Featured Post

This Party Cannot Be Saved

When is it time to pull the plug?  When is it time to give up?  When is it time to realize that someone or something has done something so beyond the pale that you have to walk away?

I think I’ve reached that point with the Republican Party.  It has been my philosophical home for 15 years and I am still more conservative/libertarian than a Democrat.  But I have come to a point that the party is reaching a point of no return, a point when it stops being a conservative party and it becomes something else: a nationalist party based on the grievances of the white working class.

As I watched the Republican convention in Cleveland two weeks ago, hearing how brown people were a threat, I realized that there will be no “retooling” of the GOP after this election.  I realized that after the 2016 election season, there will not be a party left to save.  The Republican Party, as we have known it, will be dead.  A new one is arising within the old and that will be the GOP of the future, one that is very different from anything we have seen before.

I said in an earlier post that California Governor Pete Wilson’s backing of an anti-immigrant measure in the 1994 election marked the beginning of the end of Republican power in the Golden State.  Latinos were never going to vote for the party after that and, over time, neither were other demographics.  California today is virtually a one-party state and that can be traced to Pete Wilson’s tragic gamble.

Donald Trump’s campaign against Mexicans, Muslims, African Americans, women, and others will turn off a good chunk of the rapidly changing American electorate.  He has made the party so toxic to nonwhites that there is a good chance nonwhites who were attracted to the GOP (like myself) will not come back after November.

GOP Health strategist Avik Roy, himself a nonwhite Republican, believes that the party has given itself over to white nationalism.  In his view, this has been part of the party since 1964, when Barry Goldwater’s opposition to the Civil Rights Act made it possible for white nationalists to come over to the GOP.  That was also the year that the GOP would lose the African-American vote for good.  Before ’64, the party was garnering 30-40% of the black vote.  Afterwards, it was somewhere between the single digits to the teens.

None of this means conservatism is inherently racist.  It does mean that one of the guiding forces of the Republicans since the mid-60s has been white nationalism, something that conservatives, especially conservative intellectuals, have denied. Roy notes,

It’s a common observation on the left, but it’s an observation that a lot of us on the right genuinely believed wasn’t true — which is that conservatism has become, and has been for some time, much more about white identity politics than it has been about conservative political philosophy. I think today, even now, a lot of conservatives have not come to terms with that problem.

Because conservative intellectuals and others were in denial of this fact, they weren’t able to stop Trump when he pulled back the curtain:

This, Roy believes, is where the conservative intellectual class went astray. By refusing to admit the truth about their own party, they were powerless to stop the forces that led to Donald Trump’s rise. They told themselves, over and over again, that Goldwater’s victory was a triumph.

But in reality, it created the conditions under which Trump could thrive. Trump’s politics of aggrieved white nationalism — labeling black people criminals, Latinos rapists, and Muslims terrorists — succeeded because the party’s voting base was made up of the people who once opposed civil rights.

Some conservative writers, like Ross Douthat, point out that many of the people who moved to the GOP after ’64 are no longer alive. That’s true, but ideas have a way of outliving the people who gave birth to them.  Add to that, that the message resonates with the white working class that has been dealing with social and economic disruption, and you can see how these ideas still have life.

Trump uncovered something that had been latent in the GOP.  It cropped up now and then, like Pat Buchanan’s campaign for President in 1992 and 1996, but then it would be swept back under the rug. But now that this has been uncovered, it is becoming mainstreamed into the party. You can’t go back.

There are some who believe all we need to do is retool and get the GOP ready for 2020.  But the problem is, you can’t now try to reach out to minorities when many in the GOP leadership were willing to support Trump even though they knew who he was.  Reince Priebus can’t put out another autopsy after he so blatantly ignored his own report this year. What’s to say he wouldn’t ignore that one too?

The party has lost credibility among young adults and various nonwhite groups such as Latinos, Muslims and African Americans.  When push came to shove, the party leaders backed a known racist.

Which means that there needs to be a serious attempt to define a conservatism that is inclusive.  There needs to be a new party that is right of center and works for all Americans, not just those of European origin.

Will that happen?  Only when more conservative intellectuals are willing to see that the GOP can’t be saved.  It has become like rotten milk, curdled by racial and ethnic animosity.

This is a hard acknowledgement for me to come to.  I have been a Republican for nearly 20 years, because I believe in limited government.  I moved away from the Democrats because they seemed to think the government always had to solve all problems.  I realized that there were way to encourage the free market and also work for free persons as well.  I don’t think persons of color in America should have only one party to choose from.  We need more than one party that can offer different ideas to help communities of color.

As a Republican who is gay along with being African American, I had hoped that this year would be the one where there was more of an emphasis on becoming a more inclusive party, an inclusive conservatism.

But that dream is dead forever.  An inclusive center right party will only come about when conservatives are willing to face reality and start to work to create a new future, one where other groups are viewed as fellow Americans and not threats to our way of life.


Staff Writer

Dennis Sanders is the Associate Pastor at First Christian Church (Disciples of Christ) in Minneapolis, MN.  You can follow Dennis through his blogs, The Clockwork Pastor and Big Tent Revue and on Twitter.  Feel free to contact him at dennis.sanders(at)gmail(dot)com.

Please do be so kind as to share this post.
TwitterFacebookRedditEmailPrintFriendlyMore options

265 thoughts on “This Party Cannot Be Saved

  1. IMHO we’re not there yet. It depends on how hurt the GOP is by this election. Ideally they’ll get hurt really bad and then give some Hispanic Conservative (maybe even one of the ones who was supposed to win this time) the nod to run against Hillary in 4 years.

    The problem with the California-Wilson example is that for Wilson it *worked*. His policies passed, Wilson won reelection, party as a whole followed him, and yes, it sent the party over a cliff a few years down the line but that was down the line.

    Mainstream GOP leaders still haven’t really signed on to Trump. They’ve got the problem that the guy who won the election is who he is, but he really did win the nod. They’ve also got the problem that Trump is still pretty much an unknown in terms of what he’s going to do.

    And yes, agreed, there’s still a lot of room for Trump to send the party over a cliff if he wins.

    Report

    • Trump doesn’t have enough power to send the party over a cliff.
      The Democrats are hurt more by this election than the GOP, at this point in time.
      Where the fuck did you think the neocons were going to go, anyway? If there are two parties, and EVERYONE ditches one… well, the other one suddenly has Everyone from the Powers that Be.

      [Except, apparently, Adelman and perhaps Kochs]

      Report

    • It worked for Wilson, but he destroyed the GOP in California. He was really a moderate Republican who struggled to manage San Diego as its Mayor. He sold out to radical racist and fundamentalist christian members of the GOP. It got him elected, damaged him as a politician and permanently altered the California GOP. The GOP has lost all major state races, the Calif GOP went off the rails, alienating moderate Republicans, independents and moderate Democrats. Fifty years ago the GOP held the mayoral positions in Calif’s biggest six cities, the majority of county Board of Supervisors. Los Angeles County, with a population bigger than 18 states, used to have a majority GOP Board of Supervisors. The Board is now likely permanent Democrat controlled. Today the GOP is only a factor in rural counties and even in those counties is losing ground, just at a slower rate.

      Report

      • It worked for Wilson, but he destroyed the GOP in California. He was really a moderate Republican who struggled to manage San Diego as its Mayor. He sold out to radical racist and fundamentalist christian members of the GOP. It got him elected, damaged him as a politician and permanently altered the California GOP.

        All true. When I say it “worked”, I’m talking “won him this next election”, which is the time frame politicians function. From that point of view, it absolutely worked because it won him the election.

        And yes, it also destroyed the party by scaring the hell out of the Hispanics, and the legal immigrants made the effort to become citizens so they could then vote Dem. Something GOP forgot was lots of illegal immigrants have legal relatives, and trying to rip apart families gets you branded as insane.

        Wilson deserves to be remembered as the man who burned down the California GOP. But this kind of ‘next election’ time frame thinking causes all sorts of problems. The pension crisis is basically that, ditto our various other entitlements, and I’d argue Mayor Young of Detroit set the city on a path towards bankruptcy with his actions… although to be fair the bill didn’t come due until after he’d left office and even died.

        Report

  2. Dennis,
    Let it go. The party you wanted to be a part of never really had your back. Not that the Dems ever did either. Walk away. Screw em. I did it over about two decades ago and never looked back.

    Report

      • Doing the same thing and expecting different results is insanity. Sometimes it’s best to walk away. You either get in and try to fix it or you walk. That decision is driven by the individuals forecast of the probability of your success in “fixing it”. In my case, I assumed “people will not magically get better” and decided to bail. Never been happier.

        Report

        • Let’s test this:
          Doing the same thing and expecting different results is insanity.

          Say I knock up some broad because the rubber pops.
          Next thing you know, I’m going at it hard & heavy, raincoat leading the way.

          Insanity?

          Say I’m driving in the rain.
          I hit the brakes, and the car skids into another.
          Big crash, etc.
          So, next time I’m out, just got out of the hospital, leg in a cast & all.
          Raining again, and I see the light turn red.
          Hit the brakes?
          Are you kidding?
          That was what I did last time.
          And you know how that worked out.
          Hitting the brakes will get your leg in a cast, I’m telling you.
          Screw everybody.
          Coming through!

          Insanity?

          Report

  3. I am increasingly feeling like we’re heading towards a near-parliamentary system dependent on short term coalition-building. We’re already becoming an a la carte society with the way we consume music, media, television, etc. We’re told the days of working for one employer for 40 years are over. Americans are fickle. I can see a future where third parties can actually do well if they hitch their wagons to certain popular issues. Maybe I should be scared of that, the volatile nature of things, but something has to change so I’d be willing to give it a go.

    Report

      • It’s been done on both sides of the aisle (white union guys in KY have very little in common with gay rights activists in San Francisco)…but I’m talking about coalitions that acknowledge they are only coming together for a specific issue, get it done, and then go their separate ways.

        Report

        • US politics are set up in a way that makes it virtually inevitable that major parties (a) exist and (b) are uneasy coalitions. The problem for the GOP is that most of the issues that held their coalition together either stopped being so important (anti-Communism) or were incompatible with their approach to governance (fiscal conservatism).

          Report

        • Those kinds of ad-hoc coalitions would work much better if there was a multiplicity of parties; but with the kind of duopoly we have now, will only lead to purely partisan behavior. As an example, the current Republican congressional majority has refused to take up any Obama initiatives, even when it conformed to their stated policy preferences, simply to deny him a victory.

          But if the Congress had relatively well-distributed Republicans, Democrats, Libertarians, Socialists, Greens, regional parties, unaffiliated, and nativists, these kind of deals become possible. Or if, for some reason, existing parties were severely constrained in their ability to execute “party discipline” for wayward votes, that could probably work, as well.

          If either of the above happened, the consequences might be fantastic: compromise will necessarily return to politics, and policies will have to be crafted with specific goals (rather than just messaging) in mind.

          Report

      • Four principal factions:

        Jesus!
        Guns!
        Money!
        Moats!

        This year, it looks like they’re going to try it without the Money! faction at all and an incomplete buy-in from the Jesus! faction. I hear and understand those who insist that Trump can win nevertheless, but I think he needs a Black Swan for that possibility to become manifest.

        Report

        • Perhaps the Moat faction is the one that is bringing 89% of whites in MS, 84% in LA and AL, 76% in GA, 73% in SC and TX and 71% in OK to vote Republican in 2012.

          Or perhaps we are missing one more faction. I think we are.

          Report

        • Speaking as a member of the Money! faction (although sadly that’s not the same as actually having money) the GOP is at their best when they’re out of power.

          Give them a super majority and instead of tax reform or entitlement reform we get the Medicare Drug Expansion.

          Report

        • That’s a good question. Say the GOP collapses and there’s a realignment. What’s the new axis?

          I mean judging by the cleavage lines in the Democratic party, I could see a populist/technocrat split. I’m not sure that’s sustainable as a split.

          Report

        • Neocons and neoliberals. Damn the volk, they’ll vote for whomever isn’t “racist”.
          Keep ’em scared, there won’t be a Brexit twice.

          Thats the theory of the Powers that Be, at any rate.

          Report

          • The difference is that the US is churning out college graduates like no country ever has done historically, and we have an enormous minority population. Educated voters + minorities = majority rule. White people who didn’t go to college are a minority in the US.

            It would also be the party with all the money.

            Report

    • I am increasingly feeling like we’re heading towards a near-parliamentary system dependent on short term coalition-building.

      The rules are set up so that’s close to impossible. Winner takes all really punishes the lesser parties and rewards the big guys. That’s why the Tea Party joined the GOP.

      It took slavery to create the GOP and destroy the Whigs. I don’t think we’re anywhere close to being that divided, nor the big parties that dysfunctional. If Trump goes down in flames he gets written off as a bad idea and everyone moves on.

      Report

        • The tea party was the GOP base under a new name. Which then got hijacked by the GOP proper.

          It got turned into a re-branding exercise.

          Which predictably failed fairly swiftly. The GOP seems to have twin problems — an all hat, no cattle issue (as seen by their repeated insistence that there IS no problem where tax cuts and deregulation isn’t the solution, and also occasionally bombing a random country) — and a base of voters that has to be sort of kept hidden.

          Being the party of white nationalists is….an ugly brand to have. But they can’t win elections without them.

          Long-term, they’ve got to either ditch the white nationalists OR become the straight-up party of white nationalists. Either solution leads to short-term electoral loss. The former means they lose until people believe they really meant it when they kicked the white nationalists to the curb, and thus are willing to associate with them more openly.

          The latter, of course, loses because there aren’t enough white nationalists to win elections. They’ll either stop voting or become so toxic they go back into only surfacing at family gatherings after too many beers, shedding members all the while.

          Report

      • There was one time in history that the US acted like it had a parliamentary system, the election of 1824. No one got a majority in the electoral college:

        Andrew Jackson 99
        John Quincy Adams 84
        William H. Crawford 41
        Henry Clay 37

        Adams and Clay joined forces to win the House election, taking 13 of 24 states. Adams became president and named Clay Secretary of State, This is exactly how things are supposed to go in a parliamentary system when no one has a majority: parties combine to form one and divide the cabinet offices. Here, Clay was accused of selling his votes for his office, and the incident has been known ever since as the Corrupt Bargain. Jackson, who as seen as the aggrieved party, won in 1828 with more than two thirds of the electoral votes.

        So, a parliamentary democracy is not exactly part of American DNA.

        Report

        • We need to define what we mean by “parliamentary” (and to be clear, I haven’t read the Economist piece that linked to, so maybe they go into it). It seems that different people assume parliamentary systems have any one or a combination of the following traits:

          1. A unitary (not federal) system.
          2. Legislative-body superiority: no formal checks on what the legislature can do.
          3. The head of government is a different person from the head of state.
          3. The legislature chooses the head of government (as in Mike Schilling’s example).
          4. The head of government is a member of the legislature and remains a member while head of state.
          5. Members of the government (ministers or cabinet secretaries and sometimes heads of government) are chosen by the head of state but their service must be approved by the legislature and they are responsible to the legislature.
          6. Legislators are chosen by proportional representation and not by voting districts.
          7. Governments are primarily coalition-based and no one party usually wins a majority.

          There are probably other features, too. But I have two takeaways. First, many of those features contradict each other, or rest uneasily with each other. Second, people saying the US should have or is approaching a parliamentary system would do well to expand on what they mean.

          Report

          • There are federal parliamentary democracies like Canada, Australia, Germany, and India. The real key feature of parliamentary systems is that there is a direct link between the executive branch and the legislative branch because the leader who governs the majority faction in the legislature becomes Prime Minister. This means that the legislature will generally implement the laws and regulations that the executive wants rather than fight the executive unless things get bad.

            Report

            • There are federal parliamentary democracies like Canada, Australia, Germany, and India.

              True, which goes to show that not all parliamentary systems are the same.

              The real key feature of parliamentary systems is that there is a direct link between the executive branch and the legislative branch because the leader who governs the majority faction in the legislature becomes Prime Minister.

              I’ll buy that as a good working definition. But even then, I’m not sure that’s reliably what people have in mind when they talk about “what the US would be like if it were a parliamentary system.” But maybe I’m wrong on that. (I was originally going to say it’s not what “most people have in mind” but I realize I don’t really know what “most people” think.)

              Report

              • My “Speaking for the American People” card hasn’t expired, so I’ll opine that it’s #2

                Legislative-body superiority: no formal checks on what the legislature can do.

                There is, in a sense, already something of an incoherent elision between Executive, Legislative, Federal and State powers in the American system that has happened more by accident than design – and therefore the untangling of which is perhaps even harder. So, we’re in a weird position where we think the President “ought” to decide policy for the entire nation and have it executed right down to each and every state. That’s one way to do it, certainly… but its a very quiet part of what’s breaking everything up. Maybe like arterial sclerosis… you don’t know you have it until the heart chokes up and you die.

                And, if you thought elections were contentious now?

                On the graphic… interesting concept that I suspect is meaningless because the moment you can vote by parliamentary proportional representation is the moment you vote for broader (or narrower) concepts. I recognize they are working with polling from a strange election cycle, but the options on both the left and the right would look very different than the current slate – which we have precisely because we have a winner-take-all first-past-the-post-system.

                Report

  4. You deserve a party that represents you. American politics needs a solid alternative to the Democrats, not one that makes me (and you) shudder.

    Report

  5. This is what I have been saying would probably happen. People like the primary facets of the right, the individual freedoms, the economic freedoms. However the social constructs of the right are distorted. Where to go from here?

    Many folks will divest authority in those social constructs. Invest in the libertarian branch that gives the least authority to both the social constructs of the right, and left. Basically it is a movement from the middle of the top right quadrant conservativism to the bottom of the lower right quadrant, low authority libertarianism.

    Those folks offer plenty of different ideas to help communities of color, without all the baggage. They also don’t require you sell your soul to the gods of statism. If enough people do it we could undermine the social constructs that ‘group’ people according to race, and erode the social institutions that maintain inequal outcomes of the economy.

    People may not magically get better, but neither do the social constructs that they place in the way.

    Report

    • I dissent! The right is not and has never been about individual freedom or economic freedom, no matter what they say!

      A party that is against SSM, Civil Rights Protrctions for minorities, and has members that believe Griswold and Roe should be overturned,etc. does not support individual rights.

      What the Right supports is the liberty to follow their narrow cast rules and nothing else.

      What lies the right tells themselves.

      Report

      • Saul,

        I’m going to assume you are just being provocative here? Because we can make a long list of times when the Left believed that their policies trumped personal liberties. Both sides like to jump on either side of the line between policy and personal liberty whenever it suits them.

        Report

        • This is the clash between “extremists” who will cheerfully sacrifice individuals for their Will Of God / March of History positions, and moderates. Extremists at both ends have more in common with each other than they do with the center.

          The Right/GOTP seems to be just a few years further down the path to “extremism as mainstream” than the Democrats. Ultimately they’ll both turn into straight ahead authoritarian power blocs focused on getting and keeping power and letting the sane people go hang.

          Report

      • There are a lot of assumptions there. You are probably still under the notion there will be ‘rule followers’ when this is done.

        Maybe legal rent seeking will be undermined as well.

        Report

      • Whether Roe should be overturned is a different question that whether abortion should be unlawful.
        Roe should be overturned on other grounds.
        For that matter, Casey overturned Roe.
        And it did so properly, IMHO.

        Yet even Casey should be overturned, insofar as it purports to invalidate a statutory spousal notification, as this portion is in violation of the Court’s own Rules, in that it is grounded on a hypothetical matter not properly before the Court, and therefore carries only the weight of dicta.

        Report

        • Will H.: Yet even Casey should be overturned, insofar as it purports to invalidate a statutory spousal notification, as this portion is in violation of the Court’s own Rules, in that it is grounded on a hypothetical matter not properly before the Court, and therefore carries only the weight of dicta.

          I’m confused. I was under the distinct impression that the Pennsylvania law considered by the Court did in fact have a spousal notification requirement.

          Report

          • :
            I was under the distinct impression that the Pennsylvania law considered by the Court did in fact have a spousal notification requirement.

            It did.
            However, there was no facts relevant to the case which implicated that portion of the statute.
            Instead, the Court assumed a hypothetical fact pattern.
            It is outside of their authority to issue an opinion on the basis of a hypothetical.
            Therefore, this portion is dicta.

            Not to say that the hypothetical fact pattern isn’t perfectly sound.
            Just that it isn’t valid.

            Report

            • Dark Matter: The 13th AM would be a good choice.
              Stillwater: Could you elaborate on that a bit, Dark?

              The 13th Amendment to the Constitution declared that “Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.”

              Assume a fetus is fully human. That’s great, but I don’t see why it is supposed to have ‘rights’ that I do not.

              I can’t take your blood without your ongoing permission. I can’t take your tissue, I can’t use your organs, etc. This is true even if I’m your kid, and even if you’ve promised to donate an organ to save my life.

              Up until the point where you’re physically unconscious on the table, you can get up and walk out, even if it kills me. You even have the ability to kill me to stop me if I insist on living at your expense.

              Sex without consent is rape (you can kill me to stop me there too). This is worse. We have a word to describe ‘imposing on someone else’s body, for months, where the one imposing has all the benefits and the one being imposed upon has the physical/emotional/financial trauma’. The word is ‘slavery’, and it works pretty well… and you can kill someone to prevent yourself from being enslaved. If we’re serious about giving a fetus (especially a mindless fetus) ‘rights’, then the appropriate way to do that is amend the Constitution to allow women to be enslaved by their fetus, if that sounds like a hard sell it’s supposed to be.

