Government: The Good, the Bad and the Big

I'm starting this blog to avoid being too much of a comment-box hog on the blog of the American Chesterton Society. Specifically, I want to respond to a message by Davymax3, who was responding in turn to an obnoxiously long series of messages by me. I had said that the main problem with government is not that it's too big; davy had challenged me to defend this heresy; and we are now arguing about a range of issues, from Katrina to health care reform.

Now, Davy...

On Katrina:

It's not at all clear to me that New Orleans and Louisiana alone had enough resources to prepare for and respond to a disaster like Katrian. If you want me to believe that, I'm going to need some evidence. Regardless, though, I'm sure you would agree that the slow state and local response was justified or made inevitable by the mere existence of FEMA. The state and local governments are accountable to their voters and could have asserted their share of responsibility.

And whether or not the local and state governments had sufficient respources of their own, and whether or not the federal government's customary level of responsibility for disaster relief somehow inhibited the state and local efforts, surely you would agree that the federal govenrment, by principles of subsidiarity or just by the golden rule, had some kind of supporting role to play. And the fact remains that what the federal government did, it did badly. The media did a very good job of exposing this, and evidence should be readily available on a cursory Google search. The federal government's response was too incompetent to be blamed on mere bigness; inexpereinced people were in charge, important pirorities were overlooked, and the government simply hadn't developed to capacity to effectively support its people in the event of this kind of disaster. It was not just big governent, but bad or insufficient government.

On corporate "evil":

You say I described the health care companies as evil because I said they prioritize profits over patients. But I don't think we can describe people as evil simply because they run for-profit businesses for profit. that's they're paradigm; they are accountable to shareholders, for whom they are trying to do a good job. I know people in the insurance people--I even very briefly worked in it myself--and most of them strong me as good, caring, well-intentioned people. None of them struck me as personally evil. Is there an unintended systemic evil in the structure that allows for-profit companies to make healthcare decisions without much regulation? There may be, though I'm not sure the word "evil" is helpful at this time and under these circumstances. I'm not interested in demonizing anyone; I'm interested in developing a system that works better for the public.

On statistics:

One can always impute bias to statistics, but tell me where to find statistics that trump WHO's and support your claim that we have "the best health care in the world." Immigrants I know from Canada and Europe have many good things to say about the health case.

There are many people who don't meet the income guidelines for Medicaid but still can't afford insurance--especially if they have "pre-existing" coverage. Massachusetts mandates coverage but has been giving a lot of hardship waivers; why is this, if insurance is so affordable to everyone who doesn't already have Medicaid or Medicare?

On the insurance mandate:

If your uninsured friends do get sick, they'll get expensive (albeit ineffective) emergency room care that is subsidized by the rest of us. And if they are young, healthy people, their non-pariticipation in the insurance pool is making insurance more expensive for the rest of us. I believe that it is reasonable for society to decide, through our government, that their non-participation is an irresponsible drain on the public treasury which they much make up through an excise tax. I don't think that this reasoning would allow the government to "mandate anything"; I don't see your reasoning for that.

Lowering costs:

The current legistlation doesn;t do as much to control costs as I would like. The mandate would probably help; a larger insurance pool with more young and healthy participants will help to bring insurance costs down.

Changing health care delivery would also help. There seems to be a lot of agreement among experts that our system offers too much incentive to order unnecessary tests and procedures.

If we had a single-payer system or a strong public option, the government could negotiate reasonable rates with providers--as has been done in other industrialized countries. Paying for health care through taxes could be cheaper in that it would relieve businesses and their employers of responsibility for premiums.

Quality:

Of course technological innovation is key, and of course the U.S. must continue to drive it. No one is arguing with that. In fact, the stimulus act invested in health care innovation, and so would the current legislation.

Some of the measures that have been proposed to reduce costs--such as better use of information technology and more research on best practices--would also contribute to improvement of quality. So would the legislation's emphasis on preventative measures. The current legislation doesn't socialize the pharmaceutical companies (or any other sector of the health care industry); drug companies would still do research.

Making the government ours:

I've said that there's fat to cut out of government, and there are certainly areas in which the governmetn exerts too much control. I'm glad the the current Justice Department has relaxed its position on enforcing federal laws against medical marijuana. The idea of withholding federal transportation money from states that don't agree to certain driving policies seems defensible to me; it's reasonable to expect individual states to be good partners in protecting the safety of interstate transportation. I would offer "don't ask, don't tell" as another example of an overly intrusive government; our government should not be in the business of regulated how members of the armed forces define their sexuality.

I think that in the fullness of time, a smaller government is a great goal. But I don't think we'll ever have anything like a "distributist" society if we can;t first, and transitionally, make government into a counterweight against big business.

As President Obama said in his inaugural address, "The question we ask today is not whether our government is too big or too small, but whether it works -- whether it helps families find jobs at a decent wage, care they can afford, a retirement that is dignified."

On being a demogogue:

I don't think my arguments are popular enough to constitute demagoguery. :) The CFP writer, I think, is contributing to an extremist subset of conservatism that is rising to power by appealing to people's cynicism and making a slew of false claims (from "death panels!" to "Obama's a foreigner!") that add up to "tyranny." If you Google this writer, you can see him asserting or taking for granted many of these claims, which have been widely debunked. I think he and his colleagues are demagogues. I don't think, though, that they have a monopoly on demagoguery; you can find examples on the left as well.