A Philosopher's Blog

Emergency Rooms & Obamacare

Posted in Business, Ethics, Law, Medicine/Health, Philosophy, Politics by Michael LaBossiere on January 24, 2014
Typical scene at a local emergency room

(Photo credit: Wikipedia)

On the face of it, the idea seems reasonable enough: if a person has health insurance, then she is less likely to use the emergency room. To expand on this a bit, what seems sensible is that a person with health insurance will be more likely to use primary care and thus less likely to need to use the emergency room. It also seems to make sense that a person with insurance would get more preventative care and thus be less likely to need a trip to the emergency room.

Intuitively, reducing emergency room visits would be a good thing. One reason is that emergency room care is rather expensive and reducing it would save money—which is good for patients and also good for those who have to pay the bills for the uninsured. Another reason is that the emergency room should be for emergencies—reducing the number of visits can help free up resources and lower waiting times.

As such, extending insurance coverage to everyone should be a good thing: it would reduce emergency room visits and this is good. However, it turns out that extending insurance might actually increase emergency room visits. In what seems to be an excellent study, insurance coverage actually results in more emergency room visits.

One obvious explanation is that people who are insured would be more likely to use medical services for the same reason that insured motorists are likely to use the service of mechanics: they are more likely to be able to pay the bills for repairs.

On the face of it, this would not be so bad. After all, if people can afford to go to the emergency room and be treated because they have insurance, that is certainly better than having people suffer simply because they lack insurance or the money to pay for care. However, what is most interesting about the study is that the expansion of Medicaid coverage resulted in an increase in emergency room visits for treatments that would have been more suitable in a primary care environment. That is, people decided to go to the emergency room for non-emergencies. The increase in emergency use was significant—about 40%. The study was large enough that this is statistically significant.

Given that Obamacare aims to both expand Medicaid and ensure that everyone is insured, it is certainly worth being concerned about the impact of these changes on the emergency room situation. Especially since one key claim has been that these changes would reduce costs by reducing emergency room visits.

One possibility is that the results from the Medicaid study will hold true across the country and will also apply to the insurance expansion. If so, there would be a significant increase in emergency room visits and this would certainly not results in a reduction of health care costs—especially if people go to the expensive emergency room rather than the less costly primary care options. Given the size and nature of the study, this concern is certainly legitimate in regards to the Medicaid expansion.

The general insurance expansion might not result in significantly more non-necessary emergency room visits. The reason is that private insurance companies often try to deter emergency room visits by imposing higher payments for patients. In contrast, Medicaid does not impose this higher cost. Thus, those with private insurance will tend to have a financial incentive to avoid the emergency room while those on Medicaid will not. While it would be wrong to impose a draconian penalty for going to the emergency room, one obvious solution is to impose a financial penalty for emergency room visits—preferably tied to using the emergency room for services that can be provided by primary care facilities. This can be quite reasonable, given that emergency room treatment is more expensive than comparable primary care treatment.  In my own case, I know that the emergency room costs me more than visiting my primary care doctor—which gives me yet another good reason to avoid the emergency room.

There is also some reason to think that people use emergency rooms rather than primary care because they do not know their options. That is, if more people were better educated about their medical options, they would chose primary care options over the emergency room when they did not need the emergency room services. Given that going to the emergency room is generally stressful and typically involves a long wait (especially for non-emergencies) people are likely to elect for primary care when they know they have that option.  This is not to say education will be a cure-all, but it is likely to help reduce unnecessary emergency room visits. Which is certainly a worthwhile objective.

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Corporations & Religious Freedom I: The Contraception Thing

Posted in Business, Ethics, Law, Philosophy, Politics, Religion by Michael LaBossiere on November 6, 2013
English: A typical contraceptive diaphragm

(Photo credit: Wikipedia)

As this is being written, there are almost forty for-profit companies suing the United States government over the requirement in Obamacare that health plans include coverage of contraception. The basis for the lawsuit is that the requirement is a violation of religious freedom.  The company Hobby Lobby has attracted the media’s attention in this matter, serving as the “poster corporation” for this matter.

In the case of Hobby Lobby,  CEO David Green and his family claim that their and Hobby Lobby’s freedom of religion is being “substantially burdened” by being compelled to provide insurance that would cover “morning-after pills” and IUDs for employees who wanted such them. The Greens claim that these specific types of contraception prevent implantation of fertilized eggs and are thus equivalent to abortion, which they regard as being against their religious beliefs. There are also those who oppose contraception regardless of the type on religious grounds.

