Thursday, August 20, 2009

more on civility and the health care debate

Even for someone who grew up in New York, the health care debate--and the more general political discussion--is getting nastier and nastier. As I've noted both here and at my political blog [], much of this is indisputably coming from the right. But a matching and in many respects more insidious kind of escalation has lately been coming from the left, including many academics, as well.

Last week Frank Pasquale, a professor at Seton Hall Law School, posted "Of Rodeo Clowns and Health Care Despair" at the Balkinization blog. In it he referred to several arguments being made by health care opponents as "completely unhinged" and quoted another writer (Steven Pearlstein) saying that "Republican leaders and their ideological fellow-travelers" have become "political terrorists, willing to say or do anything to prevent the country from reaching a consensus" on health care. Dan Shaviro, in "Start Making Sense," refers to the "Republicans' hateful lying about death panels" adding that his arguments are aimed at those who are "sane and believe in civil society" but that "[t]he rest, apparently a large majority of their number, do not bear discussing." (In fairness, Shaviro also devotes substantial energy to discussing more substantive objections, including adverse selection and moral hazard, which he distinguishes from more emotional positions.) Writing not about health care but economic policy, Neil Buchanan at Dorf on Law describes Newt Gingrich, a senior Republican figure, as "peddling . . . outright lies and distortions" adding "there is precious little evidence that he has ever had an innovative idea in his life." In other posts he has referred to Gingrich as suffering from "partisan Tourette's" syndrome and suggested that he (Buchanan) would uncover the "excuses" of those who opposed his views on progressive taxation.

Language of this kind obviously won't convince anyone who doesn't agree with the authors: it is probably best understood as a metaphorical letting off steam in the midst of a heated debate that is not going particularly well for one's side. But it is enormously damaging, in a much more longstanding way--especially given the sources--than anything being said by opponents of the health care package. To see this, let's consider a few basic points:

1. There is nothing fundamentally irrational, insane, or otherwise illogical about opposition to the President's health care plan.--At a time of record unemployment and large and growing budget deficits, President Obama has called for dramatic expansion of the Federal Government's role in health care, while at the same time rejecting the funding mechanism (taxation of all or a portion of employer-provided health benefits) most often proposed as a way to pay for it. In the absence of any other obvious way to finance it, senior citizens and others have not unreasonably concluded that much of it will ultimately be paid for by reducing benefits that they now receive, a suspicion that has been further encouraged by repeated comments from Administration figures about the need to rein in, control, or prevent waste and abuse in Medicare and other existing health care programs. Their fears on this score may not reflect great generosity of spirit--one can make a pretty good case that more should be spent on younger and poorer people and less on older and wealthier ones--but they are hardly irrational and, indeed, no more selfish or mean-spirited than the behavior of any other group threatened with similar consequences. The allegation that these people are somehow being used by doctors, insurance companies, or other "special" interests is especially bizarre since most special interests in fact support the bill.

2. The attempt to divert attention from the underlying reasons for opposition to the bill, and focus it on a handful of rowdy demonstrators, is both empirically unconvincing and has distasteful historical precedents.--Every major poll shows large and growing opposition to the health care proposal and President Obama's overall performance, a skepticism which (at least on the first count) crosses party and regional lines. To attempt to discredit literally tens of millions of opponents based on the rowdy behavior of a few hundred demonstrators is--in addition to being bad politics--logically incoherent and morally untenable. It is also, to say the least, historically ironic: as several authors have pointed out, this is precisely the argument that was made against Vietnam War protesters and (earlier) civil rights demonstrators, who likewise had their share of rowdies but also had winning arguments and (eventually) majority support.

