Jill and I blundered into a fair today while walking to the Post Office (side note: Jill and I have wandered into many fairs in our day, and I don't think we've ever done so intentionally). It was fun -- there was a chili cook off and we registered to vote. And as we were walking, we saw a booth for an outfit called "Generation Opportunity." It rang a very faint bell, but it sounded like one of those neat non-profits that helps empower underprivileged high school students, so we decided to check it out.
They described their mission as surveying young people to find out what their priorities were, then advocating for those values. They gave an example of a proposed sales tax which I didn't know much about, then suggested we fill out one of their surveys. Jill, good quantitative researcher that she is, immediately asked what methods they had for ensuring that their surveys were actually representative of our generation by including low-income young people and people of color. The mumbled response about how there were other people who did that might have served as a red flag.
But then we took the survey, and it took one question for me to say "This is a push poll!" ("uhh ... yeah, the questions are worded terribly, I've talked to them about that."). "Do you think jobs are created by lowered taxes or bigger government?" "Do you think we should improve the economy and lower the debt by increasing government spending or decreasing it?" "Do you want to exercise your right to opt out of Obamacare?"
That last one was a subject near and dear to the staffer's heart -- he was very keen on informing us that we could decide not to participate in the Affordable Care Act. "I thought if I didn't participate Obama would, like, throw me in jail, but it's really just a fee you pay." I wanted to ask him if, given that his old sources were so terrible he thought he'd be imprisoned if he didn't get health insurance, if maybe he had thought about turning elsewhere for information on Obamacare, but I didn't. After turning down the offer of various swag emblazened with "opt out" (surely, a slogan our generation will get behind), I walked away.
Jill was actually a pretty happy camper -- she says she enjoys push polls because you know exactly what answers will piss the pollsters off ("why yes, I think larger government is the key to a healthy economy"). But I found myself very annoyed. These guys were basically grifters. The "opt out" movement is terrible -- it encourages people to go without health insurance to prove a political point, but you can bet dollars to donuts that if any of these kids actually get sick their erstwhile allies will do nothing but encourage them to die quickly. And even if they stay healthy, the goal of the program -- to deprive the health insurance market of healthy people to make it unaffordable for sick people -- is unspeakably evil. Frankly, I found it quite disgusting.
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The "opt out" movement is terrible -- it encourages people to go without health insurance to prove a political point, but you can bet dollars to donuts that if any of these kids actually get sick their erstwhile allies will do nothing but encourage them to die quickly. And even if they stay healthy, the goal of the program -- to deprive the health insurance market of healthy people to make it unaffordable for sick people -- is unspeakably evil. Frankly, I found it quite disgusting.
Isn't your 2nd point (screwing up the health insurance market) more likely than the 1st (encouraging people to die)? I need to look into the regs more closely, but my understanding was that due to the ACA's prohibition on refusing to cover pre-existing conditions, people can buy health insurance at the next enrollment period if they become sick and realize insurance is good after all. That's why we need the tax on people who can afford to buy insurance but refuse to get it -- otherwise the moral hazard would be overwhelming. Pretty much the only reason conservatives aren't literally spitting on Chief Justice Roberts is that his controlling opinion in the ACA case said that the lowness of the tax was one of the factors in his deeming it to be a constitutional tax rather than an unconstitutional penalty:
'The same analysis here suggests that the shared responsibility payment may for constitutional purposes be considered a tax, not a penalty: First, for most Americans
the amount due will be far less than the price of insurance, and, by statute, it can never be more. It may often be a reasonable financial decision to make the payment rather than purchase insurance, unlike the “prohibitory”
financial punishment in Drexel Furniture.'
So the long game thinking here is that Congress will be unable to increase the tax without making it an unconstitutional penalty, even if it turns out that the current tax levels are insufficient to avoid the moral hazard problem (ie the tax is too low to induce people to buy insurance instead, and the revenues from the tax are too little to pay for health care those insurance-refusers will demand once they need care -- and can get it thanks to the ban on discriminating against those with pre-existing conditions).
