The Radicalness of Alleged Conservatives

In all honesty, much of what is coming out of the mouths of self-described conservatives is actually pretty darn radical.

I have been increasingly struck of late as to the degree to which policy proposals being suggested by self-proclaimed conservatives are, in fact, quite radical.

What do I mean by this?  Let’s consider:  one of the fundamental notions, at least on paper, of being “conservative” is skepticism about the ability of reason to fix a specific problem due to the complex nature of human interactions.  As such, while conservatives are willing to allow for change, they tend to prefer, again at in least in theory, small, incremental change (see:  Burke, Edmund).  The desire for incremental change is supposed to be predicated on the fear that the human mind is likely incapable of adequately considering all of the unintended consequences of a given action.   It is best, conservative reasoning is supposed to go, to engage in change slowly so as to diminish the possible of human error, given that human error is quite likely to occur.

As such I find much that supposedly passes for “conservative” policy prescriptions these days to be, well, radical.  By “radical” I mean that they encompass rapid change to the status quo.  And, further, the assumption that such rapid change can revolutionize a given situation without too much regard for unintended consequences.  Such moves tend to be the domain of the true believer.

Along these lines it seems to me that proposals that will utterly transform, in one stroke of the pen, a program that has been in place for almost half a century is pretty radical  (i.e., Medicare for those of you scoring at home).  Indeed, a grand irony here is that the PPACA was, objectively speaking, less radical than the Ryan Plan for Medicate/Medicaid as all it did was further institutionalize the existing system of private insurance mostly provided by employers, with the individual mandate being the only real innovation, and even then one that operated under the basic rules of the pre-PPACA system.  The Ryan plan is a total overhaul of Medicare (indeed, is arguably its destruction and replacement).

I will say that there is one clear way that these proposals all qualify as traditionally “conservative” and is that the direct beneficiaries of the changes in question are already established power players, specifically upper level income earners who receive tax breaks and receive a diminished amount of responsibility in paying for benefits received by the vast majority of the population.  This may sound like an ideological statement, but I find it to be an inescapably empirical one.  The issue of whether any of the above is good or ill in a normative sense I will leave to the reader.*

There are two examples, beyond the Ryan Plan, that fit this general discussion, especially as it apply to the swiftness of the proposed changes (a rather un-conservative move, at least on paper) as well as a blatant disregard for unintended consequences.

Example one is via Politico:  Tim Pawlenty: Obama gives ‘false choice’ on debt limit

“President Obama has set up a false choice,” Pawlenty said at an evening meeting of the Nashua Area Republican City Committee. “He has said either raise the debt ceiling or the United States of America will default on its bills to outside creditors, which could set off a series of negative events.”

Pawlenty, the former Minnesota governor and presidential hopeful, was forceful in opposing any increase in the country’s debt limit. He instead suggested that Congress pass legislation to prevent the government from defaulting by sequencing the payment of bills to prioritize debt obligations first — an approach that would presumably require major spending cuts to pay those bills.

I suppose that technically Pawlenty is right, there are other options.  However, the choice he is suggesting is no choice at all, as it has no chance of passage (another option is that the Congress could vote to default and dare the holders of our debt to make us pay them—so Pawlenty’s right, there is more than one choice).**  Further, he isn’t just suggesting a solution to short term issues of debt and borrowing.  Rather, he is suggesting a radical, and near-immediate, restructuring of the federal government.  This is hardly a measured approach to the problem.

Of course, as proposals go, it is problematic as it assume the ability to get massive cuts to all programs of the federal government, including entitlements and defense, pretty much on the fly.   Given the difficulties in reaching the recent budget deal for the remainder of FY2011, this seems rather unlikely and therefore an imprudent, if not impudent, proposal.  Further, it strikes me as disregarding unintended consequences.

It is worth noting, at least in passing, that Obama is hardly the only person stating that the debt limit must be raised.  For example:  George Will and Hank Paulson come to mind.

The second examples is via McClatchy:

Sen. DeMint demands Constitution be changed to ban federal debt

DeMint, a South Carolina Republican, is vowing to block any vote on raising the U.S. debt ceiling unless Congress moves to amend the Constitution by banning future federal deficits.

“I will oppose any attempt to vote to raise the limit on our $14 trillion debt until Congress passes the balanced-budget amendment,” DeMint told McClatchy Newspapers.

First, the headline is a off, as it confuses yearly borrowing and long-term debt (although, technically, if the US government never, ever ran a deficit, then theoretically there would eventually be no new additional debt).

The notion of a balance budget amendment is appealing in an abstract sense, but in reality it is a foolish idea.  Central governments need to have the flexibility to borrow funds to pay for ongoing policy as well as to engage in emergency spending.  Yes, I concur that we borrow too much and need to get deficits (and the debt itself under control), but forcing balanced budgets by fiat is too constraining.  For example, an ability to borrow (i.e., to run a deficit) is necessary for any number of things, such as having funds to respond to national emergencies (e.g., earthquakes, hurricanes, floods, etc.) not to mention national security issues that may arise. Averting the collapse of the financial sector and the economy have to be on the list as well.