3. Even the most bizarre and extreme arguments being made by protesters, if exaggerated, contain important kernels of truth that should not be dismissed by policy-makers.--The two arguments most commonly cited as irrational are (i) the "death panels" suggestion and (ii) the distinction between Medicare and socialism (as in, no socialized medicine but don't touch my Medicare benefits). Obviously, these are not arguments that would be made by law professors. But neither are they wholly incoherent. The death panels argument reflects, if crudely, the fear that the new legislation will set spending priorities in a way that puts older and weaker people at the bottom of the barrel: hardly an idle fear given the rules in other national health care systems and the indifference that liberals have shown toward religious values on matters ranging from abortion to end-of-life issues. The socialism vs. Medicare argument--which I doubt anyone except President Obama has actually made--reflects a not unreasonable distinction between elderly people, who are uniquely vulnerable and may not have the ability otherwise to provide for their own health care, and younger, healthier people whose tradeoff between security and independence may be quite different. For similar reasons society provides financial protection for the elderly (social security) that is not extended, and which no one seriously proposes extending, to the remaining population. Again, this may or may not be a convincing argument--one could argue that children are more vulnerable than old people, and certainly a better investment--but neither is it irrational, incoherent, or reflective of a false consciousness.

Why do liberal commentators persist in a smear campaign that is both logically unconvincing and unlikely to gain them much political traction? It may help to reflect upon the life experiences of today's liberals and their view of recent history.

I think that most contemporary liberals--especially in academics--have never been exposed to serious conservative opinion, other than the law-and-economics version which is (in my view) more a bastard version of marxism than real conservatism, anyway. In particular, few of them have any grasp of the worldview identified with the evangelical and Catholic churches and their very real sense of Government as a dictatorial, anti-religious force in contemporary life. Unable to comprehend the underlying moral bases for opposition to abortion, gay marriage, or an overbearing Federal Government, they tend to place the opposition into categories they are more comfortable with--race, gender, economic self-interest--and attack it on that basis. Indeed, many younger liberals are not even comfortable with economic issues, seeing all opposition as based on "racism" or "bigotry" and the evil effects of television advertising.

One most also consider the liberal interpretation of recent political history. Eight years of the Bush Administration were rendered tolerable only by the sense of its supposed illegitimacy and the hope of something better after. The notion that Obama is less than a savior--that he is following a trajectory not essentially different from that of Carter or Clinton before him--is simply too much to handle. Unable to face the increasingly obvious fact that most Americans don't share their agenda, they turn to conspiracy theories.

What is most chilling about this kind of rhetoric--what I think makes it ultimately worse than anything the Republicans are doing--is its effect on young people. At the end of the day, nobody thinks that the town hall meetings are a model of political behavior. But today's students see their own teachers--the people they look to as role models--using words like crazy, unhinged, or liars to describe people that they disagree with on domestic policy issues. They see careers advanced, and reputations made, using terms that a fourteen year-old would be punished for using at the dining room table. What is going to be their future, and what will the effect of all this name-calling be when today's politics have long since been forgotten?


At 9:39 PM, Anonymous Richard said...

What does one expect the Left to do? The facts are not on their side, so they resort to ridicule a la Saul Alinski. Proponents of Obamacare want change. Therefore, the burden is on them to produce evidence in support of their position. To date, no liberal, including President Obama, has been able to muster a fact-based argument in support of their position. Every reliable study indicates that U.S. healthcare is the best the world has ever known. Of course, the Left would point to the WHO’s rankings. However, their metric is odd to say the least. Our healthcare system’s ranking is diminished significantly by gang violence and fatal auto accidents, yet their silly rankings do not even consider the fact that Americans are two to three times more likely to survive cancer than their European counterparts.

On a separate note, maybe a law professor wouldn’t make the “Medicare/Socialized Medicine” argument, but is it that unreasonable to argue that there should be a limit placed on social nets in order to preserve the virtue of productivity?

At 2:25 PM, Blogger Daniel Shaviro said...

This comment has been removed by a blog administrator.

At 2:40 PM, Blogger Daniel Shaviro said...

Michael, in response to your comment, I spent 8 years at the University of Chicago Law School and am certainly aware of conservative points of view. I am very thoroughly familiar with pro-market and libertarian ideas, and indeed am strongly influenced by them.

As I noted in my blog entry, I was leery of the Clinton healthcare plan, and only support the current one because (a) I have become persuaded over time that the U.S. healthcare market is badly screwed up and (b) there don't seem to be any reform alternatives right now. As I noted, the David Bradford healthcare plan which Bush I might have proposed had he won the 1992 election (with risk-adjusted vouchers) might well have been preferable to what these guys are ginning up. But it's pretty indisputable that the Republicans do not now stand for a responsible conservative-minded reform. So it really is the flawed Obama plan versus the flawed existing system.

