The Stupidity of Government Non-Shutdown Shutdowns

It remains to be seen whether Congressional Republicans will force a government shutdown. What's already clear is how counterproductive it would be.

government-shutdown-lincoln-memorial

It remains to be seen whether Congressional Republicans will force a government shutdown in a quixotic quest to defund ObamaCare. What’s already clear is how stupid it would be to do so.

Two bits of housekeeping:

First, while I am once again a government employee, I would almost certainly not be impacted by a shutdown. Military schools have always been considered an essential service in the past and will surely be considered that again. It would be beyond idiotic to have hundreds of field grade officers sitting around Quantico getting paid for going to school while furloughing their civilian professors. (For that matter, the DoD schools for their children will be funded, too, although summer school would not if the shutdown somehow extended that long.) At worst, there would be some delay in my actually getting paid, a contingency for which I am well prepared.

Second, I agree with neither the president nor Congressional Republicans on ObamaCare. That is, I think the program is mostly a step in the wrong direction but think the right direction is a baseline single payer system augmented with Cadillac private options. That’s a position to the left of the public position of most Congressional Democrats, although I suspect pretty close to Obama’s private view.

That out of the way, while I at least understand why Republicans are fighting so hard on this issue—if they give up, they’ll legitimate the program and never be able to achieve rollback—this tiresome game of chicken in which they trigger a crisis at every opportunity is no way to achieve their goal. Aside from the fact that the president, as chief of the Executive branch of government, has the tools at his disposal to maximize the pain caused by the shutdown and that the public will likely blame the Republican for said pain, it’s just a counterproductive ploy.

First, like myself, most federal workers are considered “essential” and therefore required to report for duty regardless of whether Congress has funded their paychecks—and guaranteed by law of being paid eventually for said work. USA Today:

An estimated 59% of non-defense federal employees would be exempt from the shutdown and would go to work as usual, according to a USA TODAY analysis of 119 shutdown contingency plans filed with the Office of Management and Budget.

Among them: political appointees, law enforcement, most overseas foreign service officers and anyone else deemed necessary for health or safety of people or property.

That last category can account for a broad cross-section of federal employees, because positions that support a key function — such as information technology, security or even legal help — are also protected. Even a receptionist responsible for picking up sensitive mail deliveries could be considered essential and exempted from furlough.

Agencies that don’t operate on an annual appropriation from Congress also will continue to operate normally. That would include the Postal Service, the Patent and Trademark Office and the Federal Highway Administration. A Census Bureau statistician working on a project in Bangladesh is paid outside of the annual budget and could continue to work.

Meteorologists at the National Weather Service would continue to issue weather forecasts because they’re necessary for aviation safety. But ocean and atmospheric scientists who don’t produce daily forecasts would also continue to work in order to maintain “crucial long-term historical climate records,” according to the Department of Commerce’s plan.

At the Consumer Product Safety Commission, the commissioners would continue to work because they’re appointed by the president. But the commission’s contingency plan also calls for some of the agency’s lawyers to go to work, so they can provide “timely and accurate legal advice” to the commissioners about what they can and can’t do during a shutdown.

About 65% of Washington-based State Department employees — and 10% of overseas-based employees — would be furloughed. Passport offices would be closed, but any State Department official deemed necessary for the president to carry out his treaty-making responsibilities under the Constitution would come to work. And foreign nationals employed by the State Department may be subject to their country’s labor laws, which may not allow an unpaid furlough.

Conveniently for the president, the least essential employees are often the most visible to the general public.

Need to get away? Well, you can’t. At least not to national parks. Or to national zoos. Or to national museums. They’d all be closed. That’s 368 National Park Service sites closed, millions of visitors turned away.

Were you thinking more along the lines of a trip to France? If you don’t already have a passport, you could bid that adieu. It’s unlikely you’d get your blue book in time. The last time the government threw a hissy fit, 200,000 applications for passports went unprocessed. Tourism and airline revenues reeled.

[…]

A shutdown would affect the Bureau of Alcohol, Tobacco, Firearms and Explosives. Translation: That gun permit you wanted processed wouldn’t happen anytime soon.

[…]

Well, if you own a small business and needed a loan from the government, you’d have to wait. If you were planning to buy a house and needed a federal loan, you’d have to wait. If you’re a veteran, you might have to make a few trips to the mailbox before that check arrived.

If you’re on Social Security, however, don’t worry — probably. Social Security payments were sent during the last shutdown. President Obama’s expected to keep workers on the payroll to process checks. But would there be enough employees to process new benefits for the newly retired?

People will get up in arms quite quickly if they are unable to renew their passports when they have travel plans hinging on them. Or have long-planned vacations to national parks or the nation’s capitol ruined. And we won’t put up for long with our retirees—much less our troops in harm’s way around the globe—not getting paid on time.

Oh, and even if there’s no shutdown, we’re going to waste a lot of money preparing for it:

Federal agencies have to use up time, energy and resources to plan for one. Shutting down and then reopening the government also costs money.

According to the Congressional Research Service, the two previous shutdowns — in late 1995 and early 1996 — cost the country $1.4 billion.

And, traditionally, Congress has wound up paying workers who were forced to stay home. They’ve done it every single time there’s been a shutdown. But maybe not this time.

While there is no law requiring that nonessential employees be compensated if they are ordered off the job, Congress has in the past voted to reimburse their losses once shutdowns ended.

But this go-round could be different. The bitterly divided Congress includes many lawmakers who are unsympathetic to the plight of federal workers and could be loath to help them recoup their money.

“It’s a very different time and a very different Congress,” said Colleen Kelley, president of the National Treasury Employees Union, which represents 150,000 federal workers. “I’m concerned when employees who were here remember that last time employees were paid and think it will happen again, because it’s not a given at all.”

After the past two shutdowns in the 1990s — when federal workers were furloughed for five days in November 1995 and 21 days from December of that year into January — Congress passed a bill awarding them back pay.

Interestingly, it’s illegal for federal employees to conduct any work while they’re furloughed. They can get into serious trouble for so much as responding to work-related emails.

FILED UNDER: *FEATURED, US Politics
James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. And its smart to grow the government pell mell, without disruption moving to $17 trillion in debt with no end game in sight. I totally get it.

  2. john personna says:

    Second, I agree with neither the president nor Congressional Republicans on ObamaCare. That is, I think the program is mostly a step in the wrong direction but think the right direction is a baseline single payer system augmented with Cadillac private options. That’s a position to the left of the public position of most Congressional Democrats, although I suspect pretty close to Obama’s private view.

