(MANDOS POST AGAIN…)
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.
and particularly this one:
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.
Synoia
It says something very significant about US society.
Donald
No idea what the point of this article is, unless it is to pick a fight over the emphasis given on facts where you both agree.
BlizzardOfOz
Mandos, should the USA have declared war on Japan after Pearl Harbor? The moral calculus was simple: immediate surrender would mean zero additional deaths; going to war would mean the certain death of untold thousands or even millions. Amirite?
Mandos
Well, of course, it’s not clear that that was the case at all, whatever the motivations for going to war actually were. I mean, the counterfactual of a US surrender to Japan is probably not easy to construct. But top fascist whataboutery, 10/10.
Mandos
The emphasis is extremely important. I have never disagreed with the idea that the right solution for US health care is Canadian style single-payer. I have lived in the USA for an extended period in my life, and it was facepalmingly obvious to me every time I heard the acronym “HMO” or got involved in some stupid timewasting billing fight. But the emphasis of NC and of many people here goes to the core of the strategic failure of American progressives: for one thing, if you cannot concede elementary and obvious moral distinctions, why should anyone believe you are the ones able to reconstruct the system in a humane way?
Synoia
BlizzardOfOz
The Japanese attack on Pearl Harbor was a response to the US’ oil blockade of Japan.
atcooper
I kinda love Naked Capitalism, but they can get a bit lost in hyperbole. I’m not sure shepherding them is the right approach though. Asserting a blander version of the same argument, one could play the MLK to X tension.
atcooper
Thinking about it, showing up on someone’s list has probably made NC more prone to exaggeration. I’d have been a little rattled to be on the receiving end of character hits.
Mandos
I appreciate their links very much. When the political internet was somewhat smaller and more intimate, it turned out that Lambert and I could never get along, from my perspective because Lambert leaps to accusations of bad faith but then (for well-intentioned reasons) makes bad faith arguments himself. But he is a very effective organizer.
The MLK to X tension works if the X’s don’t think that the MLKs are acting in bad faith, as it were. My position is that Obamacare, whatever the underlying motives were, represents both a loss (of e.g. the public option, which after a few years would have made the US health care system look something like the German one, which is not at all single payer but is universal and high quality…) and an opportunity.
The opportunity is clearer if you’re willing to acknowledge that:
1. there is a countervailing force that actively, both out of greed and moral/emotional conviction, wants people to have even less affordable access to care than it actually does.
2. after Obamacare, that countervailing force can only impose its will by taking away care that Obamacare gave, in strong violation of widely-held moral sentiments. Like more death is worse than less death. I believe that for the majority of people, this is still so at least among your fellow citizens, whether you like that double standard or not.
Mandos
Er, replace “… than it actually does.” with “…than they currently do.”
Stirling Newberry
Italian Fascism is not bad as Naziism.
Herman
I understand where Mandos is coming from and to a certain extent I agree. Trumpcare is worse than Obamacare and the difference is not small. It will make a big difference for a lot of people. But we shouldn’t be in this position in the first place. Obama screwed up the health care issue by pushing this Rube Goldberg program instead of single-payer or at least a public option. Even reducing the Medicare eligibility age to 50 would have been better than Obamacare.
The problem with these overly-complex programs that the neoliberal Democrats love so much is that not only are they often not very effective but they tend to divide the electorate based on things like program eligibility. Social programs should be as universal as possible to avoid this problem.
I agree that sometimes Naked Capitalism and other parts of the left-wing Internet can take the “both parties stink” message too far to the point where they both seem equally bad and that this is not entirely accurate. Both parties do stink but on a number of issues the Democrats are still better than the Republicans, if only by a little bit. That little bit can matter a whole lot for many people, though.
Still, I don’t think we need to ease off Obama or the Democrats just because the Republicans are in power. To a large extent Obama and the Democrats are responsible for recent Republican victories.
bruce wilder
So, which is it? You make the argument? You don’t make the argument?
The strategic failure of the Democratic left in the last election was the candidacy of Hillary Clinton and all we heard was blather about differences between Clinton and Trump. Lost was the realisation of what a ripe horror Clinton is and was.
Obama care, taken as a whole, is horrible. Sure, it has some nice features, but as an overall policy design, it stinks.
It is not a question of being able to make fine moral distinctions. It is a question of getting so bogged down in differences that you fail to see and judge the whole. Too many people think they can economize on information and cognitive resources by just assessing differences, but politically it is sucker’s game in which your support is gradually drawn by a series of differences until you find yourself backing subsidies for predatory for-profit insurance or a war monger creature of bankster greed who cannot win.