It is worth noting that the US government has, for almost all of its existence, run a deficit. Indeed, the Sainted Founding Fathers wracked up a rather onerous debt to finance the war for independence. And those entities of political purity (the states) likewise had accumulated tremendous levels of debt to the point that one of the first major political actions of the Washington administration was for the federal government to assume said debt from said states.

And while I am not a big fan of analogizing government budgeting and family budgets, I will say this:  the typical American’s experience with debt underscores that debt, per se, is not evil.  Most of us would never be able to own a home, a car, or a college diploma without the ability to use debt as a means of financing.  Further, the ability to plunk down the Visa card when one has a flat tire or for one of a plethora of surprises that life tosses our way is quite useful.  If I had to carry enough cash on me to deal with those types of issues it would be problematic.  So again:  debt and deficits are not inherently evil (although I do agree that they are tools they need to be properly utilized).

I could see, by the way, part of the negotiation on the debt ceiling limit including a promise for a debate and vote on the balanced budget amendment, but the notion that the debt ceiling can only be raised once such an amendment is passed is a pretty darn hefty demand.  Indeed, consider:  it is basically stating that what is ultimately a housekeeping/accounting vote will not be allowed unless the Constitution itself (and the very nature of US fiscal policy) is altered.

Like Pawlenty’s suggestion, DeMint’s is pretty radical—it would require a massive and rapid shift in the way the federal government does business.  While I understand that there are many who want such an outcome, it strikes me as reasonable to request a more reasoned approach to the situation.  Again, while all the consequences of actions cannot be taken into account, what with our limited ability to predict the future and all, it is rather remarkable to see “conservatives” seeking such quick and dramatic action.  Of course, this ultimately begs the question of whether “conservative” is, in fact, the appropriate label.***

At a minimum, there is less interest in the actual consequences of the suggestion than their is a dedicated ideological position.
——

*Further, there is the issue of why the current distributions of wealth exists.  One could take the Burkean position that the basic distribution of wealth and power is the result of tried and true societal evolution, or the Randian position (as some readers have of late) that there are producers and their are “leeches” in society, or the position that the current power positions are the result of inequities that get reinforced by policies such as tax cuts (among others).

**And while I think declaring by fiat that we will not pay our debts and setting the National Debt at zero via legislation is a real option (i.e., it could be done), I would consider it to be a rather foolish option.

***Of course, it may well be that we in America have little idea what these labels mean.

FILED UNDER: *FEATURED, Congress, Deficit and Debt, US Politics
Steven L. Taylor
About Steven L. Taylor
Steven L. Taylor is a Professor of Political Science and a College of Arts and Sciences Dean. His main areas of expertise include parties, elections, and the institutional design of democracies. His most recent book is the co-authored A Different Democracy: American Government in a 31-Country Perspective. He earned his Ph.D. from the University of Texas and his BA from the University of California, Irvine. He has been blogging since 2003 (originally at the now defunct Poliblog). Follow Steven on Twitter

Comments

  1. john personna says:

    A very interesting piece. Is it that Conservatism, about the time of Friedman, came to be a free market fundamentalism?

    Is Reagan the most recent Republican President who meets the modern Conservative definition?

    Certainly not Nixon or Ford, with all their market interventions

  2. @JP: Thanks.

    In truth, part of the problem is that in the political vernacular of the US, both “liberal” and “conservative” are fairly ill-defined.

    Still, if one looks at the basic meaning of the words in terms of orientation to change, you come to at least some of the conclusions noted in my post.

  3. john personna says:

    BTW, there are huge industries telling us that car loans are rational. I’m not so sure. I started with cheap cars, and saved money for the next. That saved me interest payments of course, but also ingrained good habits.

    (for the kids in the audience, lol)

  4. tom p says:

    I was going to post something here, but SLT already said it.

  5. ponce says:

    Part of the definition problem for conservatives is most “conservative” voters don’t really want their representatives to cut government programs like social security and medicare.

  6. King of Fools says:

    I guess I see it a bit differently. I much prefer incremental change – however, the time to start the incremental change was decades ago. We are more than broke, we are deep deep in the hole and it feels like no one wants to upset the status quo.

    When 38 billion in cuts is called Draconian, then I guess I am way more radical than I once thought.

    We’ve talked about Social Security and Medicare issues since I was in High School in the 80s. Not one step has been taken to deal with the issues.

    Bottom line: the end result will be radical. Either radical changes to try to straighten this fiscal mess, or radical changes when our currency fails. I prefer the first one even though it hurts me. Politicians much prefer the second since it will (hopefully) happen after they are gone.

