Politics Discussion Thread August 2012

It seems suboptimal to only use a single poll result when we have a lot more data available. For example, there was a poll here.

which may be continued or discontinued based on its success or failure.

This thread and the other rare times I see LW commentators political leanings make me see how radically I have miscalibrated my estimations of them. This is useful information of a sort. It is probably helpful for people to be reminded that 'rational' people can disagree with them.

Whether the quality of the actual discussions is much above what you'd get on any other forum I don't know, it seems notably more aggressive than standard LW discussion.

If on the other hand you think of redistributing income as a sub-goal of increasing everyone's living standards, say, then this statement is highly dubious.

It is well established that the marginal utility of a dollar is higher for poor people than for rich people, so in the short-term, net utility is trivially increased by redistribution even though not everyone's utility is increased. Tossing out all net improvement because some people lose a small amount to support large gains elsewhere seems like poor policy to me.

But I am interested in the longer term, not the shorter term. In the long term, arguing against redistribution is the concern that productive people will be disincentivized to use their talents as much if they can't accumulate more compared to a non-redistributionist scenario. Arguing for redistribution is a concern that the more unequal a society, the less basic cohesion there is with multiple bad long term results: 1) the more force (police, eavesdropping, limitations on political expression) must be used, 2) reduced input into the education of the poorer classes, resulting in less talent developed at higher expense within the society as a whole.

The 2nd point is a little subtle. People tend to sort themselves into what they are good at. If all N people in my society have access to education, I'll have a reasonably close to optimum self-sorting of people into jobs that they are talented at. If instead my society has stratified, and only 10% of families have the resources to educate their children to be doctors, lawyers, and indian chiefs, and the rest wander the streets selling chewing gum to passing tourists and mowing lawns, then I the most productive cadre of my society will be reduced in efficiency since it is drawing its talent from only one-tenth the human resources it would have drawn from in a more equal society.

So my reason for supporting redistribution is to keep the talent pool large so we don't pay an excess in training costs for a more mediocre top layer in our society.

Well, that depends on what you mean by "increasing everyone's living standards." If you mean "people have square-root-shaped utility of money, so moving money from rich people to poor people increases total utility," then all that really matters is the redistribution. If you mean "by increasing economic activity, since poor people have lower rates of saving, thus creating more wealth," then... no, wait, the redistribution is still pretty much what matters.

Ah! If you mean "giving poor people more opportunities, thus leading to better use of human capital, increasing everyone's living standards," then you want to give the most help to the poor people who are going to take new opportunities based on more wealth. The question is then, do you have anything in mind when you refer to things that are better than, say, a public education system at providing poor people new opportunities?

It is supposed that ability in managing wealth is necessary merely to maintain it, and therefore class mobility is not as rigid as opponents of wealth inequality would argue.

How many people born to very rich parents end up very poor because they are bad at managing wealth?

Seriously, when I look at wealthy people, I mostly see people born from the right vagina. Or in some case people with good genes but mediocre memes (think about sportspeople or models).

This explanation is clear. Thank you.

Very often health care isn't a finite resource.

If you run a hotel you will seldom have all of your beds rented out. If you run a hospital you usually have all of your beds filled with patients. Why? The doctors in the hospital advice the patients in a way to seek treatments to fill all the hospital beds. A hotel manager has no way to archive a similar effect.

When it comes to big pharma drugs, there a huge cost to find a new drug but a much smaller cost to produce the actual drugs. When you use a drug on 10,000 people instead of on 100 it even becomes better because doctors learn more about the side effects of the drug.

A lot of illnesses are contagious. Even obesity might be. Treating everyone will increase the health of the elite that you are worried about.

Healthcare is a lot more complicated than simply being a "finite resource".

This appears to be the Circulation study that you cite: Kahn et al., 2008, "The Impact of Prevention on Reducing the Burden of Cardiovascular Disease". The full-text is free.