I would rather fight for something good and lose, than lose fighting for something horrible the only redeeming virtue of which is that it is allegedly slightly less evil.
Your politics of differences got the Democratic Party to a point where losing is the only feasible course anyway.
Herman
You can argue that Trumpcare is worse than Obamacare and should opposed while also arguing that Obamacare is inadequate and needs to be replaced or transformed into something better.
Politics has always been full of these strategic decisions that are less than appealing but necessary given the reality of the world we live in.
S Brennan
Shorter Mandos:
Liberals must blindly adhere to the failed policy of “the lesser of two evilism” lest liberals open their eyes and recognize the policy for what it is; the “the evilism of two lessers”.
Charlie
I’ll take your MLK to X tension analogy to a somewhat logical historical conclusion. MLK was the slow route to civil rights, while X was the quick route. Obamacare slow to health care as a right, single payer quick. MLK was killed for his troubles, and X’s way became reality. Hence, Obamacare being killed could, and probably will, lead to a call for radical change.
Sadly, a good many people WERE killed as a result. Probably myself when we are creating the analogy to health care, but then, better days are ahead.
killneoliberals
Obamacare is the reason why we might be getting Trunpcare, you idiot.
Lesser of two evilism has completely failed. A Medicare for all scheme could have passed in 2009, via reconciliation, and would have been entrenched as policy.
So, no you are not right, as usual Dumbdos.
Patricia
Sure, choosing lesser evil works in specific situations but we’ve been repeatedly only given such choices, right? For those who care, an awful calculus is regularly attended for slower decline. It grinds on the psyche. And to what purpose? In the end, dabbling in evil brings destruction as surely as it is brought when giving self wholly to it.
The sheer number of times we’ve put up with it exposes our tendency to short-term thinking. But eventually people do recognize that they’re being led by the nose in a perpetually humiliating public dance.
Some see it sooner than others, and they will sound extreme because they are enraged and also because they demand, above all and come what may, that the dance end.
When enough people see it, all hell breaks loose. I think that time is somewhere around now.
Moral calculus works differently now, Mandos.
EverythingsJake
This is like a Lawyers, Guns, Money post, a site which quite frequently seems to punch left, quite often viciously. If your point is that Camp makes his argument badly, okay, but do you seriously believe Camp can’t ultimately distinguish between the relative benefit of AHCA and the ACA? Given the overwhelming liberal noise about the greatness of the ACA, what I would tend to think of as Camp’s hyperbole isn’t a completely unwelcome tonic revealing that the ACA shouldn’t be a stopping point, leaves a lot to be desired, etc.
And, perhaps you and Lambert could work out your personal differences offline. I’m not certain I read your characterization of his point as entirely fair on the merits of his own article. He gets hung by association with Camp.
MojaveWolf
I don’t know if I’m going to have time to read the rest of the comments and still respond, so apologies if this has been covered already. And also apologies for typing fast w/out proofreding while doing other things. But I had a fairly strong reaction to this and no gaurantee I will be able to get back to it later. So …
FWIW, a few posts back Mandos asked we give him the benefit of the doubt that he’s making his arguments in good faith and means exactly what he says. I am endeavoring to do so.
But don’t pretend that Obamacare vs. Trumpcare is not a real choice and that the distinction between the two doesn’t mean something
Who is pretending this?
I only skimmed the NC article, but I do not believe Lambert was doing this. I would go further and say you pulled something out of context that means something entirely different (to me at least) in context of the whole article than separated. Yes, it’s worse, on some sort of scale, for 520k to die than 340k. That does not mean people who argue between those two scales while deliberately avoiding a solution that could reduce the deaths to under 100k or under 10 k or whatever (not to mention reducing suffering and improving life quality for people who aren’t dying but are suffering) are not equally evil. I’m sorry, but if you want to say they are wrong for saying “If one person wants to kill five of my friends and another wants to kill three of my friends, please don’t ask me to be nice to the person who only wants to kill three of my friends”, I gotta ask, what the fuck is wrong with you?
Seriously, if someone said, “I’m gonna kill those three of your friends, and he’s going to kill five, so give me your support” are you saying that’s not incredibly demented? Are you going to argue that people who would say, instead, “how bout I find someone else to support who isn’t going to kill any of my friends?” are naive?