    I think I heard on NPR that there is an industry short-hand for people excluded from private insurance by preexisting conditions. Maybe it is just something like “pre’d.”

    The problem with the philosophical argument that Obamacare is a “wrong turn” from single-payer is that it throws all the pre’d under the bus.

    Because you are talking about a solution (single-payer) which is decades away.

  3. john personna says:

    (Mean old Obama wanted to help people, poor and pre’d, in the short term.)

  4. Rafer Janders says:

    That out of the way, while I at least understand why Republicans are fighting so hard on this issue—if they give up, they’ll legitimate the program and never be able to achieve rollback

    Well, they could win a presidential election once in a while, but I think they’ve all but given up on that idea….

  5. James Joyner says:

    @Let’s Be Free: Congress has already passed this budget.

    @john personna: You either have an insurance system or you don’t. Forcing insurers to cover pre-existing conditions makes no sense. It ain’t insurance if the event has already happened. But it equally makes no sense to tie one’s ability to pay for health coverage to one’s employer.

    @Rafer Janders: It hasn’t exactly been a long time since Republicans won a presidential election.

  6. James Pearce says:

    @Let’s Be Free:

    And its smart to grow the government pell mell, without disruption

    Actually, if you read through some of the stuff James is talking about here, it will become obvious that a “government shutdown” doesn’t actually save any money. Obligations will still be met, and costs will be incurred, so it will actually waste money in the end.

    That’s why so many people consider this strategy counter-productive. It won’t actually reduce the size, scope, or cost of government, but it may politically weaken the GOP. And a politically weakened GOP puts the whole “reduce the size, scope, and cost of government” project more and more out of reach.

  7. al-Ameda says:

    @Let’s Be Free:

    And its smart to grow the government pell mell, without disruption moving to $17 trillion in debt with no end game in sight. I totally get it.

    Actually, the current trend is that the deficit is receding, declining both actually, and as a percentage of GDP – it is not growing. Also, and I know that this escapes the understanding of many conservatives, America has the capacity to meet all of its debt obligations, and never has been in actual danger of failing to meet that obligation because of impending insolvency. Of course, that didn’t stop Republicans from leveraging the last Debt Ceiling “crisis” into causing a downgrade in the rating of America’s Government securities, but that’s another story, soon to be replicated by the Republican Party.

  8. john personna says:

    @James Joyner:

    The sad position we are in is that every argument against Obamacare is, in the short (and real) term, inhumane.

    This is a perfect example. We have not had a free market in health insurance [or health care] for many, many, years. The argument is about how to manage our current, neither fish nor fowl, neither private nor public system.

    In fact, I really don’t know why you are bringinng up “You either have an insurance system or you don’t.”

    You are enough of a public policy expert to know that boat sailed long ago.

  9. Rafer Janders says:

    @James Joyner:

    It hasn’t exactly been a long time since Republicans won a presidential election.

    Um, they’ve lost the popular vote in five of the last six presidential elections. Since 1988, when Bush I beat Dukakis, they’ve only won the popular vote in one election — 2004 — and lost it in 1992, 1996, 2000, 2008 and 2012, and they stand to lose in 2016 as well. On top of that, long-term demographic trends are decidedly not in their favor.

    They’ve decided to be the Clown Car Party — good at putting on a crazy show, but with no real interest in running the circus. If they can figure out a way to get the Supreme Court to hand them another election, they may occupy the White House again, but barring that, I don’t see a path for them to get there.

  10. grumpy realist says:

    @Let’s Be Free: If you want to cut the size of government, pray explain exactly what you want in the end and how you are going to get there from here. What do you want to cut? The FDA? Fine, have fun explaining to people why they have to deal with rat turds in the peanut butter. (And why the medication they just used on their sick children has killed them.) The Department of Commerce? OK, now you’ve gotten rid of the Patent Office. Getting rid of NOAA? Gee, too bad we didn’t warn you about that hurricane, oops.

    Indeed–yes, please tell us what you want cut. Oh, you wouldn’t cut any of the departments, you’ll just cut the workforce in half. Indeed? Well, don’t complain then when your patent or trademark application requires an extra three years to get through the system. (They’ve already got a backlog of 26,000 appeals, did you know that? )

  11. James Pearce says:

    @Rafer Janders:

    If they can figure out a way to get the Supreme Court to hand them another election, they may occupy the White House again, but barring that, I don’t see a path for them to get there.

    They’ll get there. Don’t worry.

    They’ll need to put down the tea cups and clean up after the party, but they’ll get there.

  12. Neil Hudelson says:

    @Let’s Be Free:

    I’m sorry to feed the trolls but…

    You do realize that failure to raise debt ceiling, and a government shutdown, would not forestall that whatsoever, and would actually increase our long term debt, right?

    I mean, you have to, have to, after 2.5 years of this crap, understand what the debt ceiling is, right?

  13. Scott says:

    By the way, a most of contractors supporting the Government have signed contracts, with funds already obligated, so that money won’t be saved either. If the Government shuts down, that would be a breach of contract for the convenience of the Government, exposing the Government to claims.

  14. James Joyner says:

    @john personna: We’ve long had a mixed system in which most people were on private insurance, most of the rest were on some sort of government program, and a relative handful were left uncovered. ObamaCare tried to deal with the last cohort by a bizarre “fix” to insurance rather than expanding the portion covered by government.

    @Rafer Janders: People were saying the same thing about the Democrats after their second straight drubbing in 1988. By that point, they had lost 1968, 1972, 1980, 1984, and 1988–five of the last six elections–and only won 1976 very narrowly despite something of a perfect storm.

    Do I see a Republican Clinton on the horizon? No. But at this point in the 1992 cycle, nobody thought Clinton was Clinton, either. Recall that, in early 1991 George H.W. Bush looked so unbeatable that most of the top Democrats decided not to bother to run in 1992, leaving a field dubbed the Seven Dwarfs.

  15. Rafer Janders says:

    @James Joyner:

    People were saying the same thing about the Democrats after their second straight drubbing in 1988.

    Yes, they did. So what’s your point? It was because of that election, after all, that the party strategists in the DLC, along with the base, decided to move the party slightly to right, to present a more centrist image in order to appeal to the swing voter. They decided to focus on wining elections at the expense of party purity, and sold themselves to the public as a steady and reassuring hand on the tiller.

