On the Macroeconomic Subtext of Healthcare Reform

In the current healthcare reform debate, one statistic frequently cited by politicians and pundits indicates that Americans spend between 15% and 17% of their income on healthcare.

While the citation of this figure might be understood as an expression of empathy on the part of politicians and pundits toward the plight of ordinary citizens who must incur increasing healthcare costs as a prerequisite for maintaining employment (and thereby contributing to economic growth through consumer spending), the macroeconomic context in which healthcare reform is frequently debated suggests a different sort of interest.

The US economy, and the behavior of politicians, pundits, bureaucrats, and business leaders who seek to promote US economic interests frequently conceive of their task in terms of profit growth.  

In late 1980, the DOW stood around 1,000.  In late 2009, the DOW stands around 10,000.  This is an increase by a factor of 10.  Over the same period, the US population grew from around 200,000,000 to 300,000,000: an increase by a factor of 1.5.  These intensive economic growth patterns (which must outstrip population growth) are understood to be the cornerstone of US economic success -- mainly, that those who have access to surplus income for investment get richer, while everybody else is served an increasingly smaller slice of the pie.  Although typical wages have increased steadily over the past few decades, the growth of CEO salaries have increased far more dramatically, from about 40 times typical worker pay in 1980 to well over 400 times typical worker pay in 2000.  This type of economic growth disproportionately benefits the wealthiest Americans at the expense of ordinary citizens.

As healthcare costs increase faster than GDP, numerous industries suffer as a result.  If citizens spend their shrinking slice of the pie on inflated healthcare costs rather than on televisions, cars, and dining out, the economy suffers.  So do investments in education, infrastructure, and the like.  Moreover, unexpected healthcare costs are a leading cause of bankruptcy in the US, which further detracts from the potential contributions of consumer spending to overall economic growth.  A driving interest in controlling the increasing cost of healthcare is to keep consumers and corporations spending.  If consumers don't spend and corporations don't invest, the economy doesn't grow.  If employers are responsible for increasing healthcare premiums, fewer funds are available for the types of corporate investment that promote economic growth.  Even personal savings are here out of the question, as personal savings don't contribute to economic growth either (unless those savings are held for the purpose of putting a child through college -- since a college degree, on average, increases lifetime worker income by $1.3 million).

So one major factor in the current political calculation is the desire on the part of politicians to free up more funds specifically for industries that contribute more directly to economic growth -- and thereby to promote the continued enrichment of the wealthiest Americans.

Another major factor in the current political calculation has to do with the impact of illness on the productivity of workers.  At present, the annual cost of chronic illness in terms of lost productivity in the US is estimated at aver $1 trillion.  In a very direct way, if workers take fewer sick days, employers benefit because worker productivity increases.  Worker productivity has nearly doubled since 1980.  Thus, increased access to healthcare contributes to economic growth because access to regular health services makes for more productive workers.  Increased worker productivity is an important factor contributing to US economic growth -- a situation wherein for the same pay, a given worker renders an increased benefit to his or her employer.

The so-called "public option" is therefore an important means of addressing both these key factors -- by decreasing healthcare costs and increasing access to healthcare -- both of which serve to promote economic growth.  Those who oppose the "public option" reveal not only the short-sightedness of their vision, but reveal a profound disingenuousness in their rhetoric: that is, the same people who argue that government can't run anything efficiently are the same people arguing that a public health insurance plan will put private insurers out of business.  While this opposition is typically framed in terms of an ideological opposition to government interference with competitive market forces, it is important to note that industrial-scale corporations routinely do everything in their power to eliminate competition at every opportunity: by under-pricing competitors at a loss, purchasing competitors outright, or manipulating legislation to produce favorable results.  There are few industrial-scale corporations that would not prefer monopoly status to the status of one competitor among many.  The central point here is that the systems of vertical integration so characteristic of industrial-scale commerce (and monopoly) are precisely those systems which are promoted by politicians who advocate the de-regulation of industry.   It seems reasonable to suppose in this case that, while opposition to the "public option" is framed as ideological, it is more likely the product of back-door negotiations between certain politicians and the healthcare industry itself.  