Cause if that is really what you are saying, I don’t want to know you and I’m not going to bother w/your future posts. I’m trying to give you a benefit of the doubt here but I’m finding it difficult.
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.
It says something, but not what you think. Again, since you want us to take you at your word, that you truly believe Obamacare was the best people would support at the time, then I will just say either you or I is not only wrong in our perceptions, but one of us is wrong to the point of being deeply delusional.
The choice back in 2009 WAS between Obamacare and single payer and the corporate Dems you keep trying to champion chose Obamacare, which was originally much worse than it is now. Only when it was seen that the original version wasn’t going to fly and was ticking off more people than it was making happy did it get tinkered with, gradually, year by year. Had they done it even as well as it is now at the beginning, your gal Hillary would be prez and we might have a Dem majority in the Senate (maybe even in the house).
They chose not to do this. People (like me) had junk insurance they couldn’t use. People got ticked off about this.
What does it say about our country? It says our country’s rulers are evil (or, at best, hopelessly, pathetically clueless) sacks of garbage who need to be tossed out and replaced with better people who have a better understanding of reality, strategy and tactics not to mention a better moral compass, or in the long run “more death” is likely to total “nearly everyone”, and until then “more suffering” is going to be “more people suffering more every year.”
You are complaining about what you believe is a false equivalency being made here, but when the longterm (but not that long) result of corporate Dem policies is “everbody or or nearly everybody and everything dies” it makes PERFECT sense as a moral calculus to lump them all in together, even if one side or the other is mildly better.
(before you say “but short term matters too if you’re going to die or suffer more in the short term and numbers I just said” can I remind you many of us think HRC and the yay obamacare dems would have already started a shooting war w/Russia, and certainly done more badness faster in Syria, which rather even outs or possibly even wildly surpasses those numbers)(and yes, I do think all these calculations have to be made together for the particular, anti-NC argument you are making, since that site clearly does view all these things as part of a total package, imo)
FWIW, I want to keep Obamacare. Why? Because for the first time since it started, this year I have a policy that I can actually use, if I get the time, and actually probably will use, if I can get the time. I am totally with the dems in wanting to keep what we have now. I’m totally opposed to them, tho, in opposing single payer (see: Cali Dems, just a couple of weeks ago; those are people who am NOT giving any benefit of the doubt that they are acting in good faith, or the Dem party in general; they’ve had plenty of chances to do the right thing over the decades, and they keep demonstrating with dogged persistence that they either are unable to understand what is needed, or have no desire to do so, and think “the Republicans are worse” is all they need to say. It isn’t.)
paintedjaguar
Besides the tens of millions who were deliberately left out in the cold, other factors that ACA boosters and defenders have preferred not to discuss are Institutional Inertia and Opportunity Cost. Plus their old favorite Divide & Rule, which is the zombie heart of tiered, means-tested schemes such as Obamacare.
Stirling Newberry
The correct question is: “Where do you get off?” For some of us – Obamacare was it. it made no sense as policy, but it was politically motivated by getting a few people off the rolls – while leaving others on. and it wasn’t going to work ( as you’ve now seen, those of us who warned you were not listen to).
Obamacare is evil, just not as evil as whatever the Trump lead GOP is going to ram down your throats. But that doesn’t mean that Obamacare is not evil.
Ché Pasa
Those who support Obamacare are in general either political operatives — not “The Left” — who we can dismiss or beneficiaries who we should not dismiss. Unfortunately “big picture” thinkers often do dismiss those whose lives have been made possible if not tolerable by Obamacare in pursuit of their campaign of destruction against everything “Clinton,” “Obama,” and/or “Democrat.”
It’s like the general dismissal of the hundreds of thousands who die as a result of medical error every year or the routine dismissal of the fifteen million who lose health care coverage (mostly Medicaid) almost the minute Trump(no)care is enacted.
These people don’t matter because the ‘big picture” thinkers believe that something else matters more. What that is depends on which political compartment you’re in.
It’s a moral vacuum.
The health care parameters are set by the needs of the industries involved, not by the needs of the people, and that’s a big reason why industry keeps winning no matter how many die as a result. And no matter how complicated the argument becomes.
It has almost nothing to do with doing the right thing — on any side of the issue. It has mostly to do with power and objections to whoever holds and exercises power.
What the Rs are attempting to do is a destructive and deadly travesty which they acknowledge will harm untold millions, but so what? They don’t care and never did.