  7. While I am loathe to agree with some more “liberal” commentators I do believe the policies of the mainstream Republican Party has shifted (or rather been pulled) right. And I do not mean right from Nixon but right from Regan. This is not to say that there have not always been “Randian” type idealists, but that the outrage over certain things seems to be making the GOP more radical or more willing to make vast, quick changes. I would say that part of this stems from the lack of a Republican in the WH. While “conservatives” say they were as outraged by President Bush’s prescription drug benefit or reckless spending I think most honest observers would say that they are much more outraged by the not-so-different polices of Barack Obama. I don’t believe this is necessarily intentional (although some of it surely stems from partisanship), but that when a President that you support offers something the machinery that foments outrage about such things is less wonton to promote said outrage. As evidence of the shift rightward, and maybe its just revisionist history, even the likes of President Regan and President Bush Sr. understood that taxes are inherently part of our government and can’t “always” be bad or President Regan’s immigration reform. I think there can be an argument made that there needs to be “radical” change, but one should at least be honest about what that change means and who it would affect. Personally, I don’t see or hear that honesty in the conversation right now.

  8. Derrick says:

    As evidence of the shift rightward, and maybe its just revisionist history, even the likes of President Regan and President Bush Sr. understood that taxes are inherently part of our government and can’t “always” be bad or President Regan’s immigration reform. I think there can be an argument made that there needs to be “radical” change, but one should at least be honest about what that change means and who it would affect. Personally, I don’t see or hear that honesty in the conversation right now.

    Andrew Sullivan, David Frum and a few conservatives had this argument last year about the Epistemic Closure of the conservative movement where ideological intolerance and misinformation become the majority thought process of their movement. I know that some will just scream “RINO”, but as you’ve said, conservatives in the past were just not as rigid about policies.

    Healthcare is something many liberals like myself see as a “quasi-right” and I think that if you polled a majority of liberals think that some form of single payer system like Canada would be preferable to what we have now. But while we weren’t extremely happy about Obama’s eventual legislation, most of us were both reasonable enough to know that a single payer is probably not feasible and flexible enough to accept something that at least attempts to reach some of our goals. You don’t see any of that flexibility or reasonableness in movement that can’t see that taxes being raised a couple of percentage points isn’t going to turn the US into a socialist state.

  9. Paul says:

    Wake up America. It’s time…

    “THE REVOLUTION HAS STARTED”
    Read “Common Sense 3.1” at ( http://www.revolu­tion2.osix­s.org )

    FIGHT THE CAUSE – NOT THE SYMPTOM
    “Spread the News”

  10. It does seem that there’s been an intellectual break on the right with the Burkean tradition that was exemplified more recently by Russell Kirk and William F. Buckley, Jr.

  11. James Young says:

    It seems to me unreasonable to declare those who would reinstitute constitutional limitations on government as “radical” in any sense of the term save that they are going back to the roots of our constitutional republic. There’s nothing “conservative” about seeking to preserve unconstitutional Ponzi schemes.

  12. An Interested Party says:

    We’ve talked about Social Security and Medicare issues since I was in High School in the 80s. Not one step has been taken to deal with the issues.

    Really? The 1983 Social Security deal between Reagan and Tip O’Neill counts as “not one step”?

    There’s nothing “conservative” about seeking to preserve unconstitutional Ponzi schemes.

    I guess many who are opposed to Social Security don’t realize that they have lost that fight and will never be able to convince a majority or even a sizeable portion of Americans to subscribe to their position…

  13. Wiley Stoner says:

    We can follow what the donks are doing and fall off the financial cliff. We have a debt of 14.3 Trillion dollars. We have a President who wants to spend 3.6 trillion this year, 1.6 of that we have to borrow. Only an idiot would call puting a halt to that spending radical. You want radical? Look who occupies the White House. That is radical. Read his book, he sought out radical. He is a student of Saul Alinsky. He is a radical. I am tired to death of this BS. You do not have a right to what I earn. I will pay my fair share but I do not want to be forced to pay someone elses way. In a free country, you are free to suceed and free to fail. Those choices are up to you.

  14. MarkedMan says:

    As someone who works in the Medical industry, I can absolutely assure you that hospital CEO’s and CFO’s believe that PPACA and the HITECH Act (Obama-care to some) will dramatically affect Medicare reimbursements, and definitely affect the trend of rising health care costs. I’ve heard this from a number of sources but recently I was in a presentation by someone who makes his living interviewing these self-same C-level types and analyzing the results so as to sell his expertise to companies like mine. He said he had been in a few bizarre meetings recently where the CEO was upbeat about the ability to make fundamental changes to the system, leading to consolidation by those best prepared to drive efficiencies and quality care, while the CFO was contemplating jumping out the window because he felt he was looking at endless red ink as the reforms reached full steam by 2017.

    I know that all the “experts” (bloggers, reporters and politicians) “know” that Obama’s health reform did nothing to tackle the rising health care costs. But you might want to consider those of us who actually have to plan a business around it and have invested the time in studying it and analyzing how the final rules are evolving. I know conservatives especially resent people who claim to know more than they do about an issue, but I would be willing to bet a dollar to a nickel I know this issue better than any other commentator on this blog so I’ll just have to live with their resentment. (If I’m wrong, and there is someone that knows this issue better than me: Interested in doing some consulting?)

