Political Confessional Threadi

[Jon Miller]

I have been a Democrat since 2015 or 2016, when I voted for Bernie in the 2016 primary (I may have joined a bit before that with the intention of voting for Bernie).

I have been a Democrat ever since. Previously, I favored compassionate conservatives or populist progressives (as most people, I am complicated), but since January 2021, I have been an establishment Democrat. I was definitely in the populist progressive camp from 2012-2020, but I was wrong (I also voted for Bernie in 2020, but I was not as sure about it; I should have voted for Biden).

I don't believe that there is some populist progressive majority that is being kept down. Most likely, it would be better if low-information voters did not vote. I am scared of right-wing or left-wing demagogues (the right-wing ones are in power).

I think that the establishment Democrats that I support are out of touch and too comfortable, and so they don't act when they need to. While I didn't like Newsom and wanted him out in 2020/2021, I think he is engaging and acting, unlike Schumer. The same is true for some other governors. This is generally not true for national-level establishment Democrats.

Israel is finally losing me this year, although I think that Kamala had the correct position with respect to Israel in 2024.

I think that small donors might be even worse than big donors because big donors want some policy due to their donation, while small donors seem to be happy with just more small donors (which is different from actually winning and changing policy). Big donors wouldn't donate if they didn't get delivery, while small donors continue to donate without delivery.

I think the progressive left is missing the fact that right now, we need a supermajority to resist the reactionary populists and defend democracy. The only progressive group is left-wing whites. Every other group is more socially conservative (for example). Pushing on progressives isn't going to end up with a progressive populist rise in 5 years or 10 years. If we are lucky, it will end with us becoming Argentina in some decades.

Populist movements usually end up hijacked, and you get suffering. Peron is way better than Pol Pot. This is why I support establishment Democrats (establishment Republicans are basically dead). I have kids. I want them to grow up safe and prosperous.

JM

[Jon Miller]

I still want national health care. I still want a basic income.

But more importantly, I want freedom of speech, due process, the rule of law, and democracy. These are more important to me than reasonable gun control, national healthcare, basic income, free college education, and other policies I think are best.

JM

[Agathon]

Worth reading this article from Joe Health, who teaches at my alma mater. He's the one who reminded me of the "American Libertarianism" joke.

https://josephheath.substack.com/p/my-two-cents-on-abundance

[Elok]

Not even going to get into what's wrong with Aeson's take on (specifically American) healthcare. There's too much I wrong, I don't have infinite time, and I have a bit less of an appetite for argument on the internet since I became a dad. In the spirit of addressing what you said, Agathon, I'm certainly not going to go to bat for any part of American bureaucracy, but I don't like the idea that our solution is going to be to copy what other countries have done. Human beings are not fungible, culture matters, and I don't want America to be Germany, or Canada, or Australia. America's healthcare system is insane, and it is devouring our wealth, but I think the solution is going to have to be uniquely American. That is going to involve a much more free-market approach. We don't have anything remotely like a free market approach. You are correct that actual socialism would be better, because what we have isn't a market at all, it's a cloaked feeding frenzy subsidized by debt, and it's rapidly approaching collapse.

That said, I think part of the reason American bureaucracy sucks is that the process of hiring American bureaucrats sucks. I have worked for the census and the dcf, briefly in both cases, and back in the day I tried applying at USAjobs.gov (I think that was the URL) and oy, what a miserable stupid slog it was. Just getting hired is a tiresome burden, the rules are pedantic and asinine, and the whole system is set up to prevent innovative or intelligent candidates from drawing interest to themselves, because that wouldn't be fair. Who on earth would sign up for that if he had a choice? My father was a career bureaucrat with NIH, and very intelligent, but he stayed with the Feds because his personality was so difficult that he would likely have gotten himself fired from the private sector.

EDIT: Also, thank you for the link, Agathon; the writer seems interesting and I'm always glad to diversify my wonk-thought intake.

[Agathon]

I'm certainly not going to go to bat for any part of American bureaucracy, but I don't like the idea that our solution is going to be to copy what other countries have done. Human beings are not fungible, culture matters, and I don't want America to be Germany, or Canada, or Australia. America's healthcare system is insane, and it is devouring our wealth, but I think the solution is going to have to be uniquely American.

NP. Elok. Joe is one of the best philosophers writing about this sort of thing.

Back to the topic. If that’s the case, then I don’t think the future looks good. I have a personal saying that goes like this: “In any seemingly intractable problem, the thing that people could, but are least willing to give up, inevitably turns out to be the cause.” I’m sure someone like Mark Twain could put it more succinctly, but that’s the best I can do.

[Elok]

HAHAHAOHLORD okay, so I said I wouldn't get into it, but this is just perfect: https://pnhp.org/news/insurers-avoid...-subsidiaries/

Found this while trying to look up the exact law(s) capping insurers' profits. There is, in fact, a law about that; they can't retain more than X% of premiums, period. If they do save that much, they have to give it back. This sounds superficially sensible but is actually a massive perverse incentive; since they can only sign up so many people, this rule puts them in much the same position as a salesperson working on commission. Their best hope of getting more income is to make no or limited efforts to contain costs, since that will justify raising premiums and letting X% be X% of a bigger number. I guess you can call this "greed" if you believe "greed" can refer to not making a special effort to screw yourself out of free money. And if you look at that PDF I shared--did anybody do that?--you'll see that table one shows premium income doubling since 2014, in near-perfect lockstep with expenses. I believe a similar rule applies to hospitals in some contexts, where they are allowed to pass on costs plus a percentage. But I got that from a book written ten or more years ago.