    At present, by contrast, the GOP has decided to deal with its losses by becoming even more crazily right-wing. Their preferred method seems to be to further alienate, frighten and confuse swing voters, and to build up their brand as people who can never, never be trusted with the wheel. Party purity trumps electibility. The GOP’s position in 2013 is the opposite of, not the same as, the Democrats’ position in 1989.

    All of this is so well-known and so obvious that I really don’t understand why you’re having a hard time comprehending it.

  16. Stan says:

    @James Joyner: “Forcing insurers to cover pre-existing conditions makes no sense. ”

    It’s my understanding that if you have a pre-existing condition under the present system you can’t get any health insurance unless you live in a state with a high risk pool. Am I wrong? Please advise.

    “You either have an insurance system or you don’t.”

    I’m having lots of trouble understanding this. The Affordable Care Act resembles the Bismarck type health insurance systems currently in effect in the Netherlands, Switzerland, and of course Germany. Are you saying that these countries don’t have health insurance systems?

    As a final point, and this is directed more at other posters, have any of the dire effects predicted for the Affordable Care Act taken place in Massachusetts? Have Massachusetts employers cut back on the hours of their employees to avoid the employer mandate? Is there a massive shortage of health care providers in Massachusetts? Is the Massachusetts health care system unpopular? Why doesn’t the Massachusetts Republican party call for repeal of RomneyCare? Jenos Idanian? Eric Florack? Care to answer my questions?

  17. James Joyner says:

    @Rafer Janders: I’ve written dozens of posts decrying the current state of the GOP; I fully comprehend it. I just note that, in 1989, the Democrats were in the same sorry state. Few, if anyone, saw the DLC turning things around, much less California going from a GOP gimme to a Democrat gimme. That alone was a game changer.

    @Stan: My understanding of the law pre-ObamaCare is that insurers were forced to cover everything or nothing, so chose nothing. I’m not sure in what way ObamaCare resembles the German model. The exchanges?

  18. john personna says:

    @Stan:

    My understanding, driven in by that NPR show, was that profit-oriented insurers only want the cream of the crop (of course), people who won’t have any health bills. They have a whole system set up to “pre” anyone who has even a hint of risk.

    That’s fine if your orientation is that insurance companies are like any other company, Apple or GM, and just live to make money.

    Of course, if you want universal healthcare that falls far short. Far short.

    James and similar policy bloggers should know all this. In particular they should know that a whole class of people develop long-lasting conditions as children. They never have a chance to be diligent workers who buy “insurance” while healthy. They are “pre’d” the day they turn adult and seek their own way.

    (As I’ve mentioned in the past, I know a guy who got a pacemaker as at age 14. The guy will never, ever be accepted in a “You either have an insurance system or you don’t” world.)

  19. john personna says:

    @James Joyner:

    Are you dissembling? Shouldn’t you recognize a vast array of state laws?

  20. Gustopher says:

    @James Joyner:

    You either have an insurance system or you don’t. Forcing insurers to cover pre-existing conditions makes no sense. It ain’t insurance if the event has already happened.

    Fine, it’s not insurance. It’s a community priced health care payment plan.

    I don’t love it, it don’t even like it, but it has a lot less worse outcomes — at least in theory, we’ll have to see in practice — than the current individually priced health care payment plans.

    But, for no particular reason, we call them insurance plans.

    (I suspect that despite being unable to just throw sick people off the insurance plans, the insurers will go for the route of making things so inconvenient for sick people that they switch to another insurer at the first opportunity. Perhaps they will subcontract customer service to Comcast.)

  21. rudderpedals says:

    @James Joyner: Forcing insurers to cover pre-existing conditions makes no sense. It ain’t insurance if the event has already happened.

    If the pre-existing condition exclusions were actually addressing the situation that you suggest – the sick guy signing up the day before he goes in for surgery say – then it would be rational at least, but the way it’s actually implemented (where permitted by state law)(in the individual market) is in the form of broad lifetime bans.

    For ex., merely suffering some test result, such as a raised cholesterol test result (like 170 when it should have been 160 or 150) is enough to draw an exclusion of every condition that can be “associated with” a raised cholesterol result, whether or not the problem persists, forever and ever.

  22. grumpy realist says:

    @john personna: I wonder about people like Sarah Palin, who seems willing to throw her child with Downs’ Syndrome to the wolves. Oh, yes–Down’s Syndrome is considered a “pre-existing” condition. Insurance companies won’t cover your disabled kid–you’re just going to have to shell out for everything on your own.

    Ditto for people who have donated a kidney: sorry, pre-existing condition now, won’t cover you.

    I ask, are the far-right Republicans totally mad?!

  23. mantis says:

    @James Joyner:

    Forcing insurers to cover pre-existing conditions makes no sense.

    With an insurance mandate, it makes a hell of a lot more sense than what we have now.

    We’ve long had a mixed system in which most people were on private insurance, most of the rest were on some sort of government program, and a relative handful were left uncovered.

    30-40 million people is not a “handful,” even relatively speaking.

    ObamaCare tried to deal with the last cohort by a bizarre “fix” to insurance rather than expanding the portion covered by government.

    Because the latter was a possibility under the circumstances how, exactly?

    Stop playing dumb, James. People might believe you are.

  24. Gustopher says:

    @James Joyner:

    We’ve long had a mixed system in which most people were on private insurance, most of the rest were on some sort of government program,

    And, generally, the healthy are covered by private industry and the sick by the government. Just another example of privatizing profits and socializing losses. Why is that ever an acceptable policy goal?

  25. jib10 says:

    @James Joyner:

    Forcing insurers to cover pre-existing conditions makes no sense.

    Except we are already doing it in some states. We do it here in WA state and it works fine. Some small tweaks eliminates the worse cases, if you have no insurance at all and try to buy it, pre-existing conditions are not covered for 1 year but everything else is. After 1 year, everything is covered.

    Because of this, the Obama care plans that are coming out are about the same as the plans we have had before. Small diffs in things like kids dental but about the same plans at about the same prices.

    But the tax credits mean that the actual amount payed will be much lower. Much lower. As a small biz owner, I have been buying health care in the open market for 20 years. The tax credits are a game changer.

    And your damn right I will be taking my tax credits. I am finally getting the same deal Mitt Romney and his buddies get on their taxes. Its about time!

  26. john personna says:

    What really bothers me about this thread is that (in a “why do you respond to trolls?” sense), James just returns to zero.

    We established why a free market insurance system was lacking as a national health care system years ago.

    And yet now in a discussion of Obamacare and government shutdown, he just sort of touch-bases on this old Republican chestnut. Zero progress. Back in time.

