Wednesday, July 11, 2007

One Year On...

Reasons and Opinions was born this time last year. Those of us who founded it thought long and hard about a name (at one point we considered bloggy-woggy-- no joke!). Originally intended as a group blog among some friends, it gradually evolved (not by my choice!) into a solo adventure. But now, a year later, and after more than 300 posts, the time has come to shift directions a little. I have become a contributor on an excellent Catholic group blog, Vox Nova, and most of my blogging energy is now spent over there. Frankly, I have no time left to do any original blogging here any more, and most of my recent posts have simply been cross postings from Vox Nova.

With that in mind, I'm going to put Reasons and Opinions on hiatus for a while. I'm still blogging-- just over at Vox Nova. Frankly, I just don't see the point in continuing to cut and paste every post over here. I won't say this is the end, as I may well come back here at some stage in the future. For now though: it's been a fun ride, I've learned a lot, and I'm grateful to all of you who bother to waste your time reading my random scribbles. Actually, I have no real idea who reads this! So, if you would like to provide any general feedback, positive or negative-- now is the time to do it! And if you don't want to comment here, just send me an e-mail. Most importantly: bookmark Vox Nova. Do it now!

All the best,

Morning's Minion.

Friday, July 06, 2007

Iraq War: the Disproportionate Evils That Just Keep Coming

As is now evident to almost everyone, the Iraq war failed to meet the strict just war criteria. At the outset, as was made plain by the Vatican, the war did not garner the approval of the proper authority in this particular case, the United Nations. For what right does one country have to unilaterally invade and occupy another country, half way around the world? None. But let's set this aside for a minute, and go through the just war conditions, one by one.

Was the damage inflicted by Saddam Hussein's Iraq "lasting, grave, and certain". Well, we were peddled a story about Saddam possessing weapons of mass destruction-- nuclear, chemical, and biological-- that could threaten the US and the world at short notice. Sounds pretty "lasting, grave and certain". Except it was not so. There were no such weapons. An honest mistake? Hardly. The Bush administration (shepherded by Dick Cheney) deliberately put forward dubious evidence that over the qualms of the intelligence community and other experts. In short, they lied, obfuscated, cheated. And since Satan is the father of all lies, is it any surprise that events rapidly descended into chaos? It is also pertinent that this war was conceived in the shadow of the fallen towers, by a confused and angry nation desperate to lash out at the most obvious enemy. Saddam Hussein, with his demonic visage and even worse history, was well suited to such a role. We know that vengeance, absent justice, is seriously sinful. But it gets worse. We were also told that Saddam Hussein was in league with Osama Bin Laden and had a hand in the attacks. Take some lies, add some vengeance, stir in all up in a cauldron of fear, and what do you get? That answer is now far too obvious.

Let's move on. Was it truly the case that "all other means of putting an end to it must have been shown to be impractical or ineffective". Not in the slightest. The administration short-circuited a UN process. This war was a war of first resort.

Were there "serious prospects of success"? That depends on perspective. Nobody doubted that the might of the US military would overpower the troops of a tinpot Arab dictator. But it was always quite evident from the beginning that the war could also unleash the kind of chaos that was next to impossible to defeat. Which brings me to the next point...

... the oft-neglected "disproportionate evils" critique, or, to state it properly: "the use of arms must not produce evils and disorders graver than the evil to be eliminated. The power of modern means of destruction weighs very heavily in evaluating this condition." War proponents in the US often get this backwards. They see the awesome power and precision of modern weaponry and delude themselves into thinking that civilian are somehow safer than in times past. This is a generation numbed to the glorification of violence in popular culture, where war is just another video game writ on a large scale: lots of high-tech wizardry and "cool" explosions, and no human suffering in sight. As the old Peter Gabriel song so aptly says: games without frontiers, war without tears. Except war does bring tears. War brings about great human suffering, death, carnage, and destruction-- whether we choose to see it or not.

The Iraq war has caused untoward carnage. At this stage, nobody really knows the death count. At the low end, Iraq's health minister estimated 100,000-150,000 civilian deaths, extrapolating from 2006 statistics from morgues and hospitals. Using survey evidence, the reputable British medical journal, the Lancet, claims an unfathomable 655,000 deaths. This report has faced severe criticism, but they stand by their statistical methodology, which they claim mirrors the approach taken in places like Kosovo and Afghanistan. But the point is not to quibble about statistics (even if behind every statistic is a human being made in the image and likeness of God). Whatever position you take, the extent of human suffering (that could have easily been avoided) is evident.

But while the disproportionate evils condition encompasses civilian deaths, it goes far beyond it. And this is where many of the pro-war brigade simply put on their blinkers and see no evil. The disproportionate evils stirred up by the Iraq war include the complete destabilization of the country, the knock-on effects in the region, and the massive increase in worldwide terrorism that has germinated in the ensuing chaos and lawlessness.

The war draws angry militants from all over the world, allows them unimpeded training in terrorism, and at the same time inspires a whole new hate-inspired generation. These trained militants, experts claim, are using their training in other parts of the world. As pointed out recently, the recent evil attacks in London can be traced clearly to the Iraq war. As Josh Marshall puts it, we are seeing the first wave of graduates from the Iraq School of Terrorism. The Iraq war is the one of the greatest gifts Osama Bin Laden ever received (second only to his escape from Afghanistan, arising again from Bush administration incompetence). Ominously, experts are seeing a huge influx of funds and resources, out of Iraq to Al Qaeda headquarters in the tribal regions of Pakistan. In an almost demonic irony, the link between Iraq and Al Qaeda is now more obvious than ever. And the world is paying the price.

Could this not have been foreseen? Of course it could have been, and indeed it was, to those who chose to look. Can can anybody even remotely familiar with the complex confessional mechanisms of the long Lebanese civil war feign surprise at the outbreak of civil war between the various groups in Iraq? And given the perceptions of the west (and especially the US) in the Arab world-- a history of post-Ottoman colonialism, the tendency to forcibly remove leaders that did not do the west's bidding, an insatiable thirst for oil, and a callous one-sided tilt in the Israeli-Palestinian conflict-- how in the name of God can they claim surprise at not being welcomed with flowers and open arms? The mainstreaming of torture only added (a great deal of) fuel to the fire, but evil has a way of doing that. No, all of this could have been foreseen, should have been foreseen. And the US bears grave responsibility for unleashing such carnage.

Such nuance and complexity was smothered by the utopian dream, the desire to bring "freedom and liberation" to the Iraqi people. Actually, this was a latter-day excuse, after the earlier lies and misinformation were exposed. But the specter of a messianic mission to use attain peace through violence using a secular ideology should have raised alarm bells immediately. As Christians, we know freedom and liberty come only through Christ. There is no other savior. For all messianic dreams and utopian visions in the past, all attempts to re-create our common human destiny along a predetermined path, from the French Revolution to the rise of communism, have ended in horror and bloodshed. We should have known.

When all else is lost, the defenders of the Iraq war resort to what I call the "Saddam Bad-man" theory. Yes, Saddam Hussein was a brutal murderous thug, who engaged in great evil. They will offer huge numbers of civilians killed by Saddam Hussein, all the while disparaging similarly large estimates of violent deaths, post-Saddam. But this is not the point I want to make. Sadly, there are many Saddam Husseins in the world. I look at Kim in North Korea, Mugabe in Zimababwe, the thugs in Sudan and Burma, Karimov in Uzbekistan. The list goes on. Based on the "Saddam Bad-man" theory, should the US not invade these countries too and overthrow their leaders? While was Iraq singled out? I think we can pretty much all agree that the North Korean regime is probably the gravest threat to world peace today. Surely toppling this regime would meet the conditions of a just war? And yet, nobody (outside the American Enterprise Institute, anyway) is seriously considering such a course of action. Why? You guessed it. The potential for massive disproportionate evils.

War may sometimes be the answer, but (in our modern world at least), it is rarely the answer.

Monday, July 02, 2007

Sicko is Healthy

There is a lot of knee-jerk reaction against Michael Moore's latest indictment of the US health care system, Sicko. But, overall, the experts pretty much agree that he gets the big picture right. Here's the New Republic's Jonathan Cohn, who writes extensively on health care:
"As Sicko rolled, it did little to allay my fears. I spotted plenty of intellectual dishonesties and arguments without context--enough, surely, to keep right-wing truth squads (and some left-wing ones) busy for weeks... Still, by the time the final credits ran, it was hard to get too worked up about all of that. Because, beyond all the grandstanding and political theater, the movie actually made a compelling, argument about what's wrong with U.S. health care and how to fix it. Sicko got a lot of the little things wrong. But it got most of the big things right."