  15. sam says:

    @James Young

    It seems to me unreasonable to declare those who would reinstitute constitutional limitations on government as “radical” in any sense of the term save that they are going back to the roots of our constitutional republic. There’s nothing “conservative” about seeking to preserve unconstitutional Ponzi schemes.

    Perhaps. But the House GOP had the chance to really do in the “Ponzi schemes” (courtsey of the Dems) and as a result had the crap scared out of it: Pandemonium! Dems Jam Republicans With Even More Conservative Budget. (Check out the YouTube of the mass pants-wetting,)

    Heh.

  16. Herb says:

    Wiley, you say “You do not have a right to what I earn. I will pay my fair share but I do not want to be forced to pay someone elses way.”

    Fair enough, but when it comes to taxes, yes, the government has a right to take a piece of what you earn. It’s in the Constitution.

    Also, you seem to be under the impression the Republicans are against taking what you earn and paying someone else’s way. They’re not. They’re the party of for-profit government privatization. Yes, they bristle at the “safety net,” but don’t think twice about directing your tax dollars into the “executive compensation” fund of your favorite no-bid contractor.

    Hell, it wasn’t that long ago that the Republican party rallied around giving tax-payer money to churches.

    Remember when we were spending all those billions rebuilding infrastructure in Iraq? Your tax dollars at work.

    To continue to believe Republican blather about the proper use of tax dollars is to expose yourself as a dupe. They have no better idea on how to spend my money than anyone else, and often times their ideas are worse.

  17. john personna says:

    It seems to me unreasonable to declare those who would reinstitute constitutional limitations on government as “radical” in any sense of the term save that they are going back to the roots of our constitutional republic. There’s nothing “conservative” about seeking to preserve unconstitutional Ponzi schemes.

    No, the Republicans aren’t trying to turn the clock back to anything real. They are trying to “turn back” to a fantasy past.

    They are “shocked” about policies which have been in place 100+ years. That is not conservatism. That is ignorance.

  18. Rock says:

    Remember when we were spending all those billions rebuilding infrastructure in Iraq? Your tax dollars at work.

    Remember when the Dems stimulus money was ballyhooed for all those shovel ready jobs sure to cure unemployment? What happened? Millions of Americans are still out of work, standing around with rusty shovels and dull pitchforks. The stimulus money was enough to pay for Iraq and Afghanistan with enough left over to do Libya and serve up arugula for breakfast to the unemployed. Where did the money go and what is the return on our investment?

  19. george says:

    Edmond Burke has as much to do with modern conservatives as John Stuart Mills has to do with modern liberals – the terms now refer to very different ideologies than they did even a century ago.

    You do not have a right to what I earn..

    Which implies that the military also lacks the right to what you earn – ie the 2nd biggest drain on our tax dollars. I think you’ll find that both the Democrats and the Republicans feel that the gov’t has a right to what you earn, the only disagreement is on what it should be spent.

  20. john personna says:

    Remember when the Dems stimulus money was ballyhooed for all those shovel ready jobs sure to cure unemployment? What happened?

    What happened? People worked, for a time. It slowed the decline, and possibly prevented a deflationary cycle. It did not bounce the economy back to full growth, but nothing was going to do that. You don’t have a plan that will do that.

  21. john personna says:

    (I think that some of our local “stimulus” packages were stupid, but I sure saw people doing them, getting paid.)

  22. thc says:

    I never took very much poitical science in college–I preferred to study things that would help me earn a good living. But, in the poli sci courses I did take, never did I hear that modern conservatism had anything to do with “incremental change” or “skepticism about the ability of reason to fix a specific problem due to the complex nature of human interactions”. Really? I thought Its basic tenets had to do with the size and scope of government and its intrusion in our lives.

    Also, isn’t extreme conservatism reactionary and extreme liberalism called radicalism?

    What kink of stuff are you teaching down there at Troy?

  23. jwest says:

    Conservative ideas only seem radical and counterintuitive to those who hold a comic-book notion of what and who conservatives are.

    When someone starts with the premise that the right wing is composed of bible-thumpers who believe Jesus rode dinosaurs and who want the total elimination of government, everything conservatives do confuses them. They can’t comprehend why people who are not already wealthy would “vote against their own interests” and they certainly can’t grasp the basics of economics.

    Naturally, when conservative proposals are made (either incremental or wide ranging) the hopelessly clueless refer to them as “radical” when they are merely logical extensions of the principles conservatives live by every day. Until people who hold these ridiculous views of the right leave their echo chambers and gain some actual knowledge, we can expect more shallow analysis of the “radical” conservatives.

  24. Stan says:

    jwest, based on your conservative principles, could you explain how Representative Ryan’s proposed restructuring of Medicare will lower the national medical bill?

  25. anjin-san says:

    Remember when the Dems stimulus money was ballyhooed for all those shovel ready jobs sure to cure unemployment?

    When I drive around the bay area, I see infrastructure projects all over the place that are being funded by stimulus money, including several that are critical and long-delayed. Considering that the GOP led us to the brink on an actual depression, it is worth remembering that unemployment could be much, much worse.

  26. jwest says:

    Stan,

    Overall, Ryan’s plan will couple seniors to the fiscal reality of healthcare costs, increasing options but ultimately reducing the amount of procedures available, especially to the poor.

    This may sound cruel, but that’s the way things are heading, regardless of whether we adopt the Ryan plan or continue Medicare just as it is now. We could even go with a Canadian or British system, but that simply hides the restrictions on procedures through wait-times instead of honestly dealing with who will receive treatment for what ailment.

    In the end, the only way to solve all the problems with healthcare is to establish reasonable cutoff points that prevent the expenditure of the bulk of the health spending on prolonging the last few weeks or months of life.

  27. Hey Norm says:

    I do not think it is a radicalization as much as a dumbing down.
    When a major political party embraces as a guiding principal a “philosophy” that the rest of us discounted in our teens or early twenties I think it is indicative of a problem. More so when you consider that Rand is in direct opposition to othe stated Republican values.
    The leadership of the party also supports my thesis. Gingrich is your big thinker? George W. Bush? Burke, Buckley, et al must be so disappointed.
    Think also about what these folks, statistically believe: 100% of peer-reviewed climate science is faked, evolution is a hoax, humans and dinosaurs roamed the planet together, tax cuts pay for themselves, and the President was born in Kenya. This list is not exaggerated, and it is all demonstrably untrue.
    Reagan employed the southern strategy to get elected and in the process empowered the ignorant. Rove lied to the naive to get Bush elected and in the process empowered idiots. Those useful idiots have now moved up in the party. As a result the collective IQ of the Republicans has dropped 20 points.
    But as long as they keep the government out of my Social Security it’s all good.

  28. Hey Norm says:

    Jwest,
    That was part of the ACA, but you remember death panels right?

  29. jwest says:

    I think Norm pretty much proves my point.

  30. Rock says:

    Considering that the GOP led us to the brink on an actual depression, it is worth remembering that unemployment could be much, much worse.

    Yeah, Right! With 44,187,831 people on food stamps at the beginning of February 2011 and 23 million people unemployed, how much worse should it be?

    http://www.usdebtclock.org/

  31. jwest says:

    Norm,

    I am the biggest supporter of Death Panels in the country.

    What is so ridiculous is that liberals refuse to acknowledge their existence or realize that the decision made regarding what will be paid for and what won’t is the singular question in this whole debate.

  32. anjin-san says:

    You do not have a right to what I earn. I will pay my fair share but I do not want to be forced to pay someone elses way.

    I am willing to bet that I am paying part of your way. The difference between me and you is that I will not waste time whining about it…

  33. anjin-san says:

    Where did the money go and what is the return on our investment?

    One of the projects referred to in my above post is the Caldecott Tunnel fourth bore near San Francisco. The current three bores are badly inadequate, causing long delays for the 160,000 drivers who use the tunnel daily.

    Let’s use a conservative estimate and say that 160,000 cars are delayed 10-15 minutes each time they use the tunnel. If the stimulus funded fourth bore eliminates that backup, how many man-hours that are currently being wasted are given back to commuters? Do the math, it’s a large number. Then think about air pollution that is not being created by tens of thousands of idled cars every day. And gas that is not being wasted as people are stuck in traffic. And wear and tear that is saved on all those cars.

    And we have not even gotten to the hundreds of millions of dollars that the project is pumping into the local economy.

    Really, the only way to not see the ROI is willful ignorance or blatant stupidity.

  34. john personna says:

    “You do not have a right to what I earn.”

    Let me see … western civilization has been taxing for at least a couple thousand years, but newborn “conservatives” not only reject it, they have no recollection of it.

    I’m sorry, but your market fundamentalism is not in any way conservative. You’ve just used conservatism as a place-holder for a relatively new kind of utopianism.

  35. michael reynolds says:

    Hey Norm:

    That’s as good a summary as I’ve read anywhere.

  36. Thc:

    I never took very much poitical science in college–I preferred to study things that would help me earn a good living. But, in the poli sci courses I did take, never did I hear that modern conservatism had anything to do with “incremental change” or “skepticism about the ability of reason to fix a specific problem due to the complex nature of human interactions”. Really? I thought Its basic tenets had to do with the size and scope of government and its intrusion in our lives.

    Also, isn’t extreme conservatism reactionary and extreme liberalism called radicalism?

    What kink of stuff are you teaching down there at Troy?

    I know I should probably just ignore this, but what the heck.

    I am having a hard time following your logic:

    1) You didn’t take much political science.

    2) I have both taken a lot of political science, and have taught it for a decade and a half.

    yet,

    3) You are the expert?

    It is a rather curious formulation, yes?

    BTW, in terms of modern conservatism and concern over the limitations of human reason and scope of change, read some George Will.

    To go backwards is, in fact, reactionary. However, Ryan’s plan, for example, isn’t backward looking and I would therefore not call it reactionary.

  37. Scott says:

    @jwest, “I am the biggest supporter of Death Panels in the country.”

