that view the suffering of other people as socially purgative, spiritually redeeming, as well as other ideas of non-scalable ethics, and so on.
But I’m always still a little taken aback when I read arguments to the contrary or that trivialize that distinction. Such as in this article at Naked Capitalism:
4) Liberal Democrats have yet to answer the question why it’s terrifying that 540,000 people will die in the next decade under the AHCA/BCRA, but not terrifying that 320,000 will die under the ACA. They have no moral standing at all.
Don’t get me wrong. Trumpcare is undoubtedly worse. The estimates are that by 2026 as many as 51 MILLION Americans would be uninsured. As of 2016 there were still 27 million Americans without health insurance. But saying Trumpcare is worse and Obamacare is better is like saying, “It’s better to catch crabs from sleeping with a hot young lady, than to get it from a used gym towel.” Sure. I guess. But shouldn’t we just be focusing on the fact you have crabs? Who gives a shit about the towel? And shouldn’t you also switch gyms?
If you’re in the, uh, 220 kilopeople additionally likely to die under the Trumpcare regime or the 24 megapeople additionally likely to be uninsured, then surely the difference between Trumpcare and Obamacare is worth more than the difference between getting an STD from a sexual encounter or without one. (And what if you’re one of the 24 million additionally uninsured, and you’re the one who got the STD…?)
Certainly, it cuts both ways. Single payer will dramatically cut the death rate from lack of health care access (although I am skeptical that it will cut it to 0, there is still complexity and austerity in the Canadian system that means that some necessary care is not perfectly accessible, even though I would never recommend trading the Canadian system for any other existing system…) So, Obamacare is certainly worse than single payer.
Thus, by all means, advocate for why single payer is better than Obamacare (it is). Absolutely, make the argument that a Republican Congress dominated by people who really like the ritual of tax cutting for visible increased suffering (remember what I said above: there is a widely held moral position that increased suffering is a moral good) should consider something that reduces the suffering for which they openly wish. Certainly, make the argument that a neoliberally-dominated Democratic party should yield up control to people who reject the market-fascination of neoliberalism. Or whatever strategy takes your fancy.
But don’t pretend that Obamacare vs. Trumpcare is not a real choice and that the distinction between the two doesn’t mean something, that the fact that the immediate political choice is between the two and not between Obamacare and single payer doesn’t say something very important about US society.
The Republicans are working hard to pass an amendment to the ACA called the AHCA. Assuming it succeeds, which I wouldn’t take for granted, it would take Obamacare, with all the latter’s deficiencies and faults, and make it even worse. Meaning: It will probably kill a lot of people through health care denial due to pre-existing condition denials and the reinstatement of lifetime coverage limits. If they fail to pass it, it would be because Obamacare is designed to make itself hard to retract; as Obamacare contains the bare minimum required to improve the status quo ante, anything significant they take away from it renders it unworkable. If it passes, it would be because they had decided that it was the closest to the status quo ante that they could achieve.
The status quo ante was terrible, but contrary to the beliefs of many, it wasn’t “unsustainable” in some sort of fundamental way. It could be contained by gradually excluding more and more people from insurance coverage, and therefore, down the line, care. This is not a debate about health care, but about how to pay for health care. It is about austerity, and the status quo ante was ultimately just a slow ratcheting-up of austerity. (Yes, I know, Obamacare is a ratcheting-up of austerity, but it is a slower one.)
One of the talking points against the AHCA is that it appears to be designed to give the rich a tax cut. However, the tax cut is, in proportion to many of its beneficiaries, quite small, even as it dwarfs the incomes of many. It’s not a giveaway that in itself should raise the political passions of its beneficiaries. Many of them won’t spend it or won’t notice the effect on their lives or wealth planning. Even the insurance industry is skeptical of key portions of the bill, and they’re not prone, as they say, to altruism.
The Republicans have invested a lot of political capital in the idea of undoing Obamacare. Instead of that small a tax cut, if they were rational political actors, they could easily have come up with a bill that targeted large swathes of their constituencies for a substantial improvement in their (bad) standard of coverage, even if they wanted to target Democratic constituencies for tribal reasons. They could have done this without even instituting single payer (aka public monopsony) and ruining their constituents among the insurance and corporate medical sector. It doesn’t appear that this is on order.
The picture only makes full political sense if you see the cutting of health insurance coverage as a political goal in itself, if not some kind of fundamental ideological “end.” Or for the symbolic appearance of trading coverage for a token tax cut, in a way that is likely to create further damage to the US economy. And that successful Republican politicians think that they can expel millions of people from the ability to pay for health care, including their own constituents, is a sign both of the significance of that symbolic appearance and the cultural limits of the US health insurance debate.