CNN (taking a short break from incessant Paris Hilton coverage, so it seems) also got their fact checkers on the job, no doubt expecting a bonanza of error-laden propaganda. But it was not to be:
"Moore covers a lot of ground. Our team investigated some of the claims put forth in his film. We found that his numbers were mostly right, but his arguments could use a little more context. As we dug deep to uncover the numbers, we found surprisingly few inaccuracies in the film. In fact, most pundits or health-care experts we spoke to spent more time on errors of omission rather than disputing the actual claims in the film"

I've already laid out many of the problems with the US health care system in my argument in favor of a single payer system last week. The analysis backs up what I was saying, including the fact that the US spends far more for health care than the rest of advanced world, and attains far less in return. Perhaps the most pertinent statistic is the one from the World Health Organization, showing that the US is ranked only 37 in the world in terms of health care outcomes (while both France and Canada make the top ten). They also show the relative inefficiency of private insurance: while Medicare eats up about 1 percent on overhead, private insurance companies waste between 10 and 30 percent (as I noted in my post last week, this is because so much effort is put into screening people). In criticizing Moore, Andrew Sullivan puts forward the most bizarre argument I've seen yet: the anti-US health care position ignores the fact that much of it is under the auspices of the government anyway. Since this is the most efficient part, the obvious conclusion from Sullivan's thought process is "Medicare for all"!

Opponents of single payer systems usually retort to two tactics: they play up waiting lists, and they argue by anecdote. And yes, in some universal health care systems, there are waiting lists for non-emergency elective surgery such as hip replacements. But that is not true everywhere. France has no waiting lists, allows free choice of doctors, and offers access to highly advanced medical care to those in need. And, in fact, the absence of waiting lists for elective surgery in the US has a dark side, as it reflects an over-supply of specialists relative to primary care physicians. This is not too surprising, given that specialists earn a whopping 300 percent more that primary care physicians here, as opposed to a norm of 30 percent elsewhere. Clearly, something is amiss.

So bear that in mind next time some smug free-marketer talks about waiting lists for hip replacements in Canada, or how Canadian doctors are trying to enter the American market. And keep some of these figures in mind too:

Health Spending per capita: US-- $4,497; Canada-- $2,483

Healthy life expectancy: US-- 68.1; Canada-- 70.5

Standardized death rate (per 100,000): US-- 670; Canada-- 561

Infant mortality rate (per 1,000): US-- 6.9; Canada-- 5.3

Child mortality rate (per 1,000): US-- 7.6; Canada-- 5.7

Maternal mortality rate (per 100,000): US-- 10.5; Canada-- 5.8

Number of uninsured:US-- 45 million; Canada-- 0

The question is, though, will people be able to see the big picture, and the basic truth in this movie, or will be they blinded by the minor inaccuracies, the stupid visit to Cuba, and the personality of Michael Moore himself?

Wednesday, June 27, 2007

600,000 Dead Germans

A recent Commonweal issue included a review of a book entitled The Fire-- The Bombing of Germany, 1940-1945 by Jorg Friedrich. The reviewer was James Sheehan. The book describes the bombing of civilian targets as a key battle tactic by the UK and the US during the second world war. The idea was to break the morale and destroy the productive capacity of the Germans. All in all, about 600,000 Germans were killed, and three and a half million homes were destroyed. Friedrich's book, in the words of Sheehan "seeks to convey the horror of the bombing with examples, a litany of relentless suffering that describes the air war's impact".

Sheehan tries to make a moral argument in favor of this tactic, and I believe he falls flat on his face. Noting that this strategy contributed to the allied victory, he asserts that there was no alternative. Otherwise, the Germans could have prolonged the war, leading to more civilian deaths in the long run, and leaving the Nazis free to further their murderous campaign. Sheehan argues as follows: "Assessing the morality of the bombing requires us to weigh the consequences of the alternatives, and to ask whether the means used were proportionate to the good that was sought." He goes on: "For the practitioners of war, the problem of ends and means is especially difficult because in war the means are always evil: violence is never contained, innocent blood is always shed." Hence, he concludes, the bombing was a necessary evil.

But evil is never "necessary". Sheehan makes the same mistake made by those who defended the actions at Hiroshima and Nagasaki, and who give the nod to torture today: they fail to recognize that some acts are intrinsically evil, evil in their very object, and can never be defended by appeal to intent or consequence. And the prohibition in the natural law against killing innocent human life is absolute. Instead, Sheehan embraces proportionalism, the notion that assessing morality is simply a matter of weighing the different options, and choosing the best of the alternatives. He embraces consequentialism in that the "end" of defeating Germany quickly justifies the "means" of fire-bombing cities.

Sheehan would do well to review the classic double effect principle, now being debated at Vox Nova (here and here). For, as we know, proportional calculations do indeed play a role in the calculus, but only if we pass two hurdles first: that the act itself is not objectively evil, and that the person making the choice does not share the intent of any evil side effects. If the act is intrinsically evil, it cannot be justified by using a proportionate reason to do it, or as a proportionate response to some circumstance. In the current case, we do not even get past square 1. Deliberately attacking civilians can never be justified, period. Pope John Paul devoted his greatest encyclical, Veritatis Splendour, to exactly this issue. He says it quite clearly: "circumstances or intentions can never transform an act intrinsically evil by virtue of its object into an act subjectively good or defensible as a choice."

Of course, assuming that the second world war met the just war criteria, then simply fighting the Germans would not in itself be an evil act. This is a crucial distinction that Sheehan sweeps over when he claims that the means are always evil in war. So, when assessing civilian deaths in war, proportional calculations come into play if the protagonist does not target them directly. But even here, there is a tendency to be overly-lax in the application of proportionality to real world considerations. Simply not willing the deaths of civilians is not enough. A too-ready acceptance of "collateral damage" may be gravely immoral. At least, in the days of world war 2, the carnage was difficult to hide. Today, thanks to technology and the media, we are inclined to view war as one giant video game, abstracting from human suffering. Just as in a game, "surgical" bombs take out their targets in a "precise" manner. But war is not like that, and we (as a society) often turn a blind eye to this messiness, and we do not want the tranquility of our live shattered by such images. Commentators decry Al Jazeera for showing images of death and suffering from the American war machine on TV, and the domestic media refrains from showing them. There is a reason that the Church notes that the bar on on the proportionality consideration is set higher with the destructive capacity of modern weapons. And yet, in contemporary society, there is often a feeling that the bar should be lowered.

In conclusion, the bombing of Germany killed 600,000. According the the British medical journal, The Lancet, the Iraq war killed 655,000. Even if the American bombing of Iraq did not target civilians in the way that the forefathers did in Germany, can we simply appeal to proportional considerations to defend this body count? I would submit that this is a gross abuse of just war theory, and the overarching principal of double effect, to make such an argument.

Monday, June 25, 2007

Health Care Reform: In Defense of Single Payer Systems

In this (long) post, I will make the case for single-payer health care on equity and efficiency grounds. I will start by showing that the US lags the rest of the advanced world in health care. I will then discuss the current predicament, leading into options for reform. I will argue that the consumer-driven approach to health care is fundamentally flawed, and that a single-payer system offers the greatest benefits.

The US health care system in a comparative perspective

Let me start with a simple observation: the US spends more than any other advanced country for health care, and gets less in return. According to data from the OECD, the U.S. spends $4,497 a year on health care per capita (in PPP dollars), as opposed to a G-7 average of $2,524. And for almost double the spending, the outcomes are far worse. Life expectancy in lower in the US. The infant, child, and maternal mortality rates are substantially higher. Americans have fewer doctors per capita, go to the doctor less often, and are admitted to hospital less frequently. They are less satisfied with the quality of health care than those in other countries. And of course, the US stands apart from other advanced countries by having a a huge hole in the health care net, as around 47 million people (including 8 million children) are uninsured. The leading cause of personal bankruptcy in the US arises from unpaid medical bills.

A recent study by the Commonwealth Fund shows is illustrative. in a detailed study of six countries-- Australia, Canada, Germany, New Zealand, the UK, and the US-- America ranks last along an array of indicators, including: quality care, access, efficiency, equity, and healthy lives. Yes, the US is still at the bottom of the heap in access, even worse than those countries that ration health care. The explanation is straightforward: cost. The US system is terribly efficient, largely due administrative overhead (more on that later), but also because patients tend to end up in the emergency room for cases that should be dealt with by a primary care physician. Death rates in the US from "conditions amenable to medical care" are 25-50 percent higher than elsewhere in the study. And when it comes to equity, "Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick, not getting a recommended test, treatment or follow-up care, not filling a prescription, or not seeing a dentist when needed because of costs." A staggering 40 percent of lower-income Americans reported avoiding seeing a doctor when sick during the past year for cost reasons.

The current impasse

Much ink has been spilled analyzing the current predicament. Paul Krugman and Robin Wells argue that the predominant employer-based system in the US came about almost by accident. During the second world war, although there was a labor shortages, firms were prevented from offering higher wages. The loophole they found was offering health care benefits. Unions supported this policy because unions largely negotiated at the firm level, unlike at the political level as in some European countries.

But with rising health care costs, this employer-based system became untenable. The long-term rise in health care costs are well-known, in the US and elsewhere. Much of this relates to new and improved medical technology. It is important to note, however, that costs have been rising in both public and private insurance, and that Medicare premiums have actually expanded at a slower case than their private sector equivalents. So this is by no means a case of runaway big government. But it does place great pressure on old-style employer-based insurance, and the numbers covered by these schemes is falling rapidly. More and more are falling outside the net. At the same time, as costs increase, the inherent inefficiency in the American health care system becomes magnified. Clearly, the current framework is unsustainable.