    That’s going to be a tough sell.The Republicans have been warning the gullible about the horrors of imaginary death panels so I can’t see how they’ll convince them that real death panels would be a good thing. I would suggest that you rename them Divine Intervention Panels.

  38. Stan says:

    jwest, I think you’re underestimating the possibility of improving the efficiency of our medical care. I know you dislike social welfare measures, but I can’t help but notice that per capita medical costs in the US are incredibly high considering that our health care statistics aren’t outstanding and that other countries in the table I’m about to show consume more medical care than we do in terms of physician care and hospital usage. Using Wikipedia, I’ve worked out the following: if per capita medical costs in the US are normalized to 1, the corresponding costs in selected industrial countries are

    USA 1.00
    Canada 0.53
    France 0.49
    German 0.49
    UK 0.41

    It seems to me that before we go over to the approach you favor, with de facto death panels, we should make every effort to improve the efficiency of our health care system. Whatever the virtues of Ryan’s plan in terms of its effect on the federal deficit, I simply can’t see how it brings down our total medical expenditure. You apparently think it will. Can you cite any empirical evidence for this?

  39. thc says:

    Steven Taylor: I think you’re a little overly sensitive. I never made any claim to be an expert in political science, In fact, I admitted that I didn’t have much formal education in it. I merely asked questions about the basis for your piece. Thank you for your “expert” response, but I pitty the poor kids in your classes if that’s how you respond to questions.

  40. @THC:

    I am more than happy to answer questions, engage in a discussion or whatever you like.

    However, if you are concerned about tone, I would suggest you rereD the comment I was responding to.

    Cheers.

  41. @THC:

    I am more than happy to answer questions, engage in a discussion or whatever you like.

    However, if you are concerned about tone, I would suggest you reread the comment I was responding to.

    Cheers.

  42. Herb says:

    “Remember when the Dems stimulus money was ballyhooed for all those shovel ready jobs sure to cure unemployment? ”

    Let’s review: Dems favor spending billions to cure domestic unemployment. Republicans favor spending billions in nation-building efforts in foreign lands.

    The results are disappointing in both cases, but one strikes me as a more worthy endeavor than the other, not only from a “spend my tax money wisely” perspective but also from a “proper role of our government” perspective.

    And despite the mythology, the Republicans don’t come out ahead on either count….

  43. anjin-san says:

    Let’s review: Dems favor spending billions to cure domestic unemployment. Republicans favor spending billions in nation-building efforts in foreign lands.

    You know, the naked fury of “patriotic conservatives” when face by spending on our own people and our own country just amazes me. And I don’t recall these guys making a peep about the billions we poured into infrastructure in Iraq.

  44. jwest says:

    Stan,

    You are correct that there are inefficiencies that could reduce the total spent on healthcare. Switching to all electronic record keeping and centralized data storage would provide a substantial savings in time, effort and reduction of mistakes, plus it would open an avenue for competition in medical treatment. This is backed by both parties and should have been put in place by now. There are many other incremental improvements that could easily be instituted given the political will, which would not only save money but improve care.

    However, the singular issue that consumes the bulk of healthcare spending is how long each life is prolonged by the use of heroic efforts. Through Medicare as it stands now, families and medical providers (the actual providers, not insurance companies or the government) have no incentive to allow natural death when the means exist to extend the life for a few more weeks or months. The efforts actually work in inverse proportion to wealth, where poorer patients receive a greater amount of end-of-life services due to demands from relatives (it’s free) and the reduced risk of liability to the provider. From a doctor and hospital point of view, why not institute hundreds of thousands in procedures and intensive care when death can be blamed on any number of maladies that the patient exhibits?

    This spending consumes over half the total healthcare spending in the country. Only by establishing open, reasonable guidelines can this be brought under control.

  45. Dave Schuler says:

    Pat Lang, a classic paleocon, refers to what passes for conservatives today as “Jacobins”, a pretty fair assessment. Another chacacterization that I think is pretty close is “right Bolsheviks”.

  46. thc says:

    @jwest:

    However, the singular issue that consumes the bulk of healthcare spending is how long each life is prolonged by the use of heroic efforts.

    Now there’s a pretty bold statement. I’d love to see your sources for that.

  47. Stan says:

    jwest, I feel as if I’m doing something wrong by engaging in a civil internet discussion about social policy. You feel that traditional Medicare with its open ended spending has to end sooner or later, and you prefer sooner, and I feel your solution is like committing suicide because you’re afraid to die. I don’t think we’re going to convince each other to give up our positions, so I’m going to retire from the field.

  48. john personna says:

    man, @thc, that c is very e-like.

    If you are dying in Miami, the last six months of your life might well look like this: You’ll see doctors, mostly specialists, 46 times; spend more than six days in an intensive care unit and stand a 27% chance of dying in a hospital ICU. The tab for your doctor and hospital care will run just over $23,000.

    But spend those last six months in Portland, Ore., and you’ll go to the doctor 18 times, half of those visits with your primary care doctor, spend one day in intensive care and stand a 13% chance of dying in an ICU. You’ll likely die at home, with the support of a hospice program. Total tab: slightly more than $14,000.