The authors of the Circulation study estimate that fully implementing all eleven prevention activities which they discuss would increase US medical spending by $7.6 trillion during the next 30 years, increasing medical spending on cardiovascular disease, diabetes, and coronary heart disease from $9.5T (their baseline estimate) to $17.1T (with $0.9T in savings from better prevention more than offset by $8.5T in new preventive spending). *

Note that these numbers are only for the effects of preventive care on medical spending; they do not include the health benefits of the preventive care. The authors also estimate that fully implementing the prevention activities would prevent 63% of all heart attacks and 31% of all strokes, increasing adult life expectancy by over a year. In total, the $7.6 trillion would buy 244 million additional quality-adjusted life-years, for an average cost of $36,380 per QALY.

* I notice that I am confused: the number "162%" appears in the paper in reference to this spending increase, but I can't figure out what it refers to. Going from $9.5T to $17.1T is an 80% increase.

What’s the real-life actuality in the United States today? A study in the journal Circulation found that for cardiovascular diseases and diabetes, “if all the recommended prevention activities were applied with 100 percent success,” the prevention would cost almost ten times as much as the savings, increasing the country’s total medical bill by 162 percent. Elmendorf additionally cites a definitive assessment in the New England Journal of Medicine that reviewed hundreds of studies on preventive care and found that more than 80 percent of preventive measures added to medical costs."

A number of people, myself included, find it suspicious that after years of advocating preventative medicine, a bunch of studies against it are coming out just after Obamacare was passed.

Prediction: If Obamacare gets repealed these studies will be refuted by subsequent studies, whereas if it stays on the books, these studies will become the baseline of a new consensus.

Working with your example: If we assume the government health service is behaving in its own self interest, why would it spend money on test that it knew not to be cost effective? Whereas if the incentives are split between a Dr ordering a test and an insurance company paying for one wouldn't they disproportionately order tests?

More generally, even if its true for particular testing procedures theres lots of low hanging fruit for intervention before things get severe. The most obvious examples would be schemes to get people to stop smoking or lose weight, that the government provides freely because they are less expensive than the projected cost of the illnesses that would arise without such intervention. Also the ability to see a general practitioner more regularly than if you paid per visit means symptoms can be picked up earlier (e.g. if someone has a mild symptom but has to pay to get it checked they are disincentivised to get it checked until it becomes severe.)

Of course finding cancer early while it can still be operated on is VASTLY more expensive than letting people die untreated. Not only do you pay for the tests on the people that don't have it, you pay for the tests on the people that do have it, and you pay for the treatment once it is discovered.

Perhaps there is some other benefit to preventive care that makes it worth more money? How does the health of someone who has avoided a heart transplant through early detection and treatment of heart disease compare to that of someone with a heart transplant, for example? How does the lifespan compare?

WIthout putting a price on the BENEFITS of the different mix of outcomes, it is impossible to know whether the COSTS of the preventive approaches are worth it or not.

No, preventative medicine does not save money, and there were people who believed that. But it may save some lives and improve many more lives. That has to be studied (and if already studied, discussed) before preventative care is tossed as a waste of money.

If the benefits of preventative care are realized over the rest of the patient's life, then an insurance company is only incentivized to pay for it if they are obligated to insure you for the rest of your life. Which is true for gov't insurance, but not for any private insurance I am aware of. Even requiring any insurance company to insure any person in the group at any time they ask for it is not enough to change the insurance company's incentive: they would still be wise to "free ride" on any other preventative care payer than to pay for it themselves.

1) the same argument applies to private insurance companies.

My understanding is that US insurance companies pay for some treatments but not others depending on the cost of the insurance?

2) governments try to maximize votes in the next election which really isn't conducive to long term planning.

True. The times where this would be relevant tend to be questions of "should we treat illness X", often 'photogenic' illnesses get disproportionately treated (e.g. breast cancer). But I would imagine similar issues exist in terms of customer demand and legislators forcing insurers to pay for treatments (which you mentioned above). Also, given the choice between a mild bias to popularity and a heavy one to wealth in spending distribution I thought have thought the former would have better outcomes.