              The problem with Roe is the Supremes wanted to leave the gov with the ability to meddle.

              Report

              • Thanks for the explanation, . I take you’re trying to accomplish two things in this argument: 1) establish the competing rights between a fetus and mother, and 2) ground a resolution of that conflict in well established and clear constitutional principles (or at least clearer than those invoked in Roe). I’ll have to think about it a bit more, but I like the basic idea since my own moral argument for choice is based on resolving similar rights conflicts.

                Report

      • The right is not and has never been about individual freedom or economic freedom, no matter what they say!

        I’ve taken to calling this position the Full Robin. As in, you never want to go full Corey Robin. The exclamation mark at the end helps emphasize how passionate one is committed to the proposition.

        If you are sufficiently committed to defining “the right” in a way that selectively cuts certain people, behavior, and events from the narrative, this can absolutely be made into an accurate statement. I’m not sure what you’ve proven, though, other than you ability to construct circular arguments.

        Report

      • This response doesn’t surprise me, but it does confuse me. If I read Joe Sal right, he’s saying there’s some individual focused (as opposed to communitarian-focused) solutions to the problems that communities of color face and other peoples face. You seem to be interpreting that as saying “the Right is about freedom.” Not only do I not see Joe saying that, I think, along with JR above (below?), you seem to be defining “the Right” in ways that are convenient for you as a member of the tribe “not Right.”

        It’s easy to paint the world as good guys against bad guys. The fact is the world is a messier place than that. Sometimes people who oppose what I value and what I think is good actually have some points that need considering. Sometimes that which I support transgresses against other things I support. I don’t–and you don’t–get the luxury of just defining them as bad guys and thereby absolve myself of responsibility for addressing and acknowledging the good points they make.

        Let’s take an example that’s near and dear to both of us. We both–you and I–support the ACA. But for all the potential good we hope comes out of it, the policy is hardly an unmixed victory for freedom or liberty and freedom for the following reasons:

        1. It compels people to buy a product from a private vendor. That’s a denial of liberty to choose not to buy insurance, unless they’re willing to pay a penalty or tax.

        2. It appears not to be reining in premium prices, at least in some markets. That means, indirectly, a denial of economic liberty. More and more of what people work for, in some markets at least, has to go toward paying for insurance they are compelled to buy.

        3. It creates a big disincentive for employers to hire full-time workers. That denies an economic liberty interest to work one’s job.

        To be clear, I’m cautiously optimistic these disadvantages can be made less painful even though they can’t be eradicated entirely.

        And I don’t for a minute believe that the “repeal and replace” crowd has a “replacement” plan I can endorse. That crowd’s willingness to rely on the cant of liberty and freedom does get tiresome. I imagine that’s part of the argument your dissent! was trying to make. But that crowd does have a point. That point doesn’t go away just because they’re disingenuous or annoying.

        Report

          • You mean the system where about 2% of the population is euthanized a year because we don’t feel like paying for their care anymore?

            Note that’s the ‘percentage killed in shelters due to lack of space’, not the actual *owned* dogs that are euthanized because medical costs are too expensive, which is way more than 2%. (We don’t even bother to *develop treatments* for a lot of the stuff we treat in humans.)

            Is *this* the point when I start screaming about how Republicans want death panels?

            But let’s dismiss that, and instead:

            Do you mean the system where, when a quarter of the population inevitably gets cancer, we let almost all of them just die instead of trying to treat it?

            Report

            • Do you mean the system where, when a quarter of the population inevitably gets cancer, we let almost all of them just die instead of trying to treat it?

              Cost to treat cancer in a dog via Chemo: Between $6k and $10k (and that’s the entire cost).
              https://www.petcarerx.com/article/managing-costs-of-cancer-treatment-for-dogs/1232

              Here’s another example: Dolly’s care cost around $10,000 for all tests, surgeries, radiation therapy treatments, and medication. http://www.dogster.com/lifestyle/10-things-dog-cancer

              What they’re missing is the multiple massive bureaucracies which only exist to deal with other massive bureaucracies, all created because of the government’s “help” and mandates.

              Reduce the cost of health care by 10x or 20x and suddenly far more people can afford it, and we as a society can afford to treat most people if not everyone.

              Report

              • What they’re missing is the multiple massive bureaucracies which only exist to deal with other massive bureaucracies, all created because of the government’s “help” and mandates.

                I have no idea what you’re talking about.

                There *are* multiple massive bureaucracies in healthcare sucking up all the money. I agree entirely.

                The problem is…these don’t exist because of the government.

                These bureaucracies are called ‘health insurance companies’. Now, I will admit that *two* of these health insurance ‘companies’ (Medicaid and Medicare) exist because of the government.

                The rest don’t.

                Now, by subsidies, I think you’re trying to make a claim that the government has subsidized health insurance…which is true, it gets a tax break by not counting against income.

                But health insurance existed *before* that, and the reason it existed was that, *even at that time*, people couldn’t pay for their own medical expenses.

                Here’s another example: Dolly’s care cost around $10,000 for all tests, surgeries, radiation therapy treatments, and medication.

                You do realize that most Americans cannot afford a random $10,000 expense, right?

                Report

                • Dark Matter: What they’re missing is the multiple massive bureaucracies which only exist to deal with other massive bureaucracies, all created because of the government’s “help” and mandates.

                  DavidTC: I have no idea what you’re talking about. There *are* multiple massive bureaucracies in healthcare sucking up all the money. I agree entirely. The problem is…these don’t exist because of the government.

                  We have massive government bureaucracies and regulation in creating all of the tools any medical personal use, in the drugs, in the education of the various medical personal, in the regulation of everyone involved, and yes, in the various lawsuits which spring up as lawyers look for billiables.

                  And yes, on top of that we have insurance companies, hospitals themselves, and any company over a certain size which has it’s own bureaucracy. Anything which has anything to do with ‘compliance’, regulation, the law, or protecting yourself from a lawsuit ultimately goes back to the gov.

                  Dark Matter: Here’s another example: Dolly’s care cost around $10,000 for all tests, surgeries, radiation therapy treatments, and medication.

                  DavidTC: You do realize that most Americans cannot afford a random $10,000 expense, right?

                  Even with Credit Cards, bank loans, & insurance? Better question, how much do you pay for insurance right this moment? If you have a family, it’s probably more. Even if it’s through your employer, it being hidden doesn’t mean it’s less.

                  Report

                  • We have massive government bureaucracies and regulation in creating all of the tools any medical personal use, in the drugs, in the education of the various medical personal, in the regulation of everyone involved, and yes, in the various lawsuits which spring up as lawyers look for billiables.

                    No one has any idea what you mean about ‘government bureaucracies and regulation’ ‘in the education of the various medical personal’, unless you mean the concept that ‘only doctors can practice medicine’.

                    The state has granted the *medical establishment* a monopoly on allowing the practice of medicine. Everything hurdle and complication beyond that is the medical establishment *itself* doing things and nothing to do with the government.

                    If you think that’s a problem, you need to stop hiding behind indirect comments about ‘bureaucracies’ and just flatly say ‘I think a medical license should not be required to practice medicine’, or whatever variant of that you’re talking about.

                    Additionally, if you think *regulations* are what cause the high price of drugs, you are…100% correct, in that the only thing that allowed drugs to have such high prices are intellectual property laws, granting, again, a monopoly to the various producers for a limited time.

                    You want to remove intellectual property rights from drugs, you say *that*, not yammering around regulations.

                    Or is your theory that, with less testing (But still with intellectual property laws), that drug companies will be able to invent new drugs faster? This is not actually how medicine works, there is not some infinite amount of different type of drugs that work, there are not infinite alternatives to any current drug. Types of drugs are not fungible.

                    If some company has a patent on a drug to treat an specific illness, it might be the *best* treatment, or the best treatment anyone can currently figure out. If they sell it for $2000 a dose, yes, it *looks* like other drug companies should try to step in and find an alternative and underbid them, and you seem to think it’s ‘regulation’ stopping them by requiring they do things like ‘testing’ it and other sure over-regulated nonsense…but often it’s just ‘We don’t really have any ideas for a functioning alternative. Doesn’t really matter if you make the development 90% cheaper.’

                    There are not ‘massive government bureaucracies and regulation’ in the practice of medicine. There are a few *very specific* regulations granting the practice of medicine to a certain group of people, and there are *very specific* regulations granting the control of drugs to the companies that develop them. I.e., none of those things are a ‘government bureaucracy’, if there’s any bureaucracy there, it’s by private corporations. The only thing close to a ‘government bureaucracy’ is is the part of the government that checks that companies aren’t selling non-functioning medicate.

                    Also, it’s a fun trick to assert that there are too many ‘massive government bureaucracies and regulation’ in *lawsuits*. Assuming you actually mean there are too many lawsuits, period, you sure have an interesting way of getting rid of them by making things *less* regulated.

                    Report

                    • No one has any idea what you mean about ‘government bureaucracies and regulation’ ‘in the education of the various medical personal’,

                      The increase in college costs is mostly a story about the increase in the number of administrators per teacher, changing from 3 or 4 to 1 into 1:1 (or more admins than teachers). So, yes, “bureaucracies” is the right word. Yes, the bulk of these are either outright gov institutions (most schools at that level are) or dance to the beat the gov sets.

                      http://www.nytimes.com/2015/04/05/opinion/sunday/the-real-reason-college-tuition-costs-so-much.html

                      If you think that’s a problem, you need to stop hiding behind indirect comments about ‘bureaucracies’ and just flatly say ‘I think a medical license should not be required to practice medicine’, or whatever variant of that you’re talking about.

                      Because clearly every aspect of the entire massive bureaucracy is totally needed and if it were cut back by even one dollar, we’d have an anarchy.

                      I went to a lecture by a world class specialist surgeon the other day, the subject was (basically) “how to make his life better”, so he talked about the ergonomics of surgery (everyone in the audience was an engineer)… and some of the insanities of medical training.

                      There are 7 surgeries he does, in his professional career he’s never delivered a baby and he never will, but in order to get his degree he had to be fully trained in doing that. Total waste of his time. Basically he thought medical training could be shortened by somewhere between many months and several years without impacting *anything*.

                      Notice that shorting the training time for doctors would massively speed up the pipeline for creating them, also notice that it’s basically impossible right now.

                      if there’s any bureaucracy there, it’s by private corporations.

                      Small companies simply can’t afford to deal with the FDA. When they have to, they typically end up selling themselves to one of the big companies because the big companies have the experts in regulation/bureaucracy.

                      Assuming you actually mean there are too many lawsuits, period, you sure have an interesting way of getting rid of them by making things *less* regulated.

                      Tort reform is a different (off topic) subject.

                      Lack of Regulation costs lives (you understand that); But do you understand that Regulation also costs lives?

                      There are useful drugs which aren’t cost effective to “prove” that they work, the Zeka-virus’ mosquito has a nasty counter which is still awaiting regulator approval (creating and releasing lots of sterile males), and so forth.

                      Report

                      • He needs to learn how to deliver babies, because society expects that if he is stuck in a plane with a woman in labour, he can help.

                        It’s part of the price he has to pay for his license to be an orthopedic surgeon

                        Report

                        • He needs to learn how to deliver babies, because society expects that if he is stuck in a plane with a woman in labour, he can help.

                          If we cut his training by two years, we’d have significantly more doctors. That’s one heck of a trade off to handle a ‘movie’ situation… especially when normally they’d declare an emergency and land the plane.

                          If this is a serious societal concern, then we should be giving taxi drivers ‘birthing’ training because it’s a lot more common there.

                          Report

                      • The increase in college costs is mostly a story about the increase in the number of administrators per teacher, changing from 3 or 4 to 1 into 1:1 (or more admins than teachers).

                        You think the increase in costs of health care is due to *educational* costs? How the hell does that work?

                        Please note that *doctor pay* has not increased along with the rising costs of health care, if the theory is they have to charge more to cover their education. In fact, doctor pay has slowly *dropped* (Once you account for inflation) over the last couple of decades.

                        Notice that shorting the training time for doctors would massively speed up the pipeline for creating them, also notice that it’s basically impossible right now.

                        Yes, I am also in favor of speeding up the training time for doctors, and also having more nurse practitioners. There are many things that could be done.

                        And note this doesn’t really have anything to do with the bureaucracies at all. The time requirements to get a degree are not a ‘bureaucracy’, and it’s not ‘regulation’ either.

                        You seem completely unable to actually point at any government bureaucracy or regulation that’s in the way of anything. That’s because it’s not. It’s a bunch of doctors being reluctant to set up competition with themselves decades ago, and then they just sorta left a broken system in place and we ended up with not enough doctors.

                        Small companies simply can’t afford to deal with the FDA. When they have to, they typically end up selling themselves to one of the big companies because the big companies have the experts in regulation/bureaucracy.

                        Yes, which sucks for smaller companies, but what you failed to notice is: There is no indication that this would result in cheaper drugs, or cheaper healthcare in general.

                        Do you want to know the dirty secret of drug development? Most new drugs are…pointless. The entire thing is riddled with errors, drugs are claimed to work because they did ten trials and were able to find one ‘that worked’, aka, sheer random chance got a positive result. Years later, we rerun the test, discovers that drug doesn’t actually do that thing and the results are just the fact that if you do tests asking 100 cats to predict twenty coin tosses, at least one cat is going to be *really good* at it. But heralding that cat as a cat psychic is sorta stupid.

                        Drug development is actually moved along by a) a new understanding in how humans work, or b) a new way to administer something we already know works. If a drug doesn’t have one of those premises, it’s just money-making gibberish.

                        But small companies could work within that premise. Sure.

                        Except for the new drugs that do actually work, there’s not any reason a smaller company would price them cheaper, and in fact plenty of reasons they’d make them more expensive, because being the cool new drug on the shelves has a limited lifespan. In fact, we’ve had some recent cases of super-price-increases in the press recently, and none of them have been by established large drug companies.

                        Or, to put it another way: If you are actually concerned about competition in drug development, you’d be a lot better off stopping these *insane* mergers going on, and breaking up the giants, so we have a dozen or so *medium* sized companies, instead of tiny tiny companies trying to compete with four (*Is* it still four, or is it down to three?) giants.

                        But wait. That would be ‘regulation’.

                        There are useful drugs which aren’t cost effective to “prove” that they work, the Zeka-virus’ mosquito has a nasty counter which is still awaiting regulator approval (creating and releasing lots of sterile males), and so forth.

                        And now you’re on some sort of general anti-regulation rant.

                        The FDA’s process to clear drugs is totally broken, and it’s actually totally broken in many, many ways, including ways you didn’t mention.

                        But here’s the problem. We’re not talking about regulation in general. We’re talking about *reasons healthcare costs so much*.

                        The cost of developing drugs is not the reason that healthcare is so expensive. Hell, the cost of developing drugs isn’t even the reason that *drugs* are so expensive.

                        The reason the health care system is so expensive is that it is totally disconnected from the market…and it’s not the *government* doing that. Half the cost is that healthcare has an ’emergency hostage’ situation where people can’t actually make market decisions (Which means the market might not be able to reduce prices *anyway*.), and the other half is the entire insurance system we’ve set up.

                        Report

                        • You think the increase in costs of health care is due to *educational* costs? How the hell does that work?

                          Oh, the bulk of increase is from other factors, but the increase in educational costs is an excellent example of the sprawling bureaucracies we’re creating.

                          I lumped it in there because all costs of the system are passed on to it’s consumers (both patients and tax payers). We’ve increased the cost to create a doctor from tens of thousands of dollars to hundreds of thousands or a million dollars. Somehow that cost gets passed onto us, just like the cost of every bar of soap used in a hospital.

                          Yes, which sucks for smaller companies, but what you failed to notice is: There is no indication that this would result in cheaper drugs, or cheaper healthcare in general.

                          All costs get passed on, including and especially overhead. And yes, I know, the gov does not ‘black letter’ insist that big companies have huge levels of overhead, that’s just a side effect.

                          If you are actually concerned about competition in drug development, you’d be a lot better off stopping these *insane* mergers going on, and breaking up the giants, so we have a dozen or so *medium* sized companies, instead of tiny tiny companies trying to compete with four (*Is* it still four, or is it down to three?) giants.

                          I’m all in favor of breaking up monopolies and quasi-monopolies and encouraging competition.

                          The reason the health care system is so expensive is that it is totally disconnected from the market…and it’s not the *government* doing that.

                          The health care system is one of the most regulated we have, there’s heavy gov involvement left right and center at every stage. You can argue that various segments of the industry have captured their regulators (or even Congress), but it’s appropriate to blame the guy who has a gun to the head of everyone else for what they’re doing.

                          Probably the best example of the gov running around creating/expanding bureaucracies is the ACA. We just had a massive reform of the system and the gov’s idea of what to do was create thousands of pages of law and tens of thousands of pages of regulation. Of course as a ‘side effect’ (or more likely a direct effect desired by it’s authors) it’s increased the size of the bureaucracies implementing this, and everyone dealing with it has also needed to increase in complexity. When you need to have a huge team of lawyers just to read the law, much less the regulations, that’s a clue it’s increasing bureaucracies.

                          If the ACA had managed to decrease costs you’d be able to argue the gov was reducing costs. That, after the ACA, costs are going up means the opposite. The gov deserves the blame just like it would be able to claim credit.

                          Report

                  • Even with Credit Cards, bank loans, & insurance? Better question, how much do you pay for insurance right this moment? If you have a family, it’s probably more. Even if it’s through your employer, it being hidden doesn’t mean it’s less.

                    Oh, and I totally ignored this, but you do realize that blaming a bunch of costs on insurance-required bureaucracy and then asserting that insurance could cover things is nonsensical.

                    You can’t say ‘Look how cheap the system is when almost everyone pays out of pocket like in animal care!’ and then assert that…people could have insurance to cover their expenses.

                    Hospitals and other medical providers have entire bureaucracies to deal with insurance. Insurance companies are entire bureaucracies themselves. These bureaucracies are expensive, and they’ve actually *completely* distorted the market.

                    For example, when people talk about insurance negotiating prices lower, what they are actually talking about is insurance companies using their quasi-monopsony patient-directing power to force what *the insurance company* pays lower (While making them seem really high)…which forces what everyone else’s pays to higher.

                    Insurance companies, in fact, are a huge reason medical bills are completely insanely random between locations, why MRIs can cost 10x different in the same area…because no one in the medical profession even bothers to sit down and come up with intelligent prices for them, because 80% of that billing is going to be ‘We will get paid for that whatever we agreed to with the insurance company’, and another 19% are going to be people who don’t pay *at all*. So who cared what we bill that last 1%, the guy without insurance but who *does* pay his bill? (I *was* that guy for quite some time.)

                    I had assumed, with your rant about government subsidies causing all the problems, in that you were including ‘insurance companies’ as a government-created problem. Insurance companies *don’t* actually exist due to subsidies, but it’s possible to pretend they do, as they didn’t really get *big* until the government stopped taxing employer-provided plans….although as that was exactly the point that medical stuff started getting expensive anyway, I suspect some people have cause and effect backwards there.

                    But we don’t even need to debate that, because you apparently think insurance companies are part of the *proper* operation of the medical market.

                    Fair enough, so do most people, but you don’t get to complain about bureaucracies setup to deal with *insurance companies*, or the crazy pricing that *insurance companies* have caused, and you certainly don’t get to blame those on the government.

                    Report

                    • DavidTC: Oh, and I totally ignored this, but you do realize that blaming a bunch of costs on insurance-required bureaucracy and then asserting that insurance could cover things is nonsensical.

                      It is trivially possible to get rid of the insurance bureaucracy if we’d just use insurance the way it’s supposed to be used, i.e. to spread risk, as opposed to cover costs (and yes, the gov forces them to cover costs by regulating what types they can and can not sell and by making them cover things which everyone will run into).

                      Home Insurance is cheap, if you want to make it seriously expensive then force it to cover the cost of every changed lightbulb, you’ll instantly have people checking to see if you bought the lightbulb, or have to hire people to install it for you. Then we’ll have the insurance company making deals with the installers and so forth.

                      Similarly Home Fire Insurance would be murderously expensive and complex if you could buy it after your house has already burned down (i.e. no ‘preexisting conditions’).

                      If it’s something that I have a 100% chance of needing (vaccinations), then insurance shouldn’t be covering it. Either I should pay for it out of my own pocket (btw I’m strongly pro-vac), or, if we as a society decide we want to force everyone to do this (probably a good idea), then it’s a good use for gov dollars.

                      Insurance is for things you *don’t* run into every month, year, or even decade which break your bank if you do (and our example here was cancer so it qualifies).

                      The illusion that a 3rd party pays is one of the roots of how medicine has gotten so expensive, probably the best way to deal with that is Health Savings Accounts with insurance limited to just major medical.

                      And I’ll answer your other post later.

                      Report


                      • It is trivially possible to get rid of the insurance bureaucracy if we’d just use insurance the way it’s supposed to be used, i.e. to spread risk, as opposed to cover costs (and yes, the gov forces them to cover costs by regulating what types they can and can not sell and by making them cover things which everyone will run into).

                        Yes. You are correct. Insurance is, indeed, an *utterly stupid* system to operate the health care system.

