Editore"s Note
Tilting at Windmills

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February 26, 2006
By: Kevin Drum

GLADWELL BLINKS....Six years ago Adam Gopnik and Malcolm Gladwell debated healthcare in the pages of the Washington Monthly. Gopnik was for universal healthcare and Gladwell was agin it.

But wait! Via Rufus X, I learn that Gladwell has blinked! He now says Gopnik was right:

Why have I changed my mind? Some of my reasons are in the piece on moral hazard I wrote for the New Yorker last summer. The bigger reason is simply that I woke up one day and realized what much smarter people than me (Adam Gopnik) realized a long time ago, which is that the idea of employer-based health care is just plain stupid and only our familiarity with it and sheer inertia prevent us from rising up in rebellion.

I always try to think of a suitable analogy and fail. The closest I can come is to imagine if we had employer-based subways in New York. You could ride the subway if you had a job. But if you lost your job, you would either have to walk or pay a prohibitively expensive subway surcharge. Of course, if you lost your job you would need the subway more than ever, because you couldn't afford taxis and you would need to travel around looking for work. Right? In any case, what logical connection is there between employment and transporation? If you can answer that question, you can solve the riddle of the U.S. health care system. And maybe I'll change my mind back.

Gladwell wrote this because, for some reason, his old debate with Gopnik has suddenly gotten renewed attention in the blogosphere (20 cites in the past week) and, he says, "I shudder when I read what I said back then."

By the way, did you know that Malcolm Gladwell now has a blog? Well he does.

Kevin Drum 9:17 PM Permalink | Trackbacks | Comments (93)

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Comments

well, i suppose it beats pretending that he never thought what he thought, but still: how could any reasonably intelligent person not already ideologically blinded (the way that republicans are) think that our current health-insurance system, invented as a way around world war ii wage-and-price controls, makes any frickin' sense at all?

Posted by: howard on February 26, 2006 at 9:22 PM | PERMALINK

Wow, "I told you so" twice in one week.

Good for him for being a grownup and admitting that he was wrong. Read his piece on moral hazard, btw; it derails whatever else is left of the BushCo arguments about health care.

Posted by: craigie on February 26, 2006 at 9:28 PM | PERMALINK

The connection between health care and having a job is "someone willing to buy off insurance companies." Anyone who doesn't grasp that has no notion of the powerful lobbies and influence buying that have blocked a humane health care policy in this country.

Posted by: Scorpio on February 26, 2006 at 9:35 PM | PERMALINK

Howard, if we pound on someone who's admitted a mistake, why should anyone ever cop to an error?

Posted by: Bobarino on February 26, 2006 at 9:42 PM | PERMALINK

bobarino, i'm sorry it sounded like i was "pounding on" gladwell. he's a smart guy: i was just expressing my astonishment that a smart guy without ideological blinkers could believe something as dumb as he did. even if you don't believe in some form of nationalized health care, the status quo is nuts, and that should have been obvious.

but i accept that to gladwell it wasn't and now it is, and i'm not trying to pound on him for noticing. (well, let me rephrase that: part of why the health-insurance system in america is deranged is because too many smart folks won't accept the reality in front of their faces, and so i am a little aggravated, but it's not like gladwell is the reason we don't have a substantive debate about wither health-insurance in america.)

Posted by: howard on February 26, 2006 at 9:47 PM | PERMALINK

Wow. Malcolm Gladwell scores a lot of points with this. I don't think his voice was keeping us from shifting to national healthcare or anything like that. But I do appreciate when people display emotional maturity and class.

I myself spend a lot of time fighting to preserve our current sucky system from efforts to get rid of tax supports for employers to provide insurance because the proferred alternative - health savings accounts and a bullet to bite on - is pretty poor. I could conceive of real improvements coming from a pay or play style mandate on employers. So, while a real national system would be better, I think there is more we can do with the employer based one mostly because incremental change is easier. The ideal policy is a national system. The problem is the "and a pony" problem. I want national healtccare and a pony and victory in Iraq. I'm not feeling likely to get any of it now.

Posted by: benton on February 26, 2006 at 9:48 PM | PERMALINK

Dang, have a lot to do this evening - Will have to check back in the morning to peruse the sterling rebuttals by TBrosz and Yancey Ward.

Posted by: thethirdPaul on February 26, 2006 at 9:50 PM | PERMALINK

... and do you know that Gladwell is Canadian? Or at least that he went to college in Toronto? I can't say for sure that he was born and raised in Canada, but I do know that he attended Trinity College at the University of Toronto from 1980 to '84, that no one ever said he was American, and that there were few if any American students at the college at the time. For what it's worth...

Posted by: DNS on February 26, 2006 at 9:51 PM | PERMALINK

DNS -- he was born in England, raised Canadian, but why does his nationality matter?

My only problem with a national, single-payer system is that spammers would then be covered.

Posted by: otherpaul on February 26, 2006 at 9:59 PM | PERMALINK

Oh, so now Gopnick has his balls invert into a pussy and he loves Clinton healthcare, and now all Republicans are magically supposed to rush out and vote for National Healthcare, which is as discredited as Soviet communism.

Yeah, right

Posted by: egbert on February 26, 2006 at 10:03 PM | PERMALINK

"Oh, so now Gopnick has his balls invert into a pussy and he loves Clinton healthcare, and now all Republicans are magically supposed to rush out and vote for National Healthcare, which is as discredited as Soviet communism."

Uh, oh. Looks like Gopnick has lost the support of overweight teenage boys with bad acne living in their parents' basement.

Posted by: Joel on February 26, 2006 at 10:10 PM | PERMALINK

egbert, go ahead and explain to us how nationalized health care in one form or another is discredited: is it the way our system is cheaper? our lifespans are longer? our bureaucracy is easier to navigate? our child mortality rates better? our overall population healthier? our carmakers more competitive?

we really do want to know....

Posted by: howard on February 26, 2006 at 10:15 PM | PERMALINK

Gopnick => Gopinck

Know what I'm sayin?