In many respects, then, an important subtext to the ongoing healthcare debate relates more to factors promoting specific macroeconomic benefits than to moral imperatives relating to the personal benefit of individual citizens.  That individuals benefit from affordable healthcare is almost a politically expedient side-effect to the greater benefit rendered to the wealthiest Americans and the largest corporations.  And yet, it is individual citizens who are in the end asked to pay for this healthcare reform -- who are asked, in essence, to subsidize the economic growth of which they receive a steadily decreasing share.  President Obama has pledged that he will not sign into law any healthcare legislation that increases the national debt.  While this may seem like a noble goal, it is, in a sense, just another way in which citizens are treated as a means to the end that the profitability of corporations continues to grow.

Privatization is an important tactic used by the wealthiest Americans to entwine their interests with those of government -- that is, to bring their personal interests more closely into alignment with those of government.  In an economy whose growth relies on easy access to credit -- essentially, debt as currency -- why shouldn't government incur some cost to see its interests so well served?  The government has, after all, demonstrated its willingness to incur large amounts of debt to rescue bankers and pursue protracted war efforts.  That the government is so reluctant to incur additional costs for the benefit of the healthcare interests of the citizenry is an indication that the benefit of the citizenry is not a primary motivation behind the current healthcare reform debate.

What positive conclusion can be drawn from all of this?  Primarily, it is that the wealthiest Americans and the largest corporations should bear the greatest part of the cost of healthcare reform precisely because the wealthiest Americans and the largest corporations derive the greatest economic benefit from healthcare reform -- even if they are paying for the healthcare of citizens who are not their employees.  Of course, this conclusion is profoundly out of step with the contemporary political climate in the United States, which in recent years has been driven by an unprecedented inclination towards the privatization of profits and the socialization of losses (most dramatically evidenced in the recent financial crisis).  Thus, presented with the possibility of immediate relief from the pressures of disproportionately increasing costs and proportionally decreasing incomes, many Americans will gladly accept whatever healthcare reform is enacted -- even if the final legislation is perceived as far from perfect; and though the effect of whatever healthcare reform legislation ends up being enacted will be to further the exploitation of workers for the benefit of the wealthiest Americans, this exploitation can be easily framed as a significant and long-overdue social benefit.  Those who remain dissatisfied after the issue is settled will likely be dismissed as extremists, radicals, and malcontents; and since much of what causes their dissatisfaction will remain in the realm of political subtext -- not widely discussed in the mass media -- they will have little in the public discourse by which to justify their claims.

Sympathy for the Details of Wall Street's Bailout

These are difficult times and many of our leaders have a difficult job ahead of them.

While Congress is busy summoning the proper demons required to purchase the souls of the 13 Republican holdouts in the House, please don't mock United States of Homeland Security Chairman Henry Paulson. Political theatre, like black magic, is difficult work.

In these difficult times, it is your duty as a consumer to represent your leaders to the best of your ability.

As you await the consummation of the appropriate Satanic Congressional rituals, please help save the economy by flying to Las Vegas and gambling away your life savings so that your remaining wealth can trickle up to Wall Street.

Should you have neither life savings nor the time to fly to Las Vegas, expect that any contributions you would have made to Democracy will be extorted from your children by the full force of the US legal machinery.

Thank you for your continued patience during this difficult time of engineered wealth redistribution.

Debating Popular Intelligent Design

A recent article on Wired sparked a debate in the online comments section about the relative merits of evolution and popular intelligent design; it is with some dismay that I've seen this and similar debates enacted in a variety of forums.

I think part of the problem with the evolution vs. intelligent design debate is a conflation of ontologies that is ultimately the failure of the American education system. Even calling intelligent design a theory is problemmatic: this is the element of satire behind the Flying Spaghetti Monster.

The propositions of popular intelligent design are, in the vocabulary of the sciences, best described as hypotheses (although in ordinary speech, "theory" and "hypothesis" are often used interchangeably). Just as we use different vocabularies to describe sports, medicine, and law, science and religion also use different vocabularies. There is certainly some overlap: just as law has things to say about the practice of medicine, religion has things to say about the practice of science. Where things get problematic is when different vocabularies make use of what seem like similar phrases, but which are, nevertheless, understood quite differently in different disciplines (a "low score" is good in golf, but bad in basketball). These vocabularies need not be inherently contradictory, but frequently, inferences made about one vocabulary using the terms of another lead to statements that are by and large nonsensical.