What the Ds did with Obamacare made life possible — or even better — for some who otherwise might be dead, but that was never the point of the program. It was a beneficial side effect of ensuring profits and rents to the medical insurance and care industries.
Of course the correct approach is to recognize that there is a public interest in a healthy population and that the public interest overrides the pecuniary interests of industry and the political interest of factional power players. Americans used to be able to do this — not always perfectly to be sure — but can’t seem to do it any more.
Thus we have spectacles like the one Mandos points to.
Donald
I don’t think it is ” extremely important” to pick fights with people where you agree on the facts. It is clear the nakedcapitalism people recognize that the Republican proposal will make things worse and kill more people — Lambert is taking the opportunity to point out to Democrats that by the same logic, single payer is less evil than Obamacare. That point is ” extremely important” to make. It is universally recognized on the left and even in a few places on the right that the Republicans have no solution to Obamacare’s problems and in fact their solution will be absolutely horrible.
Donald
Didn’t finish my thought. It is universally recognized on the left that the Republicans are going to make things worse– it is not universally recognized that the same logic shows that Medicare for all is better than the ACA So it is ” extremely important” for someone to point that out.
And yes, I read nakedcapitalism and also think we should save the ACA from the Republicans. Somehow I manage to do this. Sheer force of willpower, maybe. Or a recognition that there is no conflict.
realitychecker
Some people miss the forest for the trees.
Mandos prides himself on being able to miss the forest for the toothpicks.
Ché Pasa
Problem is, Democrats have no reason to listen to Yves or Lambert, not after the constant efforts at NC to defend Trump (“I hate to sound like I’m defending Trump…”) destroy the Democrat [sic] Party, eviscerate the Clintoons [sic] or kill them with fire, and their frequent denunciations of Obamamometer [sic].
It’s something like Yves’ failed campaign against Strike Debt’s medical debt forgiveness project. She was absolutely convinced that the project would result in extensive income tax consequences for those whose debt was forgiven by Strike Debt and therefore should be stopped. She was wrong. And rather than discuss her concerns about the project with the Strike Debt organizers, she ranted at NC — which Strike Debt was not inclined to pay any attention to.
peonista
America has a real problem with healthcare. Obamacare was not a real solution to the problem. This gave the Republicans and Trump traction to exploit Americans real frustration and fear over our inadequate healthcare. Everyone hates it’s complexity. Everyone hates navigating HeathCare.gov.
The only good part was the Medicaid expansion which is a mini-single payer. Not addressing cost controls by the government as a large buyer of services makes the program’s costs balloon.
Timid policy on the part of Democrats when we need leadership has resulted in Trump.
Charlotte W
I’m 70. I’ve been to a doctor exactly ONCE in 20 years. Shingles. Dreadful illness, but easily treatable. I don’t smoke, drink or do drugs. I eat healthier than when I was raising the family. Meat, Veggies, low carbs.. that’s tough but doable.
I take responsibility for my health. When I cross the aisle for opposition research to sites like this and Naked Capitalism… it’s to better understand cognitive dissonance.
POLL –
How many here think Trump’s crack down on immigration is EVIL?
How many want single payer universal healthcare?
I rest my case.
Stirling Newberry
Backward thinking fallacy.
Mandos
Charlotte W: There’s no contradiction between opposition to Trump’s crackdown on immigration and desire for universal healthcare. The conflict between immigration and social welfare programs is overrated.
peonista
@ Charlotta W
My niece who does not smoke or drink, does not drink pop or eat junk food, got lots of exercise, was a junior life-guard, gets good grades in school, is a Girl Scout Cadet and is 12 years old, was diagnosed with osteo sarcoma last year when she was 11. Unfortunately she now takes lots of expensive drugs. Until this happened she also took responsibility for her health.
Sometimes shit happens to people.
MojaveWolf
@Charlotte W– if your point is that a social welfare state and open borders are not compatible, I am strongly inclined to agree with you.
I understand the ideological arguments for open borders, but in today’s world as it is constructed I think they are a terrible idea in most places, possibly all places except those not many people will want to go.
I realize I may be a minority opinion here on this, but am not sure. We on this side of the aisle are not a monolith any more than y’all are.
Sadly, I do not think Trump’s particular approach to the issue in either practice or PR has accomplished anything worthwhile, and has actually been counterproductive in almost every possible way, long term (which can be said about a lot of his policies, from my point of view).
On the positive, I think you picked two of the best places possible to read left wing (or left of center in US) policy discussion, so yay!