Posted by: egbert on February 26, 2006 at 10:15 PM | PERMALINK

"Know what I'm sayin?"

Yeah. That you're completely out of your depth here.

Be quiet now, egbert. Grownups are talking.

Posted by: Joel on February 26, 2006 at 10:19 PM | PERMALINK

Ok, you guys want to keep blabbing away in your echo chamber, go right ahead.

It doesn't take away the fact that socialized medicine has been shown to NOT WORK in Canada and Europe. In Britain, wait times for operations are laughably long. But maybe not laughable for the people who die waiting for an operation. And the quality of the care is poorer than here.

And one last thing. Europe and Canada piggy-back off our technology. If we try to control health care costs through centralized planning, then our rate of technological progress will fall and how many future lives will have been lost then?

Posted by: egbert on February 26, 2006 at 10:23 PM | PERMALINK

"It doesn't take away the fact that socialized medicine has been shown to NOT WORK in Canada and Europe."

Haven't met a Canadian yet who would trade their system for ours.

"In Britain, wait times for operations are laughably long."

Rather like the medical care experienced by the ca 40 million uninsured citizens in America.

Posted by: Joel on February 26, 2006 at 10:29 PM | PERMALINK

Pardon, who are these two people and who cares?

Debating just the benefits side of healthcare is stupid. More healthcare and more coverage is always better.

If you debate everything, including its costs - that's got real choices.

If you don't more of a nice good for free is always better. The problem with universal health care is a 'free rider' problem. Given, the US's lack of an immigration policy, any universal system would be burdened and broken as quickly as your Emergency Room system.


Posted by: McA on February 26, 2006 at 10:35 PM | PERMALINK

And one last thing. Europe and Canada piggy-back off our technology

i agree, we should all deal with shitty health insurance in the name of protectionism for US compaines.

fuck the free market

Posted by: cleek on February 26, 2006 at 10:36 PM | PERMALINK

"Pardon, who are these two people and who cares?"

Who are you? And who cares?

Posted by: Joel on February 26, 2006 at 10:42 PM | PERMALINK

Ebert apparently has no actual response to the ways in which national health care systems have been shown to not work, so he relies on the old: you have to wait for elective surgery.

as if rationing by insurance companies doesn't take place in america, resulting in such lovely aspects of the american system as emergency rooms being flooded with people who have no coverage at all with which to get routine treatments and obviate the emergency altogether.

meanwhile, here's something that doesn't happen in any country with nationalized health care: no one goes bankrupt as a result of their medical expenses. unlike what happens here.

which takes us to McA. yes, costs are the issue, aren't they? too bad for your argument that our system costs more than other systems.

Posted by: howard on February 26, 2006 at 10:50 PM | PERMALINK

David, you spelled 场-高崎机场 wrong you pinhead. I agree with your larger point though, namely if this wasn't obvious to Gladwell six years ago, why should I give a fuck what he thinks now?

But David, do remember, 崎 before 高 except after 机.

Posted by: jerry on February 26, 2006 at 10:51 PM | PERMALINK

I see McA is making an ass of himself again.

The current US healthcare system benefits the insurance and pharmaceutical industries. For everyone else it is government enforced blackmail; and, if you can't pay you suffer horribly and die.

Posted by: joe on February 26, 2006 at 10:53 PM | PERMALINK

The problem with universal health care is a 'free rider' problem.

no it isn't.

and if we in the US want the opinion of people who don't live here and aren't even citizens, we'll gladly ask. until then, STFU

Posted by: cleek on February 26, 2006 at 10:56 PM | PERMALINK

Jerry: That was awesome. Classic.

Posted by: Jeff on February 26, 2006 at 10:59 PM | PERMALINK

You know what Jerry, 场-高崎机场 you!

I 场-高崎机场 'in know how to spell 场-高崎机场!

;)

Posted by: David on February 26, 2006 at 10:59 PM | PERMALINK

Because he's brilliant, spent years as a health reporter, and actually knows what he's talking about?

Think back, if you will, to 1999. It's hard, but just do it. In that halcyon time, it appeared that the lessons of 6+ years of Clinton prosperity were that triangulation worked; that a head-on confrontation with vested business interests and conservative ideology (a la Hillarycare) was foolish, but that common-sense incremental changes could be extraordinarily productive and bring better living and prosperity for all. It was still believed that finding common ground between conservative and liberal positions was not only possible, but necessary, and that a certain governor of Texas was a "compassionate conservative" who just might offer the GOP a post-Clintonian way forward.

After 5 years of staggeringly right-wing ideological corporate-financed Bush madness, we now know that the real political alternative to national health insurance is "Personal Health Accounts" - i.e. no health insurance at all. But in 1999, that wasn't obvious. And that's why it's so instructive to watch Gladwell's changing thinking on this point over the course of 6 years. He's through the whole maze of contrarian conservative anti-nationalization arguments, and by tracing his path, you can see how they dead-end.

Posted by: brooksfoe on February 26, 2006 at 11:02 PM | PERMALINK

and if we in the US want the opinion of people who don't live here and aren't even citizens, we'll gladly ask. until then, STFU

Uh, cleek, sorry, but you STFU. I personally welcome the opinions of people who don't live here and aren't even citizens - such as, say, the citizens of Canada and France.

I share your annoyance at McA, but the fact that he doesn't live in the US isn't what makes him wrong.

Posted by: brooksfoe on February 26, 2006 at 11:04 PM | PERMALINK

"... Gladwell was agin it."

But wiat...

I agin it two...

Posted by: christian typo artist on February 26, 2006 at 11:05 PM | PERMALINK

I share your annoyance at McA, but the fact that he doesn't live in the US isn't what makes him wrong.

I think what chaps everyone's ass about McA is not that he's a non-American, it's that he's a non-American who does nothing but repeat right-wing American talking points. In short, his problem is that he's a pathetic wannabe American, giving up every opportunity to think for himself and instead merely reading from the same script as right-wing ignoramuses.