Basic health care economics

Before analyzing the issues, we need to review a few basic concepts. There are two key issues in health care economics, adverse selection and moral hazard. Let's start with adverse selection. Let's say an insurance company offered policies to a certain group, based on the average person's health in the group. Who would join? The less healthy, as for them it's a great deal. Premiums would rise, and more healthy would drop out, until the insurance company is left with the worst risks. Insurance companies deal with problem by carefully screening out the highest risks, and devoting immense resources to the task.

What about moral hazard? Moral hazard simply means that not bearing the full cost induces overconsumption. If something is free, or subsidized, you will consume more of it than if you had to pay for it. In the domain of health care, some argue that the very nature of insurance causes you to over-consume, pushing up costs. For these people, the solution is forcing the patient to pay more out of his or her own pocket.

Consumer-driven health care?

One solution, pushed by many in the Republican party and the pseudo-conservative world would move toward a system of individual health insurance. Adherents argue that this would bolster flexibility, allowing people to transfer insurance between jobs, and save money by making people more financially responsible for their health insurance choices. And so they propose tax-advantaged health savings accounts. The idea is that people can park some of their savings in these tax-free accounts, using them to meet medical expenses. There will be a residual catastrophic insurance policy, but with a huge deductible. Now, this all makes sense only if you believe moral hazard in the biggest problem in health insurance. In other words, if you are forced to pay out of pocket for more of your own health care, you will refrain from overconsuming, holding down costs.

The problem with this mode of thinking is that people simply do not consume health care as they consume ordinary goods and services. As quoted by Malcolm Gladwell, Princeton economist Uwe Reinhardt makes the point that moral hazard arguments are overblown as “you always hear that the demand for health care is unlimited. This is just not true. People who are very well insured, who are very rich, do you see them check into the hospital because it’s free? Do people really like to go to the doctor? Do they check into the hospital instead of playing golf?” A RAND study back in the 1970s showed that people, when faced with higher co-payments, did indeed cut back on the medical care they sought. But here is the problem: they cut back equally on frivolous and not-so-frivolous care.

If you follow the train of thought in the moral hazard argument to its inevitable conclusion, you will conclude that the problem in American health care is not too little insurance, but too much of it. In fact, those without insurance often choose to be without insurance as they are young and healthy, and this is (by the logic of the Bush administration and its allies-- see the 2004 Economic Report of the President) not a bad thing at all. So the solution is not to insure the uninsured but make the insured behave more like the uninsured. Bush himself complains that bad incentives allow workers to choose "overly expensive, gold-plated plans". Does this sound a little like bizarro-world yet?

As Gladwell notes, the unspoken word in this whole debate is poverty. About a third of those lacking insurance lie below the federal poverty line. This is not mentioned in the arguments for consumer-oriented health care. There's another problem, something Krugman and Wells refer to as the 80-20 rule: 80 percent of medical costs derive from 20 percent of the population. A mere 1 percent account for 22 percent of expenses. These are the people with serious long-term illnesses that require constant treatment. On the other hand, about half of the population has practically no medical expenses at all. This kind of skewed distribution suggests there is a lot more going on than moral hazard.

Which brings us back to adverse selection. The fundamental flaw of the individualist approach is that it encourages adverse selection. Think about it. The young and the healthy would benefit from health savings accounts, as they pay very little on health care. Those who are left behind in the traditional insurance plans are the older and the sicker, who will face higher premiums from a diminishing (and less healthy) pool. Traditional employer-based insurance, already under grave strain, would wither away. This is exactly the problem of moving from social insurance to actuarial insurance. Social insurance involves a social bargain. By paying similar premiums, the young and the healthy agree to subsidize the old and the sick, on the basis that if they themselves ever need help, it will be readily available. Actuarial insurance treats medical insurance like car insurance, based on individual situation and risk.

The advantages of single payer

So what is the alternative? Well, there are two core principles that must be met. First, there should be some mechanism to prevent adverse selection. The old employer-based model was able to guard against adverse selection, partially at least, by pooling the risk over a large group of workers. But now? This is why the health care reform plans by people like John Edwards and Arnold Schwarzenegger impose "community rating" requirements that forbid insurance companies from discriminating between people. Second, there needs to be universal coverage, which is why most reform plans offer financial aid to the less well off to purchase insurance (Edwards promises to roll back Bush's tax cut on those earning more than $200,000 a year to pay for it). Coverage needs to be mandatory, to prevent emergency rooms taking on the burden of leading with the sick-- a sure recipe for ballooning costs.

There is one simple solution to all of these problems: follow the lead of most advanced economies and move to a single payer system, where a single entity, usually a government body, provides insurance. The US has a wealth of experience with a successful single-payer program called Medicare. Although this violates every ideological bone in a psuedo-conservative's body, it turns out that Medicare outscores private insurance on both equity and efficiency grounds. As well as providing universal health care, single payer systems can be pretty cost-effective. Why? A number of reasons:

First, the administrative costs are far less. As Paul Krugman notes, Medicare devotes less than 2 percent of its resources to overhead, while private insurance companies spend as much as 20 percent on profits, marketing and administrative expenses. Two-thirds of the administrative costs of the drug companies are devoted to marketing and underwriting. The reason for the discrepancy is that private insurance companies need to weed out high-risk customers, screening applicants carefully.

Second, and related, moving to a single-payer system reduces the administrative costs arising from excessive fragmentation and administrative duplication in the health care market. The current health care jungle explains why the US is slower than other countries at adopting electronic medical records that can both reduce costs and save lives by reducing errors.

Third, costs can be contained by using the negotiating power of the single payer to get better deals from suppliers, including drug companies. As it stands, Medicaid recipients and those under the auspices of the Veterans Administration get deals on drugs similar to Canada. Everybody else pays a lot more.

Fourth, a single payer system would make it easier to focus on preventive care, and to look after the patient in a holistic manner. Eliminating the fragmentation and complexity would make it much easier to facilitate such a policy. It would also end the incredibly inefficient practice of using emergency rooms as primary care providers. Although preventive care is cheap and saves money in the long-run, it is not necessarily in the insurer's immediate interest. An example of how this can be put into practice is the Veteran's Administration, where the underlying philosophy is a lifetime relationship with clients. This makes it easy to keep track of patients' medical histories, facilitates better use of information technology, and encourages cost-effective preventive medicine.

Overall, then, one solution to the American health care crisis would be to simply adopt a "Medicare for all" solution. This would be paid by a dedicated tax that would almost certainly be less than current health care premiums. Coverage would automatically be universal, cheaper, and more focused on preventive care. Before people drive themselves into a tizzy over "socialized medicine", it is important to note that, under such a system, people would be be able to choose their own doctors. And there is no reason why private insurance companies could not participate in the system, provided they played by the rules.

Of course, the main complaint from opponents of single-payers systems revolves around long waiting lists. Rationing by cost, they say, is replaced by rationing by time. Of course, one could argue that a short wait is eminently more preferable to not being able to afford care in the first place. Remember the results of the Commonwealth Fund study: the US is at the bottom of the list in terms of access, even without rationing by time. The US has a distinct insider-outsider model of health care access, where insiders get every medical treatment they desire (at whatever cost), and outsiders get nothing. Krugman and Wells liken this to "robbing Peter of basic care in order to pay for Paul's state-of-the-art treatment."

At the same time, these waiting list problems are overblown, driven by revolving anecdotes and urban legends. Krugman and Wells also note that, while there are sometimes long waiting lists for elective surgery, this is not the case in all single payer systems, and anyway, the "waiting list procedures" account for only 3 percent of US health care spending, so the cost is decidedly minor. As noted by Jonathan Cohn, critics spend a lot of their time focusing on the UK and Canada, two of the most centralized systems in the world. Note that the UK really has socialized medicine, where doctors work for the government, and it tends to spend very little on health care. Cohn instead would divert critics attention to countries like France, Japan, and Switzerland, all offering high-quality universal care with no waiting lists and free choice of doctors. Patients in these countries see doctors more and spend more time in hospital, all the while securing better health outcomes at lower cost.

The Catholic Perspective

Moving to a single-payer health care system is justifiable by appealing to Catholic social teaching. The existence of 47 million people without health insurance, many of whom are below the poverty line, is a scandal, showing neither solidarity nor a preferential option for the poor. Catholic social teaching emphasizes that the provision of basic health care is an essential component of the common good that all societies are called upon to foster (Compendium of Social Doctrine, 166). Also, the preferential option for the poor relates to social and well as individual responsibility and embraces "those without health care" (Compendium of Social Doctrine, 182).

It should be noted that the proposed solution by many pseudo-conservatives, pushing for consumer-based health insurance also feeds into a radical individualism with little place in Catholic social teaching. For the basic argument is that the young and healthy should be free to spend less on health care by not being forced to subsidize the old and less healthy. This violates the principle of solidarity.