    It really is the laziest form of conservatism to name any complex public-private venture in America as “free market” and then to label any incremental change in the public direction as “socialism.”

    But it works, right, by mood affiliation.

  27. grumpy realist says:

    P.S. And I take of it none of you remember all the disclaimers you get with instructions when signing up for insurance: won’t cover people with diabetes, won’t cover obese people.

    I’m with James: let’s go for a broad, single-payer system, with private insurance covering the “nice-to-have” treatments (or maybe getting them quicker, or whatever.) Those who are irrevocably opposed to NHS systems can deliberately stay off the system and take their chances. But that means TOTALLY take their chances. No Medicare, no using-the-emergency-care-room-as-a-freebie. You can’t get covered? So what–live (or die) according to your principles.

  28. Gustopher says:

    while I at least understand why Republicans are fighting so hard on this issue—if they give up, they’ll legitimate the program and never be able to achieve rollback—this tiresome game of chicken in which they trigger a crisis at every opportunity is no way to achieve their goal.

    I don’t blame the Republican congress critters, I blame the people who voted for them. The Republicans are doing exactly what they’ve been doing since 2010, and those who voted for them in 2012 knew exactly what they were voting for.

  29. Jack the other one says:

    It takes two to tango. If the Liberals don’t get 100% of what they want, they claim the other side won’t compromise. If they do get what they 100% of what they want and it goes badly then it is the other side fault for not contributing. Liberals never take any responsibility for any of their negative actions. If it wasn’t the attempt to defund Obamacare, the Democrats would come up with some other disagreement to scream that Republicans were trying to shut down the government.

  30. Nikki says:

    @Jack the other one:

    If it wasn’t the attempt to defund Obamacare, the Democrats would come up with some other disagreement to scream that Republicans were trying to shut down the government.

    You really haven’t been paying attention, have you? Because an honest commentor would admit that it’s not the Democrats who won’t compromise. Also, are you trying to get us to believe that Cruz, Lee and the rest of the gang aren’t going to shut down the government if they don’t get their way?

  31. john personna says:

    @grumpy realist:

    I’m with James: let’s go for a broad, single-payer system, with private insurance covering the “nice-to-have” treatments (or maybe getting them quicker, or whatever.)

    Is that for real though?

    Or is it, like Heritage Foundation foundation support of a mandate, something they say when it is not remotely on the political horizon?

    I think if it was for real they’d be fine with going through Obama care as an interim, pragmatic, improvement, before we get there. Otherwise the poor and the pre’d go under the bus.

  32. Console says:

    I’d argue that the most visible impact job actually doesn’t get shutdown during all this. Air traffic still has to come to work. Last time it only took two days of delays at like 3 major airports and congress was squealing. Imagine if no air carrier could fly.

    And the point that seems to get missed is that essential employees aren’t entitled to pay either. They work for free until the shutdown is settled and congress decides to pay them. IF congress decides to pay them.

  33. Rick Almeida says:

    @Jack the other one:

    If it wasn’t the attempt to defund Obamacare, the Democrats would come up with some other disagreement to scream that Republicans were trying to shut down the government.

    It would be very hard to do this if the Republicans weren’t trying to shut down the government or default on the interest of the national debt.

  34. Rob in CT says:

    @Jack the other one:

    Bull.

    The Democrats compromise (often pre-emptively) often, which is right in line with what the poll data says Democratic voters want (Dem voters want compromises to get things done by a 2-1 margin). The GOP compromises as little as possible, which is right in line with what the poll data says their voters want (Rep voters oppose compromise to get things done by a 2-1 margin). This is also evidenced by the reaction to GOP pols who are preceived to be RINOs: they get primaried. This rarely happens to Democrats.

    GOP officeholders have gotten the message. Their base believes that any compromise with Democrats = total defeat, and will punish them for it. The Democratic base isn’t the same way. The left wing of the Democratic party (aka “Firebaggers”) is the same way, but holds very little actual power. They scream online and that’s about it.

  35. Rob in CT says:

    @john personna:

    Good question.

    At this point, I think we have a right to be skeptical, James. We’ve seen this act before from the Right. You are you, not “The Right” so this may be unfair. But it’s not crazy of us to think about all those Republicans who used to support a Romneycare solution that includes a mandate and then suddenly decided, overnight, that it was terrible.

    Single payer was not realistically on the table. Things that aren’t actually on the table are always more palatable. Just like “generic Republican” often out-polls the actual wingnut they nominate.

  36. Scott F. says:

    James –

    If I’m reading the tea leaves on this correctly, Obama sees the real problem is “this tiresome game of chicken in which they trigger a crisis at every opportunity” and that increases the likelihood of a government shutdown this time.

    Last Wednesday, Obama spoke at the Business Roundtable, an association of CEOs who wouldn’t be seen as his natural allies. Here’s what he said…

    So here’s where we are — and I think this is the bottom line, and I want to make sure everybody is clear here. I have presented a budget that deals with — continues to deal with our deficit effectively. I am prepared to work with Democrats and Republicans to deal with our long-term entitlement issues. And I am prepared to look at priorities that the Republicans think we should be promoting and priorities that they think we should be — we shouldn’t be promoting. So I’m happy to negotiate with them around the budget, just as I’ve done in the past.

    What I will not do is to create a habit, a pattern, whereby the full faith and credit of the United States ends up being a bargaining chip to set policy. It’s irresponsible. The last time we did this in 2011, we had negative growth at a time when the recovery was just trying to take off. And it would fundamentally change how American government functions.

    It seems clear to me from these comments that Obama’s “long game” objective this time around is to avoid cementing a pattern of apocalyptic brinkmanship every time one of these fiscal deadlines comes around. From his remarks last week, it seems he sees that cycle of dysfunction as a greater threat to the economy long term than a temporary government shutdown would be. If breaking the precedent is his primary objective as I see it, he could opt for the shutdown over ANY Democratic concessions, let alone any shenanigans with the ACA. The hardline Republicans could get what they’re asking for.

    There will be much noise, but ultimately the House bill will fail in the Senate. This moves the Continuing Resolution into the negotiation phase and the House GOP either holds firm or requests other concessions from Obama to salvage what they can. With Obama preferring the shutdown to the alternatives, he has no incentives to give much of anything, so the Republicans won’t make any deal and government funding stops for a time. The shutdown gets old fast – daily news stories on unavailable services will do that – and a clean CR gets passed sooner rather than later.