Posted by: Constantine on February 26, 2006 at 11:07 PM | PERMALINK

Think back, if you will, to 1999. It's hard, but just do it. In that halcyon time, it appeared that the lessons of 6+ years of Clinton prosperity were that triangulation worked; that a head-on confrontation with vested business interests and conservative ideology (a la Hillarycare) was foolish, but that common-sense incremental changes could be extraordinarily productive and bring better living and prosperity for all.

But this seems to have little or nothing to do with why Gladwell argued the way he did. The anecdote he gave at the beginning about his experience in Canada with CAT scans was nothing more than a classic only-the-free-market-can-provide-good-healthcare argument. Might as well have been straight out of the well paid mouth of a Cato "intellectual".

Posted by: frankly0 on February 26, 2006 at 11:17 PM | PERMALINK

Gladwell, in short, has a VERY GOOD REASON to be embarrassed by these arguments.

Posted by: frankly0 on February 26, 2006 at 11:18 PM | PERMALINK

If Gladwell changes his position because he can sense that the political winds have changed on this, and he's going to look like he was a right wing tool if he DOESN'T change, why, I wonder, should we be obliged to admire his change of mood?

Posted by: frankly0 on February 26, 2006 at 11:20 PM | PERMALINK

In short, his problem is that he's a pathetic wannabe American, giving up every opportunity to think for himself and instead merely reading from the same script as right-wing ignoramuses.

Posted by: Constantine on February 26, 2006 at 11:07 PM | PERMALINK

Excuse me! Wannabe American is a real fucking insult!

Let me explain:

Hong Kong has a 15% maximum tax rate and
universal healthcare

Singapore has a 20% maximum tax rate and universal healthcare (plus a health savings account)

As to my right to lecture American liberals, its
not as if we don't get our share of American labour workers, human rights organizations and
greenie idiots overhere. We put up with your free speech, you put up with ours.

Posted by: McA on February 26, 2006 at 11:21 PM | PERMALINK

I've gotta say, Gladwell Blinks was what really turned me off to the whole Star Wars series.

Posted by: dj moonbat on February 26, 2006 at 11:24 PM | PERMALINK

In short, his problem is that he's a pathetic wannabe American, giving up every opportunity to think for himself and instead merely reading from the same script as right-wing ignoramuses.

Ah yes, but remember that according to McA us lefties are merely racist arrogant cultural imperialists who are lording it over the developing world. The 'Left Agenda' (TM) is designed to keep the developing world downtrodden and poor.

As opposed to the Bush administration.

:)

Whatever else he may or may not be, McA is certainly culturally and politically confused.

Posted by: floopmeister on February 26, 2006 at 11:24 PM | PERMALINK

We put up with your free speech, you put up with ours.

Exactly what Google should have said to Beijing.

More confusion from McAddled Brain.

Posted by: floopmeister on February 26, 2006 at 11:27 PM | PERMALINK

Ever see a pic of Gladwell? He looks like CarrotTop.

Posted by: davids on February 26, 2006 at 11:28 PM | PERMALINK

Oh, and McA - a word of warning. Don't practise your free speech too loudly in Singapore.

Let alone Beijing.

Posted by: floopmeister on February 26, 2006 at 11:28 PM | PERMALINK

Hong Kong has a 15% maximum tax rate and
universal healthcare

I am totally baffled, McA. And you oppose universal health care in the US?

There are a lot of things the US could stand to learn from Hong Kong and Singapore - including the importance of public transit, public housing, and a strong department of public health to fight the increasing threat of communicable disease. What I can't figure out is why, on questions like these, you think the US should ignore the examples of Singapore and HK, and instead continue to pursue policies which are proven failures.

Posted by: brooksfoe on February 26, 2006 at 11:29 PM | PERMALINK

I must say it is disheartening, on my occasional visits to St John, New Brunswick, to see those poor, poor people, sapped of all initiative, dragging themselves in a zombified stupor through the streets of the province's largest city, all because of the missing stimulus provided in this country of finding the best health care at the lowest cost.

Shameful simulacrum of normal human life. Wonder what their suicide rate is.

Posted by: Davis X. Machina on February 26, 2006 at 11:32 PM | PERMALINK

...how could any reasonably intelligent person not already ideologically blinded (the way that republicans are) think that our current health-insurance system, invented as a way around world war ii wage-and-price controls, makes any frickin' sense at all?

Well, I think it's a matter of efficacy, not really (in this case) of whether employment-based health insurance "makes sense". One could imagine a situation where it did indeed make sense. Let's suppose that labor were extremely scarce, and employers simply couldn't get workers even on a part-time basis when they failed to offer healthcare benefits. Furthermore, let's suppose government programs did a thorough job at insuring everyone not covered through employer-based insurance. Under such a scenario, getting one's health coverage from the workplace wouldn't necessarily be all that bad a system. And as I recall, a number of countries (Japan and Germany, for instance) do incorporate the workplace as a key player in the provisioning of healthcare benefits.

Unfortunately, labor isn't nearly so scarce in America as to make employer-based healthcare comprehensive and universal, and it is indeed getting weaker in these regards.

Posted by: You on February 26, 2006 at 11:33 PM | PERMALINK

I've got to say, I just don't get the fascination with Gladwell. I can't recall a single I've ever read by him that wasn't disappointing shallow.

And I mean EVERYTHING. I happened to read an article of his in a recent New Yorker about profiling that spent three quarters of its space devoted to the problems in profiling DOGS -- as if the inferences to people were instantly obvious.

It strikes me as crap written for the lay public who are always happy to be deluded into thinking that they're thinking.

Posted by: frankly0 on February 26, 2006 at 11:36 PM | PERMALINK

By the way, I think we're nearly all in agreement that tying healthcare to employment is a sucky idea. If so, can we all at least stop bashing Wal-Mart (and other firms) for not providing an expensive benefit they're not required by law (save in Maryland) to pay for? Of course paradoxically, one possible way around the lack of universal healthcare in America (it's not a method I favor, mind you, but it would be better than nothing) would be to pass legislation either nationally or at the state level requiring employers to provide healthcare. Massachusetts may soon follow Maryland's lead. This wouldn't be all the different from countries that require biggish payroll levies to pay for universal coverage. But absent such a requirement, I actually think Wal-Mart and every other firm, large and small, should be wildly cheered on in their efforts to screw workers out of health insurance benefits. Only when the 45 million uninsured multiply to 80 or 90 million (or more) will the political critical mass necessary to change the system be reached.