What about subsidiarity? Catholic objectives to a single-payer system are largely based on subsidiarity considerations. The Church justifiably opposes "certain forms of centralization, bureaucratization, and welfare assistance and to the unjustified and excessive presence of the State in public mechanisms" (Compendium of Social Doctrine, 187) on the grounds that bureaucratic modes of thinking tend to downplay the dignity of the person. It is important, however, to note that subsidiarity and solidarity go hand-in-hand: "Solidarity without subsidiarity, in fact, can easily degenerate into a “Welfare State”, while subsidiarity without solidarity runs the risk of encouraging forms of self-centred localism" (Compendium of Social Doctrine, 351). Therefore the role of the state should be neither "invasive nor absent". The state can have a role "when the market is not able to obtain the desired efficiency and when it is a question of putting the principle of redistribution into effect." (Compendium of Social Doctrine, 353). Well, if one thing should be clear by now, it is that the market does not work well in the domain of health care.

But the caution holds. A health care system overly-laden with an interpersonal bureaucracy is not in accord with human dignity. But what is the essence of subsidiarity in health care? It is that the patient should be able to choose his or her own doctor, and build a personal relationship. This is why long-term preventive care, sadly undeveloped in the current US system, is so critical. At the end of the day, does it really matter to the patient if a large impersonal government or a large impersonal insurance company is making the decision for the patient? The current system in the US is not one based on subsidiarity. Indeed, any form of risk-pooling (through government or private insurance companies) automatically implies a modicum of centralization. There is no way to avoid it. What we must do is make it less impersonal. In fact, if we regard bureaucracy as synonymous with overhead, then bureaucracy is actually more pronounced under the current framework in the US, lessening the link between the institution and the patient's care. And one more thing. Remember that the last attempt to curb burgeoning health care costs was by restricting consumer choice and letting insurance companies make key medical decisions. Absent reform, this approach-- not exactly aligned with the principles of Catholic social teaching-- is still on the cards. Also, as noted, single payer systems support an emphasis on preventive care that is laudable. But, at the same time, we must resist the urge to overly-centralize in a single payer system. The patient must remain in control of his or her destiny. In this regard, the French model works better than the overly-centralized British system. But we should remain open to alternative models that achieve the same results.

In conclusion, it is not enough to oppose these proposals using the catchall "subsidiarity" critique. It is necessary to put forward a reform agenda that would guarantee all the benefits of a single payer system in a more decentralized manner.

Saturday, June 23, 2007

Excellent Advice for the Democrats

In a thought-provoking New York Times op-ed today, Melinda Henneberger has some harsh words for the Democrats on the abortion issue. Henneberger has taken it upon herself to visit 20 states, talking to women on all ages, races, and income levels on this issue. She is now convinced that the female vote ebbed away from Kerry in 2004, not because Bush scared the hell out of them with images of phantom ghoulish terrorists, but because of his stance on abortion. Granted, Henneberger is arguing from anecdote rather than statistics, but I think she might have a point.

She noted that most of these women are instinctive Democrats. They support social spending. They oppose Bush's war. They do not feel at home in the Republican party, but still hold their nose and make the switch. Hennerberger notes that a lot of the problem is attitude. When two-thirds of Americans favor either a complete ban or restrictions on abortions, continuing to couch any attack on "abortion rights" as a line in the sand to be defended at all costs simply sounds extreme, rigid, and out of touch. In fact, she claims the Democrats have helped Karl Rove by consistently exaggerating the threat to Roe v. Wade from the election of Bush, boosting his pro-life credentials substantially. The classic example is the sense of manufactured outage over the Carhart decision on partial birth abortion. Instead of acknowledging it as a narrow decision that does not ban all late-term abortions, Democrats jumped immediately into Chicken Little mode, decrying the end of civilization as we know it. And all this over a procedure that most voters regard (quite rightly) as little different from infanticide.

So what should the Democrats do? I do not expect them to suddenly shift gears and come out in favor of a pro-life constitutional amendment. But I do expect them to show more respect to the pro-life cause, and to the people who view abortion as one of the most important issues in the seamless culture of life. I expect less snarky comments about religious extremists and theocrats. I expect less condescension. But above all, I would like them to acknowledge that the optimal abortion rate is a zero abortion rate, and that policies should be set with such a goal in mind (even if they don't want to criminalize it). The problem is, though, if abortion is a "right", how can too much of it be "wrong"?

The person who said it best is actually Archbishop Chaput, coincidentally in an interview with Melinda Henneberger:
"You can have good Catholics who say that they’re not for the criminalization of abortion, or they want to take gradual steps toward eliminating it by convincing the public that this is a bad thing. Those are all legitimate political positions-as long as you’re really moving towards the goal of protecting unborn human life. You at least have to have the goal."
I fear that unless Clinton and Obama (and the others) start paying attention, they could be in trouble in 2008, despite the plethora of advantages in other policy areas. And they would have only themselves to blame.

Friday, June 22, 2007

The Senate's Energy Bill

By a 67-25 majority, the Senate passed an energy bill that would increase fuel efficiency requirement from 25 to 35 miles per gallon; the first improvement in such standards in almost two decades. The new standards come into effect from 2020, and (here is the best bit), the industry attempt to maintain higher standards for "light trucks" (read: SUVs) was beaten back. Hooray! Of course, Bush could always veto, but the sizable majority increases the pressure on him to sign. Incidentally, all of the Democratic presidential candidates (Biden, Dodd, Clinton, and Obama) supported the bill, while the two Republicans (Brownback and McCain) were absent.

Of course, I would like to see this twinned with an increase in the gas tax, which remains far too low in the US, imposing (as economists would say) a negative externality: by not paying the full social costs of driving, every driver simply drives too much. Steve Levitt (of Freakonomics fame) argues that the various social costs call for a roughly $1 a gallon increase in gas taxes. This is not a "leftist" issue. Greg Mankiw, formerly Chairman of Bush's Council of Economic Advisers and currently an advisor to Mitt Romney, also backs a $1 increase in the gas tax.

But which policy is best? Personally, I prefer the increase in efficiency standards, in part because gas taxes are highly regressive (the poor bear a disproportionate burden). Also, the consumption of petroleum products is notoriously price-inelastic (people will still drive, no matter the cost!). But, weighing against this, the gas tax raises valuable revenue, and, as noted by Kevin Drum, higher efficiency standards may actually prompt believe to drive more too!. So I think the best conclusion is: both, please.

Markets and Middlemen

You hear it all the time, even from many Catholic thinkers: Big Government is bad, markets are good. Now, I'm certainly not going to argue that governments should be running steel mills, but there are clearly areas where the profit motive can lead to highly inefficient (and even unethical) outcomes. I'm talking about social policy, where profit-making entities merely (in the manner of Tony Soprano) take their skim from an enticing pile of cash without providing any real benefits whatsoever. In other words, they engage in classic rent-seeking behavior, seeking to extract "uncompensated value from others without making any contribution to productivity". Let me provide two example, one in education, and the other in healthcare.

Education loans

As noted by TNR's Jon Chait, the old student loan program was inefficient. Third-level students borrowed from private lenders at interest rates set by the government, and the government agreed to cover any defaults. Bill Clinton decided to cut out the middleman, by having the government make the loans directly. Estimates suggested billions of dollars in savings. Clearly, the middleman loses. And clearly, the middleman was not happy. The lenders allied with a powerful chunk of so-called conservatives to fight what Grover Norquist referred to as the "government takeover of the student-loan program." And so a compromise was hammered out. Both schemes would stay, and the college would decide which to choose. The reformers were not unhappy, as they assumed the cheaper direct loans would win. But it was not so. Colleges started edging back toward the old model with private lenders. Conservatives gloated, complaining about the "shoddy management and financial losses" of the direct loan scheme. The truth turned out to be otherwise. Indeed, the earlier Sopranos analogy is quite apt, because the lenders simply bribed the colleges into choosing them. Classic rent-seeking activity!


Traditional Medicare, a single-payer system (the government pays doctors and hospitals) is actually a lot more efficient than private sector alternatives, though you would not always know it from listening to the rhetoric. Again, we are told that bringing a cold dose of market efficiency into the Medicare system would yield innumerable benefits. In the 1990s, as related by Paul Krugman, the government tried to entice people to leave traditional Medicare for private plans, with the government paying a fee instead to the HMO. But there were problems. No longer able to engage in adverse selection (weeding out the sickest), HMOs could simply not compete with Medicare, an efficiently-run program without a huge overhead. That wasn't the end. In 2003, unwilling to throw in the towel, the Bush administration began heavily subsidizing HMOs to induce them to keep taking Medicare patients. This program now costs 11 percent more per beneficiary than traditional Medicare. Clearly, a direct transfer from the taxpayer to the insurance industry!

But then the drug companies wanted a piece of the action. Possibly anticipating more unfavorable comparisons, Bush's Medicare drug coverage (Medicare Part D) takes traditional Medicare out of the picture entirely, as the government does not pay directly for the drug. Instead, the participant joins a private insurance plan, and the government then sends out the subsidy. There are two problems with this. First, the government is prohibited from negotiating prices with the drug companies. Of course, the "conservatives" will decry "socialist price controls". This is pure rhetorical nonsense, as the negotiation is market based. If the government has greater market power, so what? Consumers benefit (technically, the government takes advantage of is monopsony power). This, plus the skim that the insurance company takes for acting as middleman, pushes up costs dramatically. Doesn't this sound like Tony Soprano is in charge of health care too?