    Now hopefully, there’s a silver lining. A shutdown over the CR may be enough to assuage the hardliners, so a debt limit increase could pass without another big showdown. As the debt limit increase is much more critical (full faith and credit of the US and all), this would be a welcome turn of events.

  37. Grewgills says:

    @Let’s Be Free:
    It’s much smarter to continually stage stunts to downgrade the countries credit and increase debt interest payments with no benefit other than to those that stage the stunts.

  38. jukeboxgrad says:

    And its smart to grow the government pell mell, without disruption moving to $17 trillion in debt with no end game in sight.

    The 17 largest deficits (as a % of GDP) in the period 1947-2009 were all produced by Republican presidents, and most of those 17 are Reagan and later. 75% of the debt Obama inherited was created by three presidents: Reagan, Bush and Bush. Reagan tripled the debt and GWB doubled it. The GOP now whining about debt and deficits is like a bunch of arsonists returning to the scene dressed as firefighters.

  39. michael reynolds says:

    @James Joyner:

    There was zero chance that Obama could pass a single payer. Zero. So we let it go while focusing on what to me is the essential bit: defining health care as a right guaranteed by the federal government. Obamacare does that. It moves health care from pseudo-private to pseudo-governmental.

    Obviously we all know it’s been a mix forever, but conservatives had their usual inability to face reality and continued to whine about the wonders of the marketplace. The GOP and the handful of blue dogs would have killed anything more overtly governmental. Obamacare means that two or three years from now people will still have issues, but now they’ll go right to their Congressman for solutions, which moves health insurance into the government sphere, and from there, finally, having taken a time out to deal with the very slow mental processes of conservatives, we can finally join the rest of civilization with some version of single-payer. I’d guess right about at the start of Hillary’s second term.

  40. grumpy realist says:

    Hello, people? (waves hand, whistles). How many of you have actually experienced health care under both systems? For all the squawking we’re hearing from the right, there’s damn few of them who have the experience or the data to really comment on this. America == Automatically Good seems to be the level of their logic.

    I agree there are problems under a NHS — but it seems to me that it’s comparing a pin-prick to the leg-amputation-without-anesthesia we have under the “Free Market System.” Basically, I’d rather take my chances under the Japanese NHS than have to deal with the putrid, ridiculous mess called Health Care in the US. What in effing good is having “the top-level medicine” in the world if only the rich can afford it?

    I guess for the rest of us, it’s “eff off and die.” Lovely.

  41. merl says:

    @Let’s Be Free: Where do you totally get it from? Your ass?

  42. al-Ameda says:

    @James Joyner:

    ObamaCare tried to deal with the last cohort by a bizarre “fix” to insurance rather than expanding the portion covered by government.

    As you might recall, the reason ACA did not include a “government option” is that most Republicans and some Democrats did not want a “government option” because, the feeling was that it would put the country more directly on the road to a single payer system. The GOP did not want the “government option” because of ideological reasons and Democrats did not want it because of strategic reasons, i.e. including it would sink the bill. The rest is history.

    By the way, it is interesting that you characterize the insurance mandate as a “bizarre fix.” I suppose that’s what you get when Democrats deign to adopt a conservative idea.

  43. Scott says:

    @michael reynolds: Worldwide, there are a number of workable universal healthcare models and not just single payer. However, they all have heavy government regulation.

    I think the real issue is that we don’t, as a nation, have accepted the proposition that healthcare is a right and the universal healthcare is a goal. If those two ideas are accepted then all you are arguing over are differing payment systems. Until then, we will continue arguing past each other because there are two competing paradigms.

  44. merl says:

    @grumpy realist: I have experienced both systems. I much prefer the VA.

  45. jib10 says:

    @michael reynolds: Yep. In fact that has been the plan all along. In the post-mortems on Hillary care, the consensus was that Clinton should have accepted the Repubs market alternative at the time (which is Obama Care). If they had done that, we would have single payer today. That is why Obama went with Romney Care as his model, not to repeat the same error as last time. Problem was, what ever he proposed would have been opposed by repubs. So he should have proposed single payer and settle on Romney Care so repubs could claim victory but he knows that now.

    Dont know if it will happen as fast as you say but it will happen. It has to. Paying twice as much (as a % of GDP) than any other economy for health care puts the US at a severe competitive advantage in the world market. Of course repubs never seem to get that part……

  46. michael reynolds says:

    @Scott:

    I think in effect we have accepted it, we just don’t realize it, yet. In fact, we were already accepting it in a bizarre, disconnected sort of way that was evidenced by the now famous “Government Hands off my Medicare” mentality.

    Medicaid has been expanded and will expand further, the exchanges will be up shortly, and the tipping point will have been reached.

  47. grumpy realist says:

    @merl: VA is a government-provided health care system, by the way.

  48. Scott says:

    @michael reynolds: I’m not convinced such a concept has been accepted by the right. I would like to see direct polling questions on the right to healthcare. I would like to hear direct questions to our elected officials on whether they believe healthcare is a right and whether universal healthcare is a goal. Pin them down.

    However, you may be right about the part about not realizing it. However, right now, the radical right seems to have the philosophy of healthcare rationing by ability to pay.

  49. Rob in CT says:

    I agree with Scott: lots of right of center people will straight up tell you that healthcare isn’t a right, and then make some foolish comparison to buying this or that widget. The more sophisticated go on about how it’s not “real insurance.” This is fun when I’m involved, because I work in insurance and have a pretty good idea of how it works, so they can’t just throw that up there and rest their case.

    Regarding medicare: a lot like social security, a lot of middle-income folks really think that they get back what they paid in. In reality, the system is somewhat progressive, meaning that they will likely take out more than they paid in. But this does not register. Somebody ELSE (undeserving for one reason or another) is a moocher, not them.

  50. Jeremy R says:

    @al-Ameda:

    The other thing about that quoted sentence is obviously the ACA did in fact expand “the portion covered by government” through the Medicaid expansion, though unfortunately by millions of Americans less than intended in states with GOP “governance” or GOP obstruction where 100% federally reimbursed insurance coverage for their neediest of residents is being denied.

  51. john personna says:

    @Scott:

    For what it’s worth, I think “is universal healthcare a right” is sloppy verbiage. I much prefer “are we rich enough, as a nation, to provide universal healthcare at some basic level?”

    Yes.

    And I’d really like any Republican who likes to note in the margin that he is “for” universal coverage to stand up and ask for it. It’s not actually OK to dis Obamacare, make the margin note, and move on.