                        As I have pointed out in the past, if we did this for something else, like food, if we paid $200 a week for ‘food insurance’ and had middle-men provide it that kept *more* of our money the *less* food they bought and gave to us, we’d all slowly starve to death. (While they *insisted* they are providing the legally required amount of food.)

                        There are very few places where insurance makes sense. *Liability* insurance does, so people don’t end up on the hook for people’s medical bills or car repairs or whatever.

                        And I understand the need for home or car insurance when the bank owns it, although I find it sorta dumb that they make *us* participate in that insurance. Dude, it’s legally still your property, *you* insure it, and just include X years of insurance as one of the costs when I buy it! Why am *I* involved?!

                        And I kinda get life insurance, at least the ‘cover the cost of the funeral’ level of life insurance. (I’m sorta dubious about the ‘my family can’t survive without me’ level. It seems to me it might be smarter to just invest that money.)

                        Anyway, nothing that *regularly* happens to people should be contained with the paradigm of insurance.

                        If it’s something that I have a 100% chance of needing (vaccinations), then insurance shouldn’t be covering it. Either I should pay for it out of my own pocket (btw I’m strongly pro-vac), or, if we as a society decide we want to force everyone to do this (probably a good idea), then it’s a good use for gov dollars.

                        …did you just go single payer? With perhaps some sort of means-tested ‘You have to pay for a *reasonable* amount of your own care if you can, and the government stuff kicks in later’…aka, a deductible.(1)

                        Or even past that, to basically saying ‘The government should pay doctors for providing medical care?’, which is what *I* keep saying. Not via ‘insurance’, which has a idea of people ‘having insurance’ and doctors negotiating payments and companies authorizing procedures and stuff, just basically, ‘If you do this medical thing for someone, we will give you $X, with perhaps some sort of cost-of-living adjustment for different areas.’. I mean, it would be more complicated than that, but you get the idea…we basically treat every doctor as a government contractor. (Basically one step short of NHS, where they are are an outright employee.)

                        But anyway, that was an aside…ignore it.

                        You know, if you had started this off with complaining about *health insurance* bureaucracy, and the health care bureaucracy needed to deal with it, and said we needed to get rid of it by moving single payer, everyone would have been right on board with you.

                        Instead, you called out the *government* for creating these bureaucracies, which it didn’t do, insurance-wise. Insurance companies invented all those rules themselves, the government just came in later and *changed* some of them.

                        1) Incidentally, not to rain on your parade, but in any system where a third party ends up paying for *expensive* medical care, it’s probably in that party’s best interest to pay for vaccines and preventive care. I know it *seems* reasonable to say ‘All but the very poor should have to pay for their own stuff there, they can handle that, it’s the *expensive* stuff people have problem with.’.

                        It’s entirely reasonable, and everyone nods along. We, as society, need to care about excessive medical expenses, not routine ones…and if some people legitimately can’t afford the routine stuff, that sounds like a job for a charity or means-tested government program. Even I, a liberal, would agree, if that was the end of it.

                        The problem is, a moderately large percentage of the people just don’t do it! And the percentage of them that get sick end up costing that third party *way more* than it would have cost to pay to vaccinate everyone! It’s sorta like if homes didn’t come with locking outside doors, and only half of homeowners installed them, you can bet homeowner’s insurance companies would be handing them out for free to their customers and saying ‘Please use these!’.

                        Hell, even *with* it free, it’s hard to get people to use it. Everyone’s health insurance, thanks to the ACA, includes a *free* flu shot. 100% free, and it’s something you can get at many pharmacies without an appointment. If everyone in the US got one (And not everyone should), that would be maybe 2 billion dollars total insurance would have to pay. But somehow, flu season keeps happening, and the medical costs alone are *millions* of days stay in hospitals…most of which are probably on someone’s insurance, and I’m sure costs insurers more than 2 billion dollars.

                        Report

                        • The problem, as always, is that we have the inconsistent triad where we have to pick two from:
                          Done Fast
                          Done Cheap
                          Done Right

                          And since it’s medical care, we need it done fast lest the person die without the care. So we have to pick between done cheap and done right.

                          And when we look at how the rich are treated (they get their care done fast and done right), we say “SEE! IT’S POSSIBLE!” without really addressing the whole issue of how it’s not particularly cheap.

                          Well, we should just make it scale!, one thinks. Put the latest and greatest discoveries in medical journals and on the internet, figure out ways to get the training mastered by 160+ IQ people who have been doctoring for decades into 130+ IQ people who have been doctoring for years or months, and figure out which corners you can cut in order to spread this out a bit… and, suddenly, you’re not doing things right anymore.

                          Which sucks.

                          Report

                        • (Going to split this in two)

                          Dude, it’s legally still your property, *you* insure it, and just include X years of insurance as one of the costs when I buy it! Why am *I* involved?!

                          Because the risk is something you control/effect and the bank doesn’t. If you smoke, are disorganized, disconnect fire alarms, and tend to accidentally start fires, your insurance should be really high and the bank is poorly equipped to understand that.

                          And I kinda get life insurance, at least the ‘cover the cost of the funeral’ level of life insurance. (I’m sorta dubious about the ‘my family can’t survive without me’ level. It seems to me it might be smarter to just invest that money.)

                          Investing money is something that pays off in 40 years. Dying tomorrow at the age of 23 and leaving your kids without a breadwinner is a horrible, expensive, but rare risk and what insurance is designed to spread. The odds are low so insurance is really cheap… and since it’s *risk* that’s being spread you can decide for yourself what size payout you want.

                          Anyway, nothing that *regularly* happens to people should be contained with the paradigm of insurance.

                          Fully Agreed.

                          Report


                          • Because the risk is something you control/effect and the bank doesn’t. If you smoke, are disorganized, disconnect fire alarms, and tend to accidentally start fires, your insurance should be really high and the bank is poorly equipped to understand that.

                            Huh?

                            I understand that insurance *should* work like that, but I’ve never seen homeowner’s insurance that *did*.

                            Homeowner’s insurance is almost entirely based off the condition of the house and if there are obvious things that could cause damage, like a tree about to fall into it, or a screwed up roof that will result in water damage.

                            I’ve never heard of anyone getting an increased premium for smoking or being disorganized.

                            Report

                        • Dark Matter: If it’s something that I have a 100% chance of needing (vaccinations), then insurance shouldn’t be covering it. Either I should pay for it out of my own pocket (btw I’m strongly pro-vac), or, if we as a society decide we want to force everyone to do this (probably a good idea), then it’s a good use for gov dollars.

                          DavidTC: …did you just go single payer? With perhaps some sort of means-tested ‘You have to pay for a *reasonable* amount of your own care if you can, and the government stuff kicks in later’…aka, a deductible.(1)

                          Single payer brings us back to the whole ‘free money’ problem. The benefits of medicine flow to me, the costs go to some 3rd party, ergo my demand for medicine is infinite.

                          With vaccinations many of the benefits flow to society, herd immunity and all that. Healthy people can argue they don’t need vaccination… but that lack endangers people who can’t get vaccinated, so is seems fine for society to force vaccination. For the same reason they can force support of an army or the creation of roads.

                          Instead, you called out the *government* for creating these bureaucracies, which it didn’t do, insurance-wise. Insurance companies invented all those rules themselves, the government just came in later and *changed* some of them.

                          The gov is always on the hook for it’s own bad policies and the unintended consequences of the same. Yes, agreed, it didn’t mandate these specific things, but it’s the one with a gun to the head of all of the players in this game, it’s also the one with massively distorting checkbook, and it’s also the one who is subject to regulatory capture by various interests.

                          The gov shields various parties from competition via licensing and other restrictions, and the history of these issues always goes back to gov policy. If we go back to the start of this I think we’re looking at the gov freezing wages in WW2 and companies needed to compete for workers… but that really doesn’t matter. The gov is the 2000 lb gorilla in the room with it’s hand in every pie, trying to pretend it’s an innocent bystander is absurd.

                          in any system where a third party ends up paying for *expensive* medical care, it’s probably in that party’s best interest to pay for vaccines and preventive care.

                          Yes and No. Yes for vaccines, anti-smoking, & a few others (and they do). But just claiming breathlessly “it’s preventative so it will save money” is a claim we’ve seen a lot, but implemented as a policy it blows a hole through the budget outside of a few corner cases.

                          The problem is, a moderately large percentage of the people just don’t do it! And the percentage of them that get sick end up costing that third party *way more* than it would have cost to pay to vaccinate everyone!

                          I got taken to task on this forum, correctly btw, for pointing out that BLM is doing what they want to do instead of what I think is most useful for them. The same principle applies. People mostly get to use their own judgement on what’s in their best interests.

                          The way to deal with this is insurance should reflect the risk someone brings to the pool. This raises politically uncomfortable truths that politicians want to magically erase with bad policy. If you smoke, you should be able to buy insurance, it should just be more expensive. This means if different ages/races/genders/classes have different risks, they should be paying different amounts.

                          Fundamentally it should not matter to an insurance company if someone is skipping preventative care which results in them getting expensive illnesses if their insurance is priced for that. It’s a public health issue, not an insurance issue.

                          Report


                          • Single payer brings us back to the whole ‘free money’ problem. The benefits of medicine flow to me, the costs go to some 3rd party, ergo my demand for medicine is infinite.

                            It seems to me that’s not quite it. That has the implication that people are setting the demand for medicine.

                            In reality, that’s not the problem, because people don’t do that. We have deductibles in place to stop them from wandering into the doctors for no reason, and that’s all we need. Beyond the ‘Do I need to go to a doctor at all?’ choice, patients rarely make any choices about *how much* medical care they get. They say ‘I think I need a doctor’, and beyond that, everything that happens is up to the health care system.

                            The reason the costs aren’t being controlled is that the patients are getting the correct amount of health care, but they’re getting it with absolutely no concern, or even knowledge, of the cost. There is no price comparison.

                            Of course, insurance companies are paying, and do have price comparisons…and their attempts to solve the problem, aka, ‘narrow networks’, aka, ‘We’re not going to pay the idiots you want us to use $1000 when you can get exactly the same thing from these guys for $200’, are exactly what people bitch about from insurance companies.

                            The entire paradigm is broken. And the weird thing is, it’s perfectly possible to have cost controls with reimbursement just by having a *fixed* reimbursement for most things.

                            I.e., if insurance companies said they would pay $800 for an MRI, period, end of story…suddenly cost controls would start happening, because anything above that would be directly passed on to patients. (Which would, tada, mean that customers would actually demand that they could *comparison shop*.)

                            Instead, insurance companies idiotically say they’ll cover basically ‘whatever the place charges, except we might negotiate a custom rate’ at 10 different places (All with different prices and now there’s no incentive to make it lower.), and not cover it at all at 5 more. This is just really stupid.

                            Now, in medicine, *sometimes* this is hard to figure out, especially in surgeries, where dozens of different variables exist. I know that. But there are a lot of places it could work. All labs, for one.

                            This means if different ages/races/genders/classes have different risks, they should be paying different amounts.

                            Down to what specificity, and what difference in amounts?

                            The current rules are: Smokers can be charged more, and ages are allowed to be divided into three groups and internally each group is charged the same amount.

                            I repeat again: I was someone that insurance companies literally would not sell insurance to, due to pre-existing conditions, until required by the ACA. (And oddly I do not actually cost them much at all, I’ve not even come anywhere near my deductible once…it’s just they *think* I might.) I am quite sure that, without them being required to treat me equally, (Even if they were required to let me sign up) they would charge a million dollars a month or whatever it would require to make sure I don’t sign up.

                            OTOH, you *didn’t* list pre-existing conditions there, so that solves a lot of that. Health insurance companies really really shouldn’t be allowed to vary their prices based on *that*. (In addition to the fact that gets them like 90% of their rescission excuses…oh, you suddenly get cancer and cost us money? Let’s pour through your application vs. your medical records and find that you omitted mentioning a broken arm when you were 4. POLICY RESCINDED, NOT PAYING FOR YOUR CANCER TREATMENTS! Oddly, they were perfectly happy to take your money for years before that….you’d think, in a logical world, if they asserted you didn’t really have insurance with them this entire time, they’d have to give your premiums back.)

                            And I am not sure how you think insurance companies can judge what class, or even what race, someone is.

                            Leaving gender. And gender is one of those odd things that there is a lot of weird assumptions in the pricing.

                            For one thing, we sorta arbitraily assign born childen to their mother’s insurance. You can argue that almost all pre-natal care involves the mother in some way (Even though it’s not really), but that argument sorta ends the second the child is born. There is no logical reason to say ‘The insurance of the mother should pay for the care of premature babies’, and, yet, it does, which would make women’s premiums higher.

                            Same with contraceptives. That is something that has a medical benefit for *two* parties, but only one of them is using it, and it only goes on their insurance.

                            If you could somehow magically divide the bills of those two things between the actual involved parties, if we billed father’s insurance for half the cost of sonograms and childbirth, if the cost of every other birth-control pill was on the boyfriend’s insurance, it would basically equalized the amount of medical care the genders needed, and thus the cost of their insurance.

                            Or, instead, we can equalize that *via* insurance. (Which, it must be pointed out, means that women are *still paying more*, because they have to cover deductibles and out-of-pocket costs.)

                            Fundamentally it should not matter to an insurance company if someone is skipping preventative care which results in them getting expensive illnesses if their insurance is priced for that. It’s a public health issue, not an insurance issue.

                            That doesn’t make any sense.

                            Insurance premiums do not magically alter because the policy holders behave slightly more or less responsibly. They can be, and in fact will be, adjusted eventually, but, uh, competition exists.

                            Because competition exists, or people might not even buy insurance at all, it is in the bext interest of insurance companies to have as low rates as possible…which means they do, indeed, have a strong incentive to reduce the amount of illness of their customers, as long as *that* is cheaper than dealing with the illnesses.

                            I don’t know why you think insurance companies have no goal to hold their costs down, because they can just charge more…but that isn’t how *anything* works in a market economy.

                            ‘Why does the all-you-can-eat buffet spend any time and energy trying to make sure I don’t smuggle out a backpack full of food? It shouldn’t matter to them…they can just raise their prices to cover it.’

                            Report

                            • The reason the costs aren’t being controlled is that the patients are getting the correct amount of health care, but they’re getting it with absolutely no concern, or even knowledge, of the cost. There is no price comparison.

                              Very, very close… although I’d quibble with “the correct amount of health care” because there are multiple factors which inflate that. I don’t regret the $10k I paid for a surgeon, but I do regret the $200 I paid for a test which probably wasn’t going to reveal anything and didn’t. If you go to a used car lot and let the salesman decide how much car you “need”, the answer is probably “a lot”. The benefits of the system flow to both the patient and the health system itself, the costs do not.

                              And that world class surgeon’s $10k had a huge administrative overhead baked into it which is also a problem. If we take our ‘college administration’ example and assume three quarters of that isn’t value added (:massive handwave:), in theory I could saved a lot of money by flying to a different state… assuming I could find someone like that who isn’t attached to a massive bureaucracy.

                              If we had competition then a guy like that could set up his own shop, with thin administration, and he’d personally get a massive pay increase while at the same time charging less. The ACA supposedly strongly encourages the opposite.

                              And the weird thing is, it’s perfectly possible to have cost controls with reimbursement just by having a *fixed* reimbursement for most things.

                              You’re totally correct in that the solution is for consumers to have skin in the game. But why not go whole hog?

                              Get the insurance company totally out of the picture for small items, force consumers to have HSAs, if they save money then they keep it. There are multiple other things which need to happen, the big one being prices need to be clear and easily available.

                              Insurance companies are this massive impediment to competition and letting them stay in there ‘helping’ people by ‘negotiating’ is just making things way more complex for no good reason. Keep in mind how college costs have zoomed up to support their bureaucracy.

                              Now, in medicine, *sometimes* this is hard to figure out, especially in surgeries, where dozens of different variables exist. I know that. But there are a lot of places it could work. All labs, for one.

                              All labs. What a “typical” labor costs. I think we’d be really surprised at what could be compared (especially in the age of smart phones) if there weren’t so many road blocks set up to prevent it. When my kid sliced her head open, I went to her local doctor because I figured (correctly) that he’d be much more skilled and a lot cheaper than some emergency room intern (and that’s without waiting the multiple hours).

                              This means if different ages/races/genders/classes have different risks, they should be paying different amounts.
                              Down to what specificity, and what difference in amounts?

                              Those are political questions to what really should be a market decision.

                              The current rules are: Smokers can be charged more, and ages are allowed to be divided into three groups and internally each group is charged the same amount.

                              The current rules have heavy political pandering and so forth. You’re not allowed to sell across state lines so some/many state insurance industries are micro managed by their state regulators and there’s no competition between different states. So the result is a heavily shielded industry which doesn’t need to serve it’s consumers very well.

                              OTOH, you *didn’t* list pre-existing conditions there, so that solves a lot of that. Health insurance companies really really shouldn’t be allowed to vary their prices based on *that*.

                              I’m taking “Pre-existing” to mean “before you got insurance”. The moment a pre-existing condition (say, cancer) becomes a ‘regular’ part of you then you’re not spreading risk anymore, you’re trying to cover costs. If a disease has a million dollar cure and effects one-in-a-million, then insurance should be able to cover everyone for a dollar each. That’s spreading risk. If someone goes without insurance thinking that it can’t happen to him but does, then we’re not dealing with risk any more.

                              To address multiple other comments you made, the insurance companies aren’t serving their customers well, they’re acting like a heavily shielded near-monopoly who has corrupted it’s regulators.

                              And I am not sure how you think insurance companies can judge what class, or even what race, someone is.

                              The amount of publicly available information is scary, but the issue is whether different groups have different risks which should be insured differently. Anything which gets in the way of pricing risk correctly is a problem, that includes lack of competition and political meddling.

                              For example one of the flaws of the ACA was it wanted to pander to the elderly, so there are rate caps (don’t remember the mechanics). So the young are risk-priced incorrectly too-high. Which in turn contributes to the difficulty in getting the young to sign up.

                              If you could somehow magically divide the bills of those two things between the actual involved parties, if we billed father’s insurance for half the cost of sonograms and childbirth, if the cost of every other birth-control pill was on the boyfriend’s insurance, it would basically equalized the amount of medical care the genders needed, and thus the cost of their insurance.

                              We already have this, it’s called ‘family insurance’. It’s an interesting idea to split medical costs in this situation, but you’re raising a ton of other issues, 3rd party pays, proving paternity, etc.

                              Because competition exists, or people might not even buy insurance at all, it is in the best interest of insurance companies to have as low rates as possible…which means they do, indeed, have a strong incentive to reduce the amount of illness of their customers, as long as *that* is cheaper than dealing with the illnesses.

                              In theory, reducing the risk of a customer *should* result in reducing the cost of that customer’s insurance and not profit for the insurance company itself. Where it doesn’t we’re probably looking at market distortions, poor service, gov mandates, and so on (which admittedly we already know we’re looking at). But we’re trying to look at insurance as it’s supposed to function, not as it does.

                              Let’s look at “perfect” risk sharing, say a company hires an insurance company to administer insurance for their employee pool. All medical costs are distributed to the employees, the insurance company itself has *zero* exposure to anything. If someone gets cancer, all that happens is those costs are distributed to the pool via rates. Co-pays, HSAs, health of the employees, risk profile of the employees, none of those things matter (or increase/decrease profit) to the insurance company. As a matter of public health they matter to the employees, but that’s a different issue.

                              This is the theory of insurance, and in practice, with a sufficiently large pool with competition, it gets close to this ideal.

                              Multiple issues:
                              1) Pool size (that 1-in-a-million, million dollar disease needs a pool measured in many multiple millions). A small and unlucky pool can just fall apart, say a thousand people who need to cover one of their members who gets our ‘million’ disease. Their risk is $1 but their cost that year is $1000, or it can be spread over a thousand years which is nonsense.

                              Being unable to sell across state lines is a huge problem because ideally you’d be matched up with others in your risk pool, and if that pool is small (per state) then no sane insurer would want to touch it.

                              2) As both you and I have pointed out, this works for spreading risk, it sucks for controlling cost.

                              3) Pre-existing conditions which don’t add to risk should be covered normally other than the condition itself. If it’s not then that’s either a competition issue or a regulation issue.

                              4) Medical insurance, as a construct, is poorly suited to be linked to a job. The average job lasts perhaps 3 years, losing your job (perhaps even because you’re ill) shouldn’t also require you to seek re-insurance.

                              5) There are people who are too sick to get insurance. This is an issue of cost, not risk, so it really should be outside the bounds of insurance-working-as-it-should. That it does is mostly an accident of history and politicians looking to spend other people’s money.

                              Note that any fiscally sane answer on what to do is also going to be ugly. The left’s answer is typically ‘write a blank check and spend until society goes bankrupt’ (which is nuts), the market’s answer is ‘let them seek charity or failing that, be untreated’. Note there’s also an element of personal responsibility here, assuming health insurance is cheap (which it should be aka life/house insurance), widely available, and not connected to a job, lack of insurance becomes a result of personal choice.

                              6) There are going to be problems with an insurance company takes, or is forced to take, people at rates different from their risk. This isn’t all that different from the homeowners on the coast of Florida being unwilling to pay for flood insurance and insisting that the gov step in. Sooner or later a really nasty hurricane will move down the coast and break the bank.