The legal foundation for this challenge is the Religious Freedom Restoration Act (RFRA) which allows a person to seek exemption from a law if it substantially burdens her free exercise of religion. The government can deny this exemption if it can prove both a compelling reason to impose the burden and evidence that the law is narrow enough in scope.

From a moral standpoint, this exemption does seem acceptable if it is assumed that freedom of religion is a moral right. After all, there should be a presumption in favor of freedom and the state would need to warrant such an intrusion. However, if it can do so properly, then the imposition would be morally acceptable. The stock example here is, of course, limitations on the right of free speech.

From both a moral and legal standpoint, there seem to be two main points of concern. The first is whether or not a for-profit corporation is an entity that can be justly ascribed a right to freedom of religion. The second is whether or not such the contraceptive coverage imposes a substantial burden on the free exercise of religion. Obviously, if a corporation cannot be justly ascribed this right, then the second concern becomes irrelevant in this context. However, since it is a simpler matter, I will address the second concern first and then move on to the main point of interest regarding corporations and religious freedom.

For the sake of the discussion, I will assume that those bringing the lawsuit are sincere in their claim that contraception is against their religion and that this is not merely cover for an attack on Obamacare. I will also assume that their religious belief is about the use of contraception.

On the face of it, being compelled to follow the law would seem to not impose any substantial burden in regards to such a belief. After all, those impacted by the law are not required to use contraception. This would, of course, be a clear imposition on their freedom (religious and otherwise). They are also not required to directly give their employees contraception. This could be seen as an imposition by giving them a somewhat direct role in the use of contraception.  However, they are merely required to provide a health plan that covers contraception for those who are exercising their freedom to choose to use said contraception. As such, the burden seems minimal—if it exists at all.

It might be objected that to be forced to have any connection to a means by which employees could get contraceptives would be a significant imposition on the corporation. The rather obvious reply to this is that the corporations pay employees with money that can be used to buy contraceptives. So, if an employee would use contraception, then she would most likely just purchase it if it were not covered by her insurance. In cases where the contraceptive medicine is being used for medical reasons (as opposed to being used as contraception) the employee would probably be even more likely to purchase it (which raises the question of whether such use counts as using contraception in a way that would violate these religious beliefs).

As such, if a corporation can insist that health care plans not cover contraception on the grounds that they would be forced to play a role in situation in which an employee might get contraception by means connected to the corporation, it would seem that they could make the same claim in regards to the paychecks they issue. After all, paychecks might be used to acquire all manner of things that are against the religious views of the corporation’s owner(s). This is, of course, absurd and would be a clear violation of the rights and freedoms of the employees.

As such, the second issue is easily settled: being compelled to offer insurance that covers contraception is not a substantial burden on the religious beliefs of corporations. In my next essay I will turn to the more important issue, namely whether or not for-profit corporations are the sort of entities that can justly be ascribed religious beliefs (and thus be entitled to religious freedom).

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Republicans & Rhetorical Explanations

Posted in Law, Philosophy, Politics, Reasoning/Logic by Michael LaBossiere on October 25, 2013
Mitt-Romney

Mitt-Romney (Photo credit: Wikipedia)

After a defeat, it is natural for people to try to explain why they were defeated. In some cases, the explanation provided is aimed at doing what an explanation is supposed to do: to provide an illuminating account of how or why something occurred. In other cases, the explanation is aimed primarily at influencing peoples’ attitudes and behavior. Not surprisingly, an explanation that is aimed at achieving these goals is a rhetorical device known as a rhetorical explanation.

This is not to say that a rhetorical explanation need be in error—it could provide an accurate account of how or why something occurred. Being a rhetorical explanation is more a matter of intent—that is, those offering it do so at least in part to cause people to have a positive or negative feeling about a matter.

Back in 2012, the Republicans lost the presidential election and various people endeavored to explain how this happened. Some folks pointed to the demographics of America and how minorities played a critical role in the election. Others claimed that the media’s love for Obama handed him the victory. One of the more interesting explanations was that the Republicans lost because they were not conservative enough.

More recently, the Republicans lost on their bid to get the Democrats to agree to delay or defund Obamacare. After this defeat, various explanations have been offered and among them is the claim that it was the result of the Republicans not conservative enough. In this context, this seems to mean not being will to let the shutdown of the government slide into defaulting on the national debt.

On the face of it, presenting the claim that the Republicans lost because they were not conservative enough seems to be a rhetorical explanation. After all, it seems to be aimed (in part) at chastising the Republicans who are being accused of not being adequately conservative. As such, people are supposed to feel negatively about these Republicans.  It also seems to be aimed (in part) at creating positive feelings towards the conservative Republicans—it is supposed to be believed that they had the winning approach (but were betrayed by the Republicans in Name Only). This explanation might prove to have some bite—many Republicans are taking pains to cast themselves as being very conservative and repudiating the charge that they might be moderates.