Of course it's perfectly reasonable to oppose the Obama plan. But my point is that the people opposing it most prominently are either lying or out of touch with reality. The "death panels" lie is one good example. Yes, you are right that there could conceivably be some sort of concern about government officials (although also the existing system) giving seniors, say, insufficient priority. (Although I think this argument is incorrect - one thing the history of U.S. entitlements programs teaches us is that the seniors do way better than anyone else.) But whichever way one resolves this particular dispute, to shout "death panels" is dishonest and false - the relationship to the underlying concern is too attenuated and is not honestly presented by the lie.

This is not an "attempt to divert attention" from something or other. I am appalled by the hijacking of honest debate by liars and scoundrels, and yet agree that in an honest debate between people of good faith it's genuinely open which way it would come out.

To call it a "smear" to point out how people like Palin and Grassley have been lying about the bill is not a persuasive gambit on your part.

All the best - Dan

P.S. You and I actually agree more than all this make things sound. If the Republicans returned to where they were in the days of George H.W. Bush and Baker and Darman this would become much more apparent. You've evidently been angered by left-wing scoundrels in the academic world, whereas for me it's been right-wing scoundrels in the broader political world, and our emotional reactions to these stimuli pull us further apart in rhetoric and emotion than in underlying reality.

At 9:11 PM, Blogger Frank Pasquale said...

I was intrigued by your comment that "few of them have any grasp of the worldview identified with the evangelical and Catholic churches and their very real sense of Government as a dictatorial, anti-religious force in contemporary life."

As it turns out,

1) I have been invited by St. Thomas Law School to give a talk on the relationship between Catholic Social Thought (CST) and intellectual property this fall. I was President of the Harvard Catholic Students Association while there, and I have attended discussions of CST at Seton Hall Law. I also served as co-chair of the university's Mission and Identity Committee last year. I believe Catholic social thought is reflected in my articles "The Cost of Conscience" and "Two Concepts of Immortality."

I am deeply aware of the tension between solidarity and subsidiarity in encyclicals on CST, having read them and some of the secondary literature on them. But I think it is morally clear that the poor and uninsured deserve insurance, and I can find support for that position in both encyclicals and pastoral letters of the USCCB.

I advocate for health reform partly out of my Catholic faith--my sense that we need to care for those on the "margins of the circle of life" (as Father Bryan Hehir would put it). I am mystified by those who would prioritize a dogmatic libertarianism over, say, health insurance for children (as I saw during the SCHIP debate).

2) As for a sense of "Government as a dictatorial, anti-religious force in contemporary life:" Along with Danielle Citron and Patricia Regan, I organized a panel at Maryland Law School earlier this year on new tactics of surveillance by the federal government that pose extraordinary threats to freedom and autonomy. I've read Sheldon Wolin's "Democracy Incorporated" and find his diagnosis of the integration of state and corporate power quite worrisome. Finally, my article "Technology, Competition, and Values" worries that both the state and market can create dynamics that erode traditional belief systems and replace them with a sterile and neutral pursuit of "productivity" and pleasure. In short, I recognize that both state and market actors can threaten freedom and religious values.

To conclude: I find much in the current health reform bills objectionable. But I can't ignore the plight of the kids in Newark living through the pain of a lack of dental care, and trying to learn in school while suffering through the pain of rotting teeth. I can't ignore the thousands of Americans who have to choose between paying for insurance for their kids and putting food on the table or paying the electric bill. I find it tragic that we have over 18,000 preventable deaths a year in the US due to lack of health insurance.

And I will continue advocating for social justice here--even if some find fantasies of death panels more interesting to contemplate than the suffering that real health reform would help end.

At 3:41 PM, Anonymous Richard said...

1. I’m not sure why people like Palin have received so much criticism over the death panel issue. I grant that she may be guilty of exaggeration, but her fears and claims are warranted and correct by default. First, Palin’s fears are warranted because it’s perfectly possible for a future generation, not as virtuous as our own, to interpret the “end-of-life counseling” clause not in favor of granny given the prevalent use of dynamic interpretation theories. Second, Palin’s beliefs are correct by default. My family comes from socialized medicine, and it’s customary to ration care to the elderly and terminally ill. I’m not suggesting there literally is a panel deciding whether granny lives, but the metaphor is right on.