    Debate surrounds end-of-life health care costs

    It’s a big issue. There are many similar stories.

  49. john personna says:

    On the other hand, this claim seems loaded with possible bias:

    The efforts actually work in inverse proportion to wealth, where poorer patients receive a greater amount of end-of-life services due to demands from relatives (it’s free) and the reduced risk of liability to the provider.

    We also know that the poor and under insured over-use emergency rooms, and so giving them less (it’s not free) costs us more.

  50. thc says:

    Maybe I should just change my name to something like “Evans” or “Edwards”?

    Now I understand the point jwest was making but his use of the term “heroic efforts” threw me. In medicine, “heroic measures” generally refers to measures of last resort like cardiac and respiratory resusitation, not procedures and hospitalizations that many Americans use to excess in their final months of life.

  51. anjin-san says:

    Advance end-of-life planning is a simple, effective way to combat out of control EOL costs. Yet the right seems to regard it as something sinister, and has used misinformation very effectively to fight this simple aspect of health care reform.

    Which leads me to suspect that they are not interested in reigning in medical costs…

  52. Axel Edgren says:

    I keep on telling you guys – if you don’t start crushing the “Taxation is theft” people with the same vigor you opposed the “Property is theft” crowd after WWII you will go down.

  53. mannning says:

    The tactic of saddling a political party or an individual with historical misadventures is a well-developed art.. It presumes that the misadventure of years ago in different circumstances and for rather uniquely different reasons is cause to believe that the same or very similar decision or policy would be promoted the next time the party or the individual is in a power position. So beat them over the head with it till they bleed!

    Such a tactic wilfully ignores several points: 1) Parties and people do learn from their mistakes and will most likely take a far better position the next time out; 2) The accusers most often do not have all of the facts, and wilfully ignore what actually was the case for political reasons. Then too, hindsight is so much more accurate than foresight! The real factual basis quite often turns a trumped up losing proposition into a winner if you maintain your objectivity; 3) Quite a few of the accusers are simply twisting the facts around to create a (false) club with which to clobber the opposition and influence the average voter; 4) The emphasis should be on the NOW and not the past; and, just to be a tad facetuous, 5) Political promises are not worth very much in the scheme of things to begin with. We have ample proof of that in the last two years from Obama, and from other Presidents as well, as we all know! Circumstances alter cases, as the saying goes, just to make things more difficult for you and me.

    You know who your are and which tactics you use–honest or dishonest!

    /rant

  54. mannning says:

    @angin san

    In all of the hospitals I have been in, either for myself, or my wife and relatives, there has always been an upfront discussion of the personal Advanced Medical Directive, with a model directive for the patient and family to use or modify s they see fit, and it is included in the standard data package for each patient. The hospitals insist on it, and they seem to get compliance from the families with the idea. Admittedly, the number of hospitals I have been in is limited–only 6–but it is indicative of the emphasis on private AMD’s today.

  55. mannning says:

    I will try for an analogy here to paint many Republican views on change as quite necessary today. If you find yourself driving an auto down the road and suddenly realize that you have drifted dangerously into the left lane and are courting an imminent headon collision with an 18 wheel semi at a combined closing speed of 100 mph, you do not have much choice but to attempt to wrench the car hard right back into your proper lane. In other words, you must perform a radical change in direction to avoid hurtling into death and distruction. That is the situation now in the nation with an 18 wheel semi of a national debt broaching the yearly GDP and the powers that be are continually jerking the spending wheel further hard Left. Time has run out for simple and ideologically biased and symbolic correctives such as taxing the rich more, which by itself cannot succeed in turning the wheel sufficiently to avoid catastrophe. (of course, the rich are quite free to offer up some of their vast wealth to the governmental sinkhole without any rule changes at all if they feel like it!)

    It does not matter now just how the auto drifted left, or that it was perhaps even diabolically planned to go in that direction, the only thing that does matter is to get your auto back in its lane very fast using a radically hard right maneuver. Which is quite sensible under the circumstances.

  56. @Manning:

    One major problem with your analogy is that you are not using the word “radically” in the same way it is being used in the post.

    Another problem is that while there is a need for reform, we are nowhere near the 18-wheeler head-on collision mark. That analogy does not hold.

  57. mannning says:

    “By “radical” I mean that they encompass rapid change to the status quo. And, further, the assumption that such rapid change can revolutionize a given situation without too much regard for unintended consequences” This is your definition, and it fits:.

    What, pray tell, is more rapid that an emergency right turn to avoid a headon collision, instead of allowing that drift to the right–the status quo– to continue?

    We can argue about what “nowhere near” means relative to a headon collision, but I submit to you that, in mortgage terms, we are virtually underwater now, have our national credit under question, and we are mortgaging our children’s futures for some sort of instant gratification program. If these don’t rate as a headon financial collision needing rapid change, what does?

    The analogy holds in spades.

  58. mannning says:

    Oops— Drift to the left!

    The sooner we make the right turn, the less the danger.

  59. Well, actually you are talking about, in your metaphor, a rapid change to the status quo ante, which strikes me as more a reactionary than radical move.