Posted by: You on February 26, 2006 at 11:44 PM | PERMALINK

In a sense, the anecdote on the CAT scans is essential Gladwell. That is what he does, and really all he does: act as though a few anecdotes makes a rational or scientific case for a point.

Posted by: frankly0 on February 26, 2006 at 11:44 PM | PERMALINK

Uh, cleek, sorry, but you STFU. I personally welcome the opinions of people who don't live here and aren't even citizens - such as, say, the citizens of Canada and France.

and i personally don't welcome the opinions of people who aren't here for any kind actual discussion, who don't have a stake in the actual outcome and who don't have a say in how it gets accomplished. maybe you're under the illusion that McA is some kind of resident scholar on exhange here to share with us his vast wealth of experience and knowledge on the topic of US partisan politics and how we should best run our country? well, he's not. he's a fucking troll

Posted by: cleek on February 26, 2006 at 11:46 PM | PERMALINK

I totally disagree with you about Gladwell, frankly0. He's an extremely intelligent thinker and an extraordinarily clear and entertaining writer. His problem is never that his piece doesn't have an idea; it's that it always has to have an idea. He's only interested in writing when he can synthesize a problem down into an illustration of some type of interesting technical-philosophical phenomenon. This is the model he's been following since "Tipping Point", and it's come to define him as a writer. Other writers, like Robert "Nonzero" Wright, have tried to imitate him, but with less success.

I think Gladwell's problem is his insufficient sensitivity to or interest in consequential phenomena which are relatively ordinary and straightforward, not intellectually quirky - plain old stuff about interest groups, ideology, history, established scientific stuff that surprises no one, and so forth. Sometimes, the reason why something happens - why we don't have universal health care, for instance - is just a matter of brute-force power politics and greed, not an interesting intellectual paradigm shift. And I think that's what makes Gladwell a quintessential writer of the late '90s, not of the early 'oughts. Nothing could be clearer than that under Bush, it's not about the ideas.

Posted by: brooksfoe on February 26, 2006 at 11:53 PM | PERMALINK

You shouldn't say he blinked, it's demeaning. He did what so few of us ever do, he used his head.

Posted by: Boronx on February 26, 2006 at 11:54 PM | PERMALINK

Only when the 45 million uninsured multiply to 80 or 90 million (or more) will the political critical mass necessary to change the system be reached.

I think you're right about mandating business health-care provision, frankly0, but I don't think we need to wait that long. In a lot of states, the critical mass is already there. My only amendment is that heath care should either be mandatory for EVERY employer, regardless of size, or there should be a state safety net healthcare plan for employees of small businesses. If insurance is mandatory for SMEs too, small businessmen will be banging down the doors of the state legislature to set up affordable state-organized insurance systems so they're not all driven out of business.

Posted by: brooksfoe on February 26, 2006 at 11:58 PM | PERMALINK

Well, now that the New Yorker vote has swung in favor of universal health care, it's just a matter of time!

Posted by: clb72 on February 26, 2006 at 11:59 PM | PERMALINK

The 'Left Agenda' (TM) is designed to keep the developing world downtrodden and poor.
...............
Whatever else he may or may not be, McA is certainly culturally and politically confused.

Posted by: floopmeister on February 26, 2006 at 11:24 PM | PERMALINK

The Left opposes free trade (third world getting a chance to grow), outsourcing (the third world getting higher value work), thinks Arabs are incapable of democracy and sided with the communists in Asia (not the capitalist, quasi-democracies who did so much good).

Why would anyone believe the Left supports the third world?

-------------

Don't practise your free speech too loudly in Singapore.

Let alone Beijing.

Posted by: floopmeister on February 26, 2006 at 11:28 PM | PERMALINK

Sure, when in Rome do as in Rome.

--------------

and i personally don't welcome the opinions of people who aren't here for any kind actual discussion, who don't have a stake in the actual outcome and who don't have a say in how it gets accomplished.

Posted by: cleek on February 26, 2006 at 11:46 PM | PERMALINK

So why does this site run by an Orange County American have any say on world affairs?

Posted by: McA on February 27, 2006 at 12:04 AM | PERMALINK

I do actually enjoy reading McA, because he's such a good example of how Asian educational systems, for all their strengths, inhibit their citizens' ability to make reasoned, logical arguments. They just aren't taught to argue competently and independently. The "Orange County American on world affairs" line is a good example of the kind of argument one might read in a Vietnamese conservative newspaper - a transparently false equivalency. (Orange County Americans are, of course, residents of the world, whereas people who live in Hong Kong do not live in the US.)

Of course, while the upper third of the American educational system does a pretty good job on this count, the lower two-thirds don't teach Americans how to reason or argue, or how to do anything else. So we've got little to crow about.

Posted by: brooksfoe on February 27, 2006 at 12:11 AM | PERMALINK

Re:Waiting lists.

Waiting lists are not important to this discussion. Please do not mention them again, as they are a red herring. They would only be an issue if they were caused by universal health care plans refusing to spend the money in order to reduce the health care lists.

Let me tell you that this is not the case. The problem isn't one of not enough money. The problem is one of not enough STAFF.

Because of the massive money sink that health care is in the US, it acts as a sponge, taking away labor units from other countries. Combine this with artifical limits on the number of new doctors...

We got a problem.

No, the important list that we need to look at here isn't a waiting list. It's people who don't even get ON the waiting list. Those that are uninsured. Those who's insurance company rejects the procedure for one reason or another.

THAT'S the important list. The people who have been denied health care.

And I will guarentee that America's health care system create a vastly longer list than ANY single-payer system in the world.