Krugman concludes with a moral point: "The costs imposed on Medicare by gratuitous privatization are almost certainly higher than the cost of providing health insurance to the eight million children in the United States who lack coverage". Indeed.

Thursday, June 21, 2007

The Current Supreme Court-- What Is It Good For?

I've already written on how the Roberts court is extremely supportive of the death penalty. Now, David Savage in the LA Times notes that the court is also uniquely friendly toward business and corporations. The Court has already issued a dozen rulings this term that limit damages and make it harder for people to sue corporations. The court is seen as tilting more toward business than even the Rehnquist court.

As for all those good pro-life people who cheered when Bush appointed Roberts and Alito to the Court-- I recommend the song that ended the Sopranos franchise: Don't Stop Believing...

Michael Novak's Shoddy Economic Analysis

Over at the First Things blog, Michael Novak has written a detailed post against what he sees as persistent criticism of the "American economic system" (is there any real doubt where his allegiances truly lie?). He wants to hone in on such criticisms using "the fires of critical thought". Except than when he gets down to his actually arguments, he shies away from critical thought and instead relies on ideologically-tinged obfuscation.

I wish to deal only with one point he made. He criticizes the assertion that income inequality is growing in the US, with the rich getting richer and the poor getting poorer. To make his point, he cites the result of a recent study by the Congressional Budget Office (CBO), analyzing the income growth of low income households with children over the past 15 years. One result of this study is that the income of the bottom 20 percent increased dramatically from 1991-2005. Novak concludes: "This is, of course, because the welfare reform act brought millions in the bottom quintile back into paying jobs. This seems to me like a good, Christian thing to do."

Novak seems to take his cue from the notorious Wall Street Journal editorial page, which jumped on the findings as a change to mock the "class envy" peddled by John Edwards and others. But there is a problem. This CBO study was commissioned by Republican Judd Gregg, and the choices of start and end dates were somewhat auspicious. 1991 was a year of deep recession, and 2005 was a boom. So, as noted by TNR's Jon Chait, if you start in a recession and end in a boom, then you expect incomes to be rising. Incomes of the poor, and of everybody else, always rise and fall with business cycles.

In fact, if you look at the data, you will see an interesting pattern. While the real income of the lowest quintile of households with children rose by 35 percent from 1991-2005, this increase was concentrated in the 1990s. In other words, real incomes of the poor rose by 51 percent from 1991-2000, and actually fell by 11 percent from 2000-05. To put it crudely, the poor got richer under Clinton, and poorer under Bush. If Novak is truly concerned with "critical thought", be would be touting the accomplishments of Bill Clinton, and deriding the economic performance under Bush!!

But of course, it is not that simple. It is actually really hard to disentangle the effects of policy and the economy on these changing patterns. Strong economic growth in the 1990s was the proximate cause. Clinton's sound budget-balancing policies certainly laid the groundwork for this boom, but it would be facetious to credit him with the IT-related expansion. But a remarkable fact about this period is that the rising tide really did lift all boats. In terms of policies, Novak mentions only welfare reform. This is somewhat disingenuous, as the CBO report describes three key changes: (i) welfare reform, requiring participation in activities as a precondition for cash benefits; (ii) a large expansion in in-work benefits, through the earned income tax credit; and (iii) an expansion in children's health insurance. Contrast this with the Bush years, when the income of the bottom 20 percent dropped precipitously. Of course, the administration cannot be blamed for the 2001 recession, but a valid question is whether the income of the poor have reached where they were at the peak of the last cycle. And the answer is no.

Novak is on even shakier ground when he discusses changes in middle-class incomes. Here's what he says:

"Incidentally, the middle class also gained significant ground between 1992 and 2005, in large part under President Clinton but going even higher under President Bush. The median family with children earned $8,500 more in purchasing power (after inflation) in 2005 than in 1990. Put another way, the level of income of the bottom half of the population moved much higher in about fifteen years. The steady progress of the middle-class family, as well as of the poor household, is also a good outcome, is it not?"
There are so many errors in this statement, I don't know where to start. Again, he is doing his "bottom of cycle to top of cycle" comparison, which makes no sense. Yet again, the real income of the middle quintile rose under the Clinton administration, and fell under Bush. But let's look a little deeper into median real income growth, based on Census data, as this reflects the true economic welfare of the middle class. During the Clinton years, between 1992-99, real median income rose by 14 percent. In contrast, it fell by 3 percent from 2000-05, and each year saw another decline until 2005.

Let's look deeper into the recent period, 2000-05. This was by no means a recessionary episode; the real economy expanded by 12 percent over this period, and productivity rose by 17 percent. What's going on here? Basically, the middle class stopped participating in the economic expansion. Workers are working harder, and are more productive, but their pay and living standards stagnate. Meanwhile, corporate profits soared. According to research by Robert Gordon and Ian Dew-Becker, the productivity gains went to the top 10 percent. This lies in stark contrast to the 1990s, where the large productivity gains (related in part to the IT boom) were shared more broadly.

Note that the rising inequality is a long-term phenomenon. The top hundredth of the US population had an 8 percent income share in 1980, and this rose to 16 per cent by 2004. The 1990s boom did not reverse this long-term trend, but it smoothed out some of its negative consequences by lifting all boats. Economists still don't fully understand the underlying dynamics. While, as noted by Jon Chait, Clinton's fiscal responsibility combined with downward redistribution stands in stark contrast in Bush's fiscal irresponsibility combined with upward redistribution, the patterns in pre-tax income are too stark for fiscal policy to play much of a role. Economists posit a number of explanations for these longer-term trends. First, there is "skill-biased technical change" or the idea that new technologies place a huge premium on brain over brawn. But there are problems with this hypothesis. Europe faced the same technology shock, but did not see a huge rise in inequality. Moreover, wages of engineers and computer scientists did not grow as would be expected. But CEO compensation doubled.

What are some other explanations? Well, first, globalization has changed the balance of power between labor and capital. Second, the continuous pattern of de-unionization has left workers adrift, as profits are not shared. Third, the stagnating minimum wage has reduced purchasing power at the bottom.

These are all big issues, deep issues, worthy of debate. But you would not notice any of this from Novak's little pro-capitalism rave. The mission statement of First Things is to forward a "religiously informed public philosophy for the ordering of society." How does peddling pro-rich policies, ignoring the real problems of the middle class, making facts subservient to ideology, and deliberately obfuscating the data achieve this goal?

Wednesday, June 20, 2007

Is Scalia Dissenting Again?

Remember Scalia's attack on Evangelium Vitae, when he mocked John Paul's teaching on the death penalty by calling for "new staffers at the Congregation for Prudence in the Vatican."? And now Scalia's keen sense of dissenting irony strikes again. This time, the topic is torture. And, no, Scalia is not writing a treatise on the topic in First Things. Rather, he is ad-libbing about a television show.

Scalia is a huge fan of 24, the show where the main protagonist (Jack Bauer) regularly tortures people for information. Here's what Scalia said:
"Jack Bauer saved Los Angeles. ... He saved hundreds of thousands of lives... Are you going to convict Jack Bauer?.. any jury going to convict Jack Bauer? I don't think so."So the question is really whether we believe in these absolutes. And ought we believe in these absolutes?"
Actually, Antonin, as Catholics we do believe in these absolutes. We live our lives by them. We believe torture is intrinsically evil, never justified by intent or circumstances (and those circumstances include Jack Bauer-style ticking bomb scenarios). We are not proportionalists, we are not consequentialists. Scalia once explicitly mocked Evangelium Vitae; is he now implicitly mocking Veritatis Splendour, possibly the most important of all the late pope's encyclicals? I don't want to get into too much detail here, as I've discussed the main points on why torture is absolutely unacceptable from a Catholic point of view on my very first post on Vox Nova (see here).

Sadly, Scalia's comments feed into two prevailing trends among a key element of the contemporary American right: first, the embrace of torture (just look at a Republican presidential candidate's debate), and second, the blurring of fact and fiction, reality and fantasy. You might not realize it from Scalia's rhetoric, but Jack Bauer is a fictional character. The show is supposed to be about entertainment, not a guide to foreign policy. I am a big fan of the Sopranos, but this does not mean I support "whacking" one's enemies as a solution to life's problems! From the early days of the Bush administration, Ron Suskind noted the very postmodern denial of all objective truth among some in this group, especially when a Bush aide remarked that "we create our own reality". And today, pluralities still believe that Saddam Hussein had weapons of mass destruction, and strong links to Al Qaeda. In such a nihilistic world, facts and opinion are intertwined, and reality and entertainment are blurred.

But there is a dark side to applying this philosophy to 24. A few months ago in the New Yorker, Jane Mayer noted that glorifying torture on TV was having an effect on the real world. Mayer:
"However, it had become increasingly hard to convince some cadets that America had to respect the rule of law and human rights, even when terrorists did not. One reason for the growing resistance, ... was misperceptions spread by '24,' which was exceptionally popular with his students. .. “The kids see it, and say, ‘If torture is wrong, what about '24'?’