  60. And in regards to “nowhere near” my point would be that in your story, death is bearing down on the driver in near immediate fashion requiring a reckless and equally immediate reaction.

    That does not describe the current situation.

  61. mannning says:

    There is the question of both scale and time involved when transitioning from metaphor to reality. Obviously, my metaphor compresses both into a far more immediate crisis situation, and deliberately so! It was done for emphasis, of course, recognizing that the readers could easily perform the mental exercise of rescaling and retiming. It is thus a metaphor of our situation “in a nutshell.” It is time, even past time, for action on the scale of reality.

    We do need that hard right turn rather badly!

  62. So, really, it is a metaphor that expresses an opinion (fair enough) but it really isn’t a metaphor that actually helps describe the situation for the purpose of actually enhancing understanding.

    This may sound harsh, but I think it is fair because if we are going to actually to solve the real problems that confront us we need a realistic assessment of the problem.

  63. mannning says:

    I beg to differ. The need is for action right now to get our fiscal house in order, as it has reached a crisis state. My metaphor underlines the urgency quite well. The Standard and Poor’s downgrading of the nation’s credit worthiness is a major sign of the crisis, as is the meeting of nations excluding the US, for the purpose of finding an alternative to the dollar as the International currency of record for transactions.

    I am rather surprised, even shocked, that you do not fully understand the depth of our fiscal problems, and that you seemingly believe that we have room to go before we need to act. An official change in the status of the dollar on the part of key nations will trigger a major depression in the US, and grave difficulties in obtaining loans from other nations. The 18-wheeler is bearing down on us as we debate the issue, and so many, such as yourself, seem wilfully unconcerned about it that it scares me to death!

    My metaphor stands.

  64. If you were metaphor was accurate, then we would have to act now, in the current fiscal year, to avert a clear and devastating crisis in the coming year. Regardless of whatever may be the case with our finances, that is not an accurate assessment.

    Your illustration underscores what you see to be the dramatic difficulties we face, which is far enough. It is an attempt to drive home (no pun intended) what you see to be the consequences of our current path. All well and good, but it is not an accurate picture of the current circumstances–it is a prediction.

    Yes, we need policy change, but a rapid jerk of the wheel in a willy-nilly move to save ourselves from the truck that is still in the next county could quite easily land us in the ditch, rather than on the right path.

    Yes, if we stay in the current lane, there will be a collision. But that doesn’t mean we can’t more calmly change lanes.

  65. In other words: if you want to state that your metaphor described your preferred course of action, fine. But as an accurate description of reality, it is off base.

  66. mannning says:

    Last word game, huh? ok. I’ll play!

    My metaphor is a scaled down version of the reality we are facing today, and it shows the imminent danger the nation is in by comparing the serious financial woes we have with an 18 wheeler coming at us full tilt while we have drifted into the left lane. If we do not take action, we will be crushed, and the recommended action is a hard right turn back onto the right side of the road before it is too late. As everyone knows, the sooner we take proper action, the better.

    The metaphor is quite satisfactory to me. I really do wonder why Stephen has fought me so tenaciously about it? Mystery time!

  67. mannning says:

    Sorry, Steven, for the mistake,

  68. I am not sure I would call it “tenaciously” (or, for that matter, a fight).

    No mystery: I am a professor and my inclination is to correct error. I find your metaphor problematic for the reasons expressed. I have no problem with it being an expression of your preferences, but it is a poor explanation for current circumstances. One of the things that I really would like to see in the discourse is realistic discussions of political problems. I think that an overly dramatic approach will lead, like the motorist in your tale, to an unnecessarily dangerous over-correction. It matter greatly whether the truck is right in front of us or in the next county. I don’t deny the truck, but I differ with you over how dramatically we need to correct the course to avoid hitting it. No doubt I will post more on this in the future.

    I will leave it at that–no last word games. You are free to leave one more post and I promise not to answer, if you like, so that you can have the last word.

    Cheers.

  69. mannning says:

    As usual, it is really a matter of opinion. I see the need for urgent and immediate corrections to avoid the many, many troubles we might get into if we default, or debase the dollar one step too far, or legislate even more spending to burden our children with later on. The corrections can be milder for the individual if done early enough, but any delay will make the problem almost daily far, far worse. Then too, I believe that the needed corrections can be carried out with careful reason, great compassion, and solid street smarts if there is bipartisan will to succeed in lowering our debt threat gracefully, and without imposing socialistic solutions.

    This is not the time for business as usual, or for massive new spending legislation. We will face the hyperinflation 18-wheeler rather soon as things are going, and that will utterly and completely ruin my retirement. So this is a very personal battle to me, in an attempt to shut down the big spenders and support the rational cutters before it is too late. Frustratingly, it seems to be of little use to talk to Democrats about this in a calm and rational manner. They, some of them, have the bit in their teeth to legislate Obama’s and their dreams, and to hell with most of the middle class and the commercial sector, or so it appears to me.

    Thank you for your comments. There is no need to consider the last word game.