1941

And you wonder why nobody listens to you and the health care bill has failed thus far? You should try listening when somebody explains to you why the argument you’re making doesn’t go over so good. The point is, I can do it, and, guess what - I’m not necessarily wrong. For every single one of these numbers I’ve seen anybody cite, there are reasons you could reject them that are not ludicrous on their face. This isn’t an engineering design competition - there’s no absolute basis for comparison that you can use to measure who’s the best at what and who’s the worst. You’ll notice that I’m not saying that nothing needs to change. You’ll further notice that I do, in fact, favor something substantially more interventionist than any of the proposed changes to our health care system. That doesn’t change the fact that YOUR NUMBERS ARE USELESS IN ANY DISCUSSION BECAUSE I CAN REJECT THEM AND FEEL LIKE I AM DOING THE INTELLECTUALLY HONEST THING. This isn’t a novel problem - economists have been dealing with it for years.

1942

You may feel like you’re doing the intellectually honest thing, but you’re not.

1943

This seems like a dodge to me, because I didn’t think we were talking specifically about equality as seen by the government. Your previous post indicated you were talking about equality as a societal issue. Government is a part of that, but not the whole. But when the rest of society produces harmful inequalities, government should step in. That seems to follow whether you believe in “treatment” or “ends” - a dichotomy that I do not subscribe to, being a vast oversimplification, but anyway.

1944

Are you naturally thick, or do you have to practice at it on the weekends? One more try, and then I fucking give up - what you think are indisputable facts kind of aren’t. The numbers are interpretable, and at least one legitimate interpretation completely undercuts any ground that you THINK you have. None of your data is controlled, and the confounding factors render it evidentiarily worthless. Your data CANNOT be controlled, and thus it will NEVER be useful as any kind of unassailable basis of fact. You should stop trying to build an argument out of them because you will fail. You will fail every single time you try, because you are arguing for a big complicated course of action and I am going to sit here and explain how you are stupid and I am not going to be wrong, because your data is entirely open to interpretation.

This isn’t science, and even science allows more interpretation of results than you seem to think reasonable. This kind of fingers-in-my-ears refusal to try and engage people with reasoning and arguments that they will find attractive is one of the biggest things wrong with political discourse in general, and you aren’t making things any better. I would politely suggest you should either shut up and let people more effective in engaging with the actual discussion handle all of the talking about this sort of thing for you or you learn to do it yourself. It’s not fun. It’s pretty much the opposite of anything on the internet these days. But it’s about the only helpful thing you can do.

1945

I really don’t see how this sums up as anything other than “I reject the use of data as evidence to support policy arguments.” Good for you.

This isn’t science, and even science allows more interpretation of results than you seem to think reasonable. This kind of fingers-in-my-ears refusal to try and engage people with reasoning and arguments that they will find attractive is one of the biggest things wrong with political discourse in general, and you aren’t making things any better. I would politely suggest you should either shut up and let people more effective in engaging with the actual discussion handle all of the talking about this sort of thing for you or you learn to do it yourself. It’s not fun. It’s pretty much the opposite of anything on the internet these days. But it’s about the only helpful thing you can do.

Based on your posting, the arguments you find attractive are some combination of crazy and dishonest. In that sense you’re right, I have absolutely no intention of engaging in that sort of argumentation. You are a moderately more functional version of Koontz.

1946

It’s both. I guess I didn’t explain that very well. The most orthodox of all conservative viewpoints with respect to the current health care system would say that everybody ALREADY has equivalent access to health care because they all pay the same bill going in. They would draw an essential difference between “not having enough money” and “being poor.” “Being poor” is a condition - it implies that there is a fundamental difference between a poor person and a not-poor person. Conservatives do not believe in poor people. Conservatives believe in people that do not have enough money to do some things. To your average random conservative, it makes very little sense why he should have to effectively pay twice as much money for the same service as somebody who has half as much as him simply because he has more. And he’s kind of got a point. The reason why conservatives are mostly okay with the status quo as far as provision of care goes is because right now, we do kind of provide an equal baseline of care to all people. Unless there’s a place that I don’t know about (and that’s possible), there is nowhere in the United States that you cannot go to a hospital to have your leg fixed if I hit you with my car or you fall out of a tree. You WILL get your service. We don’t provide universally equal access to insurance, but, the conservative says, that is because insurance is a private enterprise. Why SHOULD my brother, who is in fucking perfect health because he has clearly struck some sort of unholy bargain with one or more demons, have to essentially pay the cost of my care, what with the crazy brains and the diabetes and the thyroid thing and, just recently, the hemerrhoid that I need to get looked at?

To a liberal, all of this is just a foregone conclusion. You have a right to access to health care because you just kind of DO, just like you have a right to a basic level of other kinds of social support whether you’re a captain of industry, a filthy lazy hippy, or anything in between. They’ve got a point themselves - there’s some convincing argument and evidence that uniform access to health care and cost controls are necessary to keep the entire nation from exploding into bankruptcy.

Actually, screw it - Wolfe does a better job than I do of defining what in the hell he’s talking about on EconTalk.

1947

The bill is virtually identical to the plan that Mitt Romney, Republican Governor of MA, signed.

Do you seriously believe the bulk of the conservative population opposes the bill because they have a different interpretation of the statistics?