While rhetorical explanations such as this are often used to make other people feel a certain way (positively or negatively), people can also use them on themselves. Whether the explanation is inflicted on others or self-inflicted, the problem is that such appealing explanations can make it very easy for a person to buy into an explanation that is not correct, thus leading to obvious problems. As such, it is worth considering whether the explanation about these defeats is correct or not.

If the explanation for the 2012 election was correct, then the prediction that would follow would be that the Republicans would have won if they had been more conservative. In this case, winning is clear—Mitt Romney (or a more conservative Republican like Michelle Bachmann) would have been elected rather than Obama.

For this to happen, more people would have had to vote for the Republican than Obama. Since this did not happen, for the explanation at hand to be correct, there seem to be three main options (and perhaps others).

One is that some conservatives voted for Obama because Romney was not conservative enough.  They would have, however, voted for someone who was conservative enough. It seems reasonable enough to dismiss this option out of hand on the grounds that such people would not vote for Obama. Thus, it seems rather implausible to think that a more conservative Republican would have pulled votes away from Obama.

A second one is that some conservatives voted for someone other than the two main candidates or wrote in someone else rather than voting for Romney, thus allowing Obama to win. This is more plausible than the first option, but is still fairly unlikely. That is, it does not seem likely that enough people to change the election voted in this manner because Romney was not conservative enough.

A third option is that some conservatives decided to not vote at all because they thought Romney was not conservative enough, thus allowing Obama to win. Of the three, this is the most plausible. Elections in the United States have a low turnout and it certainly is possible that some of those who did not vote would have voted if there had been a candidate that was conservative enough. These voters would thus seem to have preferred allowing Obama to win over voting for Romney, but this would assume that the voters were rationally considering the consequences of their failure to vote. It could be a simple matter of motivation—they were not inspired enough by Romney (or their dislike of Obama) to vote.

It is also worth considering that the explanation is in error because a more conservative Republican would have merely increased the votes for Obama. As noted above, a more conservative Republican would not have pulled votes from Obama. What seems more likely is that a more conservative Republican would have lost the more moderate voters who voted for Romney. As such, if the Republican candidate in 2012 had been “conservative enough” Obama would have either still won or would have still won with a larger number of votes. After all, most Americans are not extremely conservative and being “conservative enough” would seem to involve holding views that most Americans do not hold. Thus, the explanation seems to fail.

Jumping ahead to the most recent defeat, the matter is somewhat more complicated in that the victory conditions are not so clearly defined. At the start of the battle, the Republicans wanted to defund or delay Obamacare—that would have been a win. However, as the shutdown continued, the Republicans seemed to become less clear about what they wanted—especially when Obama made it clear that he was not going to negotiate Obamacare.

Interestingly enough, the shutdown was explained by some as being the fault of the Democrats and after the Republican defeat, the more conservative Republicans are using the narrative that they would have won if the Republicans had been conservative enough—thus creating dueling rhetorical explanations.

But, to get back to the main point, the victory conditions were not clear. However, it could be speculated that a win would involve the Republicans getting more of whatever they ended up wanted than the Democrats got of what they wanted. So, I will go with that.

There is also the question of what it meant to be conservative enough. Given the rhetoric, it seems that what this means is being willing to take the United States into default if one does not get what one wants. If so, the Republicans being conservative enough would not seem to have yielded a win—unless what they wanted was a default on the debt and the ensuing economic and political disaster. If this is what counts as a win, then being conservative enough would have led to that “win”—a win that almost everyone else would regard as a disaster.

Most Americans disapproved of what Congress was doing and most blamed the Republicans. Presumably if the Republicans had been more conservative, this would have merely made people more annoyed with them—after all, the view of most people was that what was going on was bad, not that it did not go far enough into this badness. As such, it would seem that the problem was not that the Republicans were not conservative enough. They lost because they had a poor strategy and most Americans did not like what they were doing. The solution is, obviously enough, not being more of that—the result will just be worse for the Republicans.

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The Day After

Posted in Ethics, Law, Philosophy, Politics by Michael LaBossiere on October 18, 2013
Official photographic portrait of US President...