I’ve tried to read some right wing sites on occasion as well, but haven’t found a whole lot where I think I can get much out of them. Even when I think the people there are nice, we are basically working from an entirely different view of the world, where, as I said about mine and Mandos’ perceptions on a certain issue, either I or they are so wrong that one of us borders on the delusional, so it’s hard to find common ground.
That said, I think in general we’d all be better off trying to understand each other better. So site recs are welcome, at least from my p.o.v.
MojaveWolf
@Charlotte a second time–about “taking responsibility for your own health”–sometimes, people are just unlucky. A lot more often than most of us want to acknowledge. That’s why we want single payer, for those people who life decides to smack upside the head, and who aren’t positioned to deal w/the crisis adequately no matter how hard they try.
Also, speaking for me personally? Even if someone gets sick or hurt because of some fault of their own, unless they are a truly horrible person, I’d still want to try and mitigate their suffering.
And even from a purely “enlightened self interest” pov, the overall costs to society and the “responsible people” would be less w/single payer than what we have now. If you’re worried about incentives, no one is going to go out and get cancer or some other horrible illness or get in a car accident because single payer is available. “Hey, if I get in an accident that could leave me paralyzed, it’s okay because I don’t have to pay for the medical care! So I can try to take this turn at 120 and not worry about the angle or the 600 foot drop!” Seriously, won’t happen.
MojaveWolf
@peonista — best wishes and best of luck to your daughter!!! I got cancer when I was 19, and am still kicking at just-turned-52 without any reoccurrence, if its any encouragement. I think the overall survival rates are much better now than they used to be, as well.
(and should she have gotten a poor prognosis, *I* had a poor prognosis, as did a couple of other still surviving members of my family, which seems to have, on several different unrelated sides, been very prone to cancer. Not all of us made it but many did/have, fwiw)
And yeah to “you never know” factor, I got a kind that usually shows up in terminal AIDS patients and VERY young children in Africa, neither of which fit me at all. Life is not always predictable and disaster isn’t always avoidable.
Stirling Newberry
Lesson to idiot liberals:
Charlotte taught you to give time to an obvious fallacy, you spent endless time on the argument, and he did nothing. (And I said “he” intentionally, because the odds are it’s a male) If what someone wants to present: a conservative viewpoint, then hold their argument to rigid forms of debate. There is a reason why on every investment site they end with “past results are no guarantee of future results” or some such. We’re talking 2500-year-old traditions.
This is a basic lesson of debate: tell your opponent which policy they have exploited, and perhaps lecture on why this fallacy is not permitted.
Mandos
That is exactly the point — the core of the disagreement. Where the institutional inertia really was, and where and what the opportunity costs were, and why that was the case — much as many people here. Lambert and company have been bolstering their argument about this for years by trivializing the difference between Obamacare and the status quo ante, and they’re attempting to defend their viewpoint by trivializing the difference between Obamacare and Trumpcare.
Mandos
Arguments with people like Charlotte are useful because they remind people of some of the things that are actually at stake.
Mandos
You may think that there is no conflict. They (NC) think that the ACA retarded progress on single payer, based on an analysis of the opportunities that completely neglects how American society works and how American government works. Perhaps the still on-going Republican inability to pass an ACA retraction (or even their success!) will eventually lead to the political moment for single payer health insurance. That is fervently to be desired. But more likely than not, it will be despite and not because of the kinds of arguments that NC has made on the topic and the type of political strategy it implies. That kind of argument is the disingenuous kind that deliberately downplays that difference between what Obama did and what the Republicans want to do.
someofparts
“there is a widely held moral position that increased suffering is a moral good”
Could you expand on this? Links and specifics would be welcome.
realitychecker
@ someofparts
The proof is that Mandos keeps offering up these posts lol.
Mandos
someofparts: You’ve really never heard of the Catholic Church’s position on birth control? The obvious (and well-known) result of deliberately denying women access to birth control is a strict increase in human suffering. While modernist elements in the Catholic Church attempt to argue that the result of such a “Culture of Life” will be that society will learn to cherish mothers (as though lack of being cherished is the only reason why a woman wouldn’t want to have a child…), traditionalists are clear on their belief that the suffering that occurs from lack of birth control is virtuous and socially healthy.
Ché Pasa
I’m so old, I remember when the nuns would say “Suffering is good for the soul” as if it were a command from The Lord Himself.
We should be so blessed as to endure what the saints did.
Basic, no?