Although reports of abuses by U.S. troops in Iraq and Afghanistan and at Guantánamo Bay, Cuba, have angered much of the world, the response of Americans has been more tepid. Finnegan attributes the fact that 'we are generally more comfortable and more accepting of this,' in part, to the popularity of '24,' which has a weekly audience of fifteen million viewers, and has reached millions more through DVD sales.

The third expert at the meeting was Tony Lagouranis, a former Army interrogator in the war in Iraq. He told the show’s staff that DVDs of shows such as '24' circulate widely among soldiers stationed in Iraq. Lagouranis said to me, 'People watch the shows, and then walk into the interrogation booths and do the same things they’ve just seen.' He recalled that some men he had worked with in Iraq watched a television program in which a suspect was forced to hear tortured screams from a neighboring cell; the men later tried to persuade their Iraqi translator to act the part of a torture 'victim,' in a similar intimidation ploy."
Remember, an official Pentagon survey of US troops in Iraq showed that more than a third support torture for gathering information, 40 percent support torture to save the life of a fellow soldier, and two-thirds would turn a blind eye to mistreating civilians. Where are they getting these attitudes? 24? The Bush administration? Probably both.

In earlier times, successive US administrations stood by the Geneva Conventions. No more. Which brings us back to Antonin Scalia. He was a key dissenter in last year's Hamden v. Rumsfeld case, which threw out Bush's military commissions on the grounds that their structures and procedures violated both the Uniform Code of Military Justice and the Geneva Conventions (especially Common Article 3 which states that detainees shall not suffer torture or outrages upon personal dignity.) As noted by Marty Lederman, the most significant finding of this ruling was that the Geneva conventions applied to Al Qaeda suspects. For the US has always applied these "minimum, fundamental standards to all detainees, whether or not the detainees themselves were party to (or abided by) Geneva or not (including, for instance, the Viet Cong)." This long-standing practice ended in 2002 when the Bush administration determined that Common Article 3 did not apply to Al Qaeda, and that for all others, the standards were to be applied only "to the extent appropriate and consistent with military necessity." In Lederman's view, therefore, the most important aspect of the Hamden decision was its ruling on Common Article 3, not what it had to say about the military commissions themselves.

But Scalia was a dissenter on this decision. His dissent was primarily on the question of jurisdiction, and he did not address Common Article 3 directly, but his silence in the face of suffering is telling. Note that the minimum protections accorded by Common Article 3 are fully in accord with Church teachings on the dignity and intrinsic worth of each and every human being. These are principles that every Catholic should support vigorously. In his World Day of Peace message, Pope Benedict lauded international humanitarian law, and called for it to be reaffirmed in "present-day situations of armed conflict, including those not currently provided for by international law". But why bothering listening to Benedict, or more pertinently, to Christ, when Jack Bauer can save the world?

Tuesday, June 19, 2007

The Welfare State-- Right and Wrong Reasons

(Cross-posted from Vox Nova).

It is a well-observed fact that the US eschews the kind of welfare states popular in Europe. Favoring low taxes, and hence a smaller government, the US offers fewer benefits (unemployment insurance, pensions, disability payments, childcare subsidies etc.) and less income security. The ratio of social spending to GDP remains low.

What accounts for the differences in preferences? According to a triumvirate of top economists (Alberto Alesina, Edward Glaeser, and Bruce Sacerdote), the reasons are largely cultural. For a start, the US is a curiosity among advanced economies in that it is governed by 18th century principals that were designed to, first and foremost, protect private property rights. With much upheaval caused by war in Europe, the old system was largely swept away, and a more democratic one arose to take its place. The US also never faced a major socialist threat that prompted center-right politicians to embrace the welfare state, as occurred in Europe. Again, part of this is cultural, with entrenched individualism (abetted by low population density), and part of it reflects the majoritarian electoral system that makes it hard for the rise of other parties.

But these authors pinpoint two specific factors that they believes explains a lot of the US-Europe difference on this matter. The first is ethnic or racial heterogeneity. The basic argument is that people are more comfortable redistributing income to those of the same race or ethnic group. Americans are inherently opposed to "welfare" because a disproportionate amount goes (or is perceived to go) to minority races. On the contrary, a country like Sweden has been historically quite homogeneous (although this is changing rapidly). The second argument relates to attitudes toward the poor. The authors quote the World Values Survey to show that 60 percent of Americans, but only a quarter of Europeans, believe the poor are lazy. In contrast, the numbers are almost reversed when it comes to believing the poor are trapped, and whether luck determines income. They show that the more people believe luck drives success, the larger the social spending.

If these indeed are the two key arguments that explain the cross-country differences in welfare spending (and they use statistical techniques to come to this conclusion, not mere conjecture), then this is highly problematic from a Catholic point of view. Opposing redistribution on the grounds of "hostility between the races" is not in accord with recognizing the dignity or intrinsic worth of the human person, and it deviates from an appropriate sense of "catholicity" (not placing boundaries on who our neighbor should be). Believing the poor are lazy comes directly out of Calvinism, through the belief that God rewards the elect with earthly success. Quite clearly, this is not how Catholic social teaching treats the poor.

Therefore, from a Catholic point of view, the main reasons for the small size of the welfare state in the US seem to violate Catholic social teaching. Does this mean the US is impelled to move toward European-style welfare-state policies? Not at all. It is quite possible to argue that some welfare-state policies create a culture of dependency that in itself violates the dignity of the human person. And there is no doubt that this became an issue in many European countries, leading to low labor market participation, marginalization, and ghettoization, prompting reform.

But at the same time, this is not a license to ignore the plight of the poor altogether. Just look at some basic statistics. In 2000, the poverty rate in the US was 17 percent, against an EU-average of around 9 percent. Moreover, the countries with the largest social spending ratios have the best poverty outcomes-- Denmark (4 percent), Sweden (5 percent), Netherlands (6 percent).

The key then, is to reduce poverty without creating a culture of dependency. The Nordics have one solution. They offer generous replacement rates (if you are unemployed, you get paid a lot) but for limited periods and on the condition you enter training programs and other active labor market policies. Also, it is easy to hire and fire, meaning that you don't see the kind of dual labor markets that exist in France, leading to the disenfranchisement of large classes of people (including Muslim immigrants). In other words, the Nordics subsidize income loss, but not job loss. The economy retains sufficient flexibility, but the worker is not forced to bear excessive risk. It works.

Of course, it is expensive, and Americans are notoriously averse to higher taxes. But I'm not sure it is really possible to tackle poverty on the cheap. There are a few things that can alleviate the pressures without adopting a full Nordic model. First, in-work benefits such as the earned income tax credit can be expanded-- this is a great boon to the working poor. Second, childcare should be subsidized to alleviate the pressure on working mothers. And third, we need to move to a system of universal health insurance (of course, to be truly cost effective, this should ideally be a single-payer system, but this is an argument for another day).

Sadly, too many in the US dismiss the welfare state as an outdated relic from socialist Europe, often for the reasons enunciated by Alesina-Glaeser-Sacerdote, ignoring the plight of the poor in their own country. And Catholics will routinely dismiss a core aspect of Catholic social teaching as mere prudential judgment. As I've said a million times by now, prudential judgment is not a license to ignore, but the application of Catholic teaching to changing concrete facts and circumstances. In terms of addressing poverty, there is more than one solution, but there needs to be some solution.

Monday, June 18, 2007

Neuhaus and Nationalism

(Cross-posted from Vox Nova).

The presider of First Things, Fr. Richard John Neuhaus is a fan of nationalism, so it seems. In attacking Cardinal Mahony's staunch defense of immigrants, he writes:

"But most striking and, I believe, unfortunate is the cardinal’s conceptually confused but unmistakable attack on the nation-state, both in its domestic responsibilities and in the international order. Such an attack has no warrant in Catholic social doctrine."
Clearly, Neuhaus needs to invest some quality time reading Vox Nova! He is also mistaken. From its onset around the time of the reformation, the Church vigorously opposed nationalism because it sets limits and conditions on who is considered our neighbor, thus violating the Catholic principle. There is a reason why the Vatican is a staunch supporter of the United Nations in the international arena.

And in the immigration debate, Catholic social teaching recognizes the role of the state as strictly limited. In this, Katerina posted an apt quote from Pius XII recently: "Since land everywhere offers the possibility of supporting a large number of people, the sovereignty of the State, although it must be respected, cannot be exaggerated to the point that access to this land is, for inadequate or unjustified reasons, denied to needy and decent people from other nations, provided of course, that the public wealth, considered very carefully, does not forbid this." Borders serve a purely administrative function, and are not endowed by any pseudo-mystical quality.

But the opponents of immigration are not concerned with allowing workers to migrate from deprived regions to wealthier ones in an orderly manner, meeting their material needs as well as a legitimate demand for labor on the other side. No, the issue for them is almost entirely cultural, and reflects an antipathy to Spanish-speaking Latin Americans. This is the defining issue.