(Photo credit: Wikipedia)

According to the Republicans, the initial motivation for the shutdown came from their desire to prevent the damage they alleged will be inflicted by Obamacare. It is thus rather ironic that their shutdown, as a matter of fact, cost the United States about $24 billion and slowed growth. It also harmed the government employees who were furloughed and the other Americans who were impacted directly by the shutdown. Naturally, it also impacted how we are perceived by the rest of the world. As such, the Republican strategy to protect America seems to have the exact opposite effect. Thus it is no wonder that while the majority of the public disapproves of the way the situation was handled, the Republicans are bearing the brunt of this disapproval.

One counter is to endeavor to lay the blame on the Democrats. Fox, for example, did its best to spin the story so that the Democrats were morally accountable for the shutdown. This does raise an interesting question about responsibility (and perceived responsibility).

In terms of the facts, the Republicans initially insisted that, on the pain of putting the government on the path to shutdown, Obamacare be delayed or defunded. Obama and the Democrats noted that Obamacare is a law and that it had been ruled constitutional by the Supreme Court. As such, they refused to negotiate the matter. Given that Obama had yielded in the past, the Republicans probably expected that he would yield once more. However, he did not and the shutdown went on until the brink of the default.

The facts would seem to show that the Republicans bear the moral blame for the shutdown. After all, the law was passed and upheld in accord with the constitutional process. That is, it was done by the proper rules. The Republicans partially shut down the government and threatened to take the country into default if they did not get what they wanted. Obviously enough, this sort of thing is not in accord with constitutional process. That is, the Republicans were not acting in accord with the proper rules and the Democrats refused to give in to them.

To use an analogy I have used before, this is like having the Red Sox beat the Yankees in a legitimate game and then having the Yankees threaten to burn down the stadium if the Red Sox refuse to negotiate the outcome of the game. If the Yankees then set the stadium on fire, it is not the fault of the Red Sox-they are under no obligation to yield to the unwarranted demands of the Yankees. The Yankees bear full blame for the burning of the stadium. As such, the Republicans bear the blame for the shutdown and the damage it caused. As a general rule, if someone threatens to do harm to others if he does not get what he wants, then the responsibility for the harm he inflicts rests on him and not on those who refuse to give him what he has no right to demand by means of a threat.

It could be countered that Obamacare is so bad, “the worst thing in our country since slavery”, that the Republicans were in the right to inflict such harms in order to try to stop it. It could even be argued that by passing such a wicked and destructive law the Democrats are to blame-the Republicans had to take such extreme measures in order to try to save America.

This, obviously enough, rests on establishing that the law is so wicked and destructive that such extreme measures are warranted. It would also involve showing that the damage done by the Republican strategy is outweighed by the harms that the strategy was supposed to prevent. This would most likely involve a utilitarian assessment of the harms and benefits.

The damage done by the Republican strategy is known: $24 billion in 16 days. Obamacare would certainly have to deal some serious damage in order to match that, but perhaps it can be shown that this will be the case. As it stands, there are only guesses about what the impact of Obamacare will be. There is plenty of rhetoric and hyperbole, but little in the way of disinterested, rational analysis. However, it does seem reasonable to believe that Obamacare will not be the worst thing since slavery (let alone as bad as slavery) and that it will not destroy America. After all, its main impacts will be that people without insurance will need to get some (or pay a small fine) and that large employers will need to provide insurance (or pay a small fine) or evade the law by cutting employee hours. Even if the worst case scenario is considered, it will hardly match the hyperbole. As such, Obamacare does not seem bad enough to warrant the Republican strategy.

To be fair, the Republicans might honestly believe that Obamacare is as bad as they claim. That is, they believe their own hyperbole and rhetoric. If this is true, they could be morally excused to the degree that they followed their informed consciences. However, if they are operating from willful ignorance or do not really believe their own hyperbole, then they would have behaved wrongly—both in their hyperbole and their actions based on this.

In any case, most Americans do blame the Republicans and this is one of the political impacts of the shutdown. Whether this has an effect on the upcoming elections remains to be seen—as many pundits have noted, voters often have a short memory. As with the alleged damage of Obamacare, we will have to wait and see.

As a final point, one ironic effect of the shutdown is that it gave the Democrats an amazing distraction from the real problems with the implementation of Obamacare. One legitimate concern is the fact that employers get a one year delay in implementing Obamacare while individuals have been denied this same option. This, on the face of it, is unfair and the main “defense” of this has been the use of the red herring and smokescreen, as I noted in an earlier essay. While the Republicans did initially want to delay Obamacare for a year, they handled this poorly and instead decided to go with hyperbole and a shutdown. What could have been a potential win for them turned into what seems to be a major loss. A second legitimate concern is the problems plaguing the sign up and implementation of Obamacare. While there were some attempts to raise criticism about these serious problems, the shutdown dominated the center ring of the political circus. Thus, what could have been a reasonable criticism of Obamacare was drowned out by the Republicans themselves. In the Game of Obamacare, you win or you die. The Republicans did not win.