Posted by: Karmakin on February 27, 2006 at 12:18 AM | PERMALINK

The Left opposes free trade (third world getting a chance to grow)

False. But nice strawman.

BTW, I love your simplistic analysis ('getting a chance to grow'). It's precisely because it doesn't do this that most of Latin America has rejected the free trade model.

All because of protesting lefties at uni, right.

...outsourcing (the third world getting higher value work)...

No, actually that's the protectionist Right (a la Buchanan).

...thinks Arabs are incapable of democracy...

What, like in Palestine?

I know Arabs are capable of democracy - there have been a few democracies in the Arab world. Of course, they were removed because they were also not sufficently pro-Western.

Oh, I'm sorry. Does democratic equal pro-Western?

...and sided with the communists in Asia (not the capitalist, quasi-democracies who did so much good).

The first formal recognistion of Communist China was by the labour government of Australia, under Whitlam. Is this an example of 'siding with the Communist dictatorships'?

Nixon did the same a few months later.

Or is China one of "the capitalist, quasi-democracies who did so much good"? In which case Whitlam was supporting constructive engagement with an Asian neighbour, on its terms and without using a hectoring Western 'colonial' tone.

Frankly, you don't define your terms well enough to conduct a meaningful debate. Which is China? A Communist dictatorship or a quasi-democracy?

Hell, what's Egypt? The biggest recipient of US aid after Israel - is it a quasi-democracy or a dictatorship?

Posted by: floopmeister on February 27, 2006 at 12:21 AM | PERMALINK

...do actually enjoy reading McA, because he's such a good example of how Asian educational systems, for all their strengths, inhibit their citizens' ability to make reasoned, logical arguments.

I had many bar discussions with young Chinese workmates about the One China policy. They argued that the West should butt out, and not try to split China by supporting Taiwan.

I agreed, being a neo-colonial Leftie, of course (!)

Then I'd suggest that they, of course, keep One China, but take Taiwan's government instead of Beijing. They offered more freedom, better economic prospects. Have One China, but ruled by the Kuomindang.

DID NOT COMPUTE.

Then they'd start reminding me that the Tiannanmen Square 'incident' never happened. It was all a Western plot...

Posted by: floopmeister on February 27, 2006 at 12:29 AM | PERMALINK

Sure, when in Rome do as in Rome.

Note, everyone, that this is McA talking about freedom of speech.

Note the relativism. Freedom of Speech is an absolute value for our conservative warriors - until it isn't.

Then it depends upon the situation.

Sounds like fluffy post-modernist rationalising to me.

Posted by: floopmeister on February 27, 2006 at 12:33 AM | PERMALINK

So why does this site run by an Orange County American have any say on world affairs?

who cares?

this isn't about our kind host, this is about you - a guy who shows up parroting warmed-over GOP talking points, making no apparent attempt at actual discussion, but instead is just trolling for flames about topics in which he has no personal stake, and can't even participate in. your whole schtick is disingenuous.

Posted by: cleek on February 27, 2006 at 12:39 AM | PERMALINK

To be fair, floop, there is a small but substantial segment of the Left, the anti-globalization part, that does pretty much oppose free trade. The smarter segment is more involved in supporting fair trade - e.g. getting Europe and the US to drop their killer agriculture subsidies if the 3rd world is going to be forced to drop electronics subsidies - but there are still some folks arguing an unreconstructed anti-trade agenda. But they're not terribly important.

In fact most of the left has basically supported free trade, agreeing that it helps the third world to develop. But what's interesting is that in the post-Washington Consensus world (as Stieglitz terms it), we're starting to recognize that the promised gains from free trade don't necessarily materialize; they only happen where governments and societies take the right policy steps to make them happen. And if China is the example, those policies seem to include managing exchange rates, government stimulus of key industries, ignoring intellectual property law, and some protectionism; and increasingly, in the future, raising minimum wages and letting independent labor unions demand worker-safety measures and health insurance.

One of the left's weaknesses, in retrospect, has been a Marxist attitude that historical progress is inevitable. Looking at what's happened in the past few decades, it's becoming more and more clear that many of the great improvements in average people's living standards in the US and Europe weren't inevitable: they happened because labor unions and Democratic New Deal governance made them happen. Most liberals have always felt that with rising industrialization and development, people will just naturally demand and get better living conditions. It's increasingly clear that that's not so: it's a matter of actually people having the will and capacity to organize for such demands. History is not predetermined, and you have to go out and get what you want out of it.

Posted by: brooksfoe on February 27, 2006 at 12:41 AM | PERMALINK

I've got to say, I just don't get the fascination with Gladwell. I can't recall a single I've ever read by him that wasn't disappointing shallow.

This is a point on which I am inclined to agree. I once described Gladwell's "Tipping Point" as "Linked for people who are shallow and afraid of math." However, given that many people are shallow and afraid of math, such writing may be useful in order to reach the public.

Posted by: Constantine on February 27, 2006 at 12:46 AM | PERMALINK

Oh, and floop, missed your anecdote about the one-China arguments. That sounds classic. I had a conversation with a reasonably smart young Vietnamese guy a while back, a student at the top university in Hanoi (the Trade University, natch), about One China. He felt the West should butt out and that Taiwan should definitely not try to become independent from China, since it's a province of China. I said, well, Vietnam used to be a province of China. If you followed that logic, Vietnam would still be part of China.

Like you say: did not compute. Blank stare.

Posted by: brooksfoe on February 27, 2006 at 12:52 AM | PERMALINK

To be fair, floop, there is a small but substantial segment of the Left, the anti-globalization part, that does pretty much oppose free trade. The smarter segment is more involved in supporting fair trade - e.g. getting Europe and the US to drop their killer agriculture subsidies if the 3rd world is going to be forced to drop electronics subsidies - but there are still some folks arguing an unreconstructed anti-trade agenda. But they're not terribly important.

Absolutely. They're not hugely important - but then one gets the impression (as you once suggested) that these are the people McA has had a run in with at some point.

Ergo - this is 'The Left' - monolithic and ideological.