1948

Just what, precisely, the fuck is so broken inside of your brain that you cannot comprehend this simple fact? Comparative inequalities in infant mortality between the United States and other developed nations can be explained through a simple examination of differences in standard health care practices in the United States and elsewhere (specifically, there’s a geometrically greater number of premature deliveries here, and that is literally where all of the difference is) and subtle differences between how data is tabulated and collected in the reporting nations. Differences in health care outcomes can be explained away similarly. NONE OF THOSE METRICS ARE EVEN REMOTELY USEFUL. They are not evidence because they are not non-controversial - they are simply arguments that you have dressed up with a percent sign. Evidence is what you get when you run a controlled experiment - 41% of patients reported less pain while on Active Drug X as compared to 27% reporting less pain on placebo. Your numbers are not evidence. You need to abandon them, because they only serve to muddy the discussion by introducing (or, rather, reintroducing in a different place) additional points of dispute. That is not rejecting evidence - it is understanding WHAT EVIDENCE IS and how to use it.

1949

I think that’s the reason they would give. There are a lot of hurdles to jump before you get teabaggers to endorse government-sponsored health care, but one necessary first step would be removing their legitimate factual defenses to demonstrate to them that their position is nothing more than dressed-up ideology.

1950

This is why infant mortality is a good proxy measure for general health care, and useful for international systemic comparisons.

1951

You can’t possibly believe that there is always an honest but completely different ‘interpretation’ of any statistical data that involves a political issue. Sometimes there is just a stack of data that shows one conclusion again and again about human behaviour and political outcomes. Its then just about a scientific as any piece of physics. Science is just the continued accumulation of data and the ability to make accurate predictions based off that data. Humans are not so mysterious and perplexing that they can withstand analysis.

You are essentially arguing that either the UN and the CIA are getting the numbers wrong in all their ratings, or that the difference in outcomes is not large enough to be significant. Either way you have some steep mountains to climb or the need to produce a similarly credentialed set of data that shows something different, or you are on the same page with the climate change deniers. Health care outcomes based on all the credible data I’ve seen are overall are either worse or roughly the same in the US. Even if they were very slightly better overall they wouldn’t account for the much, much higher cost.

1952

That’s the reason some of them would give sure, but it’s just a justification, not the actual reason.

For the vast majority it’s one of the following, near as I can tell:

  1. Paranoia, largely class and racial, that when the government does something for someone who’s not like them it’ll necessarily screw them.
  2. They don’t care about anyone but themselves.
  3. Party-based tribalism; they’d support the exact same programs suggested by a Republican.
  4. Donnor party conservatism. It’s long as hell, but it’s the single most explanatory thing I’ve ever read on conservatism.

Personally, I think arguing and all the data in the world isn’t going to change anything more than a tiny minority of the public ideology and worldview; people just don’t operate like that. It’s not a coincidence that all the major changes in political outlook are centered around economic and political crises; personal experience and social circle norms are what matter.

1953

Did you miss the part where I found numbers that adjusted for the factors that you are harping on?

1954

Except that when you go poking around in it, you find out that mostly it’s because:

  1. The United States has more high risk pregnancy activity than other nations

  2. Doctors in the United States tend to induce labor in premature delivery scenarios where there is risk to the mother rather than attempting other alternatives (carry-to-term, abortion in one of those trimesters that will get you all kinds of bad press), resulting in a greater number of high-risk scenarios even within the general category of “premature deliveries.”

  3. Quite a few nations will not attempt to preserve the life of some highly premature deliveries that doctors in the United States will. They get written down by those reporting agencies (remember - all of this data comes at least in significant part from the countries themselves, and if I’ve learned anything by looking through UN Trade Data, it’s that countries will fudge the stupidest things about themselves) as stillbirths, whereas the United States reports those events as infant fatalities. The CIA will try to correct this data to the extent that they can (always look at UN numbers skeptically because of their data collection and reporting approach), but even they’re going to be working off of relatively squishy information.

That’s the problem with health care outcome numbers in particular, and why they’re a canard when it comes to this discussion. All that you accomplish by introducing something like comparative rates of heart disease mortality between the United States and Japan or infant mortality differences between the United States and the rest of the world is a giant argument over the humongous stack of confounding factors that plague data like this.

Now, I don’t think that all numbers are useless - the one number that the Democratic party should have settled on long ago and run with is the Heath Care Spending as a Percentage of GDP in the United States versus the World (present and year-over-year growth rate), which quite clearly illustrates exactly what the problem is, why it’s bad, and does so in a fairly unassailable fashion.

1955

Which, if you follow the link, conditions that it’s STILL deriving itself from fundamentally unreliable underlying data. They cite as a limitation of the study every single objection that you have seen here. Seems to me that they’ve only accounted for the shortcomings of the data in that they’ve pointed them out specifically.

That is not good evidence. That is not evidence at all. It’s an argument with a byline and it’s not helpful.

1956

I surrender.

1957

This is a fucking amazing link. One of the most brutal takedowns exposing the total lack of intellectual rigor at the heart of the modern conservative movement.

1958

Thats a great read Jason, thanks for the link. I am now convinced that David Frum, whoever he is, is quite, quite mad.

My favourite bit so far:

1959

Well, as he points out, there’s no way he’s actually thought about it enough to really believe the implications of what he’s saying. It’s a very good overview of how lots of conservatives think though - a falsely romantic view of how things used to be, combined with a not-very-well thought out plan to go back to that mythical past.

The other major faction was “rich people who just want more money and don’t care a lot about the other stuff”; economic libertarians. I think there was a lot more of them back in the 1980s and 1990s, but in the 2000s the palin-esque variety has taken over.

1960

Those are some of the reforms that Republicans have suggested. There are also the proposals of decoupling health insurance from the employer by way of empowering interstate coops. Also, allow health insurance to be sold across state lines to encourage price competition. Also, health information systems modernization – getting away from clipboards, papers, and 20th century technology.