  52. Barry says:

    @Scott F.: “From his remarks last week, it seems he sees that cycle of dysfunction as a greater threat to the economy long term than a temporary government shutdown would be. If breaking the precedent is his primary objective as I see it, he could opt for the shutdown over ANY Democratic concessions, let alone any shenanigans with the ACA. The hardline Republicans could get what they’re asking for.”

    He’s also figured out that there will be one of these at every opportunity, so he needs to demonstrate to the GOP that this is not a free shot. Otherwise he’ll spend the rest of his administration on these.

  53. grumpy realist says:

    @Rob in CT: I really wonder what these people want–to go back to 19th century America? Heck, the early twentieth century wasn’t that great either. People just took their chances and died. Ditto for children. I guess parents were just supposed to shrug their shoulders and put up with it.

    I’d be perfectly happy to get rid of Medicare for people who consider it an Evil Government Imposition. We’ll figure out how much you contributed in via your salaries and pay it back to you (with interest.) Just don’t ask for any assistance later, ok?

  54. john personna says:

    @grumpy realist:

    But that’s not compassionate because conservatism is just another preexisting condition 😉

  55. jib10 says:

    @john personna: It is not a question of ‘can we afford universal coverage’, it is ‘we can not afford the system we have’. The US pays 16% of GDP for health care. Everyone else pays 6% to 8% of GDP for health care. We are paying a hell of tax, 8% of GDP, $1.2 trillion a year to keep our current system.

    It is a serious competitive issue in the global economy yet some how, no one ever talks about it that way. We are told all the time we cant have certain tariffs or raise certain taxes to combat offshoring because that will hurt our global competitiveness. Yet many of those same people saying we cant do anything about cheap offshore labor are silent about how our health care system currently hobbles us.

  56. michael reynolds says:

    @Scott:

    Of course it hasn’t been accepted by the Right, they’re idiots. They still don’t think Social Security is a government program. The Right as currently constituted has nothing more to offer in American politics. Now it’s just tick-tock and checking our watches while they age out and die — on government programs, of course.

    No, it’s about the middle. We don’t need 100%. We do need 60% And in a couple of years we’ll have it, which of course is why the Right is in such a panic about Obamacare. They’re terrified it will work, and thus encourage more government.

  57. michael reynolds says:

    @john personna:

    Yeah, it’s sloppy verbiage. But this is politics, not science or philosophy.

  58. john personna says:

    @jib10:

    OK, of course. I was speaking in the abstract, because I think wealthy societies tend to add “rights” over time. It’s a choice that becomes a right.

    But you are absolutely correct that in this case it is even simpler. Our crazy system costs us more than a simpler, universal, system would do.

  59. al-Ameda says:

    @Rob in CT:

    Regarding medicare: a lot like social security, a lot of middle-income folks really think that they get back what they paid in. In reality, the system is somewhat progressive, meaning that they will likely take out more than they paid in. But this does not register. Somebody ELSE (undeserving for one reason or another) is a moocher, not them.

    Ha! I tried many, many times to explain that to my mother – that is, that what she paid into Social Security and Medicare did not in any way equal the benefits that she rightfully realized from those programs. I think it was a willful denial, and what she was trying to say is that she deserved those benefits and many other are not as deserving. Many Americans have that view – their benefits are earned and deserved, the problem is with those other undeserving people.

  60. Tony W says:

    @Rob in CT: Indeed – Obamacare IS the compromise! Most of us wanted James’ single-payer system with an employer “Cadillac” plan supplement.

    Instead the left caved and went with the Republican plan – the ACA (to get something done) and the winners have been complaining that they lost ever since.

  61. Scott F. says:

    @michael reynolds:

    I’d say acceptance without realization of healthcare as a right came with the passage of the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986. Once we, as a nation, decided it wasn’t okay to deny care to someone needing emergency healthcare treatment due to their citizenship, legal status or ability to pay, we implicitly accepted health care as a right.

    As Rob in CT notes, there is a sizable group of libertarians and conservatives who will talk about healthcare as if it were like a widget, but until those same people start clamoring for repeal of EMTALA, we can rightfully ignore these people.

  62. Rob in CT says:

    I always bring up EMTALA (which I call that law from the 80s that says hospitals have to treat anybody). People sputter incoherently and then change the subject. Especially when I point out the mechanics of a system without EMTALA (what do you do? Go through the pockets of the unconcious patient to determine whether they’re insured before you start treating them? Maybe, just maybe, the people who passed EMTALA were addressing a problem).

    @al-Ameda:

    Hey, I hear you. Every election cycle I find myself trying to be patient as I explain, yet again, to my mother how marginal tax rates actually work, as opposed to how they work in her mind. It’s a frustrating experience, because it doesn’t seem to stick. Maybe it stuck last time. I’ll find out in 2015-2016, I guess.

  63. Rob in CT says:

    @Tony W:

    I’d argue that “The Left” didn’t cave really. The Blue Dogs were the critical swing votes, and those guys weren’t going to go for a more radical reform. Neither were Susan Collins or Olympia Snowe. Result: a reform that tinkers with the existing system.

    And the political calculation about the public response made sense too: 70% of the country had some form of employer-provided healthcare. A reform that iced that (single payer or a libertarian-style reform that would of course yank the tax deduction for medical insurance, right? RIGHT?) would have been scarier to a lot of people.

    Is recognizing those things caving?

  64. Rob in CT says:

    The incredibly frustrating part of all of this, for me, is that this whole healthcare debate has taken place amid all sorts of fulminating about deficits, debt and wastefraudabuse. Meanwhile, we spend ~18% of GDP on healthcare (roughly split evenly between governmental and private expenditure) as against sane countries spending ~10-12%. How? By utilizing single-payer universal healthcare systems, of course.

    If the GOP had looked at the ACA and said “you know, it’s not a terrible idea but you’ve set it up such that this or that plan is too generous and the subsidies are a bit much” there could have been a reasonable conversation about those things. If the problem was the 30-hour cutoff, that could have been worked out.

    If the GOP had said “nah, let’s do a basic governmental plan for all and have private insurance above and beyond that” (hahahaha, like that’s even in the realm of possibility!), there could have been a reasonable conversation (about what “basic” means and how the funding should be done and such).

    But those things didn’t happen. We got a total meltdown. Hysteria. All of the things the Right typically accuses Leftists of doing. Emotional arguments divorced from fact.

  65. al-Ameda says:

    @Rob in CT:

    But those things didn’t happen. We got a total meltdown. Hysteria. All of the things the Right typically accuses Leftists of doing. Emotional arguments divorced from fact.

    in 2009 I went to a town hall meeting, where our legislative representative was there to take comments and questions from the public and discuss the proposed ACA legislation.