There is an important difference in the sciences between descriptive accounts and explanatory models, which is often neglected in this debate. Questions about why God made evolution and why evolution made humans address very different problems. In the popular debate, those on the side of scientism don't often see that their views are biased by cultural perceptions of "the onward march of progress." In the scientific understanding, humans are not objectively the "most advanced" or "most evolved" species on the planet; in quantitative terms, ants have been far more successful than humans in propagating their genes, and have been continuing to evolve over a longer stretch of time than humans. The bias of progress also appears in discussions of technology: today's most "advanced" digital cameras are just starting to catch up to the amount of detail found in a typical photograph from 100 years ago. Needless to say, ants don't engage in such nuanced social behaviors as art; but by the same token, art is different from science: in general, we don't talk about the Mona Lisa in terms of the chemical composition of the pigments, but rather, we usually discuss it in terms of how the colors make us feel and what the forms make us think about as individuals.

Many reasonable people, from the time of our earliest cultural memories, have held that there is something mystical to be found in art. Many reasonable people have held that there is something mystical to be found in geometry. Given that the mathematics of geometry have figured prominently in art and religion for centuries, it seems reasonable to suppose that religion and science aren't the mutually-exclusive disciplines we often consider them to be today.

Much of science works with the language of mathematics; mathematics provides a "lingua franca" whereby different scientific disciplines can compare their propositions and results. To many people, this language is quite foreign or esoteric; therefore, in order for science to be relevant to daily life, many of science's mathematical assertions must be expressed in ordinary terms. When the consequences of mathematical statements are translated into plain language vocabularies, some consequences have to do with how we describe the world, and others have to do with how we explain the inherently meaningful things we experience on a daily basis; unfortunately, there's no rigorous curriculuum to sort out when scientific propositions are meant to be understood as descriptive and when they are meant to be understood as explanatory.

I think that part of the frustration many creationists may feel in expressing their experience of the world to scientific audiences is that even the dichotomy of description and explanation is a function of a scientific vocabulary, and those motivated by an ideological scientism are enculturated to dismiss other vocabularies categorically, without looking for patterns in the assertions typically formulated in those other vocabularies.

From an anthropological/linguistic perspective, we have these different vocabularies because they usefully identify distinct phenomena. Why do we think things are meaningful? Religion provides one set of answers which in many cases -- such as Buddhist psychology -- are rational and in many respects empirical.

It is often useful to discuss things in terms of dichotomies such as good and bad, or true and false; at the same time, we often experience things in shades of grey. When we do things, it is usually because of psychological states that fall into one of two categories: reasoning and emoting. But we can have three possible categories for describing the motives behind an observed action: rational, irrational, or arational (just as we have theists, atheists, and agnostics).

Just because we don't see the reason behind an action doesn't mean it's contrary to reason; one can arrive at the right answer to a math problem even if one's arithmetic is wrong. But we also believe people act from the heart: through ideology, through conviction, through intuition, or through a love of life. In this realm, reason doesn't always apply to motivation (although the results of such actions can often be described as grounded in morals, ethics, and what is generally considered acceptable social behavior).

When we negate the linguistic validity of an ontology, perhaps we too often ignore that diverse vocabularies come into use for a reason, and that embodiments of that reason often result in some emotional satisfaction, which is a form of validity.

Perhaps creationists should stop trying to describe God in scientific terms, and accept that science is a demonstrably insightful description of God's acts of creation. There are so many problems with trying to describe God in scientific terms. Algorithmic information theory provides a fairly precise definition of "complexity" -- the subject of the Wired article under discussion -- that is intuitively satisfying, intellectually rigorous, and useful in the applied sciences. This and closely related understandings of complexity will become more important for anybody who uses modern computers or anything made with modern computers, and who also wants to see any sense of the world. This is so for numerous reasons: as the science of thermodynamics and the science of information systems move closer together linguistically, mathematically, and theoretically, we will see ever more profoundly in our daily lives the applied effects of emergent phenomena such as self-organizing systems, dissipative systems, stochastics, and heuristics, all of which will leave traces of their activities in our experiences and our discourse; and these traces will often be felt in constructed social phenomena such as art, politics, media, and the like, which rely in many ways on scientific research (the use of digital media in the arts, the demographic or economic consequences of legislation, or the psychology of marketing and advertising in the mass media).