2. There is no reliable study indicating that a significant percentage of inner-city children suffer from untreated dental ailments.

3. 18,000 deaths are attributed to lack of insurance, but the figure could be misleading because the IOM study does not consider life choices of the uninsured. If the 18,000 figure is to play a role in this debate, it should be cited side-by-side with the number of lives saved each year given that Americans are 2-3 times more likely to survive cancer than their European counterparts.

4. No provision of the Constitution states that the poor deserve healthcare, and it’s not clear why providing them free care is moral. For starters, Americans’ definition of ‘poor’ is ridiculous. By global standards, the poor in this nation are well-off. We’ve been so rich for so long that we’re gullible enough to believe that the overweight, homeless man begging for change really doesn’t have enough food to eat. My friend administers welfare checks to the ‘poor’ and has access to their bank accounts. So often, the ‘poor’ spend their entire checks at Macy’s and similar stores. I do not deny that some Americans face tough choices when it comes to the essentials, but included in the analysis should be the $400 Macy’s spending spree and the availability of cheaper options on clothing.

Where does it stop if everyone deserves healthcare? Why wouldn’t every person then deserve housing, employment, and free transportation? The issue isn’t what people deserve, but rather what they have the opportunity to attain. People fall through the cracks in any healthcare system, but there is no reliable study indicating that a non-negligible percentage of Americans are denied the opportunity to be insured. Providing free healthcare to those possessing the opportunity to attain it is unproductive—not moral. Free healthcare, of course, is not free. The wealthy will pay for it. Punishing those exercising their opportunity to attain healthcare, while rewarding those who do not, is immoral and does not strike me as equal protection under the law.

At 5:16 PM, Blogger Frank Pasquale said...

To Richard:

Try googling

"dental care" studies disparities

Here are some results I get:

"Most US children enjoy good oral health but about a third do not. Significant and
consequential disparities in oral health continue for low-income, minority, and special needs

"Disparities in dental insurance coverage and dental care among US children: the National Survey of Children's Health."

"Racial and Ethnic Disparities in Medical and Dental Health, Access to Care, and Use of Services in US Children"


At 8:04 PM, Anonymous Richard said...

I should have been clearer. My point was that there is no reliable study indicating a significant percentage of inner-city children with rotten teeth. Of course there are disparities, but that doesn’t mean their teeth are rotting. Unfortunately, there are also disparities in socialized medicine.

I’m not a dentist, but my guess is that daily brushing and flossing, and modest sugar intake reduce tooth decay significantly. Do we really have to socialize our healthcare system in order to remind children to brush? Can’t we just have teachers take five minutes to explain the importance of dental hygiene to students and parents?

In my view, the studies you’re citing reflect poor parenting and prioritizing—not a broken healthcare system. I agree these problems should be remedied, but I’m not sure the answer is spending money on a new bureaucracy when we’re teetering on the line of depression and waging two wars. We can’t even figure out existing entitlement programs. President Obama claims these programs benefit seniors, but it’s not clear how it will benefit them in the future. Anyone born this decade has a 4% chance of receiving Social Security benefits upon retirement.

At 2:13 AM, Anonymous Jefferson said...

Sorry, but I completely disagree with your post. I have just spent four weeks in the US (I am an American living abroad), and it seems to me that only opponents of the President, such as Glenn Beck, are guilty of using objectionable rhetoric and tactics in the public debate of the Administration's healthcare proposal. They effectively make an intelligent debate impossible. The sensible people who point this out are not doing anything wrong. Their criticism of Beck and similar ranters is perfectly justified. If facts are being distorted or simply made up, it is important for young people and others to know that. If purported arguments are nonsensical, it is important to say so. If someone persists in making idiotic statements, it is not wrong to call him or her an idiot. If in addition the statements are made in bad faith, it is appropriate to dismiss the speaker and his or her statements as unworthy of consideration.

At 11:13 AM, Anonymous Richard said...

This is a prime example of what I was referring to in earlier comments. The Left is unable present their points in the form of substantive argument. Even accomplished law professors are unable to present fact-based arguments in support of a single-payer system or against its critics. It has become cosmopolitan to label Glenn Beck as a nut, but why are his substantive arguments nonsensical?


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