We used to get the head of the World Bank in Lao (a wonderfully pithy French woman, BTW) in for lectures to our students and she used to make exactly the same points you just made. She was obviously in the Stiglitz camp before it started openly challenging the ideologues.

And if China is the example, those policies seem to include managing exchange rates, government stimulus of key industries, ignoring intellectual property law, and some protectionism; and increasingly, in the future, raising minimum wages and letting independent labor unions demand worker-safety measures and health insurance.

Actually, that also sounds like the US as an example. Pretty much what the US did for many, many years. Opening up is fine, once the house is in order. In this respect, India and China are simply following the path the West has taken.

One of the left's weaknesses, in retrospect, has been a Marxist attitude that historical progress is inevitable.

Well, as Fukuyama shows, that tendency is not confined to the Left! ;)

Looking at what's happened in the past few decades, it's becoming more and more clear that many of the great improvements in average people's living standards in the US and Europe weren't inevitable: they happened because labor unions and Democratic New Deal governance made them happen.

Again, you're absolutely right. But I would argue that the New Deal also happened because the Great Depression happened - events created an opportunity in the US to introduce that raft of policies.

In Germany in the same period the opportunity was taken to introduce a differing range of policies.

Posted by: floopmeister on February 27, 2006 at 12:57 AM | PERMALINK

In Germany in the same period the opportunity was taken to introduce a differing range of policies.

Well, not even so different on public works employment. But they figured out the utility of the defense-industrial complex as an economic stimulus before we did. ;)

Posted by: brooksfoe on February 27, 2006 at 1:08 AM | PERMALINK

Orange County Americans are, of course, residents of the world, whereas people who live in Hong Kong do not live in the US.)

Posted by: brooksfoe on February 27, 2006 at 12:11 AM | PERMALINK

And this isn't American exceptionalism?

Have you ever been overseas, brooksfoe. America is one of the most inward-looking cultures I have ever seen.

The very fact that multinationals are American means its hard to do business on a global scale without Americans. We know you more than you know us.

You might notice that I know your language and you don't know mine.

------------

they, of course, keep One China, but take Taiwan's government instead of Beijing. They offered more freedom, better economic prospects. Have One China, but ruled by the Kuomindang.

Posted by: floopmeister on February 27, 2006 at 12:29 AM | PERMALINK

Say we combine both countries and have a vote. How do you expect one frigging billion votes not to dictate who runs the country?

-----------------------


Vietnam used to be a province of China. If you followed that logic, Vietnam would still be part of China.

Posted by: brooksfoe on February 27, 2006 at 12:52 AM | PERMALINK

Vietnam's not a province of China because
of its track record in humiliating invading superpowers. He was probably trying to decide if he should remind you of that.

-----------------------

Absolutely. They're not hugely important - but then one gets the impression (as you once suggested) that these are the people McA has had a run in with at some point.

Posted by: floopmeister on February 27, 2006 at 12:57 AM | PERMALINK

Their importance is a matter of opinion. They certainly showed up at the Dubai Ports thing and started trying to pull Singapore into this.

------------------------

Posted by: McA on February 27, 2006 at 1:09 AM | PERMALINK

I find it amusing that once McA is forced into a corner the GOP-talking-points script does not apply, he becomes completely incoherent, spewing forth a stream of non-sequiturs.

Posted by: Constantine on February 27, 2006 at 1:16 AM | PERMALINK

What I can't figure out is why, on questions like these, you think the US should ignore the examples of Singapore and HK, and instead continue to pursue policies which are proven failures.

Posted by: brooksfoe on February 26, 2006 at 11:29 PM | PERMALINK

Nothing against universal healthcare, welfare, free university scholarships, whatever.....
If you can manage things to keep the overall tax budget low and government out of the way of business - that's good government.

This is Singapore Socialism. Tax the rich the help the poor, but recognise you have to have some rich to tax in the first place, and since they can move, you just have to recognise you can only do so much from an equity viewpoint.

If you cut taxes down to 25%, and had money left - go ahead and make more social adjustments.

-------------------

Note the relativism. Freedom of Speech is an absolute value for our conservative warriors - until it isn't.

Posted by: floopmeister on February 27, 2006 at 12:33 AM | PERMALINK

Actually, you are the one lumping people into an undifferentiate mass. I'm not an extremist on freedom of speech.

Americans protesting at the funerals of their own fallen soldiers, in defiance of family wishes is kinda disturbing.

I'm not sure your society will not be replaced as world leaders by some kind of Asian capitalist, democratic model - that doesn't look like yours.

------------

reminding me that the Tiannanmen Square 'incident' never happened. It was all a Western plot...

Posted by: floopmeister on February 27, 2006 at 12:29 AM | PERMALINK

It happened.

If you can find a faster way for China to recover from Mao and become some kind of civil society, great.

If not. Deng Xiao Ping's little master plan seems to be working quite well even after his death.

Posted by: McA on February 27, 2006 at 1:26 AM | PERMALINK

"If I have to shoot 200,000 students to save China from another 100 years of disorder, so be it." - Minister Mentor Lee Kuan Yew evoking the ghost of Deng Xiaoping whilst endorsing the Tiananmen Square massacre, Straits Times, Aug 17, 2004

Posted by: McA on February 27, 2006 at 1:31 AM | PERMALINK

This is Singapore Socialism. Tax the rich the help the poor, but recognise you have to have some rich to tax in the first place, and since they can move, you just have to recognise you can only do so much from an equity viewpoint.

Sounds like European Democratic Socialism to me.

Sweden on the Malacca Straits?

I'm not sure your society will not be replaced as world leaders by some kind of Asian capitalist, democratic model - that doesn't look like yours.

Of course it will. You're describing India.

Posted by: floopmeister on February 27, 2006 at 1:32 AM | PERMALINK

"If I have to shoot 200,000 students to save China from another 100 years of disorder, so be it." - Minister Mentor Lee Kuan Yew evoking the ghost of Deng Xiaoping whilst endorsing the Tiananmen Square massacre, Straits Times, Aug 17, 2004

"Better 100 years of tyranny than one day of anarchy" Arab proverb.