                              Report

                              • First, being able to sell across state lines is a completely nonsensical solution, as *my* state found out when it allowed it. In fact, *five* states currently allow that, although two of them seem to require some sort of authorization first. But three just allow any health insurance company, allowed to sell health insurance in any state, to walk in and sell insurance there. (Well, presumably they have to register somewhere first. I hope companies can’t sell insurance with the state literally having no idea!)

                                You know how many insurance companies actually sell insurance across state lines? None. Zero. In the entire country. Ever.

                                This is because insurance networks need *medical professionals*. No insurance company could sell insurance here when they don’t have a network here! And they’re not going to try to set one up from another state.

                                Seriously, this idea is complete nonsense. Selling across state lines is absurd.

                                What Republicans appear to actually be trying to do with their bill is *force* states to allow this, not in an attempt to actually have more competition (Because that cannot make any sense), but to allow all insurance companies to immediately ‘move to’ the state with the least regulation, while continuing to have the same network as before. I.e., every insurance company would instantly become a Texas health insurance plan, under Texas regulations, which still selling exactly where they sold before.

                                Republicans: In favor of state’s right unless it’s the right to regulate industry.

                                Additionally: People probably didn’t notice it, but the ACA actually had a part to deal with this, where *any* insurance company can sell across state lines, because it created the idea of interstate-compacts where multiple states sorta operate the same exchange, where everyone on it would be able to sell in all states in that. Presumably any states that set those up would create *joint* insurance regulations.

                                If Republicans had really been on board with insurance across state lines, nothing was stopping, say, Oklahoma and Texas from creating a joint market and centralizing all their regulation. Although, technically, nothing was stopping them from doing that *before* that either.

                                Of course, no one actually *created* any of those interstate-compacts, so whatever. (And the real irony is that Republican states didn’t even bother to set up their own exchanges…so ended up with the Federal government in control of them. There actually were *options* in that process that the states might have, you know, wanted to do select, things that could have made the setup more conservative…but they didn’t bother to participate in the process, so didn’t get the chance and so, functionally, ended up with the Federal government running what should have been a state agency. Smoooth. ‘We demand local government, and if we’re required to do things by the Feds that we don’t like, we demand the setup that allows us literally no input at all! Next up, we’ll stop working with the Federal Highway Administration, and just make *them* build all the interstates here wherever they want to!’)

                                For example one of the flaws of the ACA was it wanted to pander to the elderly, so there are rate caps (don’t remember the mechanics). So the young are risk-priced incorrectly too-high.

                                The ACA divides allows insurance companies to divide ages into three ranges, and requires the price be even inside that range. Additionally, the high end can be no more than three times the low end. (Which in practice means the old are charged three times as much as the young…although if an insurance company was insane, it could go the other direction.)

                                I am not sure how the 3x ratio was decided. There have been other rations at other times, like 5x. It might indeed be too low.

                                However, the young also have access to special catastrophic plans for people under 30.

                                I don’t regret the $10k I paid for a surgeon, but I do regret the $200 I paid for a test which probably wasn’t going to reveal anything and didn’t.

                                ‘Regret’ is not what we are caring about.

                                People’s health is not something they know enough to make decisions about, in general. *You* don’t know if you needed that test or not. You shouldn’t be expected to decide not to do that to save everyone money. That’s the job of the doctor.

                                That’s not to say there are points in health care where people *do* make decisions, but *that* decision-making process shouldn’t involve costs, only various risks and recovery times and stuff.

                                And that world class surgeon’s $10k had a huge administrative overhead baked into it which is also a problem. If we take our ‘college administration’ example and assume three quarters of that isn’t value added (:massive handwave:), in theory I could saved a lot of money by flying to a different state… assuming I could find someone like that who isn’t attached to a massive bureaucracy.

                                I have no idea what a different state has to do with anything.

                                And the problem, of course, is that people often *can’t* choose their surgeon, or where they are getting care, and no amount of posting prices is going to solve that.

                                Get the insurance company totally out of the picture for small items, force consumers to have HSAs, if they save money then they keep it. There are multiple other things which need to happen, the big one being prices need to be clear and easily available.

                                I don’t understand why you think a HSA plus insurance to cover major expenses is any different than currently existing high-deductible plans.

                                Because that’s basically what you’re suggesting….a large deductible.

                                I’m taking “Pre-existing” to mean “before you got insurance”. The moment a pre-existing condition (say, cancer) becomes a ‘regular’ part of you then you’re not spreading risk anymore, you’re trying to cover costs. If a disease has a million dollar cure and effects one-in-a-million, then insurance should be able to cover everyone for a dollar each. That’s spreading risk. If someone goes without insurance thinking that it can’t happen to him but does, then we’re not dealing with risk any more.

                                So someone like me, who was born with a heart defect, should never be able to get insurance?

                                It’s incredibly easy to point to people who do not have insurance, get some major disease, and then try to get insurance, and say ‘Those people should not be able to do that’.

                                The problem is that there are a lot of *other* ‘pre-existing conditions’. A lot a lot. And a lot of times where it’s either pay for insurance or pay for food.

                                And the other problem, of course, is the fact that those people who didn’t have insurance until they got sick *are still sick and still need medical treatment*.

                                We have decided that no one dies on the street from medical issues in this society. The only way that works is if *everyone* has insurance. (Or it doesn’t even have to be ‘insurance’, but it has to be something that will cover absurd medical expenses if they start incurring them.)

                                The solution the left came up for this was single payer. The solution the right came up for this was the mandate.

                                Report

                                • And a lot of times where it’s either pay for insurance or pay for food.

                                  I didn’t really explain this well, so, to elaborate:

                                  We should not set up a system where people are expected to try to figure out exactly how likely they are to get hit with some disease that is a pre-existing condition and makes them uninsurable, vs. using that money for other things.

                                  That is demanding that people make a very complicated and almost unanswerable risk-based decision that might ruin their lives…either way. I mean, it could equally turn out they *never* needed that insurance, but putting that $200 a month in savings instead would have been really helpful when their car broke, but as they paid for health insurance instead they lost their job and became homeless.

                                  And here’s the real thing: There is no actual right answer….and, yet, there will always be people who get hurt by their choice, and other people will go ‘Well, they got what they deserved’, whichever that was.

                                  That is a *really* easy out. ‘Oh, they should have made a better choice. It’s their own fault.’

                                  No. It’s not. People are not psychic. People are not saying ‘I will not get health insurance until I get cancer’, they are saying ‘I do not wish to spend my money on health insurance I don’t need’, and then, when they get cancer, ‘don’t need’ becomes ‘*do* need’, so of course they will pay for it.

                                  There is a large ‘free rider’ problem in insurance, but the solution is not to rage against the free riders and try to keep them out of the system. You can kick a bus free rider off and bar them from the bus, but you can’t bar someone *from needing medical care*. That is not a solution. We give medical care to everyone in society. We give medical care to people *sentenced to death*.

                                  The solution is to get rid of free riders by having everyone pay to start with. The way we *normally* do that in society, the way we make everyone pay for the police and roads, is taxes. For some reason the right wasn’t in favor of that, so demanded the mandate instead, which they also are not in favor of apparently.

                                  Report

                                  • We should not set up a system where people are expected to try to figure out exactly how likely they are to get hit with some disease that is a pre-existing condition and makes them uninsurable, vs. using that money for other things.

                                    There’s a solution for that. What you do is get a large pool of people, big enough that you can statistically price their average healthcare costs, and then everyone pays enough a year to cover average medical costs, with enough extra to cover the big unlikely events.

                                    I think it’s called “insurance”.

                                    (The healthcare blogger over at Balloon Juice was pitching an idea about basically creating, something akin to a bond fund that basically handles insurance jumping. Basically, if you’re the unlucky company that Bobby switched to, got a 100k case of cancer, then switched off to another company the next year, there’s basically a bond that spreads out that cost over the entire business. Because there’s a reason that getting a hip replacement or knee replacement in the US is like pulling teeth compared to Germany or Canada — it’s because it’s a large upfront costs that pays for itself over time, but that doesn’t do squat for the company that paid for it only to see you switch to Aetna the next year).

                                    Report

                                  • The solution is to get rid of free riders by having everyone pay to start with. The way we *normally* do that in society, the way we make everyone pay for the police and roads, is taxes. For some reason the right wasn’t in favor of that, so demanded the mandate instead, which they also are not in favor of apparently.

                                    The mandate was proposed by a right-wing think tank and then got shot down when it was pointed out just how intrusive it’d be. Given that the left voted in lockstep to implement it, the left owns it. They didn’t have the votes for a single payer or we’d have that instead.

                                    The history of single payer in this country has been the left wanting to implement it but flinching away from how much it would cost.

                                    You want public money for healthcare (and we’re already spending a lot)… but what is the limit on this? *That* is the reason single payer (or whatever) keeps failing. What exactly is the line here which prevents this from breaking the budget? Do we spend a million dollars so a premature baby can grow up with various problems? Do we spend a million dollars to give a 90 year old man another few months? Is it realistic to expect Congress to make decisions which kill little old ladies?

                                    The death rate in this country holds steady at 100%. Whatever we do, people are going to die, whatever line we draw, people are going to die, and yes, some of them on the street. As far as I can tell, your solution is to draw no lines.

                                    Report

                                • I don’t understand why you think a HSA plus insurance to cover major expenses is any different than currently existing high-deductible plans.

                                  From personal experience with an HSA: You put off necessary care, wait until the problem becomes bad enough (or your HSA gets enough money in it) and then get the care, which generally costs even more.

                                  That’s not just me — they actually ran a big study because a very large company –10k+ employees– (possibly even mine, it was the right time frame) switched to all HSA plans one year. And indeed, people put off necessary care and ended up costing both themselves and tcompany more money.

                                  My first year on it? I maxed out my HSA, and still ended up 7k out of pocket. (That’s the full HSA AND seven thousand of my own dollars). I went with the ‘medium’ deductible too. I’ve had healthcare with that company (they’re self-insured, they use companies like Aetna or Cigna to manage networks, but the pool of money is their own) for a decade, and my previous most expensive year’s total (mine payments + what the insurance paid out) was less than my OOP last year.

                                  HSA’s are awful, awful plans. Moderate co-pays are actually more efficient at saving money for everyone involved. (In fact, my HSA switched to treating a huge list of drugs like you’d already met your deductible, so people wouldn’t stop taking their important medication).

                                  The plain truth of the matter is, outside of hypochondriacs, most people find going to the doctor unpleasant and only do it when they think they have to. You don’t NEED financial disincentives, because the mere fact that going is an unpleasant chore is plenty to prevent most overuse.

                                  I’ve done allergy treatments. I didn’t do eight freaking hours of rather painful injections for fun. Frankly, if that’s what I was into I could have paid someone a lot prettier to do it for a lot less.

                                  As for pre-existing conditions: I have nocturnal seizures. Started when I was 14. I’ve had less than 10 in my life, have not had one in over a decade, and they’re controlled with a minimal dose of medication that costs (cash on the barrelhead, no insurance) about 30 dollars a month. I see a PA at a neurologists office once a year for a prescription, a visit that involves no tests other than blood pressure and a questionnaire that boils down to “had any seizures since we saw you? No? If you do, make an appointment right away”.

                                  I could not get insurance on the private market, pre-ACA, because of that.

                                  That was sufficient to make me uninsurable.

                                  Report

                                  • they actually ran a big study because a very large company –10k+ employees– (possibly even mine, it was the right time frame) switched to all HSA plans one year. And indeed, people put off necessary care and ended up costing both themselves and the company more money.

                                    I think you’re talking about the Commonwealth Fund study. The thing is that although consumer satisfaction went down (compared to ‘more comprehensive’ insurance, i.e. more expensive), health didn’t.
                                    https://en.wikipedia.org/wiki/Health_savings_account#Consumer_satisfaction

                                    You don’t NEED financial disincentives, because the mere fact that going is an unpleasant chore is plenty to prevent most overuse.

                                    So the next time you buy a car, just give the salesman a blank check and tell him to use his own judgement on what you need.

                                    That was sufficient to make me uninsurable.

                                    I’m sorry to hear that, and I don’t understand the medical/actuarial ins and outs to even begin to justify this nor to know whether or not it is justifiable. This sort of thing hits the radar as exceptionally poor consumer service.

                                    Report

                                • This is because insurance networks need *medical professionals*. No insurance company could sell insurance here when they don’t have a network here! And they’re not going to try to set one up from another state.

                                  First, the bigger insurance companies already function in multiple states, and thus already have networks in multiple states. What’s going on is every state wants to have the insurance company’s administration (i.e. jobs) in their own state.

                                  2nd, needing “networks”, at all, is a rotten side effect coming from using insurance companies for cost control. When my car crashed they wrote me a check and let me deal with it rather than insist every bolt come from the supplier with whom they’d made a deal.

                                  nothing was stopping, say, Oklahoma and Texas from creating a joint market and centralizing all their regulation.

                                  So the solution to too much central planning and political interference is more political interference? State level politicians don’t want to compete with other states. Consumers would benefit from larger markets and more competition.

                                  The ACA divides allows insurance companies to divide ages into three ranges, and requires the price be even inside that range. Additionally, the high end can be no more than three times the low end.

                                  A young and invincible can only have a policy one third the price of the elderly? :Ouch: And of course the young are largely poor and the old are largely rich.

                                  That’s not to say there are points in health care where people *do* make decisions, but *that* decision-making process shouldn’t involve costs, only various risks and recovery times and stuff.

                                  Shear nonsense. Try applying that logic to anything else, say buying a car, or a college education. Should the decision-making process really not involve costs for either of those?

                                  Dark Matter: And that world class surgeon’s $10k … in theory I could saved a lot of money by flying to a different state… assuming I could find someone like that who isn’t attached to a massive bureaucracy.

                                  I have no idea what a different state has to do with anything.

                                  The other docs I found of his caliber weren’t in my state.

                                  I don’t understand why you think a HSA plus insurance to cover major expenses is any different than currently existing high-deductible plans. Because that’s basically what you’re suggesting….a large deductible

                                  I think there’s an emotional difference, an HSA is money in hand, it’s yours, if you reduce medical spending.

                                  So someone like me, who was born with a heart defect, should never be able to get insurance?

                                  I don’t know whether a heart defect is an “increases risk” thing or a “treat every day” thing or both. If it’s just risk, then you should be paying for the risk you bring into the pool, which might be large enough that you can’t afford it. If it’s a “treat every day” thing then that’s not something “insurance” should be dealing with, meaning in theory they’d just add it to the cost of your insurance.

                                  And you should be able to get insurance as cheap as anyone else for issues that are unrelated to the heart defect.

                                  It’s incredibly easy to point to people who do not have insurance, get some major disease, and then try to get insurance, and say ‘Those people should not be able to do that’.

                                  Sure, just like you shouldn’t be able to buy home insurance after your place burns down.

                                  And the other problem, of course, is the fact that those people who didn’t have insurance until they got sick *are still sick and still need medical treatment*.

                                  This is a problem, and a big one, but it really shouldn’t be handled via insurance. Tax dollars probably are appropriate, but forcing it onto insurance companies is just politicians *literally* spending other people’s money.

                                  Report

                                  • First, the bigger insurance companies already function in multiple states, and thus already have networks in multiple states. What’s going on is every state wants to have the insurance company’s administration (i.e. jobs) in their own state.

                                    Uh, no. What’s going on is that every state wants to *regulate* health insurance sold in their state. There’s absolutely no reason that insurance companies that operate in multiple states would need to have administrations in multiple states.

                                    Meanwhile, the fact that insurance companies *already* operate in multiple states sorta proves my point that they don’t want to sell across state lines. Humana *and* UnitedHealth both sell plans in my state and in other states…but they don’t sell other state plans here in Georgia, despite that seeming rather trivial.

                                    Because, again, this does not make sense within of how insurance works. They’d have to put Georgia doctors in, for example, a Minnesota network, to sell that plan in Georgia. And they’d have to make sure that Georgia doctor was now complying with *Minnesota* health insurance regulations! (Seriously, selling plans across state lines doesn’t reduce regulations…it just means everyone has to know how to operate under *other* regulations instead of just their own state’s!)

                                    Or, let me put it more bluntly: There are two health insurance entities that lobby the federal government, ‘America’s Health Insurance Plans’, and the ‘Blue Cross Blue Shield Association’. Neither of them has *ever* asked for such an ability, or supported a bill with it in it.

                                    I mean, it’s absurd enough that the Republican ‘sell plans across state lines’ is obviously stupid and yet supported, but it’s something that literally *will not happen*, because INSURANCE COMPANIES DO NOT WANT TO DO THAT. It doens’t matter if it becomes legal!

                                    This is goddamn stupidiest ‘plan’ to solve anything I’ve ever seen. Why not ask for a law allowing insurance companies to distribute free puppies, too? They won’t do that *either* if you pass that law, but you sure as hell can waste several decades with that nonsensical demand instead of actually solving problems.

                                    So the solution to too much central planning and political interference is more political interference? State level politicians don’t want to compete with other states. Consumers would benefit from larger markets and more competition.

                                    And, I feel I must point out, for all your talking about how regulation is increasing costs, the obvious counter is that health insurance is not noticably cheaper in places less prone to regulation.

                                    If you run around talking about how regulation is harming an industry, it should be possible to compare, say, California and Texas. Or New York and Alabama. In reality, of course, Califoria *and* Texas have very cheap insurance, and New York *and* Alabama have every expensive insurance.

                                    Oregon, menawhile, has some of the most heavily regulated health insurance in the country, adding a bunch of mandatory things (Like the ACA did, but like twice as much)…and has some of the lowest insurance rates in the country at the same time!

                                    Shear nonsense. Try applying that logic to anything else, say buying a car, or a college education. Should the decision-making process really not involve costs for either of those?

                                    Every aspect of buying a car that involves *costs* is a luxury, because car companies, and even people selling used cars, are not allowed to sell cars that do not do the basic premise of cars. (Well, not allowed to sell them as functioning cars, that is.) And cars, in the end, are basically optional anyway.

                                    Same with a college degree. You fail to get one, you don’t die.

                                    Health care is *both* something people do not fully understand the risks of, *and* something they must particulate in or die.

                                    I think there’s an emotional difference, an HSA is money in hand, it’s yours, if you reduce medical spending.

                                    Erm, if there was any emotional difference, it would surely be towards less spending with *deductibles*, which you have to pay out of your *normal* money, as opposed to money you already set aside for spending on health care. Stuff in an HSA is *for* medical spending, whereas deductibles are ‘Oh, crap, I have to pay for this out of pocket because I haven’t hit my deductible yet’.

                                    Frankly, and I hate to have to point this out, the reason Republicans like HSA is that they can use them to reduce their taxes…which is a very clever trick to let people *wealthy* enough to operate an HSA pay less taxes, whereas poor people *don’t* get to do that. (Whenever you hear a politician say ‘encourage Americans to save for X’, mentally replace it with ‘Reward Americans wealthy enough to save for X and punish those who are not’.)

                                    I don’t know whether a heart defect is an “increases risk” thing or a “treat every day” thing or both. If it’s just risk, then you should be paying for the risk you bring into the pool, which might be large enough that you can’t afford it. If it’s a “treat every day” thing then that’s not something “insurance” should be dealing with, meaning in theory they’d just add it to the cost of your insurance.

                                    I don’t really want to get into it, but let’s say that my health condition has not cost me any medical expenses in nearly two decades besides visiting a cardiologist every few years. I *used* to be pretty expensive, as I needed a new pacemaker every eight years or so, but don’t need one anymore.

                                    Oh, and I’m at increased risk of some heart infection thing, so I have to take some cheap antibiotics before visiting the dentist. (They were like $5 when I didn’t have insurance.)

                                    And you should be able to get insurance as cheap as anyone else for issues that are unrelated to the heart defect.

                                    There is an awful of ‘shoulds’ in there for someone who is demanding *less* regulation of health insurance *and* doesn’t like the mandate. How, exactly, are these ‘shoulds’ going to happen?

                                    Insurance companies do not sit down and try to figure out things at a personal level. Insurance companies go ‘Oh, you were born with X? Denied.’

                                    Sure, just like you shouldn’t be able to buy home insurance after your place burns down.

                                    I like how you cut out my *next* point that a lot of uninsurable people *had* insurance. Pretending that all uninsurable people were free riders is nonsense.

                                    I had insurance when I was born. I had insurance my entire life until I aged off my mother’s insurance.

                                    At which point I could not longer get insurance.

                                    And there are plenty of people who played the game *correctly*, who *thought* they had insurance and paid their premiums every month…and then got stupid-expensive sick and the insurance companies spent a lot of time and effort figuring out some reason to kick them off, aka, ‘rescission’ …or, hell, they just hit a lifetime cap.

                                    At which point *they* can’t get any insurance either.

                                    And, I will note, this is *perfectly logical* behavior for insurance companies…which is why ‘health insurance companies’ are a completely idiotic paradigm to even be operating in.

                                    Report

          • One where we regularly put down dogs because the care is too expensive?

            That’s quite accurate. “Cash on the barrelhead or die” is, indeed, the free market approach to healthcare.

            The ACA is an attempt to harness the free market’s ability to work efficiently with the general public’s unwillingness to let the poor die of treatable illnesses.

            As data pours in, we’re starting to learn very fun things about healthcare as a market — it’s actually a pretty crappy one. For instance, it’s irrational — people will often ignore minor to moderate needs (due to cost) even though in the long-term dealing with it once it’s become urgent is more expensive. (Diabeties care and management, for instance).