General infrastructure planning tends to be decided on long term efficiency as its not a day to day political issue.

3) There's still the perverse incentive to encourage people to die in cheap ways.

Possibly, but the dead don't tend to pay taxes, I would imagine other than in the very last stages of life a living citizen is more valuable than a dead one.

Interestingly the NHS spends a lot of money on people in the final stages of their lives, while they could save a lot money by legalising or enforcing euthanasia, so that seems a counterexample.

Wouldn't the state have to own the hospital to alter the actual care?

In fact, that's how the UK's NHS works. It's like the US's VHA, where the government actually provides health care. It's unlike the US's Medicare, which is "single-payer" because the government pays for everything, but the money goes to private hospitals and doctors who actually provide the health care.

See http://en.wikipedia.org/wiki/Single-payer_health_care and http://en.wikipedia.org/wiki/Socialized_medicine for more information. From the latter:

The original meaning was confined to systems in which the government operates health care facilities and employs health care professionals. This narrower usage would apply to the British National Health Service hospital trusts and health systems that operate in other countries as diverse as Finland, Spain, Israel, and Cuba. The United States' Veterans Health Administration, and the medical departments of the US Army, Navy, and Air Force, would also fall under this narrow definition. When used in this way, the narrow definition permits a clear distinction from single payer health insurance systems, in which the government finances health care but is not involved in care delivery. More recently, American conservative critics of health care reform have attempted to broaden the term by applying it to any publicly funded system. Canada's Medicare system and most of the UK's NHS general practitioner and dental services, which are systems where health care is delivered by private business with partial or total government funding, fit this broader definition, as do the health care systems of most of Western Europe. In the United States, Medicare, Medicaid, and the US military's TRICARE fall under this definition.

In general private enterprise does a lot better than the government.

Does it? Thats a pretty broad statement, and even if it does in general that doesn't mean it does in particular cases. The obvious counterexamples are natural monopolies, e.g. water, roads and I would argue healthcare.

It's not like government healthcare has very direct incentives,

The main incentives are voter pressure for better healthcare and the cost of various infrastructure and treatments. As the public generally demands healthcare be at least as good as it has been before, if not better, there is an incentive to be efficient in allocating cost to healthcare.

From what I understand, there is massive overspending on healthcare in the US,

A large part of the problem is that since private insurers don't have that much political power, politicians can score points by passing laws requiring them to cover certain procedures, which may very well not be cost-effective.

No, I mean both "Christian" and "progressive" in a fairly conventional sense. It's just that while I'm aghast at MM's policy suggestions, I love his analysis of social history, at least the parts of it based on his idiosyncratic outside view.

He has a very poor understanding - indeed, a denial - of the emotional factor in society and the internal workings of ideology/religion, he's very US-centric and really ignorant of more collectivist societies (e.g. Russia or Japan - he has never once written a single illuminating sentence about them), he rarely admits that his enemies can be simultaneously honest and intelligent.

However, many of his key points - the identification of truly history-making social forces ("the Clergy" et al.), Pronomianism vs Antinomianism, Leftism as a fundamentally Neoplatonic/Christian current, etc - that's where he makes more sense than most other writers on the topic(s). Well, some very modern leftists, like Zizek, do approach such analysis at times - but with insufficient clarity, I'd say.

So, I endorse his broad sociological description (with caveats), but I'm in complete and utter normative disagreement with him on nearly every issue. E.g. I believe that "Antinomianism" is indeed morally superior to "Pronomianism", because living through a system of artificial bindings - local, unequal, justification-free bindings - is in my opinion an affront to humanity's better side, and that outweighs the material benefits of "law and order". I think that certain states of being and feelings - especially social ones - are a more worthwhile thing for humanity to pursue than hedonism or QALYs. And many other such things, which IMO leave me in fundamental ethical opposition to him and his allies.