    The first hour of the meeting was hijacked by conservative speakers who denounced our legislator as an idiot and a socialist, and the bill as a loss of freedom, and of course “death panels.” In retrospect, those guys were well-prepped, angry and had their talking points memorized. There was very little constructive discussion of ACA – it was an example of how generally, people do not show up to support something, they show up to oppose something.

  66. Rafer Janders says:

    @James Joyner:

    I’ve written dozens of posts decrying the current state of the GOP; I fully comprehend it. I just note that, in 1989, the Democrats were in the same sorry state. Few, if anyone, saw the DLC turning things around, much less California going from a GOP gimme to a Democrat gimme. That alone was a game changer.

    Right, but in 1989 the Democrats HAD A DLC that was trying to change things around. In 1989 the Democrats weren’t all running around demanding that everyone become more doctrinaire and left-wing, they weren’t trying to sabotage the Bush I presidency, and the base wasn’t refusing to vote for any but the most left-wing of candidates. They took a lesson from their losses, and decided to move to the middle. They decided to try to win.

    None of that is true of the Republicans, who have decided to respond to a losing strategy by…doubling down on the crazy.

    Look, my initial comment, which you objected to, was that the GOP has given up on wining presidential elections. Your response, a bit of a non-sequitor, was that the Democrats had also lost a bunch of presidential elections 30-40 years ago. Again, yeah, but so what? The fact that Democrats once had a losing streak a generation ago is not really relevant to the fact that the Republicans are on a losing streak now, since the parties’ response to their losses has been so radically different.

    But I understand how someone with bothsidesdoitism may not be able to see that.

  67. Rob in CT says:

    http://www.whitehouse.gov/sites/default/files/docs/marketplace_premiums_ib_final.pdf

    Trainwreck!

    Or… not.

    What will be verrrrry interesting is if ACA implementation goes ok despite GOP sabotauge efforts. They’ve been screaming “trainwreck” for some time now, and claiming all sorts of other things. If these things are shown to be demonstrably false despite the GOP’s efforts to make them true, will a critical mass of voters finally figure out that they lie constantly, about everything?

    I don’t expect the above to happen. But it would be nice.

  68. Rob in CT says:

    Heh, speaking of EMTALA:

    http://www.ritholtz.com/blog/2013/09/investing-around-obamacare/

    Granted, he’s talking about investment, not macro effects. But the mention of EMTALA after our discussion here yesterday tickled me.

  69. PD Shaw says:

    @Rob in CT:” lots of right of center people will straight up tell you that healthcare isn’t a right, and then make some foolish comparison to buying this or that widget. The more sophisticated go on about how it’s not “real insurance.” This is fun when I’m involved, because I work in insurance and have a pretty good idea of how it works, so they can’t just throw that up there and rest their case.”

    I must be a fool and an idiot then. I would simply like to know the name of your insurance company that does not believe in the concept of “insurable risk.”

  70. john personna says:

    @PD Shaw:

    Was that a hypothetical? A question for an unregulated, free market, insurance system?

  71. john personna says:

    The quest for a universal health care system in America isn’t that old, maybe 100 years, but what came out of it was a tenuous social contract.

    We’d keep “insurance” but we’d make it act like universal coverage.

    That’s the best we’ve got, until people who want single payer or etc go out and get it.

  72. Rob in CT says:

    @PD Shaw:

    You misunderstood my comment, though I can understand why given the way I phrased it.

    I understand the distinction between health insurance that provides payments for routine care and property casualty insurance, which only insures against accidents (occurrences, of course).

    The thing is that doesn’t provide some sort of ironclad argument against health insurance as we know it. Most of the people who advance the argument, in my experience, simply state it like that’s it, they win. Because they think others don’t understand insurance and they can wow them by appearing more knowledgeable about how it works. Therefore, one should defer to them. Yeah, no. It’s not nearly that simple. I *do* understand the basics of insurance (specifically property casualty), and yet I reject the idea that the only way to make healthcare work is to have catastrophic insurance only. There are other models out in the wild, functioning well, and they provide for routine care.

  73. Rob in CT says:

    Also, too: the people who like to bring up “how real insurance works” never seem to get around to the bit about how insurance works best when you have really large risk pools. The larger the better, with the caveat that if you can avoid the riskiest customers via underwriting controls – refusing to sell them insurance at all – you can do even better. Which is why you get state pools, forcing carriers to provide auto insurance to people with DUI convictions and such, because otherwise they wouldn’t touch ’em.

  74. john personna says:

    @Rob in CT:

    One of the oddest beliefs in the “free market community” is that, since markets work, they would make health care (and insurance) cheap and affordable for all. More knowledgeable students of economics understand that the market is about rationing scarce goods. Somehow though a certain segment of conservatives filter their view when thinking about health care. They think that, since we can all afford iPhones and Starbucks, we’d be able to afford kidney dialysis as well.

    This despite the daily experience of things we can’t afford in a market economy, until we hit that lottery.

  75. Rob in CT says:

    @john personna:

    Right. A well-functioning free market would not provide for the poor/weak/sick/old, except via charity (which is, of course, hit & miss, with a whole lotta miss). There’s no money in that! You lose $ on those people. Remember the outcry about recission? There was a strong incentive (hint: it’s green and rectangular) for companies to go back and see if they could weasel out of policies after their insureds ended up with expensive illnesses. Now here’s the thing: there are times when recission is appropriate. When people make a material misrepresentation when applying for a policy, and that very lie ends up being directly connected to a later loss, recission is appropriate. But some companies went beyond that because there’s a really strong financial incentive to push it.

    No underwriter in their right mind would offer insurance(that covered cancer) to a cancer survivor, unless they were forced to do it. Nobody would offer affordable (as in low-to-middle income people could plausibly afford it) health insurance to older folks, even if healthy, unless the coverage provided was hitched to a very high deductible or large % coinsurance.

    This is what I mean by people going on about how insurance really works. No shit, I know how it works and I understand what it would mean to have an actual free market with high-deductible catastrophic coverage plans as the norm. The really wealthy, of course, would always be able to pay for more complete coverage if they want to. Just like if you are a large business you can negotiate the terms of your insurance program, including, if you like, special manuscripted policies saying pretty much whatever you want so long as you have the $ for the resulting premium, whereas the mom & pop business buys off the rack.

  76. Rob in CT says:

    One last little bit of ranting, then I will leave this be for a bit.