            Pricing is incredibly opaque, with the same procedure’s cost varying by an order of magnitude or more in the same zip code (a fun paper tried to price the cash cost of an MRI in California — anywhere from 500 dollars to 5k, depending on the place).

            Moreover, judging healthcare needs requires a specialist’s expertise — often the person you’re talking to. It’s the “my car is broken, is the mechanic lying” problem — except it’s over your health, where you can’t say “screw it” and buy a new car and sometimes you can’t even take it to a new mechanic. (And even when the mechanic’s honest, he sometimes doesn’t realize he’s getting screwed — I was once prescribed a drug that cost 400 a month. Not being able to afford it, I did research and realized it was a combination of two OTC that cost — combined — 40 bucks a month. My doctor was unaware it was a 400 dollar prescription).

            Lastly, people in need of care — especially urgent care — do not shop around. In fact, it’s generally a massive effort just to ensure you end up in a facility in your network — trying to find the cheapest one is beyond them, even if they could get good prices.

            Opaque, inelastic, trending towards monopolies, requires expert level skills to determine need — it’s basically a recipe for a crappy market. Even BEFORE you get into a society that says “We’re not going to say “Pay or Die” to get healthcare”.

            Report

            • …the general public’s unwillingness to let the poor die of treatable illnesses.

              Resources are not unlimited, this is health care, people are going to die. If you want to call $100k a year a “treatable” illness then you’re killing the ones who need $500k. If you call $500k treatable then we can take it to $5Million.

              “Cash on the barrelhead or die” is, indeed, the free market approach to healthcare.

              Charities have always existed, if healthcare were cheap it wouldn’t be as big a deal.

              People are going to die, no matter what system we use. The real question is whether we could save more people (and if they’d be better off) in a free market where the costs were 20x lower.

              If the dog comparison is accurate, we’re spending more than 90% of our healthcare dollar on overhead. Bureaucrats dealing with other bureaucrats. IMHO this is not value added, and that money would be much better spent on healthcare.

              Report

                • greginak:
                  Or we could look at the many examples of other countries that provide universal care and have good outcomes.

                  There are issues.

                  1) As far as I can tell, UHC doesn’t make things cheaper, they control things via rationing (which is fine… if we can reasonably expect Congress to kill little old ladies by withholding care).

                  2) UHC somewhat decently holds prices in check, but it’s never been known to reduce prices. If we’re going to reduce prices then we need a lot more disruption than that.

                  3) Most UHC comparisons include “equality” and parts of our population don’t (or at least didn’t) have access to HC (maybe the ACA changed that).

                  4) UHC comparisons never adjust for our population being fatter and more murderous.

                  5) I talk with a lot of immigrants who grew up under UHC, and needing to bribe the doctor so you can see him is maybe an experience I can skip.

                  Report

                  • UHC also acts to make things cheaper, both by a massively smaller bureaucracy that the nightmare combination of market and regulation has created in the United States and also by curtailling health care professional wages compared to America. Two of the biggest expenses not directly related to treatment are significantly reduced compared to the American system.

                    UHC isn’t going to reduce prices in places it already exists it has existed for decades and then had price increases because of the same reasons healthcare is increasing everywhere. The experience of the one industrialized country that didn’t get into the game when it was popular becoming like everyone else might be a bit different than starting a universal system in between 1945-75.

                    I’m also skeptical if the immigrants you talked to about bribery came from 1st world countries with that level of anti-corruption norms.

                    Report

                    • I’m also skeptical if the immigrants you talked to about bribery came from 1st world countries with that level of anti-corruption norms.

                      Very good. I think the formerly communist countries would be 2nd world.

                      In the 1st world, with total anti-corruption… they just wouldn’t be able to see a doctor in anything like a reasonable amount of time.

                      Report

                      • Wait times are an issue with rationing, but its important to understand what gets waitlisted in an advanced UHC system. They work by triage, anything that’s an emergency or life-threatening gets priority and tends to be dealt with swiftly.

                        Its the non-lifetreatening quality of life stuff that gets triaged into waitlists. Most systems have supplimental private insurance that allows you to buy earlier access for that kind of thing if you have the resources.

                        The biggest kicker with a UHC system compared to the present American one though is you don’t have to spend 17% of GDP of one of the richest societies in the world to get basically the same or worse overall outcomes. I really think Americans should be made clear about is the absurd economic inefficiencies of their approach compared to everyone else’s. I think your intuitions about a gigantic amount of health care in America going to overhead is reasonable, but it appears the Americans in the pursuit of a “market” system have that problem more than anyone else right now.

                        It also should be noted that most UHC approaches use market mechanisms and tend to be public-private hybrids to some extent or another. I think what particularly bedevils the American system is that its a particularly poorly-designed hybrid of goverment and private action that manages to get the worst of both.

                        Report

                  • 1) UHC controls cost not by rationing but by a combination of aggressive negotiating with the healthcare suppliers and by not having luxury amenities like private hospital rooms. Hospitals, clinics, and doctor’s offices tend to be more spartan. They do not kill old people.

                    2) There is no evidence that free market healthcare, which is never really that well defined even by free market advocates will keep prices in check because people generally choose living over dying. Most people also don’t have the energy to negotiate and do price checking when dealing with issues of health. This isn’t buying a car or furniture.

                    3) The government can provide access to health care more than the market because the market could rationally decide to abandon areas in the way that a democratically accountable government could not.

                    4) Many non-American countries with UHC like Canada, Australia, the United Kingdom, and Germany also have an obesity crisis. It could also be that our population is more murderous because of the lack of access to basic social services like healthcare.

                    5) This is like the old claim that Canadians go south to seek healthcare in the United States. Anecdotes are not data. Provide evidence not anecdotes.

                    Report

                    • The assertion that some variation of “free market” approach to health care delivery usually has overtones of faith based fabulism, that is, that this approach will result in a more just outcome, a more available outcome, a cheaper outcome, and a higher performing outcome, all at the same time.

                      There doesn’t seem to be much willingness to accept that whatever course we choose, there will be tradeoffs and sacrifices.

                      Markets do some things very well, but most often they do them well by excluding nonpaying customers from the market.

                      Healthcare is rather unique in that we declare, as a matter of principle, that there are no exclusions to health care based on price.

                      Markets aren’t really equipped to deal with that sort of directive. “Let charity handle it” is really just an “Assume a can opener” escape hatch.

                      Report

                      • Healthcare is also unique in that people are not going to have the information, time, and energy to do comparison shopping like they would for a home, car, or furniture. In an emergency people need medical help immediately and other times they aren’t going to go to many different doctors to determine the best course of action.

                        Report

                        • In an emergency people need medical help immediately and other times they aren’t going to go to many different doctors to determine the best course of action.

                          Even ignoring the growth in ‘immediate care’ facilities (which might be local). How much of medical expenses are because of “emergencies”?

                          Further, one of the big problems with “comparison shopping” currently is it’s basically impossible. The numbers are buried, difficult or impossible to find, and so forth. Imagine going to a food store where none of the products were labeled and the bill was sent to some 3rd party and not itemized.

                          This sounds like an invitation to being ripped off, but instead of dealing with that we object to the idea of making comparisons.

                          Report

                      • Healthcare is rather unique in that we declare, as a matter of principle, that there are no exclusions to life saving health care based on price.

                        Cosmetic health care is still pretty free market.

                        That said, some basic stuff, like price transparency, would still help. When I got my dental crowns installed, I knew going in how much it was going to cost, what was included, etc. I can understand how emergency medicine can’t reasonably be expected to offer up price information, but outside of that. And it wouldn’t be just for the patients. As says, often doctors have no clue how much things cost.

                        Report

                        • I called the doctor’s office on that particular drug. He was surprised. He only prescribed it (instead of the OTC stuff) because he assumed it was roughly the same price and he wanted patients to make sure they took both. (It was literally Alleve + Nexium — for people where NSAIDs are indicated but often cause stomach problems).

                          Since then, he just tells them to take Alleve as directed and Nexium as directed for three weeks. :)

                          Report

                          • I have been in a mild cholesterol drug for several years. This year my employer changed the insurance plan. The copay for my first 90 days refill went from $ 15 to $ 700 (that’s a seven with two zeros behind).

                            I got a new prescription for a same effect, different brand, with a zero copay. My doctor said the main difference was that the new pill was bigger (it is) and would be more difficult to swallow (it isn’t). But I still had to go to his office for the system to allow him to change the prescription ($ 10.00 copay). It couldn’t be done over the phone.

                            Free market in action I guess. Good thing I wouldn’t die even if I stopped taking any cholesterol pill

                            Report

                            • Epipens are filled with about 3 cents worth of drug. (A vial of the stuff, with LOTS of doses, is about 20 bucks). Used to be a pair of pens (they’re always in pairs) went for about 80 bucks — 40 a pen.

                              Then the company got bought out, released a ‘new’ version, and charges 400+ for a pair. Considering even the ‘improvements’ in this new version were fully paid for by a US Army contract (they wanted more reliable injectors that would go through a uniform), you’re still talking about 3 cents of drug in a plastic package that consists of a button, a spring, and a steel needle.

                              It is not made of gold, it does not contain a rare drug that costs thousands an ounce. It should not cost as much as a smartphone.

                              And it certainly doesn’t to make — I’d be shocked if it cost even 20 bucks to make and fill a pair of these things. 2000% markup is sweet.

                              Another fun story: Extended release metformin? For a 500 or 750mg pill, it’s about 20 a month. For a 1000mg pill it’s 250 a month. That’s “I pay cash, no insurance” money.

                              A relative of mine had to call the doctor and have them specifically order 4×500 pills instead of 2×1000. Nobody, not her insurance company or her pharmacist could explain why it cost 10 times as much for 1000mg pills as opposed to 750.

                              Her doctor didn’t know either, and I guess pharmacists are happy to sub generic but don’t tend to sub number of pills, even if the total dosage is the same.

                              Report

                      • Chip Daniels: Markets do some things very well, but most often they do them well by excluding nonpaying customers from the market.

                        Yes, agreed.

                        Chip Daniels: Healthcare is rather unique in that we declare, as a matter of principle, that there are no exclusions to health care based on price.

                        That’s an idea we need to stare down and get rid of. First, because it’s not true anywhere, every society and system puts an upper limit on total health care dollars and society itself doesn’t even have an infinite amount of resources.

                        Second because the cost of making us all equal means getting rid of future lifesaving medical treatments. New medical treatments become cheaper over time, normally much cheaper.

                        And, if we stare down the concept that we’re going to give everyone in society a blank check, then we can have a sensible discussion about how to maximize health, including future-health.

                        Report

                        • That’s an idea we need to stare down and get rid of.

                          Please proceed with this.

                          Please exhort your fellow citizens to create a world (as I mentioned below) where people behave differently, in some really deep and fundamental ways, than they do now.

                          Report

                          • :Amusement: That is the problem, well put.

                            Having said that, I think it’s possible, but we’re not in enough pain. When the budget breaks we’ll have to clean house, then we might see big time reform which priorities growth and sharply reduces gov meddling.

                            Report

                            • I guess this is where when you hold an idea that isn’t popular, like I do with property rights, we need to conjure up what sort of Big Picture we want to achieve with our unpopular ideas.

                              If our unpopular ideas are intended to create a More Just World, wouldn’t a More Just World be defined around the a priori beliefs of the people living in it?

                              I’m thinking of that Kafka story called “The Penal Colony” where there is this horrific machine that tortures a prisoner until, just at the moment of death, the prisoner finds enlightenment in his suffering, insinuating that justice lies outside of our corrupt nature.

                              We get a lot of that in political circles, the “worse the better” sort of stuff.

                              Report

                  • I talk with a lot of immigrants who grew up under UHC, and needing to bribe the doctor so you can see him is maybe an experience I can skip.

                    Dear Mr Dark Matter:
                    I am beautiful and sexy Russian girl, in need of money for with to bribe corrupt Nigerian doctor in government run inefficient top down command economy healthcare…
                    .”

                    Report

              • But the dog comparison isn’t even remotely accurate which kind of collapses the entire point. If we valued dog lives the way we value human lives then the market would indeed research and develop medical care for dogs that would be both highly efficacious and highly expensive. We don’t, so it hasn’t.

                We are not spending 90% of our healthcare money on bureaucracy. We’re also not spending anywhere near a large amount of our money on basic care for poor people either. The majority of our healthcare money is being spent on care for elderly upper middle income people (not rich people necessarily though they’re in there too- there’s just not numerically enough of them). Oh and we’re spending a vast amount of it on elderly people.

                Report

                • Several very intelligent people noted that America has a welfare state just like Europe does. Its just that our welfare state favors the elderly and affluent over the young and poor.

                  Report

                • If we valued dog lives the way we value human lives then the market would indeed research and develop medical care for dogs that would be both highly efficacious and highly expensive. We don’t, so it hasn’t.

                  This is claiming that expensive cancer drugs don’t exist (which is fine), but their radiology treatments were pretty in line with everything else.

                  The majority of our healthcare money is being spent on care for elderly upper middle income people (not rich people necessarily though they’re in there too- there’s just not numerically enough of them). Oh and we’re spending a vast amount of it on elderly people.

                  Agreed, if memory serves something like half your lifetime expenditure of HC happens in the last 18 months of life.

                  Which is why I think, if we’re going to have gov supplied HC which we clearly are, we desperately need death panels or something similar.

                  But Congress, by whatever name we want to call them (UHC, ACA, etc) is amazingly ill suited to do anything to control these costs.

                  Report

                  • You keep saying that, which is fine, but it doesn’t appear to be the case. As you note healthcare will be rationed somehow; in the US it is/was rationed by the ability to pay. In the rest of the industrial world it is rationed more administratively. The rest of the industrial world does not look at the US healthcare outcomes (before or after the ACA) with any envy.

                    Report

                    • He’s also not noting outcomes for dog cancer, btw. I don’t have the data handy, but it ain’t as good as with people.

                      Mind you, I have seen pharmaceutical companies price the same drug at a fraction of the cost if it goes to a vet, but that’s because people will let their pets die rather than be gouged. They’re price sensitive. But hey, gouging the market for all they’ll pay for drugs IS the free market!

                      Report

                      • He’s also not noting outcomes for dog cancer, btw. I don’t have the data handy, but it ain’t as good as with people.

                        Also, a lot of dog cancer is solved via amputations, which we are much more hesitant to do to humans. Once you exclude people who lost a leg to violence (Where there basically is no option), there are a lot less one-legged humans than three-legged dogs, because doctors are a lot less willing to do that than vets are.

                        About the only common form of human cancer we commonly solve via amputation is breast cancer, AFAIK.

                        And a lot of dog cancer is skin cancer, and you can basically just lope part of their skin off, whereas even if skin cancer was that common in humans(1), we’re more subtle when solving it. If it’s large enough, we do skin grafts and whatnot.

                        Additionally, humans require much more cosmetic work after *any* surgery. No one cares if their dog has a huge scar on its side, or is missing an eye, or whatever, whereas with humans we try to minimize scars and give them a prosthetic eye and whatnot. If we really had to cut off a leg, now there’s the cost of a prosthetic leg, and years of physical therapy, etc, whereas with dogs we’re like ‘Well, there you go. Hope you can still walk’.

                        1) Technically, ‘skin cancer’ is common, but the *dangerous* type isn’t. From what I understand.

                        Report

                      • I think “the free market will solve healthcare” is reflexive ideology, because the second you think about how healthcare works you realize it’s an awful problem for the free market.

                        It’d take massive government regulation JUST to make it “market-like” (forcing price disclosure, for one) and then it still wouldn’t work because sick people don’t shop around, people are particularly weird about healthcare costs and often highly irrational (‘saving’ money by neglecting maintenance meds or treatments, only to shell out 10 times as much in the ER), and int the end they rely on their doctors to tell them what care they need which introduces all sorts of perverse incentives.

                        Report

                        • When you ask “What would the ideal health care delivery system look like?” some people might answer that it would look like Germany, or Scandinavia or somewhere, but in order to claim a “Free Market” system, one would have to paint a picture of a world where people behave differently, in some really deep and fundamental way, than they do now.

                          Report

              • The real question is whether we could save more people (and if they’d be better off) in a free market where the costs were 20x lower.

                I’m late to this so I’m unclear if, by “costs”, you mean total expenditures or cost-per-service. It’s sorta hard to imagine that such a goal is achievable either way.

                we’re spending more than 90% of our healthcare dollar on overhead.

                I’d need to see some evidence that it’s 90% personally, but I agree with you that a significant chunk of our healthcare dollars cover paperwork and admin. But to be fair, a significant portion of that rollup on pricing is accounted for by profit. And to be less fair (to your point, anyway), the bureaucratic loss you cite is exactly the argument people use for going single payer.

                Report

          • If you want to look at what how an actual free market would function for healthcare, examine the HC system we have for dogs.

            Not that I really care about pursuing the analogy, but aren’t veterinarians regulated or licensed? And they should be! But it’s not exactly a “free” market. But then again, I’m of the mind that there really isn’t a purely free market to begin with. So I guess pet health care is close.

            Report

    • Ah, no. You’re making a mistake there — you assume people will change their political beliefs when they change parties, instead of changing parties with their beliefs.

      In short, say the GOP collapses tomorrow and it’s voters flee to the Libertarian party, desperate to be away from the GOP brand.

      They will not suddenly become Libertarians, other than using the name. If they were authoritarian before, they still will be. And the Libertarian party will suddenly find itself embracing those views, because that’s what the bulk of it’s new members will want. (And so the actual Libertarians will leave, and form the True Libertarian party or something that will get 1% of the vote as usual).

      Because in the end, the real rub is this — the Libertarian party platform is not very popular. The collapse of the GOP won’t make it more popular, other than a short-term “I’m not voting GOP or Democrats, and like freedom and self-reliance sounds good!” — participation which lasts about exactly as long as it takes the average voter to get a feel for what the LP actually believes.

      A party collapse and realignment won’t really make unpopular concepts popular, or vice versa. It won’t make entire voting blocks suddenly switch their political and ideological views. What it will do is rearrange the beds and change whose sleeping together, and maybe — if we’re very lucky — convince groups like the white nationalists to take their ball and go home.

      Hopefully forming a third party we can all ignore.

      Report

      • Ah, no. You’re making a mistake there thinking I’m making a mistake there — I assume people will change their political parties because they know longer believe in what those parties stand for.

        The GOP probably won’t collapse, people will just want change. Change that the party cannot deliver.

        Some will want more authority to control in a social context, the other will want to remove themselves from being controlled in a social context. There is no where but downward on the y-axis if one wishes to move away from that party and stay on the right. If they do want to keep the authority and are not that interested in staying on the right, they can move leftward into national socialism. Which really isn’t as much of a move, but a return for many. Where do you think the right got it’s nationalists?

        Report

      • I understand what you’re saying, but I severely disagree.

        One of the things that Trump has revealed is that the Republican electorate was not really all that concerned with the Movement Conservative platform. The evangelicals have supported Trump, despite has indifference and incoherence when speaking about religious issues and values. Trump has inconsistently spoken of removing the tax advantages offered to the wealthy, which is in direct contradiction to the only real issue that has been consistent and widespread in conservative “thought” for the last 40 years.

        They have supported these policies, not because they believed in them, but because that’s what the tribe believed. Not everyone is a policy wonk, so if you’re not entirely engaged in an issue, you adopt the perspectives of those you trust. I can think of no natural reason why there should be a close correlation between one’s views on abortion and global warming, but there is. And the reason is because the cluster of opinions comes from the tribe, not from careful, dispassionate analysis.

        So, new parties will enable new voters. And new outlooks.

        Report

        • Yes, so that leaves the question of what do they really want.

          And any party they drift to will have to offer it.

          To be blunt, the GOP has offered white nativism to voters since 1964. How loudly they offered it varied, but it was always on tap. If the GOP falls apart, which party is going to take up the dog-whistling banner?

          Sure, tribalism means they’ll keep opposing those Democrats — but why on earth would they stick with the Libertarian platform when they can rewrite it (by dint of now being the massive majority of members) to something they like better?

          Report

        • The evangelicals have supported Trump, despite has indifference and incoherence when speaking about religious issues and values.

          Let me channel my “evangelical” for a moment. Warning: Seriously Not me.

          I’m voting for Trump hands down. Trump is really clear on who he’d put on the Supreme Court, and that’s the only thing which matters for a President.

          So he gets a pass on multiple divorces and not being in God’s pocket personally (and all Politicians probably go to hell anyway so whatever).

          Report

          • That’s accurate from my reading of religious conservatives.

            Question for the room: If Hillary got creative and made an offer to socialcons what do you think would happen? I’m imagining something for minorities (like the ENDA) wrapped up with a strong but narrowly tailored religious liberty bill (No going after churches or religious charities that don’t take public funds, no threatening accreditation or licencing of religious schools for anything outside basic educational requirements, that sort of stuff).

            I imagine that after Dreher got done mopping his exploded head off the walls he and the socialcon right would probably rationalize that it wasn’t enough/was disingenuous so they’d still support Trump. Couple that with the far left being furious at the idea and I can see why HRC hasn’t tried it.

            Report

            • If Hillary got creative and made an offer to socialcons what do you think would happen?

              Hillary isn’t going to put a hard pro-life judge on the Supreme Court, Trump will.