P.S. Please note that my caveats about his description of reality are major ones, and even the post on Pronomianism vs. Antinomianism, which is one of his high points, contains many absurd statements and general misinterpretation of human behavior. Yet it is intellectually stimulating to an extraordinary degree, unlike saner writings. And that's the entire point to me.

P.P.S. I have just reread that post myself, and noticed with great amusement that M.M., like me, also examines Zizek's view of social ethics - then he pronounces Zizek an incarnation of evil and the Devil's emissary on Earth. It is refreshing to see my morals opposed with such mirror clarity. Here's what he quotes from Zizek:

The Benjaminian "divine violence" should be thus conceived as divine in the precise sense of the old Latin motto vox populi, vox dei: NOT in the perverse sense of "we are doing it as mere instruments of the People's Will," but as the heroic assumption of the solitude of sovereign decision. It is a decision (to kill, to risk or lose one's own life) made in the absolute solitude, with no cover in the big Other. If it is extra-moral, it is not "immoral," it does not give the agent the license to just kill with some kind of angelic innocence. The motto of divine violence is fiat iustitia, pereat mundus: it is JUSTICE, the point of non-distinction between justice and vengeance, in which "people" (the anonymous part of no-part) imposes its terror and makes other parts pay the price - the Judgment Day for the long history of oppression, exploitation, suffering...

I find this... a little scary, yeah - certainly not to be immanentized rashly - but beautiful and inspiring, sublime. We are at war, then.

As a seperate point, I think it should be on the nation (or clade or patchwork city) to provide food, medicine, etc. to its people, which is a progressive idea. Sort of like Moldbug's idea of a nation wanting to have good customer service, but moreso.

From my point of view, I think royalty is too much of a single failure point, and would approve of a small council being rulers instead.

Oh, sure. In fact, most of their stuff is bang-on. Here's another one for LW: "Stars".

I was arranging links in a "title - author" format, so naturally the article's title, which is that entire quote, was to be followed by Zizek's name. I have, in fact, read the article in question (otherwise I wouldn't have linked to it, right?), so I am quite aware that Zizek was quoting the other guy.

Norway might not have a death penalty, but Norwegians are probably OK with having a military, and a military's role does cover stopping violent insurgents with lethal force. What it does is defence, not judgment. Like I said, by accepting Breivik's narrative of his "insurgency", Norway can use an extraordinary circumstance to justify an extraordinary response, and then return to "normality".

(Jeez, I just realized this sounds a little like Carl Schmitt. Ah well, fascist times call for fascist measures.)

A related outside view observation: Whenever a Green attempts to give the Blues tactical advise, no matter how well-meaning, the advise always seems to boil down to compromising on at least half the Blue positions.

That's a great point that I didn't consider.

You can argue the slippery slope all you want, but the fact is, human beings are being killed (as they believe) while they stick to their guns.

People are really, really bad at taking action in response to this kind of thing. Selling people on "if you care about human lives, it matters how many of them you save, and you can get information about that" is tricky and about 90% of the concept of optimal philanthropy.

That is a mechanism by which availability of birth control could theoretically increase abortion; do you have any empiricism handy?

Long lasting birth control exists and the various methods have much lower failure rates than the once-a-day pill.

Here's a large analysis from the Guttmacher Institute about rates of contraception use vs. rates of abortion. Increased contraception use along with improving methods dramatically reduces the abortion rate.

While Planned Parenthood clearly could be biased, they state (noteably without a reference) that " Women typically pay between $15 and $50 a month in co-pays for birth control pills — $180 to $600 a year." Even $180 is pretty expensive.

They also claim that " More than one-third of all women voters have struggled to pay for prescription birth control at some point in their lives, and have as a result used birth control inconsistently."

Finally, "On average, a woman spends 30 years of her life trying to avoid pregnancy. That means 30 years of paying for birth control."