This is why at least one person seriously suggested (as I recall, in the NYT opinion pages) that every adult who refused to obtain health insurance when he could have gotten it should be blocked from the benefits of the system. If you refuse to buy insurance, you don't have to pay a tax -- but you also can be refused insurance later because you're unprotected by the ban on preexisting condition discrimination. It's an interesting idea, and seems like a good set-up for a speculative fiction novel or movie: a society in which people at 18 decide whether they want both the benefits and burdens of being in the regulatory system, or if they'd rather risk being outside it.
Well, the goal is to death spiral the health insurance market, so if the all the healthy people opt out, they won't be able to afford it when they later get sick (even if they can't be "excluded"). And then they have to die quickly.
“[E]very adult who refused to obtain health insurance when he could have gotten it should be blocked from the benefits of the system. If you refuse to buy insurance, you don't have to pay a tax -- but you also can be refused insurance later because you're unprotected by the ban on preexisting condition discrimination. It's an interesting idea, and seems like a good set-up for a speculative fiction novel or movie: a society in which people at 18 decide whether they want both the benefits and burdens of being in the regulatory system, or if they'd rather risk being outside it.
Kinda like the period when Amish adolescents decide whether they want to remain in the fold, or to leave it.
But this illustrates that the purpose of a social safety net is not solely – or even primarily – for the benefit of those receiving the assistance. If it were, presumably we’d reduce most forms of assistance to cash. Rather, the purpose is for the benefit of middle- and upper-middle-class people who don’t want to OBSERVE people needing assistance and not receiving it. I don’t want to see you sick. I don’t want to be in proximity to more suffering than necessary. So I want to compel you to have access to health care, whether you value that or not. Even if you might prefer to sacrifice your leg and use the health care money instead to start a business, I don’t care. You’re lack of business capital does not impinge upon my sensibilities as much as your lack of a leg does.
In short, it’s not all about you. It’s about me.
But this illustrates that the purpose of a social safety net is not solely – or even primarily – for the benefit of those receiving the assistance. If it were, presumably we’d reduce most forms of assistance to cash.
I'm not sure this is entirely correct. We give in-kind assistance rather than cash because we want people to get certain *kinds* of assistance; because we are not simply trusting recipients to maximize their utility in whatever way seems best to them. I'm not trying to make a needy person happier (especially if happiness comes in the form of hookers and blow); I'm trying to make the needy person more capable of caring for himself by providing education and job-training, and sustaining life long enough to make him capable of self-care through health care, housing, food, etc.
With regard to the coupling of the insurance requirement and the ban on insurers' discriminating against applicants for pre-existing conditions, the first is necessary to make the second work. Neither necessarily involves any charity or social safety net on anyone's part.
Similarly, my vague thought about a sci-fi story would not be so much about government-provided welfare, but about having one part of society live in a highly-regulated world of safe but expensive food, cars etc., and another part live a libertarian fantasy of cheap and high-tech but questionable medicine etc.
“But this illustrates that the purpose of a social safety net is not solely – or even primarily – for the benefit of those receiving the assistance. If it were, presumably we’d reduce most forms of assistance to cash.”
“I'm not sure this is entirely correct. We give in-kind assistance rather than cash because we want people to get certain *kinds* of assistance; because we are not simply trusting recipients to maximize their utility in whatever way seems best to them. I'm not trying to make a needy person happier (especially if happiness comes in the form of hookers and blow); I'm trying to make the needy person more capable of caring for himself by providing education and job-training, and sustaining life long enough to make him capable of self-care through health care, housing, food, etc.
Agreed: We give needy people the things that WE want them to have, whether or not it’s the things that THEY want to have.
I don’t necessarily find fault with this dynamic; I merely suggest that we acknowledge it. Among the implications of this dynamic: When Obamacare compels me to buy health insurance, the policy is designed to benefit the people who feel strongly that I should have health insurance; the fact that the policy also benefits me is merely a happy coincidence.
Ok, ok, I’m not sure I can really support this argument where Obamacare is concerned due to the peculiarities of the health care market and adverse selection. Arguably by compelling EVERYONE into the risk pool we benefit everyone in the risk pool. Thus, I don’t really want government to compel me into the risk pool – but I might freely jump in if I could be assured that everyone else was getting in, too. The only way I get that assurance is if government compels everyone else into the pool. And the only way government does that is by compelling me into the pool, too. Thus, we face a circumstance that Libertarians claim cannot exist: I’m made better off by having discretion taken away from me.
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