Here's the funny thing: most of the harshest languages emanates from the evangelical right. A while back, Eduardo Peñalver at Commonweal discussed a poll of the Family Research Council's (FRC) members showed that 90 percent of them favored deportation of the 12 million or so undocumented workers. Moreover, according to a Pew poll, 63% of white evangelicals view immigrants as a "threat to U.S. customs and values," compared to 48% of the population as a whole. So, while Jesus threatens those who do not welcome strangers with damnation, much of the anti-immigrant rhetoric derives from the evangelical right. And as we've discussed frequently in these pages, there is a strong tendency within some elements of that group to fuse Christianity with American nationalism. In this vein, it is the height of irony for Neuhaus to mock Mahony for quoting scripture like a protestant.

Economics and Immigration

(Cross-posted from Vox Nova)

In the Vox Nova comboxes on a recent post on immigration, I argued that the negative wage effects on low-skilled workers from an influx of immigrants were limited. Jonathan took issue with this claim, referring to the work of George Borjas. His point warrants an answer, and empirical analysis trumps mere assertion (in the reality-based community at least!).

Let's address the big picture first. There is little doubt that immigration increases overall GDP per capita, or the overall pie, through its direct effect on the growth in working age population. This allows for higher growth, lower inflation, favorable fiscal outturns, and less problems with longer-term sustainability arising from pressure on aging-related expenditure (especially since immigrants have higher fertility rates). It is by no accident that the countries most open to immigration (US, UK, Ireland, Sweden etc.) have grown most strongly over the past decade while immigration-phobic countries have lagged. As an example, the UK Treasury has boosted its long-term growth rate by 1/4 percent as a direct result of higher immigration inflows. This is by no means insignificant!

So far so good. But the argument usually revolves around the losers from immigration, and there are losers. If there is an influx of workers of a certain skill type, then the increased supply of labor can be expected to depress the wages of native-born workers of a similar skill type. Nobody disputes this basic economic logic. What people dispute is the relative magnitude of the effect.

One of the leading labor economists researching this topic is David Card of UC Berkeley. Card shows quite convincingly that local labor market outcomes of low-skilled native-born workers are barely affected by changing labor supply. Card also shows that, despite large-scale immigration in intervening period, the wage gap between dropouts and high school graduates is virtually unchanged from 1980. In the New York Times, Eduardo Porter provides an illustrative example. Many immigration opponents look at the experience of California, where the wages of high-school dropouts fell by 17 percent from 1980-2004. The effects of immigration? Well, no. The wages of high-school dropouts in Ohio fell by 31 percent over this same period, which did not have an influx of "illegal" immigration. Clearly, something else is going on here, a long-term pattern of increasing inequality that is worthy of further debate, but is not really relevant in the immigration context.

The sanguine findings of Card were disputed by others, notably Borjas and Katz. These researchers estimated the "illegal" Mexican immigrants between 1980 and 2000 lowered the wages of high school dropouts in the US by 8.2 percent, a not insignificant number. For a start, we need to realize that this result is an outlier, and indeed, Borjas and Katz refer to Card's results as the conventional wisdom. But there are a number of methodological problems with this work. First, as noted by Brad deLong, these coefficients are imprecisely estimated (large standard errors), in the sense that there is a one-sixth chance that the effect is actually positive. More pertinently, Borjas and Katz failed to adequately account for the fact that businesses react to increased labor by increasing investment. Indeed, certain businesses would probably not even exist without cheap immigrant labor. Taking these effects into account knocks the Borjas-Katz number down to 3.6 percent.

Overall, then, the consensus is that the effect of low-skilled immigration on native wages at the low end of the market is negligible, and declining as Americans become better educated and number of high-school dropouts continues to fall. As David Card says there is a "surprisingly weak relationship between immigration and less-skilled wages." A consensus figure lies closer to 1 percent, with Borjas-Katz providing the upper bound of the range of estimates.

How should we, as Catholics, analyze this debate? We need to look at the common good, and that means the global common good, not just the welfare of those persons who happen to possess US passports. Clearly, the Mexican immigrant benefits by increasing his and his family's economic opportunity. The US as a whole also benefits. There are some losers at the lower end of the wage distribution, but the effects are small. This does not mean they should be ignored, as that would violate the preferential option for the poor. But stamping down on immigration will do little to help them, while causing a great deal of suffering elsewhere. Subsidized training and other active labor market policies (like in Denmark) might be an apt response. Finally, something we do not hear much about in the debate, is the economic effect on Mexico. Surely, if there is a movement of labor between Mexico and the US, any downward wage pressure in the US will be accompanied by upward wage pressure in Mexico? Low-skilled Mexican workers will be made better off. As Catholics, their welfare matters too.

Friday, June 15, 2007

In Defense of the United Nations

(Cross-posted from Vox Nova).

It has become fashionable, especially in America, not only to view the UN as irrelevant, but to gleefully compile litanies of abuses committed by the New York-based international organization. This gets us nowhere. The key question to ask is whether or not the UN is relevant, or even essential, in the modern world. I believe the answer to that question is a resounding "yes". With that in mind, corruption and incompetence calls for reform, not scorn. Think of some other examples. One thing that irritates me in the US is the incompetence of local school boards and teachers unions, but this does not mean public schools should be abolished. And while we are on the topic of enduring institutions, I would remind everybody that the stench of corruption emanating from the Vatican was once so strong that certain so-called "reformers" denied its legitimacy altogether...

In fact, UN peacekeeping has been a major success, in spite of a few high profile shortcomings. A few years back in the New Republic, Gregg Easterbrook discussed patterns of war over the past half century. While the prevalence of war rose from the 1960s to the mid-1980s, it fell sharply thereafter. Global military spending is also on the wane. Very few nations have increased military spending over the past decade. A major exception is, of course, the US, which accounts for 44 percent of global military spending. Now, as Easterbrook notes, the major contributing factor to a more peaceable world was the end of the cold war, as the superpowers ended the multitude of proxy wars that caused so much carnage and suffering. But second on the list is the rise of peacekeeping, especially under the auspices of the UN. In fact, UN peacekeeping turned out to be an excellent investment, and the RAND corporation concluded that most UN peacekeeping operations were successful. Of course, these factors are intertwined, as the end of the cold war and the dissolution of hostile blocs meant that countries were now more willing to look to the UN for guidance.

How should we approach this issue as Catholics? Well, we should start by noting that the Vatican is a huge supporter of the UN system. Following up on themes stressed by servant of God John Paul, who noted that the UN was "a moral center where all the nations of the world feel at home and develop a shared awareness of being, as it were, a family of nations", Pope Benedict has this to say:
"The protection of human rights is constantly referred to by international bodies and, in particular, the United Nations Organization, which set itself the fundamental task of promoting the human rights indicated in the 1948 Universal Declaration. That Declaration is regarded as a sort of moral commitment assumed by all mankind. There is a profound truth to this, especially if the rights described in the Declaration are held to be based not simply on the decisions of the assembly that approved them, but on man's very nature and his inalienable dignity as a person created by God. Consequently it is important for international agencies not to lose sight of the natural foundation of human rights. This would enable them to avoid the risk, unfortunately ever-present, of sliding towards a merely positivistic interpretation of those rights. Were that to happen, the international bodies would end up lacking the necessary authority to carry out their role as defenders of the fundamental rights of the person and of peoples, the chief justification for their very existence and activity."
And indeed, as noted by John Allen, in discussing the just war principles, the Vatican leans closer and closer to defending military options only in cases of humanitarian intervention guided by the UN. The key issue is sovereignty and proper authority. As Allen says, from the Vatican's perspective, sovereignty is becoming increasingly vested in international organizations such as the UN. It is pretty clear that one of the reasons that the Church opposed Bush's Iraq war so vigorously is because if failed to follow the lead of the UN. When asked to expound on the Iraq war, then-cardinal Ratzinger referred frequently to the importance of the UN, with statements like: "The United Nations is the [institution] that should make the final decision", "The fact that the United Nations is seeking the way to avoid war, seems to me to demonstrate with enough evidence that the damage would be greater than the values one hopes to save", and "It is the instrument created after the war for the coordination -- including moral -- of politics".

The issue of often couched in terms of justice and solidarity. As Cardinal Lajola said a few years back:
"It is clear here that the military and economic superiority of one country, while giving rise to a particular moral responsibility vis-à-vis other nations (the principle of solidarity), does not automatically translate into an institutional pre-eminence with the subordination of other members (the principle of equality)."
Vesting the UN with such sovereignty makes particular sense in a world with a myriad state and non-state actors where technology, globalization, persisting injustices, and rapid information flow can magnify any disproportionate blowback from military actions. From the point of view of Catholic social teaching, a vital UN is especially apt. For the principle of subsidiarity suggests that most decisions should be taken at the local level. The principle of solidarity implies the need for an over-arching institution that brings all people together. You can see where I am going here. Those most opposed to the UN are those most wedded to the absolute sovereignty of the nation state and the ideology of nationalism. This is especially the case in the US where politicians compete to out-jingo each other by mocking the UN and announcing that American soldiers will never serve under UN commanders. And therein lies the problem. In a globalized world, what right does one country (the US) have to invade and occupy another (Iraq), half-way around the world and posing no direct threat, without the explicit approval of the community of nations? None whatsoever.