To be blunt: would a creationist argue that computers don't at all exist today? Many would consider doing so irrational, except perhaps in the limited context of a philosophy grounded in something like Spinoza (his is the only Jewish excommunication of which I am aware) or Leibniz or Berkeley. At the same time, a creationist and a scientist might agree that computers don't do what we think they do; such claims may furthermore be grounded in theories of mass communication, ethics, morality, or intuition.

There is scientific evidence (from cybernetics, for example: if you had to consciously spell out and deliberately move each individual muscle in your mouth to produce utterances, you'd hardly get a word out) as well as religious evidence (Taoism is a successful religion with a rich history that has very much influenced the idiom of Zen Buddhism) that intuition is often well-grounded, and to deny its validity would present a serious problem to any rational discourse that asserts that past events have occurred or that the perception of free will exists (divine foreknowledge -- omniscience -- is perfectly compatible with free will: just because you know something knocked off a table will hit the floor doesn't mean that knowledge is what brings the event about).

There is a wonderful blog called Acts of Being which discusses contemporary science from the perspective of St. Thomas Aquinas's religious philosophy, in ways that are quite sensitive and insightful. Those who have "taken sides" in the debate and are interested in getting at the essence of what "the other side" has to say might benefit from thinking about the discussion there.

My own opinion is that ultimately this isn't really a problem of science or religion, but a problem with the vocabularies that we as a culture have available for distinguishing and reconciling what different types of claims are meant to say about the world. Needless to say, things only get more confusing when politicians get into the "business" of redefining ordinary terms in radical ways for motivations that often seem less than savory ("the lesser of two evils is still evil"), and often more like marketing, spin, or a corporatist form of damage control ("we don't want this lunatic to hurt the Party's image, but we like how this other lunatic unites the Party base").

In a more tangental connection, I'm reminded of Paul Valery's assertion that philosophy should be properly considered a branch of literature. I think there's a certain poetic truth to this idea, which is relevant to the discussion: in the beginning was the Word. I imagine part of Valery's reasoning for making this assertion has to do with his discussion elsewhere to the effect that science and philosophy pursue qualitatively different sorts of Truth; this is why Copernicus is today studied as history while Plato is still studied as philosophy.

Where the debate touches on public education in America, the arguments of opposing camps are often motivated by what is perceived as the threat of false indoctrination; yet we live in a society founded upon the exercise of civil liberties and free will. Art and philosophy offer valuable ways to carry out this debate in constructive ways that don't reduce to one side spewing nonsense at the other; unfortunately, art and philosophy are often treated by our culture as overly academic or as elitist pastimes, and often given short shrift in schools. Art can be devotional or experimental, but needn't be either by necessity.

My gut feeling on the matter is that the debate has more to do with expressing a cultural dissatisfaction at people being treated like specialized cogs in the social machine, but that those who have organized into opposing camps are blinded by their own language, and thus unable to see that they share the emotional thrust of their dissatisfaction with those that they oppose.

OK kids, here's your homework: look up any unfamiliar terms in two sources, re-read this text, and write a four-paragraph critique. In the first paragraph, identify which assertions you will address in your critique. In the second paragraph, summarize those assertions and address why you chose them for your critique. In the third paragraph, offer your critique; provide counter-examples. In the fourth paragraph, examine the consequences of your critique in relation to one of your personal interests or acquired skills: what is the Tao of your hobby or passion? Ask at least one other person if he or she sees any problems with your analysis, however minor. Try to avoid preconceptions about what the process will teach you.

OK teachers: don't forget to write your representatives. Just a reminder: you have State and local representatives too. I haven't had much luck with them myself, but maybe yours will be different. The volume of constituent feedback derived from statistics about consumer behavior too often outweighs the expression of individual voices, even in chorus. They've emptied the pews with promises of an American idolatry.

OK media: stop feeding us garbage.