Are you saying that Chinese people can't handle democracy?

What's the difference between these two attitudes?

Posted by: floopmeister on February 27, 2006 at 1:34 AM | PERMALINK

And so your logic leads us full circle.

Good night McA.

Posted by: floopmeister on February 27, 2006 at 1:35 AM | PERMALINK

I really, really like the idea of employer-based subways in New York.

Posted by: King Kong on February 27, 2006 at 4:13 AM | PERMALINK

Are you saying that Chinese people can't handle democracy?

Posted by: floopmeister on February 27, 2006 at 1:34 AM | PERMALINK

Nope. The difference is that the Chinese system is getting better in all other respects including democracy.

Its not worth risking all the benefits open to 1 .1 billion people from continued development than to have chaos now.

Whereas the Arab world was not getting better and was pulling Islam in extreme directions all round the world.

----------

European Democratic Socialism to me.

Sweden on the Malacca Straits?

Posted by: floopmeister on February 27, 2006 at 1:32 AM | PERMALINK

Actually, that was Singapore's original role model. Taxes were just set lower because that was what was necessary to attract multinationals.

Taxation is the art of getting the maximum amount of milk with the minimum amount of moo. Making sure there's enough grass for the cows to hang around seems logical.

Posted by: McA on February 27, 2006 at 4:13 AM | PERMALINK
Taxation is the art of getting the maximum amount of milk with the minimum amount of moo. Making sure there's enough grass for the cows to hang around seems logical.

Wow. That's... so... profound!

Who ever would have thought of that???

Posted by: No, really on February 27, 2006 at 5:06 AM | PERMALINK

"... Gladwell was agin it."

But wiat...

I agin it two...
Posted by: christian typo artist

Damn. Somebody poaching in my domain while I was engaging in the challeging sport of circumnavigating downtown without getting trapped by parade barricades.


But I'd have to, in the interests of truth in advertising, change my log-in to Non-Christian typo artist.

And I would, too, if I got a 'lurcative' enough offer.

I think if Ike had to do it over, he'd have also thought to warn the American people about the looming threat posed by the Medical-Industrial complex.

Posted by: CFShep on February 27, 2006 at 9:55 AM | PERMALINK

Because health is not a commodity like oil that one could ultimately live without, the free market doesn't work with health care. There is no motivation in the US system for the doctor to cure the patient. If the patient is healed, the revenue stream dries up.

With socialized medicine, there is a motivation for the doctor to cure the patient, because then he/she will go away.

Posted by: kman on February 27, 2006 at 11:38 AM | PERMALINK

Because health is not a commodity like oil that one could ultimately live without, the free market doesn't work with health care.

Can you live without food? Somehow we trust the free-market to provide that, albeit with prudent regulation.

I agree that employer-based health care is an awful system, but I don't see how replacing it with yet another third-party payer is an improvment.

With socialized medicine, there is a motivation for the doctor to cure the patient, because then he/she will go away.

And there's also a motivation to declare the patient "cured" because the budget is running short. Likewise, with an unlimited budget, there's a motivation for the patient to hang around and run all sorts of unnecessary tests. Ultimately, someone is going to have to draw the line. I don't think people will be much happier when an unelected bureaucrat is drawing the lines than with an insurance agency.

Posted by: Derek Copold on February 27, 2006 at 12:12 PM | PERMALINK
The Left opposes free trade (third world getting a chance to grow),

If by "free trade", you mean the regime of deregulation of movement in capital and goods without similar freedom of movement for persons (labor and consumers) and without common labor, environmental, and other standards that has been demonstrated to drive capital out of the less developed partners and in to the more developed partners, while primarily benefitting the existing wealthiest classes in both more and less developed trading partners with the costs born by the existing poorest classes in both the more and less developed partners then, yeah, the Left has generally been against it.

OTOH, if you mean free and fair trade with common standards and fredom of movement for people as well as goods and capital, the Left has generally been for it.

outsourcing (the third world getting higher value work),

Offshoring (or "overseas outsourcing" -- "outsourcing" alone is a bad word for it, since it has a well established meaning which doesn't necessarily refer to anything international) isn't a separate issue from the kind of "free trade" you seem to be berating the Left for not supporting, it is a consequence of it, not a separate policy issue.

thinks Arabs are incapable of democracy

The Left thinks Arabs are perfectly capable of democracy, and don't need the US imposing "democracy" (which usually is defined more in terms of favorable policy toward the US than substantive popular sovereignty) on them with military force.

You are, as usual, badly confused.

and sided with the communists in Asia (not the capitalist, quasi-democracies who did so much good).

You seem to be abusing "quasi-" to mean "anti-", but even then, you aren't even approximately correct.

Posted by: cmdicely on February 27, 2006 at 12:44 PM | PERMALINK

My personal experience with socialized medicine
at the VA has been very positive. I lost my insurance 4 years ago and had to turn to the va.
The first thing they did was a general assessment of my health and then prepared a preventive plan for me. They ran all the tests appropriate for my age-blood press, colonoscopy, etc. I see mostly nurses and PA's they know me and I know them.
For me they do a mutch better job than what I ever got from the high dollar private doc's

Posted by: doc on February 27, 2006 at 1:04 PM | PERMALINK

I don't think people will be much happier when an unelected bureaucrat is drawing the lines than with an insurance agency.

Unfortunately, the facts don't back this up. Countries with universal single-payer health plans such as Canada, Germany, France, etc. all report significantly higher levels of satisfaction with health care than American consumers do. So it seeems that yes indeed, people are much happier when an unelected bureacrat (who is, remember, ultimately responsible to the electorate, since his bosses are elected) rather than an insurance agency is drawing the lines.

Posted by: Stefan on February 27, 2006 at 1:13 PM | PERMALINK

We pay 35-45 percent more for medical care just to involve insurance companies. The administrative costs are enormous if you include all the salaries of doctors and hospital ins. administrators who have to battle it out with insurance companies. The cost of the private healthcare system is never mentioned, it's too hidden, too arcane, and too boring for journalism.