    If you build or buy a house on the coast and a hurricane hits and you have a large loss, your premium rises, or maybe even you get non-renewed. You could, of course, MOVE.

    You can’t move away from Cancer.

  77. john personna says:

    I know I’ve told this one before, but I was at a graduation party for a newly minted pharmacist a little while ago. I sheepishly admitted to him that I (in my 50’s) was on medication, lipitor. He said “only one? that’s very good.”

    When it is “very good” that a 50-something is only on one long term medication, how could this “forcing insurers to cover pre-existing conditions makes no sense” idea possibly work?

    Everyone is pre’d at this point.

  78. PD Shaw says:

    @Rob in CT:

    IMHO, there is no right to healthcare. What evidence is there of such a right, other than the EMTALA? That was not that revolutionary, it was merely a restatement of the old common law rule of public callings. People who obtain a state-sanctioned monopoly to provide healthcare are under a duty to treat all comers at a reasonable price. If people cannot pay the bill they look to emergency Medicaid. So the right to “healthcare” in this instance is a right to access to emergency care and perhaps a right to government payment. Emergency care is an insurable risk since it almost certainly arises from an accident, but there can be market failures since the patient is not in a position to bargain for price — its an emergency. So the case for government intervention is good (state-created monopoly; limitations on ability to bargain), but not so good for non-emergency care.

    Beyond emergency care, though, there are a lot of planned expenses that don’t involve pooling of risks, but forced-savings and tax dodges. Should there be a right to pay for healthcare coverage with tax-free dollars? I am going to an eye clinic to get new prescription glasses this afternoon with my insurance, which will pay up to $200 per pair every two years. Its a nice benefit, but the government shouldn’t make this a right — it should fix its tax code’s treatment of compensation.

  79. rudderpedals says:

    @john personna: I sheepishly admitted to him that I (in my 50′s) was on medication, lipitor.

    Good thing you’re not in Florida. Pre-Obamacare, your hypercholesterol draws a lifetime exclusion of any malady that can be associated with high cholesterol. It’s a stupid and malicious system that also deters people from seeking medical care so they don’t get scarlet lettered with the Med Info Bureau, our friendly “credit” reporting agency for the health insurance industry.

    Everyone is pre’d at this point.

    This, oh this.

  80. Rob in CT says:

    @PD Shaw:

    IMHO, there is no right to healthcare

    EMTALA? That was not that revolutionary, it was merely a restatement of the old common law rule of public callings. People who obtain a state-sanctioned monopoly to provide healthcare are under a duty to treat all comers at a reasonable price.

    That sorta sounds like a right to healthcare, PD, for people who can’t pay. As you acknowledge.

    I grant that the case for government intervention is stronger (IMO, ironclad) with emergencies than with non-emergencies. Shall we discuss the definition of emergency? Is a cancer diagnosis an emergency? It isn’t the result of a boom event accident, certainly. It is still subject to market failure, however. A heart attack is an emergency. A diagnosis of heart disease isn’t, right? Except one can lead to the other, particularly w/o access to treatment.

    I disagree with you: I think we should treat healthcare as a right (or one could say a privilege of US citizenship, if one prefers). Not an unlimited right, of course: such things don’t exist. There is always going to be a point at which the answer is no, and we have to figure out where to draw the line.

    One thing I think that we agree on is that the tax deduction for health insurance is bad policy.

  81. john personna says:

    @PD Shaw:

    The current system is very broken and does not “provide healthcare are under a duty to treat all comers at a reasonable price.”

    Data being released for the first time by the government on Wednesday shows that hospitals charge Medicare wildly differing amounts — sometimes 10 to 20 times what Medicare typically reimburses — for the same procedure, raising questions about how hospitals determine prices and why they differ so widely.

    Three people I know (including me) recently got colonoscopies. I think there is a push to sell them right now, probably in a profit deal. It was amazing how the bill to insurance was all over the map, from $5k to $20k for the same procedure.

    I know that sometimes I don’t understand you … but I really don’t understand you. You seem to be defending the pre-ACA model along free market principles, but like many conservatives, by ignoring the messy details in the pre-ACA model.

  82. john personna says:

    BTW, my Kaiser plan does not cover eyeglasses. So there must be no California/Federal requirement that it should.

  83. John D'Geek says:

    @john personna:

    For what it’s worth, I think “is universal healthcare a right” is sloppy verbiage. I much prefer “are we rich enough, as a nation, to provide universal healthcare at some basic level?”

    Yes.

    Thank you.

    While Universal Healthcare may be more compassionate, and we can honestly debate over whether we should implement it now that (and assuming that) we can afford it, it is not a right. There is also that pesky 10th ammendment that we can disagree on.

    I do not believe that we are wealthy enough as a nation to do this — in fact, I’m convinced that in a few years, the Laws of Economics will overtake us and the house of cards will come crashing down.

    Or, in other words, I do not believe that we are as wealthy as many people like to think.

    The Quartet Problem* (which I have been looking for a link to, but can’t for the life of me find) is going to catch up to us — and not “many, many years from now”. Education, Healthcare, and the Classical String Quartet (after whom the problem is named) are already suffering because of it.

    There is also the “too much efficiency” problem (what do we do when only One Human Being is required to produce everything the Human Race needs?), though that is not as well understood.

    [* The Quartet Problem — at the risk of butchering this: there is a limit to productivity increases; the efficiency of a Classical String Quartet hasn’t changed since the time of Bach. This has some rather profound economic implications, especially in fields like Healthcare — where at least one Physican or “Equivalent’ (i.e. Physican’s Assistant) is required for each Patient; a number that cannot be reasonably lowered — aka “made more efficient” (maybe I’m just a luddite — don’t want a Robot as a doctor).

    Unlike the String Quartet (which can play for the entire planet, theoretically spreading the costs further) ande Education (which is similarly “mega-sizing”), we can’t scale the Doctor-Patient relationship.]

  84. john personna says:

    @John D’Geek:

    I do not believe that we are wealthy enough as a nation to do this — in fact, I’m convinced that in a few years, the Laws of Economics will overtake us and the house of cards will come crashing down.

    Many of us find this to be THE compelling counter-argument:

    US Health Care Spending More Than Twice the Average for Developed Countries

    If I were to accept your fears, I could still argue that “picking one” from that list is STILL a path forward.

  85. Rob in CT says:

    Right, John, but that involves… Death Panels. Also known as sane cost control for what the government will pay for. Booga booga!

    This whole argument is farcical.