So, yes, reform by all means, and stamp out abuses, but do not question its legitimacy.

Thursday, June 14, 2007

The End of the Sopranos

(Cross-posted from Vox Nova).

A while back in Commonweal, Cathleen Kaveny penned a thought-provoking essay entitled "Salvation & ‘The Sopranos’", where she explored themes of sin and redemption through the lens of this gritty mafia drama. Kaveny explores the role of fate, concluding that a main moral of the story is that "we are trapped in a world ruled by an inexorable fate that seizes upon our moral failings in order to bring about our ruin." Moreover, "the world of The Sopranos ... seems infused with a cosmic retributive justice, which even Tony himself dimly perceives, although his own time of reckoning has not yet arrived." A dark message.

Kaveny proved highly perceptive, as this theme wove through the entire final season. At the beginning of the penultimate season, the show explored Tony's experience while in a coma after being shot, a kind of "purgatory", where his ultimate fate was clear. There was no way out. He was being guided towards his destiny, and it was not a joyous one. Led by his cousin (whom Tony had murdered), he was beckoned into a warmly-lit room where he could clearly see the contours of his mother, the selfish and narcissistic Livia (who herself had conspired to have Tony killed for the indignity of placing her in a retirement home). Tony did not want to enter, as something seemed wrong, very wrong. Luckily, he came out of the coma right at that moment.

The following two seasons deal with how Tony responds to this existential experience. Knowing what lies in store for him, will be change? Can he change? The world of David Chase is a very different world from Dickens's A Christmas Carol. There is no redemption brought on by a vision of the future. Even though Tony is fully aware of his destiny, he does not change, will not change, cannot change. This is a dark and pessimistic vision, especially from a Christian perspective. Chase conjures up a world in which nature is suffused not by grace, but by anti-grace. There is no possibility of redemption, even for those who come to grips with the meaning of damnation. Throughout the Sopranos, Tony's therapy sessions always offered the possibility of a breakthough, that an increasing self-awareness would foster change. But no, we learn that not only has therapy been utterly useless, but that it may even be counterproductive, bolstering the ego of a sociopath.

And not only is individual redemption impossible, but the "anti-grace" projected by somebody like Tony destroys and corrupts all around him. When his sister Janice tries to manage her anger, Tony goads her into losing her temper, and takes pleasure in the outcome. Christopher's attempts to steer clear of drugs and alcohol are teased mercilessly, with predictable results. When Tony realizes that Bobby has never killed a person, he forces him to do so, for no other reason than to destroy his soul. Carmela's conscience is bought by a house, and piles of hidden cash. AJ's depression and intense focus on evil in the world connote some semblance of moral self-awareness, but in the end, he too is bought off by an offer to work in the move industry for another mobster. And Meadow, who previously had the greatest chance of escape, of redemption, will now end up as a debased mafia lawyer.

Throughout the final season, Tony's mind became ever more intently focused on his fate, his destiny. He knew his downfall could come from any number of corners. Something as unlikely as a dropped gun in the snow a few years back could lead to his indictment. For Tony, there were only a limited number of options. He could be killed, jailed, or grow old and fade, turning into a shadow of your former self.. None of these options appeals. At one point, Tony gets irritated with the constant reminiscing about the past, as he sees clearly the limitations of a bankrupt lifestyle. Johnney Sac dies horribly from lung cancer. Uncle Junior is in the advanced stages of Alzheimer's. And then there is Pauley, a pathetic washed-up joke; Tony is so disgusted that he even ponders killing him at one point. And he is constantly on edge over the FBI, wondering who the next informer will be. And, towards the end of the season, Phil Leotardo provokes a full-scale war, and Tony's name is foremost on the hitlist. Any number of paths, all leading to the same ultimate destiny: damnation.

And yet, with this knowledge, Tony cannot reform. Given the limitations of this moral universe, the best he can hope for is to avoid his fate, postpone the inevitable. People become mere obstacles to be removed. Tired of Christopher's problems, and nervous he will turn informer, Tony takes advantage of a car crash to kill Christopher, by suffocating him as he lies slumped over the wheel, blood dripping from his mouth. It is not mere coincidence that there was a certain amount of ambiguity over this murder-- did Tony engage in "mercy killing", or did he callously remove an obstacle? In the end, the motive hardly matters, as the act was an evil one. After Christopher's murder, Tony's mood changes. His luck at gambling turns around remarkably, and, in one of the defining moments of the entire show, he stands in the middle of the Nevada desert, high on drugs, and exclaims: "I get it!". And what does Tony "get" exactly? A realization that he can control his own universe, his own fate? Here lie shades of original sin, as Tony wants to be like God, and subverting the order of creation and the "moral norms that govern the use of freedom" (CCC 396). Is he similarly deluded?

"And what rough beast, its hour come round at last, slouches towards Bethlehem to be born?" This line from Yeats underpins the final season, and is repeated almost like a mantra by AJ. In the wake of grave evil, what follows? In such a world devoid of the redemptive power of Christianity, the message is obvious. Evil wins. Like the darkness that Tolkien envisioned coming from Morder to envelop the whole world, everybody in the Sopranos has been corrupted by evil. In fact, the Tolkien analogy is apt. The fate of people like Johnny, Pauley, and Junior is similar to the fate of Smeagol who becomes Gollum. Evil traps them. And the world of the Sopranos is also akin to the world portrayed in Eliot's The Waste Land, but with no cry for renewal at the end.

It is fitting that the final scene has the nuclear family sitting in a diner together, the embodiment of old-style clean cut "family values". It is also fitting, and brilliant, for Chase to cut to blackness, and silence, to end it. Sure, people were disappointed by the ambiguity of the ending. But think about it. We know there are many different paths to Tony's ultimate destiny. He could have been shot that night. He could have been indicted that week. He could have lived for many more years. But in the end, there is only one certainty: blackness. A void. The second death. And that is how Chase chose to end the series. In reality, there is no ambiguity at all.

Sunday, June 10, 2007

Caiaphas and Truman

(Cross-posted from Vox Nova).
"You know nothing, nor do you consider that it is better for you that one man should die instead of the people, so that the whole nation may not perish."
-- Caiaphas (John 11:49-50).
"Having found the bomb we have used it....We have used it in order to shorten the agony of war, in order to save the lives of thousands and thousands of young Americans."
-- Harry S. Truman, 1945.

Catholic Justices Vote the Wrong Way.. Again and Again and Again....

(Cross-posted from Vox Nova).

Michael Perry over at Mirror of Justice notes that a recent Supreme Court decision made it easier for prosecutors to exclude people who express reservations about the death penalty from capital juries. The appeals court judge (whose decision was overthrown) granted a new trial on the grounds that a certain juror was excluded simply because "he did not perhaps show the kind of bloodthirsty eagerness" to impose the death penalty. The five Catholic justices had no problem with this. The four non-Catholics dissented. According to the New York Times, legal experts claim that this decision "will make the panels whiter and more conviction-prone."

This is just the latest in a series of judgments whereby the five Catholic justices joined together to remove any potential hurdles to the greater application of the death penalty in American courts. Last month, a case revolved around whether or not a prisoner who would not let his defense attorney present mitigating evidence during his original trial could change his mind and get a new hearing. No way, said Justices Thomas, Scalia, Kennedy, Roberts, and Alito. As Stevens noted in his dissent, the man had a "serious organic brain disorder", and his lawyer did not uncover this fact during the trial. And before this, all but Kennedy voted the wrong way in a sequence of three death penalty-related cases.

Now, there are those who will undoubtedly defend the actions on the majority on legal technical grounds. There are those who will argue that there is no authoritative Church teaching directing how to vote on these kinds of procedural grounds. But this is surely misguided. While the Church does not claim that the death penalty is always and everywhere wrong (like abortion), it does carve out conditions under the death penalty may and may not be immoral, namely, that there must be no other way to defend society. Note that this teaching is not merely a prudential judgment but a moral principle governing particular circumstances, and requires religious assent. The prudential judgment in this case is that no death penalty in the United States meets this strict condition. But this can hardly be disputed! Given this situation, should Catholic Supreme Court justices not try to "err on the side of life" as much as they can within the law? And why are they not doing so?

In fact, the Catholic majority on the Court has actually made things worse. As Patti Waldmeir in the Financial Times wrote last month:
"The recent addition of Chief Justice John Roberts and Justice Samuel Alito, the Bush appointees, might have substantially shifted the balance of power on the court on death penalty issues, experts said. Before their appointment, the court had done much to chip away at the edifice of the death penalty by insisting on improvements in legal representation for capital defendants and ruling unconstitutional the application of capital punishment to juveniles and the mentally retarded."
I will leave you all with some food for thought. Many Catholics believe the appointment of Roberts and Alito to the Supreme Court was of signature importance, justifying sticking with the Republicans in spite of everything else. But what if their appointment has zero impact on abortion, but a substantial negative effect on other aspects of the culture of life?