Anyway. We, as a country, are determined to believe that insurance is the problem, not in the sense of acting as a blind or smokescreen but in that, you know, we interact with them and they're always denying our claims (because they can't allow costs to substantially exceed income, only grow at a predictable rate) so we assume they're sitting on a pile of money. This extends all the way to the argument seen in this webpage: insurers are getting around the profit limit by owning the people they pay! The implication is that the problem we need to worry about is not money wasted but the mere fact of insurance companies getting more money than we want them to. Because that's the actual problem here. Not that we spend too much money, that some percentage is going to people we don't like. The subtext--that UHC has found a great way to get in on somebody else's superior hustle--is completely ignored. Why? Well, the group here is called "Physicians for a National Health Program," and that might be a clue. There is, in fact, a group of people getting quite rich from healthcare costs. But they don't directly pass us the bill, and they're the people who actually make us all better, so we like them. Damn you, insurance! Damn you to hell!

[Aeson]

Congratulations on noticing one of the perverse incentives of our healthcare laws. Another is with employers who avoid giving full time work to avoid healthcare costs.

But you're missing the forest for a couple trees you myopically focus on.

We spend $4.7 trillion a year on healthcare. $14000 per person. OECD average is $6500 per person. Australia is at $6900 per person. Australia has a higher life expectancy and better health outcomes than we do. As do a few other OECD. We are slightly above average for life expectancy and below average on most health outcomes metrics.

It's actually not as close as that sounds either. We pay $1.5 trillion a year to service the debt, a majority of which was built from healthcare costs. We also pay more for everything because of the inflation caused by that deficit spending. Both of these things are compounding.

We also leave millions without access to healthcare, so the per person cost of those actually able to access healthcare is higher.

But luckily you're here to protect the giant corporations and their $billions in profit being stolen from your kids' future.

[Elok]

What on earth are you talking about? I'm specifically addressing (some of) the reasons why the waste happens. You're just gesturing in the direction of insurance companies (because GREEDY) and ignoring the specifics of what I say. Which was, in fact, part of the reason why I was initially reluctant to even get into this. I don't contest that we waste a ton of money on healthcare. I'm not getting into the Australian system, or anyone else's, because I don't have time to do the kind of digging that would require and frankly it's irrelevant. I don't need to know how they do it right, if they do it right. I already know what we're doing wrong! And I know for a fact that you are pointing at the wrong problems. The amount of money captured by insurance is pitiful compared to the amount sloshing through into specialists' pockets. $22 billion is something like a tenth of Elon Musk's net worth, and an absolutely contemptible fraction of the $4.7 trillion you just cited. You're complaining, in essence, that one of the largest private insurers in the nation is making a visible profit at all. Quick googling says that the best guess we've got for Medicare/Medicaid fraud is $100 billion per year, and that's basically extrapolated from what they happen to catch.

[EPW]

Elok is very smart and he should get a trophy.

[Aeson]

What on earth are you talking about? I'm specifically addressing (some of) the reasons why the waste happens. You're just gesturing in the direction of insurance companies (because GREEDY) and ignoring the specifics of what I say. Which was, in fact, part of the reason why I was initially reluctant to even get into this. I don't contest that we waste a ton of money on healthcare. I'm not getting into the Australian system, or anyone else's, because I don't have time to do the kind of digging that would require and frankly it's irrelevant. I don't need to know how they do it right, if they do it right. I already know what we're doing wrong! And I know for a fact that you are pointing at the wrong problems. The amount of money captured by insurance is pitiful compared to the amount sloshing through into specialists' pockets. $22 billion is something like a tenth of Elon Musk's net worth, and an absolutely contemptible fraction of the $4.7 trillion you just cited. You're complaining, in essence, that one of the largest private insurers in the nation is making a visible profit at all. Quick googling says that the best guess we've got for Medicare/Medicaid fraud is $100 billion per year, and that's basically extrapolated from what they happen to catch.

You're hyper focusing on one portion of what I've said, ignoring the rest. Of course one slice of the problem isn't the entire problem.

But $25 billion a year, with compounding interest (servicing the debt) and inflation. It adds up fast. Could save a lot of the 600,000 families who go bankrupt each year with just the profits from one corporation.

You admit you are ignorant of Australia's healthcare system, but that didn't stop you from claiming I was wrong to suggest copying their homework. You are ignorantly arguing against proven solutions to the problem.

You claim we need a uniquely American solution. We have the American "solution", and it sucks. Roughly $3+ trillion a year in excess profits to corporations, investors, and even foreign nations, most of it deficit spend which is essentially stealing from our children.

Making it a more market based approach will not fix the problems the market based approach (eg. maximize profit, use those profits to buy politicians) has created. Our healthcare system sucked before the ACA. The 80s "greed is good" and "trickle down" have destroyed everything they've touched. Yet you're here valiantly defending the poor insurance companies that only have tens of $billions in profits stolen from our children, while 10s of millions suffer without healthcare access.

[EPW]

aeson doesn't accept the wise benedictions of Milton Friedman and is thus a BIG DUMMY. For shame

[Aeson]

You're complaining, in essence, that one of the largest private insurers in the nation is making a visible profit at all.

That is a small part of my complaining, but yes, there should be $0 profit until everyone has healthcare and we have a balanced budget.
$25 billion directly by one corporation in one year. While 600,000 American households go bankrupt. While 10s of millions suffer without access to healthcare. While we add $trillions a year to the debt.

The execs, board, and politicians responsible should be in prison. Just because it's only a small fraction of the total problem does not make it not a problem.

That $25 billion has been stolen from our children. And they will pay compounding interest on it forever.

[EPW]

It's greedy doctors screwing the children. Get it together, Aeson.

[Lorizael]

To keep to the thread topic: as usual, a very weird misreading of Elok's position by my nominal allies on the left.

[EPW]

Lori, sporting a modest image of Albert Einstein, also gets a trophy.