              Report

              • Hillary isn’t going to put a hard pro-life judge on the Supreme Court, Trump will.

                I’d accept the following: “Hillary won’t and Trump may”. But I have a really hard time believing, given his statements and behavior over the primary, that he will. In fact, I’m dubious of any claim regarding what he “will do” since it implies there’s a discernible methodology to his apparent madness.

                Report

                • He already announced his judge pick list, that’s going to make it hard to back out. The Right made WBush back down on his choice and go with their guy.

                  Having said that, if the GOP loses the Senate then all bets are off. Mr. Make-a-deal will make a deal with whoever is in charge.

                  Report

                    • Judges still have to be confirmed. Dark is correct on this. I see no reason to think a President Trump would have any strong opinions on judges, certainly not enough to buck the GOP Senate majority that’d necessarily exist if he got elected.

                      Report

                      • North,

                        I see no reason to think he’d do one thing over another. The argument seems to be that he’d stick to his guns on his list, but why think that? He got neither skin in that game nor any record of playing by establishment rules.

                        Which is to say: he MAY pick one of those people as his nominee, or he may not. There’s absolutely nothing in his past behavior or generally stated approach to governance that indicates that he will.

                        Other than a presumption that he’ll adhere to establishmentarian convention….

                        Report

                        • We’re probably at a glass half full/empty point. We both agree Trump’s generally kind of unmoored in the political game. You see it as a sign that he’d not have any reason to stick to his list, I see it as a sign that he’d not have any reason to bail on his list. Short of him trying to sell off Supreme Court seats to the highest bidder or something I don’t imagine Trump would have any real personal incentive to appoint any one specific to the court and the list would have a vocal political constituency backing it. So I don’t see any reason to think he wouldn’t appoint justices from his list.

                          Report

      • the Libertarian party platform is not very popular.

        We’re not in enough pain yet. Spending other people’s money is popular until you run out and melt down the economy.

        Report

          • It’s because everyone else is sheeple, clearly.

            Fringe ideology is fringe (and yeah, 3% is pretty fringe) the world over, and it’s not through lack of PR or education efforts.

            It’s just not that compelling to many people.

            It reminds me of some coworkers talking about jobs, job creation, and wealth during the Great Recession. Each of them was speaking as members of a field where they were actively head-hunted for jobs. People randomly called them, offering contracts or positions across America.

            That was a rare condition in a single field — and geographically limited. (I suspect the Silicon Valley folks weren’t head-hunted for jobs in North Dakota, for instance). Sub-sets of IT fields, decent talent not already making it in Silicon Valley, so open to relocate.

            They generalized that to the population as a whole. Literally could not grasp why people couldn’t find work, even as you’d read news stories of companies deluged with hundreds of applications for a handful of jobs. It was “laziness” not lack of work plaguing those without jobs.

            Report

            • It’s just not that compelling to many people.

              Yes, explaining that the gov’s spending, which is mostly on entitlements, *your* entitlements, isn’t sustainable or good for the economy long term is a hard sell. It’s even a harder sell when “long term” is FAR longer than the current election cycle and it’s enough decades in the future that you might be dead.

              However math is without mercy.

              FDR started us down this path, and ever since then gov spending as a percentage of GDP has basically gone up (excluding WW2), and gov spending on entitlements (i.e. politicians using your money to buy your vote) has only gone up. Gov spending trends up over the decades, growth in the economy trends down. That’s a problem.

              How do we pay for all these wonderful benefits we’ve promised everyone? When does the gov stop expanding? So… where does it end? Communism (the ultimate in state control) has shown itself an abject failure enough times that it’s not a problem in implementation.

              IMHO it’s very fair to say we need a state to function.

              IMHO it’s also very fair to say the state is too big, doesn’t function especially well, wastes money, is prone to corruption and other abuses of power, and is attempting to do things best left to the markets. Every generation of politicians needs to *do* *something* to justify their existence, we haven’t figured out a way for that *something* to be shrinking the state as opposed to growing it.

              It was “laziness” not lack of work plaguing those without jobs.

              The gov really should get out of the business of job destruction.

              Report

    • People like the primary facets of the right, the individual freedoms, the economic freedoms.

      The bullying, the spies in your bedroom, the militarism, the contempt for diplomacy, the economic war on the poor and middle-class.

      Report

      • “The bullying, the spies in your bedroom, the militarism, the contempt for diplomacy ”
        Ha, you must have misundertstood, when I say Damn Small Government it fixes a lot of this.

        “the economic war on the poor and middle-class.”
        Nothing says love the poor like the droves of leftist elites who are just going to perpetuate the same economic situation that we have had for 8 years. Hell, it’s not even a war, so much as organized “state corporate” circle twerking, leading into flavors of socialism.

        Report

          • There have always been folks in the right that wished for Damn Small Government. Just in the 80s there was a bunch of people that came over from the left. You know, after the left got all ‘hate business people’. It’s been a mess ever since.

            Report

            • It gets screwed up in the US because many people who say “small government” mean “small federal government”, especially after things like Brown vs. Board of Education and the CRA and VRA. The first of the modern “small government” candidates got what votes he did largely on his opposition to the the second of those, and the same “small government” believers who gave you the invasion of Iraq and the Patriot Act finally got around to crippling the last of those. The “small government” justice Clarence Thomas thinks that states have the power to establish a religion.

              Report

    • The problem with libertarianism is that it is extremely attractive to racists and theocrats. That’s what caused the GOP’s problem in the first place; there’s hardly any real libertarians, they’re mostly just people posing as such who want to weaken the federal government so they can have their nasty way without the government stopping them.

      Well, the other problem is that it doesn’t work; the US tried libertarianism in the 1780s and it was a cluster, which is why we ditched the Articles of Confederation and went with the US Constitution.

      Report

      • “The problem with libertarianism is that it is extremely attractive to racists and theocrats.”

        Project much?

        “there’s hardly any real libertarians, they’re mostly just people posing as such who want to weaken the federal government so they can have their nasty way without the government stopping them.”

        Yeah, you described me to tee there! Your level of insight is stunning!

        Report

  6. Trump uncovered something that had been latent in the GOP. It cropped up now and then, like Pat Buchanan’s campaign for President in 1992 and 1996, but then it would be swept back under the rug. But now that this has been uncovered, it is becoming mainstreamed into the party.

    It was never all that covered, and it wasn’t merely an artifact of persons like Buchanan who could be dismissed as outliers. The Willie Horton ad, to pick an example off the top of my head, was completely mainstream within the party.

    What has changed is that conservative intellectuals now have a much harder time dismissing this sort of stuff as just playing the game. The Willie Horton ad could be rationalized as essentially duping racist voters for the greater good. Conservative intellectuals could tell themselves that this stuff wasn’t really the Republican Party, but just a bone thrown out to one small segment of the voters. But now it turns out that that segment controls the party.

    Frankly, conservative intellectuals have been in their own bubble. They served to give a veneer of respectability to the party, but it has been a long time since they had real influence.

    FWIW, I am a white male well on the far side of “young.” I switched from mostly voting Republican to mostly voting Democratic about twenty years ago in large part because of this kind of stuff.

    Report

    • That was the point of Avik Roy’s interview at Vox. Conservative intellectuals were in denial about why many in the GOP base voted for conservative policies.

      The conservative policies that GOP intelligentsia wants probably only appeals to a small chunk of the nation. Maybe 20 percent.

      Report


      • The conservative policies that GOP intelligentsia wants probably only appeals to a small chunk of the nation. Maybe 20 percent.

        This. This is what people need to understand.

        Well before this election, for *years*, it’s been pointed out many times by a lot of people, me included, that the Republican voters…are actually really liberal when you start asking them about policies divorced from partisan identifiers. Like, they often end up to the left of the elected Democratic position!

        I.e., Republicans will say they want things that are pretty much exactly the same as Obamacare, but do not want Obamacare the second it’s identified with Democrats.

        There were always a few different interpretations of this:

        1) It’s possible that every Republican voter could have believed liberal things about 9 out of 10 things, but the last issue they were conservative on, and it was very very important….and this issue varies between Republicans voters. (This is actually what I used to think, a decade ago.)

        2) The same, with a larger grouping, where each Republican voter believes in *one* of the three legs of conservativism, and didn’t care about the others.

        The problems with these two theories is that…they don’t actually reflect reality. Sure, you can find voters that vote that way, but it mostly only seems to happen on pro-life stuff, where that one issue will override anything else. That’s about the only *general* deal-breaker, and the number of actual ‘abortion should be illegal’ voters are much, much lower than people think.

        Other interpretations of this:

        3) Republican voters are just dumb, or have just been tricked into voting against their best interests. Aka, the ‘What’s the Matter with Kansas?’ theory.

        This theory is *really* attractive to Democrats, but I don’t think it holds water.

        4) This disconnect between what Republican voters say when asked if they like the idea of ‘everyone having to buy a minimum level of health insurance’ vs what they say about Obamacare is them *lying* in the direction of niceness. I.e., when you present abstract ways for them to be nice, they like them, but do not like actually doing them. Sorta, but not quite, the Bradley effect for political positions. Let’s call this the FYIGM theory.

        On the whole, this theory seems the most plausible. ‘Oh, of course everyone should be able to pay for their medical care, only a heartless monster would say otherwise and I’m not that! I just don’t like *this particular* way of doing it.’ (Translation: Actually, I don’t care about that, and think it’s a bad idea, but feel I can’t say it.)

        But this didn’t make a lot of sense, considering the strange fact that a few of those used to be Republican positions to start with!

        And then…we got Trump. And Trump’s huge changes in all the Republican positions, and then his winning the nomination, showed us the reality…the Truth of what is going on was #4, but *backwards*. So the actual truth appears to be:

        5) Republican voters didn’t *actually* dislike what the Democrats were presenting, with them lying sometimes to seem ‘nice’…it turns out they *did* like what was presented, and lied about *disliking* it when it was presented as a Democratic policy.

        But…wait. Now we’re back to #3, somehow, except somehow dumber! Now we’ve got almost total nonsense. I mean, that sort of thing could happen in a short term, but in the long term, shouldn’t political parties be presenting the ideas that their voters…actually like? Shouldn’t voters be choosing parties that present policies they like?

        To quote Futurama ‘That just raises further questions!’. And the answers to those question gets us deep into the weeds, and this post is long enough, but to simplify what appears to be true:

        The people in charge of the party believe that Republican voters were with them for a bunch of different things. They were factually incorrect.

        The Republican voters, meanwhile, were with the party for reasons that had *nothing to do with policy*.

        And it’s very easy to simplify that reason as ‘racism’, which is perhaps how it started, but I think ‘nationalism’ is a better word to use….but it’s pretty specific white nationalism, even if people don’t want to use that term.

        Report

        • Jonathan Chait usually explains this phenomenon by saying that Americans are “ideologically conservative but operationaly liberal.” Most polls show that when you ask Americans broad ideological questions, conservative responses predominate but when you asked more focused policy questions, you get more liberal responses. There was apparently a poll right before the 1936 election that revealed that most Americans would prefer to vote for a conservative party over a liberal party if given the choie. Than FDR won in a landslide.

          There has always been a romantic sentiment towards self-sufficiency in the United States with the free person not dependent on anybody being seen as the most ideal state. Its why the pioneers got romanticized for so long even when most Americans never lived the hard-scrapple life of the homesteader. At the same time, very few people really want a government that will do nothing for them when they need and want help becuase of the vagaries of life. Very few people even among the most educated and intelligent are really capable of planning for all or even most contingencies that could come up.

          Report


          • Jonathan Chait usually explains this phenomenon by saying that Americans are “ideologically conservative but operationaly liberal.” Most polls show that when you ask Americans broad ideological questions, conservative responses predominate but when you asked more focused policy questions, you get more liberal responses. There was apparently a poll right before the 1936 election that revealed that most Americans would prefer to vote for a conservative party over a liberal party if given the choie. Than FDR won in a landslide.

            No. Chait making a dumb over-simplification.

            That is how it polls, but it is clear what is happening is that Republican voters can *recognize* ‘broad ideological’ positions as conservative or not, so agree with the conservative ones, whereas they often are not up to speed on *specific* positions, so agree with liberals ones when they are unidentified, and conservative ones when they are identified.

            I.e., they aren’t saying they want less social services in general, but because they actually feel that way….they are saying they want less social services in general because that is *obviously a Republican position*, whereas they don’t know where Republicans stand on, for example, universal pre-K, so their actual personal preferences shine through. But if you tell them the Republicans are for or against universal pre-K, or present the question with a few different party dogwhistles indicating the Republican position, and they pick what the Republicans want.

            There has always been a romantic sentiment towards self-sufficiency in the United States with the free person not dependent on anybody being seen as the most ideal state. Its why the pioneers got romanticized for so long even when most Americans never lived the hard-scrapple life of the homesteader. At the same time, very few people really want a government that will do nothing for them when they need and want help becuase of the vagaries of life. Very few people even among the most educated and intelligent are really capable of planning for all or even most contingencies that could come up.

            I’m aware it’s the official talking heads’ position, but it really is nonsensical, so nonsensical it didn’t even make my list.

            In addition to it not actually being true, the only Republican positions it can apply to *at all* are ‘fiscal conservative’ ones, and doesn’t explain why the exact same disconnect is true for the *social* conservative issues where Republican voters show the exact same pattern!

            Report

            • I.e., they aren’t saying they want less social services in general, but because they actually feel that way….they are saying they want less social services in general because that is *obviously a Republican position*

              This got a bit confused in editing. I meant the opposite: They aren’t saying they want less social services in general because that they actually feel that way…they are saying they want less social services in general because that is *obviously a Republican position*

              Report

        • My view is that it is more ethnic/racial ethnicity. Along with Roy, there were a few state senators who switched to Libertarian from Republican because they discovered that their base was only going along with the wonky conservatism because said base thought that those policies hurt brown people.

          The whole thing about Trump being the Tribune of the White Working Class is his seemingly promising to bring back the days of true white privilege where whites had first crack at all the fruits if not a total monopoly. I think the reason many the WWC love Medicare but hate Obamacare is the perception that Obamacare was passed for brown people and not all people. They are fine with welfare but only for their tribe.

          Report

          • Which, as I said upstream, means that if the GOP collapses, some party (whether a new one or a takeover of an existing one) is gonna end up the party of “I hate brown people, but let’s be subtle about it again”.

            Report

            • November is going to decide which lessons the GOP learns from Trump.

              My suspicion is that they will embrace white identity and cultural resentment more.

              Report

              • Well yeah, they don’t have a choice. It’s a big voting block, and it’s hung around their neck like an anvil.

                Used to be dog-whistles were enough, and that didn’t scare off everyone else. I mean that’s WHY they used dog whistles. They needed that vote, but they couldn’t afford to alienate the rest of America.

                Blame talk radio, or Foxification, but weirdly the GOP’s base got deaf to dog whistles so it had to get louder and more obvious.

                Sort of a reverse Atwater, I guess. “Welfare queens” and “strapping young bucks” was just too darn subtle.

                Report

                • I would like to think that America is becoming less racist as the pre-civil rights generation dies off. I’m not sure if we have a good way to measure this however.

                  Report

                  • I would like to think so as well but I am not so sure. The neo-reactionaries and alt-right seem to be largely young. The more we learn about psychology and evolution, the more it seems that racism can become deeply entrenched and hard to pull out. Anecdotal evidence, but California lawyers are required to take courses in “ending bias in the law”. In one course I took, the lecturer mentioned how Zimmerman received a different treatment under stand your ground than a black woman who fired warning at her abusive partner. The crowd immediately began objecting at this example of “perhaps blacks are treated differently than whites by the law” and trying to differentiate.

                    You can also get into the weeds of what do we mean by racism. Julian Bond of the NAACP speculated that all the Republicans needed to do to be competitive with black voters is moderate their stance on affirmative action because many black voters are innately socially conservative. Secular(ish) liberals like me are also a mere plurality in the United States.

                    Yet the GOP seems unable to see if this small little piece of advice because they might sincerely (but IMO wrongly) see affirmative action programs as racist.

                    Report

                    • Yet the GOP seems unable to see if this small little piece of advice because they might sincerely (but IMO wrongly) see affirmative action programs as racist.

                      Elsewhere on this page we go into what “affirmative action” does to Asians, i.e. holding them to a much higher standard because we need to keep their numbers in college down. I don’t see how we can call that anything other than ‘racist’.

                      Report

                      • From what I understand, Asian-Americans have gone from being Republican friendly to also being part of the Democratic Party very firmly because they see the GOP as being unfriendly to people of color.

                        Report

                        • From what I understand, Asian-Americans have gone from being Republican friendly to also being part of the Democratic Party very firmly because they see the GOP as being unfriendly to people of color.

                          Sure, absolutely, probably because the Moats! wing of the GOP is unfriendly to people of color.

                          But we’re talking about Affirmative Action, which in California is banned. And the Dems, even with an unhealthy level of control, can’t get that ban overturned. And the reason they can’t overturn that ban is because the Asians won’t cooperate.

                          http://www.slate.com/articles/news_and_politics/jurisprudence/2014/03/california_affirmative_action_ban_why_liberals_should_let_it_stand.html

                          Report

                        • Asian-Americans like people from the USSR were generally attracted to the Republicans because they were viewed as more reliably anti-Communist. When the Cold War ended and the Republicans went off the deep end with the culture war stuff than Asian-Americans began slowly than rapidly moving to the Democratic Party.

                          Report

                          • To a pretty large extent, that’s another way of describing what Saul is describing. Cities are disproportionately non-white and most non-white constituencies seem to think that the GOP is uninterested in them for that reason.

                            Report

                            • I will accept that, with the proviso that the cause and effect are a little different. IE, the GOP has no truck in cities, and therefore little to offer Asian Americans, not that they dislike Asian Americans and therefore hate cities.

                              I don’t think that it makes much practical difference, but it makes more sense than the idea that the GOP turned around one day and just started hating parts of its voting block.

                              Report

                              • Back in the 2008 campaign, a campaign surrogate for McCain on TV talked about ‘real’ Virginia and ‘fake’ Virginia (i.e. the DC suburbs) (and said she was from ‘fake’ Virginia!)

                                It’s been a deliberate and deeply stupid choice for national Republicans over the last decade to completely write off anything that’s even just a second ring suburb of a metroplex, much less the urban cores of all of them.

                                Report

    • The Willie Horton ad, to pick an example off the top of my head, was completely mainstream within the party.

      I think you can remove those last two words. The first person to attach Dukakis on the Massachusetts furlough program was Al Gore in the primaries. The offical Bush campaign attack ads with the revolving door, didn’t even mention Horton by name (although Bush supported those ads).

      Was just reading this piece courtesy of Maureen Dowd circa 1988 (http://www.nytimes.com/1988/10/25/us/bush-says-dukakis-s-desperation-prompted-accusations-of-racism.html) that includes two interesting bits. One:

      A Dukakis supporter dressed in a Ku Klux Klan costume held up a Bush-Quayle sign and another held a placard that read, ”Bush: Ready on Day One to be a Racist President.”

      I have to wonder what makes someone think that dressing up in a Klan costume is the appropriate way to protest racism. And this, talking about Dukakis’ own crime ad:

      He cited the Dukakis campaign’s rebuttal commercial about a heroin dealer, Angel Medrano, who escaped from a Federal treatment program in Arizona and raped and murdered a mother of two.

      Here’s another bit on Dukakis’ Angel Medrano ads, from the LA Times:

      Noting that thousands of drug dealers have been furloughed from federal prisons under the Reagan-Bush Administration, the ad’s narrator says: “Bush won’t talk about (the) drug pusher, one of his furloughed heroin dealers, who raped and murdered Patsy Pedrin, pregnant mother of two.”

      I was pretty young in 1988, but I’ve always felt that Willie Horton as a narrative was something different than Willie Horton as an actual issue in that campaign.

      Report

  7. The problem isn’t the party—it’s the voters. The party adopts the policies it needs to to attract a winning coalition of voters. As such, it’s a symptom rather than a cause. The Republican Party we want doesn’t exist because it couldn’t win elections.

    I suppose there could be a re-alignment, from having a left-wing party and a right-wing party, to a populist party and a technocrat party. The problem with this is that a) The technocrat party will still have to be populist enough to win elections, and b) sometimes the populist party will win, and this will be much worse than having either Democrats or Republicans in power.

    Report

    • The problem isn’t the party—it’s the voters.

      Yes, and no.

      If the common wisdom about one of the main reasons the rise of open white nationalism is correct — that is, that the stigma of shaming certain, shall we say, un-PC statements has been eroding over time — then the party is indeed part of the problem.

      Report

      • A lot of the glue that allowed more principled types to stand with white nationalists in the GOP was “anti-PC” or “anti-anti-racism”. This dates back at least to the 1964 election and Goldwater’s defection from the GOP consensus on the Civil Rights Act, where he, putative opposition to segregation notwithstanding, had to take a stand for the little guy’s right to have a Whites Only lunch counter.

        For the following half century, it’s always the supposed dangers posted by the opponents of racism that have been the real danger, according to the right. Rhetorical excesses on the left–no matter how far out of the way you had to go to find them–outweighed any sort of policy excesses on the right. So what if the Supreme Court gutted the Voting Rights Act by pretending the 15th Amendment isn’t a thing and states immediately began looking for ways to keep black people from voting–look at what this 22 year-old SJW on Tumblr said about straight cis men!

        As other issues holding the conservative movement became political losers or fell by the wayside altogether, and principles turned into a set of mutually incompatible purity tests [1], soon there was nothing else left but anti-PC, and I think Trump was pretty inevitable after that.

        [1] “Fiscal conservatism,” became, “never ever raise taxes on rich people.”

        Report

      • If the common wisdom about one of the main reasons the rise of open white nationalism is correct — that is, that the stigma of shaming certain, shall we say, un-PC statements has been eroding over time — then the party is indeed part of the problem.

        If the stigmatic potency of a certain type of shaming or shaming over a certain type of misbehavior has eroded over time, what do we generally suspect to be the cause of that state of affairs, and what the remedy? Or, if you prefer, forget about ‘in general’ – what are the cause and remedy here?

        Report

    • I suppose there could be a re-alignment, from having a left-wing party and a right-wing party, to a populist party and a technocrat party.

      This is what I see happening. The Republican Party evolves and all of the elite types jump to the Democrats and we see the Populist types doing the Stupid Party thing.

      Ironically, the only thing that I see actually preventing this is a Trump election. If Trump fails, Trumpism will still linger and, next time, it won’t be a buffoon trying to harness it. It’ll be someone actually smart and junk.

      Report

      • Jaybird:
        If Trump fails, Trumpism will still linger and, next time, it won’t be a buffoon trying to harness it. It’ll be someone actually smart and junk.

        This is exactly why I’ve found Trump’s rise so troubling. My worry is that even if he loses, he will be the Goldwater to some future white-nationalist (well, of the open variety, anyway) Reagan.

        Report

        • I’m a lot more disturbed by Bern’s rise than Trump’s.

          Trump is running on his fame and personality. We’ve seen that before. Arnold Schwarzenegger. Jesse Ventura. Even Clint Eastwood (he was mayor). It’s a problem but it happens and it probably doesn’t mean much for the next guy.

          Hillary had to move to the left to get the nod because the party is moving left, maybe far to the left.

          Report

          • Dark Matter:
            Hillary had to move to the left to get the nod because the party is moving left, maybe far to the left.

            Well, speaking as a far leftist (at least by the standards of American politics), we likely disagree about whether that’s a good or bad thing.

            Report

          • That’s not so bad, because it has so far left to go to actually reach a point that could be reasonably described as “far” left. Even with the progressive kick in this election cycle, the D’s are kind of splattered all over the center of the spectrum, some issues a little right, some a little left.

            Of course, as others have said, it’s the religious and nationalist baggage that are confusing the issue. People like vaguely-leftist policy initiatives – even R’s – as long as they aren’t identifiably part of a liberal platform, or identified with one of the usual suspects (e.g. my go-to example – the ACA would pass with a supermajority if it were voted on line-by-line with no identification of who was proposing it).

            Report

            • People like vaguely-leftist policy initiatives

              Specifically, they like getting free stuff. Do you remember what the least popular part of the ACA was? The individual mandate. People loved community rating and the ban on exclusions for pre-existing conditions, because they wanted the opportunity to get cheap health insurance if they ever got sick, but they didn’t want to have to buy it when they were healthy.

              Public opinion on policy issues is a mess of contradictions. A poll can reduce support for a spending program by double digits just by reminding people that taxes will have to be raised to pay for it. People think the rich should pay more in taxes, but they have no idea how much the rich actually pay. Asking someone if he supports a spending program is like asking him if he’d like a beer. He’s not thinking about the cost, just the beer.

              And that’s just obvious stuff like taxes. It’s not even taking into account nonobvious costs like the long-run effects of redistributive government spending on growth.

              All of which is to say, the idea that broad popular support for free-stuff programs is based on any sort of coherent “progressive” (sic) ideology is about as delusional as the idea that there’s any broad popular support for free-market ideology.

              Report

              • A poll can reduce support for a spending program by double digits just by reminding people that taxes will have to be raised to pay for it.

                Except that’s not the entire thing. Here, let me expand:

                A poll can reduce support for a spending program by double digits just by reminding people that taxes will have to be raised to pay for it and thus reminding the Republicans, as Republicans, that they’re supposed to be against it.

                That’s what talking about ‘raising taxes’ does, it’s an indicator ‘Republicans don’t like this’ so they know how they’re supposed to respond.

                It is very easy to assume the right’s confusion about issues when polled is due to their…forgetfulness? Dumbness? Because when you remind them of certain really obvious things like ‘taxes are how the government pays for things’, they fall back in line.

                But I’ll take the controversial position that the Republican voters are *not* complete morons who don’t know anything about how the government works.

                Why? Because that’s not why they fall back in line, as evidenced by the fact they also fall back in line merely if you remind them of where their party stands. Or just hint at where their party stands, which is what the pollsters also do by saying the policy involves ‘raising taxes’. Hell, you can *lie* about where their party stands….I bet a lot of Republicans are against military spending when you start talking about it as a wasteful and bring up taxes.

                The only logical conclusion here is that Republican voters want functionally the same policies as the left, and are in favor of the Republican party for *some other reason*, but feel they have to respond on polls the way the ‘correct’, Republican way.

                (And, yes, there are some percentage of Democrats who do the same thing, but I’m willing to bet they are running around calling themselves ‘conservative Democrats’. They do the same sort of thing, rely on signals where the parties are to figure out how to answer polls, but they try to position themselves *between* the parties instead of on the Republican side.)

                Report

                • Oh, and to clarify before this blows up: I’m sure this happens to Democrats and how they poll, also. If pollsters indicate, either by explicitly saying it or implications, the Democrats like or dislike a policy, you can alter how Democratic voters respond to polls also.

                  But my point isn’t that, my point is that a large majority of people *default*, in absence of party identification, to left positions. Both Republicans and Democrats.

                  And not barely the left, either. Pretty firmly mid-left, sometimes managing to be farther left than the Democratic party!

                  Report

                  • But my point isn’t that, my point is that a large majority of people *default*, in absence of party identification, to left positions. Both Republicans and Democrats.

                    Of course they do. Left-ish positions have the supposed outcome baked in as part of the position.

                    Sample Proposal: Let’s make toilet paper a human right! We’ll force prices to go down! It will be widely available for everyone! Everyone will save money!

                    Actual Result: Massive Shortages! To get toilet paper you need to go to the black market! People get arrested for ‘hording’ toilet paper!

                    http://www.chicagotribune.com/news/columnists/kass/ct-venezuela-toilet-paper-shortage-kass-0226-20160225-column.html
                    https://www.theguardian.com/global-development-professionals-network/2015/apr/16/venezuela-economy-black-market-milk-and-toilet-paper

                    So yes, reminding people of the actual history of the leftist promises results in massive shifts of opinion.

                    Report

                    • Venezuela did not make toilet paper a human right. Venezuela put in price controls to try to fix their monetary problems. Price controls do not work like that. No one apparently told them.

                      Moreover, I fail to see what price controls has to do with US opinion polls. There are *very few* price controls in the US (Mostly limited to rent in major cities, and anti-gouging laws for emergencies), and as far as I know there are no *proposals* for new price controls, so it’s not something that pollsters would generally ask.

                      But, anyway, I have to ask you to not insult Republicans like that. Seriously, this is basically your premise on how Republicans answer polls:
                      Republican voters: We should vote for some free stuff.
                      Other people: Free stuff costs money, and can destroy the economy. The market should be used instead.
                      Republican voters: Free stuff bad! BAD BAD!

                      I mean, I always thought it was kinda rude for Democrats to claim Republicans vote against their best interest, but this is a whole new level of explaining down. Republicans, according to Dark Matter, appear to have some sort of ADD or memory-based disability, and literally cannot remember basic economic concepts presented by the Republican party until someone reminds them!

                      Of course, in reality, I *didn’t* say anything about reminding them ‘of the bad effects’. (Higher taxes isn’t actually an *effect* of universe pre-K, it’s just something you do at the start. It’s like asserting that a foundation is an ‘effect’ of building a building.)

                      I said they change their position when you remind them *which position their party approves of*. They do the same thing when it doesn’t have *anything to do* with economic issues. They do it for gun control, they do it for social issues, they do it for foreign policy. They pick middle-of-the-left positions when they don’t have context clues, and then you tell them where the Republicans are and they move there.

                      Incidentally, since you didn’t bother to mention it, is how Democrat voters work:
                      Democratic voters: We should vote for some free stuff.
                      Other people: Free stuff costs money, and can destroy the economy. The market should be used instead.
                      Democratic voters: We know that, you twits. In the case we’re talking about, the market has already failed a good portion of Americans, so we need some alternative. And obviously, we’re going to need higher taxes to cover the cost.
                      Other people: LOWER TAXES! MUST LOWER TAXES. YOU CAN’T RAISE THEM!
                      Democratic voters: Taxes are already pretty low, historically…
                      Other people: But, uh, this completely unrelated thing done in an collapsed oil-based economy by a strongman didn’t work…
                      Democratic voters: Uh, that’s not what we’re doing, so don’t really see how that’s relevant…

                      You will probably argue they are *wrong*, but at least they understand basic concepts and, unlike how Republican are (according to you), don’t need to be reminded that ‘Taxes Bad Tree Pretty’!

                      Report

                      • Republicans, according to Dark Matter, appear to have some sort of ADD or memory-based disability, and literally cannot remember basic economic concepts presented by the Republican party until someone reminds them!

                        It’s a lot easier to remember the last 6 times you bought a “wonderful” used car from that salesman it turned out to be a lemon (and ‘free isn’t free’) than to become a mechanic.

                        I expect most people (of either party) can’t balance their checkbook and basic econ is way beyond them.

                        Bern’s followers were mostly young, because if they were older they’d know better. ‘If you’re not a liberal when you’re 25, you have no heart. If you’re not a conservative by the time you’re 35, you have no brain.’ (Falsely attributed to Churchill)

                        Report

                        • It’s a lot easier to remember the last 6 times you bought a “wonderful” used car from that salesman it turned out to be a lemon (and ‘free isn’t free’) than to become a mechanic.

                          My actual used example was universal pre-K. The thing that is pretty much taking an idea that we do now, a free public education, for 13 years, and extending it another year? Not a free college tuition with a bunch of added costs, just adding a grade before kindergarten? It would add approximately 8% to school budgets, pretending that all grades cost equal amounts. (In reality, younger kids cost slightly more in staffing, but cost a lot lot less in everything else. Preschool is functionally daycare with educational activities.)

                          And also the thing that no one’s ever been ‘burned on’ before. No one needs reminding of that time public preschool destroyed the Romania economy or whatever, because that didn’t actually happen. There is no god-given reason that 13 is exactly the correct amount of years at public schools and one more will cause an economic imbalance that will destroy the economy. (As is rather obvious from K-12 not starting at 1, we *already* added a year to education.)

                          Oh, and before we start *discussing* universal pre-K, I am well aware there are studies disputing whether or not preschool is helpful to kids. I am not presenting it as a good idea that we should do. Maybe we should, maybe not. I have no stated position here.

                          What we are discussing is: Why do Republican voters support it sometimes on polls, and sometimes not?

                          But, hey, let’s pretend that Republican voters somehow are not capable of remembering that things the government does cost tax money until reminded(?), and move on to the part of my post you didn’t address: This happens on *non* economic issues also.

                          There’s an incredibly large group of Republican voters out there who call themselves pro-life who don’t want abortion illegal, despite ‘pro-life’ being a single issue platform that is trying to outlaw abortion. On the specifics of the policy, they want abortion legal, but when picking their *group*, they have picked pro-life.

                          And Republican voters do the same economic issues that are the other way around. You ask them about levels of military spending, they think the current levels are absurd and spending should be lower. You put partisan indicators in there implying Republicans want to cut spending, they’re in favor of it. You put the opposite partisan indicators in there saying Republicans are against it..Republican voters are now against it.

                          But here is the thing I think you’re not gasping: I’m not trying to say this is anything to do with Republican voters!

                          *Democratic voters do exactly the same.* They pick one position when they don’t know where their party is. When they do know where their party is, though, they pick their party’s position. I’m not condemning the Republican voters at all for that! That’s just how political parties work.

                          The odd thing, the thing I’m actually pointing out, is that everyone seems to pick *middle-of-the-left* positions when not helped by party indicators. Both a majority of Democratic voters and a majority of Republican voters have functionally the same positions when they somehow forget to think in political parties…and that position is basically ‘Roughly where the Democratic party is in 2016 on most issues’. (1)

                          Which means, as I pointed out, that something besides ‘policy positions’ is needed to explain why Republican voters are Republicans. (Call this oddity A)

                          Additionally, if everyone has the same actual political beliefs, you’d expect both parties to either be *right on top* of those beliefs, or both slightly offset in different directions from that, which is another oddity that needs explaining. (Oddity B)

                          And then we got Trump, which I assert showed us the explanation of both those oddities…but I’ve covered that elsewhere here, I’d love to hear what you think explains them instead.

                          1) Except for the few issues where both party’s voters tend to be off the map of *both* parties, like legalization of pot. But that’s an *entirely different* post.

                          Report

                          • https://www.politicalcompass.org/uselection2016

                            You may be right that a lot of people end up where the democrats are but what if the democrats are to the right of the middle x-axis?

                            I have nothing against pre-K, but hope that when you look at how things perform in difficult economies, the more and larger social constructs you have to fail, the more extreme the failures become. When people come to rely on that service, and it fails, not just fails on it’s own, but fails at the same time with a bunch of other social constructs, people are less capable of not relying on it.

                            We will soon be seeing more problems in tangible capital formations that are likely to create cascade failures of these types of social constructs.

                            Report

                          • My actual used example was universal pre-K.

                            Great! So what gov program do you plan to cut to pay for that? Nothing? Every dollar the gov currently spends is absolutely critical? What about all the money that was supposed to be saved from the ACA? Or from ending the wars? Or how about the stimulus? Isn’t the economy just humming along now and pumping up revenues?

                            There’s always a good reason to raise taxes and get something. Similarly whenever there are local cuts, it’s always either law enforcement or the football program which is held for ransom.

                            If pre-K is actually important, then evaluate everything the gov does and decide where the fat is (actually that’s a good idea anyway)… except that never happens. Every program gains defenders and then it’s written in stone, and as the gov consumes more and more of the GDP, our growth rate goes down.

                            We never eliminate programs, the gov and it’s bureaucracy just grow and need more money.

                            And btw each of my kids had two years of pre-k for less than a fifth of what the gov supplies per pupil in elementary school.

                            Report

                            • Similarly whenever there are local cuts, it’s always either law enforcement or the football program which is held for ransom.

                              Where do you live? I’ve lived all over the USA and I’ve NEVER found a place where either of those go on the chopping block for anything.

                              Report

                              • Where do you live? I’ve lived all over the USA and I’ve NEVER found a place where either of those go on the chopping block for anything.

                                I left out a few other sacred cows. “It’s for the children” is another really popular one.

                                Report

                            • I like how *I’m* talking about ‘The weird thing where everyone polls middle-of-the-left on policy positions, until you give them clues where they should be based on their party’, and I’m explicitly *not* promoting, or opposition, or anything, pre-K, but merely using that as an example of a policy position…

                              …and you decide to argue about that, pretending that I was supporting it. (Of course, you couldn’t find a *quote* of me doing that, so you just decided to quote me saying that was my example.)

                              Well, I guess you and I have no disagreements then. I agree that universal pre-K is not a particularly useful government program, and despite people constantly trying to show preschool leads to better outcomes, most of the studies that show that are flawed and preschool really seems to amount to little more than day care.

                              If we *are* going to do it, it needs to be in the context of ‘government provides free daycare’, not some educational thing. I mean, all things being equal, obviously we should let the kids play with educational toys and watch educational TV, vs. non-educational stuff, but we shouldn’t pretend it’s actually ‘school’. If we decide to do it, and we then figure out it can be done cheaper using existing school buildings and infrastructure, it can be part of the school system, sure, but it can’t be justified as a needed educational program.

                              Meanwhile, I guess *you* agree that most people are actually middle-of-the-left in the policy ideas they hold, until they are reminded where the party they support stands.

                              Report

  8. “Which means that there needs to be a serious attempt to define a conservatism that is inclusive.”

    I’m curious, Dennis, how you see this happening, both in terms of “most likely scenario” and your own near-future affiliations. Having conservative intellectuals join an existing third party, creating a new third party, or attempting to pull the Dems further right?

    Report

    • I think there might need to be a new third party or joining an existing party like the Libertarians. The GOP might be too damaged to reform. Countries like Canada show that you can have an inclusive conservative party so it can happen. Is the GOP the vehicle? I’m not so sure anymore.

      Report

      • It’s funny. I did a post a couple of years ago, imagining a future where the Dems (who I saw as being more actually conservative than the GOP at the time) gradually embracing an even more robust tradition/status quo/pro-business stance than they currently do, and with the Republicans continuing to become more and more populist, to the point of eventually becoming left wing. IOW, a near-complete reversal on those issue that most people have identified with one party or the other in my lifetime.

        When I wrote it, I was thinking a few decades down the road. Now I’m wondering if it might actually be happening, at a faster clip than I had imagined.

        Report

        • I don’t completely buy this. Populism can be left-wing and right-wing. The GOP is embracing right-wing populism via Trump but that does not mean the Demcoratic Party will become more conservative except maybe in a small-c sense.

          The Democratic Party is moving to the left in terms of income inequality, raising the minimum wage, expanding the ACA, overturning Citizens United, and continuing to fight for minority rights. How is this right-wing except in an 11th Dimensonal Chess kind of way?

          The GOP Platform this year is one of the most conservative in a long time with attacks on SSM and LBGT rights in general. GOP backed voting ID laws were overturned by courts for racial discrimination by blacks.

          Rod Dreher published an article calling Trump the Tribune to the White Working Class. Reiham Salem wrote an article on Slate about why the WWC responds to Trump’s dystopian vision because they have seen factories shut and they don’t have the same job security as their dads.

          This frustrates me because the left was talking about this as a consequence for globalization for many years but the Republican Party just sneered that we were anti-freedom and anti-trade. Now they are embracing their own anti-Globalization but doing so with a racist spin.

          Report

          • Now they are embracing their own anti-Globalization but doing so with a racist spin.

            Which fits in with the idea that all politics is local and personal. No one really embraces abstract neutral principles, except people who will never be affected by them.

            Report

          • The Democratic Party is moving to the left in terms of income inequality, raising the minimum wage, expanding the ACA, overturning Citizens United, and continuing to fight for minority rights.

            I don’t see much proof of any of this. The Democratic Party seems in just about every measurable way, a center-left party. There is certainly a lot of featuring to the further left, but I don’t think we are in any danger of getting a Clinton administration pushing anything but mainstream progressibe-leaning policies. A small hike in the minimum wage with lots of carve outs, but noting approaching a national “living wage.” More financial regulation, but nothing approaching an attempt to break up or nationalize the banking sector. Slightly higher marginal tax rates on the rich and a marginal increase in social spending, but not huge attempt at wealth redistribution.

            A Democrat-controlled Congress and a Democratic president passed the ACA instead of single player. Obama put Merrick Garland’s name forward for the court, instead of finding the liberal Scalia. Mainstream D politicians now accept same sex marriage, coming at about the same time that a large enough percentage of the population accepted it to make it defensible.

            And none of this is criticism. For someone with my policy preferences, I’m happy to see he Ds move into the space once held by moderate Republicans. Although, it is a little mean to keep stringing Sanders and his supporters along like that.

            Report

      • You can brand yourself as an inclusive conservative party, and even draw more immigrant votes than native-born votes, if you look at Canada as an example, but it’s a lot harder, according to the same example, to maintain an inclusive conservative party. The Progressive Conservatives (more centrist, but quite conservative by Canadian standards) were captured from the right by the Reform party (which was full of weird white nationalist rhetoric), and then fell into serious disarray for several years before the Alliance morphed into the Conservative Party and won 2 national elections in a row (the first one as a minority government as leftist Canadians disagreed about middle-left and more-left, and centrist Canadians wanted to punish the Liberals for egregious levels of financial corruption). Xenophobic and homophobic missteps were a steady part of the Harper years, even as they worked hard to present a different face to the public – at least as far as the xenophobic part went, we are talking about a party where the leader tried to reverse marriage equality soon after becoming prime minister (it didn’t work AT ALL – but he also did try). And things got worse, way worse, leading up to the most recent election. Quite possibly one part of why they lost so badly (though rampant disregard for basic parliamentary procedure and etc was probably part of it too).

        Not disagreeing that it can happen, just suggesting you find a different example.

        Report

  9. Saul Degraw:

    A party that is against SSM, Civil Rights Protrctions for minorities, and has members that believe Griswold and Roe should be overturned,etc. does not support individual rights.

    There was time that the Democrats were opposed to SSM, were the party of segregation and other rights. Parties can change.

    Report

    • Yes and no. The Democratic Party was always split between a Northern urban wing which tended to be Catholic and immigrant based and Southern Agarian who were as you described. Not that the Northern wing was perfect (they were far from it). Starting in 1948, the Democratic Party began being taken over by the urban and Northern wing for various reasons and changes. That is pretty much now complete.

      The parties can change. The Right can describe themselves however they want, I am not morally, ethically, or legally required to buy into their self-description.

      Report

      • There were fistfights between the northern Democratic Party and the Southern Democratic Party over the issue of Civil Rights during the 1920s at party conventions. The northern Democratic Party, led by Al Smith of New York, wanted the Democratic Party to adopt an anti-KKK resolution while the Southern Democrats supported it. Northern Democratic Party politicians opposed immigration restrictions consistently from 1924 to 1965. When push came to shove on Civil Rights, women’s rights, and latter LGBT rights the Democratic Party decieded to do the right thing.

        Report

    • Though I wish we would recognize how much more ideological the parties are today. In 1974, there were 220 Congressmen that were between the most liberal Republican and the most conservative Democrat. That’s over half. Today that number is in the single digits (IIRC around 4 or 5). That’s a huge ideological sorting that leads to a lot of issues.

      Report

  10. I wonder if the white nationalism aspect of conservatism has become stronger in part because the economic aspects have become weaker.

    That is, the Republican Party has been beating the drum of the standard prescriptions of conservatism like tax cuts, regulation cuts and free market whatever for almost 40 years now, since the Reagan ascendancy.

    Yet the plight of the white working class has grown worse, not better.

    Even if someone objects that True Conservatism has never been tried, it still leaves a voter with the realization that even when Republicans manage to control all branches of government, somehow the magic elixir of Conservatism fails to take effect, at least for the white working class.

    If you look at the RedState faction, this is their argument, that the Republican Party leaders have failed to stay true to the principle of Conservatism, and can’t be trusted any more.

    So the only party base members who see a figure they believe in, are the white nationalists.

    Report

    • “I wonder if the white nationalism aspect of conservatism has become stronger in part because the economic aspects have become weaker.”

      To me it’s less about nationalism and more about patriotism. The GOP embraced this big time during the Bush years. It hasn’t really slowed down sense. Internal dissent cannot be tolerated when you are under attack.

      Report

        • It’s what I would call the ‘Toby Keith effect’. During the Bush years we went to war and the Right suddenly had a war president with broad popular support. So they fully embraced all the patriotic stuff in direct response to all of the criticism from the Left. They wanted to cast Democrats as un-American. And within the Right, dissent could not be tolerated. Suddenly you couldn’t just be conservative. You had to be conservative AND be rah-rah for the red, white & blue. Believe me, I got my head kicked in by many fellow Republicans for being opposed to Afghanistan. You also had to love first responders and basically anyone in uniform. This eventually led to the rise of the Tea Party, an increase in xenophobia, etc but even in the mainstream Right, there’s still this patriotic streak that drives much of their message.

          And I say it’s not Nationalism because that is generally is a more optimistic view. It’s that idea of exceptionalism. Just contrast the two convention. Not much positive about the message from the Right.

          Report

          • Mike, when the job markets started tightening did you see many conservatives start working in the military or law enforcement?
            Do you think that led to some of the nationalism?

            Report

              • “indicates the military has become more liberal.”
                Why do you think this is? I know down here a lot of conservatives are leaving the military because they have concerns that it will be used against the base population.

                Report

                • I’m going to assume it’s mostly due to ending DADT, allowing women to serve in combat roles, etc. It just makes for a more diverse military. Still majority conservative (if I remember the numbers correctly) but becoming more like the rest of the country.

                  Report

                • I think by and large, the military is getting more liberal because it’s becoming less white, and because in general young people are becoming more liberal.

                  Report

                  • I started to suggest the same thing above but then held off because I was thinking the military has always have a disproportionately large number of minorities. Maybe I was wrong on that perception and I am confusing it with the draft.

                    Report

                    • Or been forced that way, with someone who is at least nominally a social liberal in the White House for 16 of the last 24 years. Certainly there’s been an ongoing battle between the top civilians and the top brass at the Air Force Academy on religion.

                      Report

                    • The military is a good example of how the old definitions of “liberal” and “conservative” become frayed.

                      The military is famously welcoming to ethnic minorities, the place where it is common for white people to be commanded by black and Hispanics.
                      Yet to assume black servicemen are necessarily “liberal” in anything but their opinions of racial matters would be an error;

                      And to think that military lifers, or those who drift from active duty to the Military Industrial Complex are “conservative” in the small government, free market sense would also be an error.

                      Report

      • , “Internal dissent cannot be tolerated when you are under attack.” is really a bazaar concept and the first thing that came to my mind when I read it was Goebbels.

        Report

  11. The Democrats just had a primary that directly pitted the identity politics of the flipside against class politics. Identity politics won. In both cases, there is a case to be made that at least part of the rise of both sides’ identity politics is a reaction to the others’. It’s far uglier on the right that on the left, but nobody should be surprised that both sides choose the same boundary on which to cleave.

    It’s too much to expect of people who have jobs, families and lives to worry about to do the homework and then stake out a principled position based on political philosophy. The ranks of people who are willing to go to the mat with their friends on Facebook over Rawls or Rothbard are pretty small. As has been said for decades now, things like how to interpret the constitution are really just code words for identity used by people who wouldn’t know a canon of construction if they were shot out of one.*

    Similarly, look at the spectacle of the hard LGBT left standing up for people who would hang them in the street against the only country in the region that even allows pride parades. It’s a statement of identity (as global underdogs) rather than an examination of what their supposed compatriots actually believe.

    So how would you rather the electorate divide? There’s urban vs. rural, rich vs. poor? Each has the potential for bad consequences and lend themselves to distorting subsidies and regulations.

    Instead, people can argue over which #livesmatter hashtag is correct and whether the top two percent of elite universities should have 8% or 10% Latinx faculties. Meanwhile, the machinery of government continues to churn as it always has, generally unmolested by people who value the symbolic most of all. Let the right whine about having to press 1 for English if it means they aren’t focused on repealing the Community Reinvestment Act.

    The gridlock of the last six years hasn’t served us particularly poorly. The bureaucracy works about the same and the economy has generally recovered. Our problems are mostly old ones, and anyone who has a lickety-split solution is more likely than not to be catastrophically wrong. So let the same 5,000 people offend each other and take offense on Twitter. The rest of us will muddle along as always.

    * Sorry. Just sorry.

    Report

    • The really anti-Israel faction of the LGBT community tends to be miniscule and perceived as not quite all there by nearly everbody else and represent a very loud but small faction of the LGBT community.

      Report

      • sometimes being the loudest matters.

        In my rather limited experience with Trump supporters, I found that they were all a bit embarrassed by his policies and statements but liked him all the same because he pissed off the right people and would create a “heighten the contradictions” crisis after which the government/country could be rebuilt newer and better.

        Does that mitigate the fact that white nationalists support him? I don’t think so. Sometimes you need to police your own side.

        Report

        • FWIW this is this Pres election in my adult lifetime without any failed speculation about whether the Jews will finally go R (they never do anyway). Trump is seen as a disaster in that regard.

          Report

        • The LGBT faction that hates Israel was also the faction that thought that same-sex marriage sold out the LGBT cause because it didn’t smash cis-gender heteronormality. They are not the faction of the LGBT community that participates within the Democratic Party.

          I think that the pink-washers have really dumb ideas about the Israel-Palestine conflict. I also think that they are willfully blind to the sheer amount of Jew hatred in the Muslim world including Abbas’ occasional dabble in the blood libel. They are coming at it from the lens of the Anti-Imperialist ideology that developed during the mid-20th century. This was the faction of the Further Left that did not and could not see the Jews as a persecuted group even immediately after the Holocaust let alone in relatively safer times. They always existed and aren’t going away anytime soon. They also aren’t going to become a big influence on the Democratic Party in my life time.

          Report

          • Point taken, in the general sense, though you’ll have a bit of trouble with that if you ever want to be visibly Jewish on a college campus.

            OK, to get back to the root comment, the point was that most supposedly ideological positions, like constitutional interpretation or Israel-Palestine, are really just coded identity politics at heart. Y/N?

            Report

            • College campuses are one of the few places in the United States where the Further Left can flex its’ muslces.

              I would argue that many ideological positions can be coded identtity politicis at times if only because many people do not like to think that deeply about things but adopt what sounds right to them on instinct. Its tricky though because some people do like to think about these thigns and there were sincere capitalists and Marxists during the Cold War. Most of the pink-washers are probably acting through a combination of instinct, helping the apparent downtrodden weaken party from the stronger, without putting that much effort into leaning the Jewish/Israeli side.

              Report

              • The thing is, what do you do when one of your sincere beliefs – e.g. that white colonialism screwed over the common people in that region for decades, and Cold War meddling tipped them right back into the boiling water just as they were looking to climb out of the pot… Is perpendicular to a different, but equally strongly held belief – e.g. that Islamic thought leaders are (still!) dangerously pre-Modern, and oppressing their own followers because of it, while Israel does pretty well in this regard despite some overenthusiastic Orthodoxy?

                I’m not sure you can generalize cleanly based on a situation that is fracked up seven ways from Sunday.

                Report

                • Well, first they can recognize that situation is complicated and recognize that Jews aren’t exactly white and do constitute a historically persecuted group like the LGBT community and people of color. On an LGM threated about Israel a few months ago, a not friendly to Israel commentator did point out that Israel’s critics adopted a sub-optimal strategy by treating Zionism as purely imperials movement rather than something that would be a natural reaction of a persecuted people even if the implementation is flawed.

                  Even Jews who aren’t entirely enthusiastic about Israel are weary about many types of anti-Zionists because they overly simplify Jewish history to fit into the white vs. people of color narrative by ignoring Jew-hatred in Europe and MENA countries.

                  Report

  12. The nomination of Hillary Clinton has been secured, but the future of the Democratic Party is far from certain. Despite the patina of unity at the end, the Democrats, like their GOP adversaries, seem divided as to their future direction. Each party is being pulled to the extremes by an increasingly unruly base which regards its own establishment as a cesspool of corruption, influence-peddling and naked opportunism.

    The devolution of the parties is reflected generally in the record distaste among the electorate toward the two nominees. Nebraska Republican Sen. Ben Sasse recently remarked, “There are dumpster fires in my town more popular than these awful candidates.” Count me among those looking for some smoldering garbage.

    For virtually all of my adult life, I have been a registered Democrat. But as the party has abandoned critical commitments to color-blind racial equality, upward mobility and economic growth, I have moved on to become a registered independent. This makes me part of the fastest-growing “party” in America – the politically homeless.

    Joel Kotkin – What happened to my party?

    Your thoughts and fears mirror my own about my former party, the Democrats. Watching them fall into a hole of machine politics, illiberalism, and identity politics over the last few years has been horrifying to a former member. And it seems that you feel the same way about the Republicans. Well, good.

    I do feel that this is the endgame of identity politics, as if you push and push hard to corral every outgroup vote for one side, the other will become the party of the remainder. In this case whites. This map gives a clue to one reason why this is happening, as there just isn’t enough of a geographical spread to make many of these groups sadly a far away other, one that is easily dismissed. Couple that with the tendency to refer to minority conservatives with strong racial epithets which only lowers the chances of members of that demographic seeing the politics as viable, and a current politics that doesn’t take many of the issues, fears and thoughts that face much of this community seriously and, well, this isn’t too surprising. And yes, it is sad.

    But as I said, I feel the same about my former party, so I do feel your pain at this. I just wish we still had a few hard conservatives writing here, to help us understand.

    Report

  13. I think we are also seeing the end of the Cold War, in the sense that the epic intellectual battle over economics, of Marxism versus Capitalism is winding down.
    For nearly a century this was the central front line in almost all political fights around the world. I compare it to the centuries-long battle between Protestantism vs Catholicism in Europe, where every political battle was informed and overshadowed by that one central divide.

    I don’t think “More Government” vs “Less Government” is going to the a dividing line much longer. I don’t have a crystal ball to predict what the new issues will be, but one example might be the divide between the tech sector workers who are doing OK in the new economy, and the service sector workers, who are not.

    Report

    • There are still plenty of people who question capitalism for many different reasons. Its just that they really don’t have a coherent ideological alternative after less than a century of unsuccessful attempts to implement Marxism. I think some of the growth in Identity Politics and some of the wilder aspects of the Further Left are because of this. Marxism gave them a coherent response to what they didn’t like about the Liberal Democratic West and a proposed alternative. Now, many of them really have nothing.

      Report

      • Feudalism is an ideological coherent alternative.
        It is capitalism that is not coherent, and falls apart if you let it.
        Piketty pushed his book, but the hidden premises should be pretty obvious if you just look at it.

        Report

      • In the same way that there are a million varying ways to have capitalism as the basic chassis of an economy, there are a million varying ways of challenging it.

        China, Norway, and Bangladesh all are “capitalist” countries’, but have wildly varying ways of doing things.

        Even absent any form of Marxist interpretation, who has control of the factors of production has always been, and will always be a fault line.

        Report

        • Marxism provided an infrastructure for the critique of capitalism that earlier critiques could not because he was speaking the same language, economics. Other critiques of private ownership of the means of production were more garbled because it lacked a consistent conceptual framework and rested on a bunch of broader ideas like fairness, justice, or patriarchal tradition. Marx came along and offered an economic critique of capitalism that could also pass as more socially progressive than previous critiques, which could be very differential towards authoritarian traditions.

          Report

          • Marxist/socialist movement has always failed to deliver on the ‘transformation’ of the economy and society. It stumbles when it ignores that not all of society is a altruist socialist cult.

            Report

  14. I can remember thinking, starting around 2006, that the Republican Party was moving into a kind of a death spiral. The war wasn’t going very well, and Republicans appeared to be in simple denial about that. It smelled like what I’ve read about Vietnam in history books. Defense of anything that the president said was reflexive, automatic, and laced with accusations of disloyalty. Having witnessed firsthand the results of what Pete Wilson’s gambit had done to the rump of the California GOP — gaining success in the party required demonstrating one’s conservative bona rides with successively more stringent litmus tests, an “arms race” of more-conservative-than-thou with no backstop for filtering out things like Pat Buchanan fanboys and John Birch Society holdouts — it looked to me like the same sort of thing was beginning to occur on the national scale, and things would have to reach a rock bottom before enough of the smart people would gather together and try to do something about keeping the party acceptable to mainstream society rather than slipping into the fringe of paranoiac fever dreams.

    Back then, I would have predicted that rock-bottom would have been reached with a figure like Ted Cruz, except one who was even more overt about his particular brand of religion. I would have been horrified had someone suggested to me that an essentially secular candidate who had never held public office and never served in the military would appeal to the basest instincts of the least informed voters (“Let’s go kick some ass on brown people and then become isolationists and protectionists!”) would a completely co-opt the Republican Party.

    Oh, who am I kidding? It’s 10 years later, that’s what’s happened, and I am horrified about it.

    I hope this is rock bottom. I hope the GOP gets exactly what it deserves for this, so it reforms itself. I’d like it very much if the party became respectable again. That’s not where it is right now. Then again, it’s gone far enough down that deathspiral that I will no longer have myself counted in that number anyway. So I understand what you’re talking about, , about looking up and realizing that the party you had identified with for so long has moved so far away from you that you no longer feel like it belongs to you anymore. It’s kind of a slap in the face of your own self-identity, isn’t it? The only thing I have to wonder about, having read your essay, is why I got to that place before you did. It seems like you have even better reasons than me for being discomfited with what this party has become.

    Report

    • I don’t remember 2006 that way. Maybe 2001-3, but by 2006, many Republicans were in open revolt. It was around this time, for example, that Bush-supported immigration reform ran up against a brick wall within his own party.

      Report

      • I think the words “for example” do not belong there. I do not recall any other revolt against Bush at least until it was clear the GOP had no chance in 2008.

        In my recollection, rejection of immigration reform was the only thing the party base wasn’t going to tolerate from Bush and the Republican Congress

        (perhaps the Social security Privatization would have also been a revolt, but it never went beyond a test balloon)

        Report

          • I had so completely forgotten about that I had to wikipidieate it. You are correct

            Though there was a bipartisan rejection of the deal in Congress, it should be pointed out that the opposition to it was started by Sen. Charles Schumer (D-NY)

            Report

            • True. But there were a lot of Republicans on the side of Schumer and against Bush on that one.

              I think it’s safe to say that by 2006, contra Burt, “Defense of anything that the president said was reflexive, automatic, and laced with accusations of disloyalty” is not an accurate way to depict the GOP. There was plenty of jumping ship by then.

              Report

    • It’s a shame for the California GOP that Arnold wasn’t a better politician. He’s a smart guy and he understood a lot of what had to be done to get the state government back on a sound footing, but it would have taken a lot more political smarts than he had to get the Democratic legislature to go along with him. Still, if he’d been up to it, he could have been a model for a smart, non-doctrinaire GOP.

      Report

      • I had high hopes for Arnold to be able to start bridging the divide, but in hindsight (even if Arnold had had the combined political acumen of Bill Clinton and Dick Cheney), I don’t think it could have been possible. Would the CA GOP of the time sign off to policies that had the assent of the CA Dems?

        I think that the deeper problem is that is not clear what the GOP’s vision for the country is. I truly think they have none. The leadership of the different legs of the coalition have completely different non-negotiables, while the base apparently cares for something completely different, though unstated (perhaps because they also really can’t put into words what it is just an emotional feeling).

        The only way to square the circle is to have basically a negative policy. Do not do anything -nor allow anything to be done- because anything that gets done will violate one or more of the leadership’s or the base’s stated or unstated non-negotiables

        Report

        • @j_a
          I think that the deeper problem is that is not clear what the GOP’s vision for the country is. I truly think they have none. The leadership of the different legs of the coalition have completely different non-negotiables, while the base apparently cares for something completely different, though unstated (perhaps because they also really can’t put into words what it is just an emotional feeling).

          And a related, but probably more important for us at the moment, problem is that the leadership of the different legs of the coalition were spending all their time trying to figure out their competing positions, and how to jockey for position between them…and didn’t have the *slightest* idea that the base wanted something completely different.

          And that something different turned out to be Trump.

          Report

        • @j_a

          I had high hopes for Arnold to be able to start bridging the divide, but in hindsight (even if Arnold had had the combined political acumen of Bill Clinton and Dick Cheney), I don’t think it could have been possible. Would the CA GOP of the time sign off to policies that had the assent of the CA Dems?

          California needs policies which would have resulted in Arnold being hated, aka Scott Walker. He decided he didn’t want that.

          Report

  15. If a new party is to rises out of the ashes of the GOP, this is a good a place as any to start: goplifer.com/2016/05/23/launching-an-urban-republican-rebellion

    One that, hopefully, would lead us here: goplifer.com/what-the-republican-party-could-be

    Report

  16. “None of this means conservatism is inherently racist. It does mean that one of the guiding forces of the Republicans since the mid-60s has been white nationalism, something that conservatives, especially conservative intellectuals, have denied.”

    “Which means that there needs to be a serious attempt to define a conservatism that is inclusive. There needs to be a new party that is right of center and works for all Americans, not just those of European origin.”

    Dennis,

    This is why your voice is so important… here and in general. When and and others talk about the need for a strong party to oppose Democrats and liberals, I believe it is what you describe here that they are referring to.

    Though I skew liberal and libertarian in many ways, I not only welcome but agree that there is a need for a recognition of what you’ve said in your first quote so that we can realize what you say in the second.

    Report

  17. Brandon Berg:
    People like vaguely-leftist policy initiatives

    Specifically, they like getting free stuff. Do you remember what the least popular part of the ACA was? The individual mandate. People loved community rating and the ban on exclusions for pre-existing conditions, because they wanted the opportunity to get cheap health insurance if they ever got sick, but they didn’t want to have to buy it when they were healthy.

    There are other reasons to dislike the individual mandate, though I suspect that the whole business of having to pay dues to a private corporation as a duty of citizenship is not likely to irritate anyone who isn’t a socialist.

    Report

  18. Allow this former Republican to tell one and all that my former party has been too far gone for a lot longer than the author suggests in the article. I have a really good friend on Facebook who says that the decline of the Republican Party truly began not long after Abraham Lincoln was assassinated and Conservatives began flocking to the GOP from the Democratic Party in a greedy attempt to control both major parties. My friend may just be right about that.
    When Ronald Reagan was elected in 1980, both my late Granddad and Dad (who, like me, were “Eisenhower Republicans”) said that the GOP would never be the same again and that the party would devolve into “Authoritarian extremism”. That statement horrified me at the time (after I looked up the word “authoritarian” in the dictionary and discovered that they were really talking about fascism, but I digress), but, what horrified me even more was that they were right; that’s EXACTLY what happened to the GOP.
    Sadly, it’s taken the fascist demagogue, megalomaniac and “high-functioning sociopath” Donald Trump to finally wake up enough Republicans to realize that the party is too far gone. That friend of mine I referenced earlier began rightly calling the GOP fascists a little more than five years ago, not long after I convinced him that is the case. He’s a “Non-Affiliated” voter, not a Democrat. It took me about three hours to finally convince him of that truth. He’s taken “the ball” and “run with it” ever since.
    I say, to the Progressive and Moderate members of my former party: wake the f**k up, people! You’re truly represented by today’s Eisenhower Republicans, Democrats. Vote for Democrats. Voting for any Republican anywhere means that you support the fascist extremists of which my Dad and Granddad warned.

    Report

    • I saw a lot of movement in the 80s also. The authoritarian drift probably could have started back then, makes sense.

      How have you been able to live over on the left with all that ‘social’ stuff. I put the shoes on and walked a mile but it just wasn’t a good fit. I had to go back to the individual freedom stuff.

      Report

Comments are closed.