Wednesday, March 14, 2018

Did I Get This Right?

Prediction from 2009. The ACA was collapsing, but is now being neutered instead. Up until Trump took office, was this true? Only sort, I think.

I doubt that I’m the first across the finish line with this, but I did want to get my predictions in early. When health care reform doesn’t work, it won’t be Obama or the Democrats’ fault. Whether it will be fault of some industry, such as insurance, or of conservatives, or of Congressional Republicans – that I can’t tell you. I think that could vary according to political circumstances.

There will also be a considerable number of people (I can think of several off the top of my head), who will be certain that health care in America is nonetheless better than it was, impervious to any actual data. Their impression that we are at last a “good country” will trump any health outcomes.

Regarding this last matter, I wonder if the desire to be thought of as a good country by some social standard is related to the deep insult non-believers feel at the suggestion that religious people don’t believe they also can be moral.* There is a touching, perhaps even childlike wish to “be good.”

*Answer: It depends entirely on how one defines one’s terms. Any individual unreligious person can be more generous or honest than many or even most religious people. They don’t tend to be so, but it certainly isn’t impossible. That tendency is unlikely to be accidental, but diverse explanations are possible. At great extremity, when the costs are very high, do religious people tend to behave better? Well, no one does very well, frankly, so no one should be bragging. But the few who behave morally even under duress tend even more strongly to be religious people. Yet caution must be applied in interpreting this. It may be that their religion makes them more able. It may also be that those of determined morality are more likely to seek out congenial religious systems. Egg. Chicken. As to the question of whether religious or nonreligious people are more moral by the definition of having warm feelings toward others, I consider this uninteresting.

Okay, that was three subjects in three paragraphs and a footnote. I’m displaying some lack of focus on this post.


Christopher B said...

I think you got the part about 'some people will think health care is better regardless' part right assuming that means post-Obamacare. There are things on the margins that are 'better' depending on your perspective and definition. Removing pre-existing condition limitations helped some people get care. Some number of people got covered who weren't before though the number is far lower than the estimates previously given for the uninsured and almost all new coverage is from the Medicaid expansion, not the marketplaces. Balanced against this is the disruption of coverage for many, rapidly increasing premiums, and tight restrictions on coverage networks and high deductibles.

Many commentors point to their favorite change and declare healthcare to be better (or less costly, or other positives) without looking at a bigger picture. While I tend to feel that on the whole the Obamacare changes are not positive, I have to say that they don't seem to be significant except to people directly impacted by changes. I think that's going to make the blame for ending Obamacare more diffuse than we expected when it was implemented.

Sam L. said...

Shotguns spread the the load around. Worked for me, AVI.

Jonathan said...

Their impression that we are at last a “good country” will trump any health outcomes.

You see this effect also with other familiar kinds of policy proposal too, for example those re gun control or subsidized mass-transit. (Why can't we be more like the Europeans?) But do we see it happen as much with more novel issues like air traffic control privatization or autonomous cars? Maybe not.

Texan99 said...

I'll mention again, as I always do, that I used to have decent individual-market coverage I'd worked extremely hard to maintain, and now I have a garbage HMO policy that barely affects my risk of ruinous medical expenses in case of a serious medical emergency. I continue to pay out-of-pocket as necessary for high-quality medical care in ordinary circumstances and have been lucky so far. That sums up what the benevolent new law did for this household, anyway. Was it worth the cost to society at large? Did someone else get coverage for pre-existing conditions to balance out the destruction of my own coverage? Hard to say. I don't think the statistics support that conclusion, but perhaps they don't quite disprove it.

As for whether religious people give a better account of themselves under extreme conditions, I worry about the margins. I don't expect a lot of courage or decency under fire from the average casual nihilist, but then people in the grips of extreme religious convictions have been known to go horribly wrong, too. Whenever I am tempted to believe my religious principles are making me act better, I try to remember how easy it was for many people to conclude it was a good idea to burn heretics to death, not only for the good of society but for the salvation of the souls of the heretics themselves. I consider that a religious error and not an indictment of the religion, but it nevertheless is a temptation and a failing particularly associated with intense transcendental supernatural conviction: the stakes are so high that any price can seem reasonable, like cutting off a gangrenous limb to save a life. To be fair, of course, the argument often applies to intense idealogical conviction of any kind. Socialists burn heretics at the stake, too.

Earl Wajenberg said...

For a somewhat abstract take on religious belief and morality, I offer this essay on my web site: