As I hate war, it is with a heavy heart that I shall start a bunch of them.

I’ve heard a disturbing number of people, all of whom I know to be otherwise sane, tell me that they think John McCain would make a good President, or even tell me that they might vote for him. This is nuts. He would be an awful President. Of course, you wouldn’t know that by watching the news or reading the paper, because the narrative of John McCain among the political press is that of the Saga of Commander Maverick of the Straight Talk Brigade. Never mind that the guy has no coherent domestic policy, nor does he seem particularly interested in one. Never mind that his foreign policy, which is supposed to be a his strength, seems to be nothing more than Bush’s “Obey, or be destroyed,” applied even more widely.

I’ve been trying to figure out how I wanted to approach building my own little counternarrative for you, my audience, because I love all eight of you, and want you to be thoughtful, skeptical consumers of political media. If along the way I can convince you that the contemporary Republican Party is a cancer on the American body politic, so much the better.

Anyway, my quandary is solved: Ezra Klein reminded me that it’s McCain week at the American Prospect. The first article, by Matt Yglesias, is called “The Militarist.” Ezra comments, in part, thus:

He was humble. Bipartisan. A nice guy, liked by partisans on both sides of the aisle. An instinctual moderate who’d constrain America’s foreign policy ambitions and ably manage our finances. He was George W. Bush, and despite what the press said, he was none of those things. Rather, the truest understanding of Bush’s candidacy came from those who had read his policy plans. The shockingly regressive tax cuts, the dismissive attitude towards international treaties, the inattention to our unraveling health care system, the denial of our energy problems — it was all there. The press assured us that those plans were just election-year pandering. Turned out they were his governing agenda.

Similarly, John McCain, we’re told, is a moderate. A nice guy. Respected on both sides of the aisle. Conscious of the limits of American power and the constraints of our fiscal situation. His plans? That hugely regressive tax cut, radical dismantling of the health care system, appetite for endless war? Oh, you know how elections go.

Bullshit.

Ezra’s own article is about McCain’s godawful health care plan.

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20 thoughts on “As I hate war, it is with a heavy heart that I shall start a bunch of them.

  1. Tom

    I’m guilty of this too, and as I think about it, it’s because I respect him, and not only ‘respect’ in an abstract way, but I’d buy him a beer. He was given an out of a POW camp because his dad was an admiral (and, you know, the Japanese surrendered TO HIS FATHER), and HE SAID NO. He said he doesn’t leave till his comrades get to leave. That gets my respect. Immensely. And I won’t be dogged into not respecting him on these grounds.

    Where things get muddy is this, just because I respect him doesn’t mean I think he’d be a good president. Actually, I take that back. I do think he could be a ‘good’ president. He couldn’t be a ‘great’ president. Obama can be great, I think (hope!), and that’s the difference.

    And he does occasionally get all nutso and wants to invade Iran or Syria or anyone really.

    Hillary would/could be a dipshit.

    Also, his healthcare plan, it should be noted, is utterly preposterous, not-thought-out and actively bad for America. Tax credits, historically, do not incentivize anyone who is not a corporation to do anything anyway. Ezra’s got it a bit wrong though. People DO over-utilize healthcare but there’s no gentle way to tell the voters, “too many of you fuckers go to the ER for routine care and it’s costing the country hundreds of millions of dollars.” Making them pay probably isn’t the answer, which isn’t to say it isn’t a problem.

  2. Steve

    He was given an out of a POW camp because his dad was an admiral (and, you know, the Japanese surrendered TO HIS FATHER), and HE SAID NO. He said he doesn’t leave till his comrades get to leave. That gets my respect. Immensely. And I won’t be dogged into not respecting him on these grounds.

    Most definitely. That kind of bravery unto heroism is grounds for free beer for life, at a bare minimum. But as you say, martial bravery like that doesn’t necessarily translate into the skills necessary to be a good president.

    I don’t think that McCain would even be a good president, as I said. His policies, and the advisors he has coming up with them, are like Tequila Night at the American Enterprise Institute. I do think he’d manage any wars far, far more competently and effectively than the jokers currently in charge of desecrating the corpse of American diplomacy. On the other hand, his foreign policy, such as it is, seems troublingly designed to give him plenty of opportunities to demonstrate that skill.

    People DO over-utilize healthcare but there’s no gentle way to tell the voters, “too many of you fuckers go to the ER for routine care and it’s costing the country hundreds of millions of dollars.” Making them pay probably isn’t the answer, which isn’t to say it isn’t a problem.

    Well, yeah, people use the emergency room as an ad-hoc walk-in clinic when they don’t have the insurance or money to pay for an actual doctor’s visit. Get ’em covered for those visits to an actual GP, and the emergency rooms would probably unclog.

  3. Tom

    Well, yeah, people use the emergency room as an ad-hoc walk-in clinic when they don’t have the insurance or money to pay for an actual doctor’s visit. Get ‘em covered for those visits to an actual GP, and the emergency rooms would probably unclog.

    This is terrifyingly untrue my friend. The people going to the ER unnecessarily DO have coverage for GP’s. Probably 90% of them. Though probably only 50% of them have selected a GP. We’re actively doing research (and have hired 4 full time people to call every single one of them and ask them why they went in whatever language they happen to speak) as to why people go to the ER for non-urgent visits. It truly is one of the biggest reasons our healthcare system is failing as it costs so, so much more than a doctor’s office visit. There is some social dogma that “good parents take kids to the ER” and, therefore, kids are taken to the ER as a badge of good parenting even when the kids are eligible and covered for urgent care visits, or same-day sick visits at the GP or specialist. This mentality isn’t limited to any race, income or education level either.

    There is also a strangely compelling argument (not making this up) that the ER waiting room is better than the GP’s waiting room as it has cable and snack machines and usually some sort of cafeteria/McDonald’s nearby.

    Also, some know that you can get take an ambulance to the ER for most anything and get a cab voucher back home and it really is more of a transportation issue. Though social workers hand out the cab vouchers, and if you pull that shit you will wait 6 hours for the social worker to get to you.

  4. Ananth

    Couple of things…
    What Tom is talking about increases the overall cost of insurance since pays for people who are covered ans still go to the ER like dipshits. What Steve is talking about is people who don’t have insurance and go to the ER when they are sick. Both happen, both are problems, and both add expense to the healthcare system.

    Tom, your point about tax credits is not correct either. The ability to deduct mortgage interest from income is one of the prime motivators for people when it comes to buying homes.

    The problem with health insurance cost being so high has to do with a lot of factors, some of them the ER thing, some of them tort and malpractice insurance, and some of them the over legislation of what has to be covered in health insurance (from contraception to mental health). If there were plans that covered bare minimums of true emergencies (broken bones, busted appendixes) and major illnesses (cancer etc) you could have a relatively cheap premium, which you could then mandate like car insurance. If you want more features, well you have to pay for them. I think the idea that everyone should be able to see an ENT whenever their throat hurts and not having to pay a premium for that luxury is nuts. At the same we don’t want people dying of things that can be cured, so a better system has to come into place, for sure, but free or really cheap yet extensive health insurance for all is pipe dream that will only serve to diminish the overall quality for the everyone (like in the health care mecca of Canada)

  5. Ananth

    Second Post RE: McCain…

    Funny, I thought military heroism was the prime reason that John Kerry would make a good president… But I guess that argument is only good when it helps a democrat and not when the war hero has an R behind his name (Bush 41, Dole).

    I gave up on the Idea of Obama being a great president a long time ago. The mores I see of him, the mores he looks and acts just like anyone else. Sure he gives a rousing speech, but as Mondale said to Gary Hart, where’s the beef? He has been an unscrutinized candidate, and when he does get scrutinized, his response is some what whiney. When faced with his first real challenge in his campaign, he did not rise to the challenge and show his greatness (and no his race speech does not count. the issue was never about race, Obama made it about race so that people would shut up). He is just boilerplate liberal politics in a pleasant and attractive packaging.

    His response to the cap gains tax rate, and his foregoing revenue for some sense “fairness”, says a lot about where his thinking lies. Isn’t having more money ultimately more fair for lower income people? Can’t the government use that increased revenue to help the down stream people thus achieving the fairness Obama wants? No, I guess fairness is what percent that is jacked from you paycheck, not how much you send in….

    Obama might make a good President. McCain could also make a good president. He has been shown to be a man of principal time and time again (and yes he had moved a little bit in positions to firm his base, so what). I think your disdain for the current war is making you deaf and blind to just how dangerous Iran is. This is a country that is working at getting a nuclear weapon (those centrifuges aren’t for a carnival) and has been actively involved in helping kill our service men and women. I would rather have a foreign policy that makes Iran afraid of us than a foriegn policy where we are afraid of Iran….

  6. Tom

    This is untrue:

    If there were plans that covered bare minimums of true emergencies (broken bones, busted appendixes) and major illnesses (cancer etc) you could have a relatively cheap premium, which you could then mandate like car insurance.

    That would actually be a more expensive premium due to flooding the risk pool with the high-utilizers. Mammograms are cheaper than mastectomies. Diabetic screening is cheaper than severing limbs or dialysis. Pre-natal vitamins are cheaper than treating spinal bifida. Preventive care is cheaper than acute care.

    And this:

    “the over legislation of what has to be covered in health insurance (from contraception to mental health)”

    Not true either. Doesn’t increase cost whatsoever as the legislation to which you refer does not require that these things be paid for so much as a benefit structure exist for them. The benefit structure need not be a generous one and the underwriting mechanism is wholly determined by the plan.

    And the Canadian model is not the gold standard by any means. None of we universal care hippies want the Canadian model (we actually want a uniquely American free-market model a la Massachusetts/Heritage Foundation). Though several European models spend less money to cover a greater percentage of their population with better health outcomes, including those cheese-eating surrender monkeys.

    And I should say tax credits do not incentivize those who are poor. Look at the adoption tax credit, it’s mostly utilized by those adopting children in foreign countries (versus foster care). Poor people don’t use it, and they’re also the ones more likely to adopt kids in foster care vs. overseas.

  7. Ananth

    Well then you can tailor the policy to provide for preventive care for those things that the high risk policy covers…

    I don’t understand your point about the benefit and law. If the legislation says all health insurance have a concreception benefit, are you saying they can print a list of birth control that they can buy? I don’t see how if a benefit structure exists that the insurance provider doesn’t pay for it.

    I agree that tax incentives benefit middle and wealthly people more than poor. Fact of the matter is poor people don’t really pay much taxes to begin with.

    I think the adoption in foreign countries as opposed to foster care has more to do with laws here as well as the desire to get *new* babies as opposed to older children….

    I think the mass model makes sense, because it punishes those who could afford insurance and don’t get it….

  8. Tom

    Well, regarding Mental Health, a plan is required to have a lifetime maximum number of inpatient days for mental health benefits that is no less than the number of inpatient days for medical services. So, in a sense, sure, it’s a required benefit. However, the legislation doesn’t prevent the plan from having medical inpatient days have a $20 a day co-pay and mental health days having a $200 a day co-pay. So a benefit structure exists (and is required) for mental health, but the nitty-gritty of the execution of the benefit is up to the plan.

    As for contraception, requirements vary more state-by-state but it can be the same idea. More often though, contraception’s provided by facilities and it’s up to the state how much if anything is reimbursed (depending on which Medicaid waivers the state participates with). I think there are only 1 or 2 states in the deep south that have flat out restrictions. Contraception/Abortion are, for insurance/coverage purposes more just a political football. They’ll always be performed and most always be covered by some means, though it may or may not be codified in policy.

  9. Ananth

    Yeah, I Don’t know if contraception was the best example, I was just thinking of things that are not what I would call basic health care (treating / preventing illness and disease) Which have been added over time by well meaning legslitatures… I think mental health is probably a better example.

  10. Steve

    Yes, it’s certainly not in a society’s interest to see that mental health treatment is available. Otherwise, where would we get our homeless?

  11. Ananth

    Yeah, mischaracterize what is I am saying jerky… It’s not government’s place to do everything that may be in societies interest. It’s government’s place to set up the frame work and rules and rule of law and then get they hell out of the way. The most efficient way for these things to get handled is through market forces. The problem with market forces is that it is often time brutal and certainly not for the faint of heart. But everytime government comes and tries to *fix* things, it introduces new inefficiencies that cause bigger and more painful problems…

    Look, I am not unsympathetic to the idea the health insurance needs to be more accessible in this country. I think everyone who works should have the opportunity to buy into a group rate of some kind and there probably needs to be some protections about preexisting conditions, but I did a quick check and a family of 4 with adults in their 50s can get insurance from 300 to 1300 a month depending on deductibles etc. with the 300 plan having a 5000 deductible 10000 per family per year then full coverage… I don’t that asking someone to spend 3600 a year to cover their family is all the unreasonable or burdensome. Obviously there are some problems like being denied coverage or whatever, and I am sure it’s more complex, but I also think that some of the problems are because people make poor choices, which often mimimilized.

  12. Steve

    It’s government’s place to set up the frame work and rules and rule of law and then get they hell out of the way. The most efficient way for these things to get handled is through market forces.

    The most efficient (and here, efficient=profitable) outcome for a health care market is for all sick people to heal on their own or die. Insurers lose money when they pay for treatments. So their incentives are to charge higher premiums, only enroll healthy people, and deny coverage whenever they can. There is no efficent market for health care. Sick people don’t have the time or expertise to evaluate various options, and maximize their value per dollar. If every person is equipped to make his or her own decisions in order to arrive at the best outcome, why do we have doctors?

    The market doesn’t solve problems, it sets prices. To solve problems takes actual politics and consensus and stuff.

  13. Ananth

    Ahh spoken like a true socialist…. Your outcome is not borne out in the reality. If this was the case, why are 260 million americans insured? Why do companies offer health care as a benefit? If health insurance didn’t help people when they were sick, then there would be a reason for companies to pay for it. Now does that mean there aren’t problems, and sad stories that make the big bad insurance companies look worse than they are? Of course. If my kid’s sick, I would want a faceless corporation to spend any amount for any chance of saving my kid, but that doesn’t meant that they should.

    How is health care any different than anything else a person decides? One doesn’t have to be in construction to get understand their options in a remodel? You have doctors to advise just like anything else.

    High deductible plans coupled with credits that go towards the deductible are a way to keep insurance and health care costs down. Almost every major company is offering these kind of plans. When you couple paying some the deductible cost, the poor people who have to decide if they can afford to emergency room won’t really have to. Forcing to people to think about the costs of their choices will force them to make better choices, lower costs for everyone, why still providing healthcare.

  14. Steve

    First, I’d like you to look up the word “socialist.” It does not mean what you think it means, which seems to be “anyone without a religious faith in the benevolent omnipotence of Market Forces.”
    What are the market incentives for insurance companies to enroll sick people? What are the market incentives for insurance companies to pay for medical treatments? How would either of these actions increase profit?

    How is health care any different than anything else a person decides? One doesn’t have to be in construction to get understand their options in a remodel? You have doctors to advise just like anything else.

    Uh, player, can you think this through a little more thoroughly? Is it possible – just possible – that one’s relationship with a doctor is just a leeeetle different than one’s relationship with a remodeling contractor? Like, could you give me a ballpark estimate of how likely I am to die if the installation of my new cabinets is significantly delayed?

    High deductible plans coupled with credits that go towards the deductible are a way to keep insurance and health care costs down.

    Ah, no wonder you trust the market to take care of everything. You haven’t actually considered any aspect of health care policy other than price-setting. Can you make, like, a chart or something that indexes what you think is a reasonable mortality rate according to income?

  15. Ananth

    Haven’t you heard of second and third opinions? Some Drs. will recommend a surgery, another Dr may tell you can treat the problem with a change in lifestyle and medication. If you were responsible for the costs of the surgery, you may actually try and the more difficult remedy (changing diet etc) rather than the surgery.

    Extending life no matter the cost is a pretty silly proposition. I may be a little heartless, but I don’t belong to the spare no expense crowd. You have to look at quality of life, length of life extention, cost of life extension. A million dollar operation on a 60 year old man that will extend his life to 70 may not make sense, as opposed the the same operation on a 10 year old (extending their life to 70). These may seem heartless, but again it comes to the idea that people would probably think twice about these costs if they were footing they bill, but when a faceless insurance company is doing it. End the end everyone owes god a death, and some sense has to be put into it. Does that mean people should die becasue the can’t afford a medication, no, but there is a balance that has to be looked, at there is a real cost.

    That being said I believe i have already said that some changes need to be made to allow accessibility for insurance for the already sick. The market incentives for insurance companies to pay for treatment is that people won’t buy policies from companies that render services. There may be some short term profit, but the company that had a reputation of denying all claims would soon lose a lot business. They are other incentives for insurance companies to provide preventive care the keeps cost down since insurance companies invest the premuims and make a return on that to, so where the can avoid larger expenses in the future it makes sense….

  16. Steve

    Haven’t you heard of second and third opinions?

    Wait, I thought we were trying to inspire thrift in those irresponible, sick, poor people, not have them run around spending money on doctor’s visits like a sailor on shore leave. Which is it?

  17. Tom

    eh. insurance companies now must market themselves using accreditation status and accreditation status (NCQA/HEDIS ratings) is tied to health outcomes, not market returns, so in the last 5 years or so, you really have insurance companies aggressively trying to increase things like their vaccination rates, post MI beta-blocker usage, diabetic screenings, mammograms, pap smears, things like that, and the insurance companies are pretty much hip to the notion that they need to increase quantitative health outcomes to a) recruit more employers, and b) recruit more consumers. The thing is most plans are playing with fed money in the private market and since they’re private they aren’t subjected to the GPRA (government performance results act) so the accreditation system has become a de facto GPRA (NCQA, JCAHO, URAC, COA) mechanism to prioritize clinical results (often with monetary pay-for-performance measures) above market elements.

    or course, i decided a few hours ago this bourbon wasn’t going to drink itself, so what do i know?

  18. Ananth

    There is nothing contradictory about trying to reduce costs and looking at second and third opinions. Only a fool would assume a Doctor unrelated to them (and even if they were) was the only possible source of a correct assessment for treatment.

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