The transfer of costs is even more hidden. The states are going bankrupt trying to overcome the CUTS in medicaid and medicare that Republicans are pushing through. The more cuts in government spending on healthcare, the higher the costs for everyone in the private system. Doctors and hospitals simply tranfer the cost to private payers. Insurance premiums go up, and this explains the huge rise in insurance costs -- the less government pays, the more you pay.

Ask anyone who's against "socialized" medical care if they want to do away with Medicare. If Medicare is ok for the elderly, why not the rest of us. This is an amazingly simple point that never gets attention.

Posted by: underseige on February 27, 2006 at 1:49 PM | PERMALINK

Can you live without food? Somehow we trust the free-market to provide that, albeit with prudent regulation.

A. Under single-payer government insurance, the free market would continue to provide health care. What it would not provide is health insurance.

B. We do not trust the free market to provide food in situations where starvation is a realistic possibility. When that happens, we send in FEMA, which is in theory supposed to make sure everyone gets enough to eat, regardless of whether they can afford it. We also used to wisely mistrust the ability of the free market to make sure that kids get nutritious diets, and thus we used to fund healthy school lunches. Then the free market convinced us to let them provide the lunches. Now 60% of our kids are obese.

Posted by: brooksfoe on February 27, 2006 at 3:09 PM | PERMALINK

Unfortunately, the facts don't back this up.

You mean "fortunately". Since government-run health insurance is far less expensive and more efficient, it's fortunate that people are also happier with it. ;)

Posted by: brooksfoe on February 27, 2006 at 3:11 PM | PERMALINK

Well, I should have said "unfortunately for your argument."

Posted by: Stefan on February 27, 2006 at 4:13 PM | PERMALINK

otherpaul -- if you're still checking this post... You asked why Gladwell's nationality would matter. First, because someone born and raised in Britain or Canada (or born in Britain and raised in Canada) would know from experience that a universal, government-funded health-care system can work. Not perfectly, but work nonetheless. Second, because it seems that only Americans believe that a government-funded health-care system couldn't work in this country. [Not all Americans believe this, but it seems to be only Americans who believe this.] Third, Canadians make it virtually a hallmark of their nationality identity to criticize the American approach. [I am reluctant to call it a system, because the word connotes coherence of some kind.] So if Gladwell was born in Britain and raised in Canada, the odds are (or were) very strong that he would be predisposed to support a government-funded health-care system and to oppose, or at least be critical of, this country's approach. The fact that, several years ago, he was against the adoption of government-funded health-care system in the US therefore came as a surprise.

Posted by: DNS on February 27, 2006 at 6:53 PM | PERMALINK
You might notice that I know your language and you don't know mine. Posted by: McA
Since Singapore was a British colony since 1819, that is not too significant. There are more English speakers in India than China; many Americans speak Chinese in fact, many Americans speak languages from all over the world. It is certain that there are more foreign language newspapers representing a greater diversity of languages in the US than in China or Singapore.

Here's a brief brief history of Singapore, which has been a one-party authoritarian "democracy" since 1968.

The one-party Parliament that emerged from the 1968 general election became the pattern, with the PAP winning all seats in 1972,1976 and 1980. In the 1984 and 1991 general elections, the PAP won all but two and four seats respectively.
On 28 November 1990, a new chapter opened in Singapore's modern history Goh Chok Tong became the second Prime Minster of Singapore when he took over the office from Lee Kuan Yew who resigned after having been Prime Minster since 1959.

In other similar political environments, it is corruption that rules, not the people.

Posted by: Mike on February 27, 2006 at 6:53 PM | PERMALINK

Can you live without food? Somehow we trust the free-market to provide that, albeit with prudent regulation.

The critical difference is that the main (at least, immediate) costs and benefits of food purchase selections are pretty transparent, at least compared to the opacity in health care, for the average consumer, so the perfect information assumptions undergirding rational choice theory and market efficiency are not as invalid in the food market as in the healthcare market.

That a resource is essential is not what makes the market fail to deliver it effectively; what causes that is either benefits or costs that are external to the participants in exchange decisions, or benefits or costs that are unknown by the participants at the time of making the exchange decisions.

Healthcare purchase decisions, and more notably health insurance purchase decisions, feature rather opaque utilities.

Posted by: cmdicely on February 27, 2006 at 7:20 PM | PERMALINK

A. Under single-payer government insurance, the free market would continue to provide health care. What it would not provide is health insurance.

Under a single-payer system, either prices would explode or the government would have to impose price-controls, which would lead to rationing. So the idea that you'd have a "free market" is risible. This will either lead to a black-market situation and people getting treated based on their connections.

We do not trust the free market to provide food in situations where starvation is a realistic possibility...

And we also try to avoid making those sitations the norm, which is what having a single-payer system would do.

I'm not saying the system is fine as it is. As someone noted, there is a lot of opacity. Some of this is due to the technical nature of the field, but most of it is due to the fact that we have set up a system where the consumer doesn't directly see the cost of his expenses, and thus has little incentive to either take care of his health or to try to control costs.

For those toting the Canadian system, it has a lot of problems.
http://www.csmonitor.com/2002/0828/p01s04-wogi.htm

"Despite spending nearly C$100 billion (US$64 billion) per year on healthcare the most per capita among countries that run a similar system a study released last week by the Fraser Institute, a public-policy think tank in Vancouver, shows that Canada ranks only slightly higher than Hungary, Poland, and Turkey in the quality of service its citizens receive."

Posted by: Derek Copold on February 28, 2006 at 11:04 AM | PERMALINK

My personal experience with socialized medicine
at the VA has been very positive.

That medicine isn't "socialized", it's "subsidized."

Posted by: Derek Copold on February 28, 2006 at 11:05 AM | PERMALINK

Evian has a lot to say about this over on "Free Canada," a blog devoted purely to Canadian health reform...

http://canada.marketplace.md

~TKM

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