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Political Impact of the Shutdown

Posted in Business, Law, Politics by Michael LaBossiere on October 16, 2013
English: Boston Red Sox Cap Logo

English: Boston Red Sox Cap Logo (Photo credit: Wikipedia)

One point of concern among the pundits and politicians is the political impact of the shutdown on upcoming elections. In a sense, this involves looking at the handling of the shutdown as moves in the larger game of political maneuvering. In the specific scenario of the shutdown, there seem to be four main goals. The first is to achieve specific objectives (for example, defunding or delaying Obamacare). The second is to keep the other side from achieving its specific objectives. The third is to score positive political points for one’s side. The fourth is to make the other side accumulate negative points.

While achieving the first two goals can impact the second two goals, there is actually no need to achieve or prevent the achievement of actual objectives (such as delaying Obamacare). After all, positive and negative points can be gained or inflicted by the means of various rhetorical devices as well as the classic tactic of simply lying about the facts.

The Republicans apparently initially set out to defund or delay Obamacare and have been using the shutdown and threat of default to try to force the Democrats to yield to their demands. Interestingly, the Republicans do not seem to actually know what they want, which makes achieving these unknown goals rather problematic. However, they do seem clear in one goal: they want to shut down the government.  Some Republicans, such as Michelle Bachmann, seem to think that the shutdown was itself a desirable goal. If so, that could be considered a “win” for her and people who think that way.

The Democrats do seem to be clear about what they want-they want the Republicans to accept the legal reality of the situation: Obamacare is a law and it has been ruled constitutional by the Supreme Court. They also want the shutdown to end, but refuse to yield to the Republican threats and coercion.  Naturally, the Republicans have tried to spin the story so that the Democrats are to blame for not negotiating the matter.

On the face of it, the Republicans certainly seem to deserve the blame. To use an analogy to baseball, it is as if the game has been legitimately won by the Red Sox, but the Yankees want to negotiate the matter. When the Red Sox refuse, the Yankees say they will burn down the stadium unless the Red Sox negotiate. True to their word, the Yankees then start burning things, all the while blaming the Red Sox for the fire. In the case of the shutdown, Obamacare won-it was passed, ruled constitutional and set to go into effect. The Republicans then decided they did not like the result and set out to burn things down, all the while blaming the Democrats. That said, politics is mostly about perception and not so much about the reality. So, a rather important matter is how the voters perceive the situation.

Not surprisingly, no one is looking particularly good to the voters. Congress started off with an abysmal approval rating, so it is hardly a shock they still look bad to the voters. However, the shutdown has also spilled over onto the parties and the president.

As of October 14, 2013 74% of Americans disapprove of the manner in which the Republicans in Congress are handling the situation. To be honest, I am somewhat surprised that the number is that low-I would expect a higher disapproval given that congress seems to be handling the matter exceptionally poorly. Last week it was 70% and at the start of the shutdown it was 63%, thus indicating that the longer the shutdown continues, the more disgruntled Americans will become. This does give the Republicans some reason to end the shutdown, assuming they are concerned about public opinion.

While the Democrats are suffering from a 61% disapproval rating, they are still better off than the Republicans. Also, the Democrats seem to be suffering less of an impact: at the start of the shutdown they had a 56% disapproval rating. As such, the Democrats are “winning” in terms of being perceived as somewhat less bad than the Republicans. While this might not seem like much of an advantage, the fact that we have what amounts to a two party lock on politics, the side that is doing less bad is thus the winner.

An obvious counter is that given the clever gerrymandering of congressional districts, the parties do not need to worry as much about disapproval. After all, if a district is rigged to be mostly Democratic or Republican, the dominate party is all but assured of victory. However, the once unified Republicans (who followed Reagan’s eleventh commandment) have become divided into factions, thanks to the Tea Party Republicans.

The Tea Party members have shown considerable willingness to go after their fellow Republicans for not being “conservative” (or, apparently, crazy) enough and this has created a situation in which moderate Republicans face the greatest challenge from their own Tea Party faction and not from the Democrats. This has played a significant role in the shutdown, which seems to have been largely orchestrated by the Tea Party faction. In contrast, the moderate Republicans would seem to prefer to have avoided the shutdown. Of course, how this plays out depends a great deal on what the voters think about the situation.

As it stands, 47% of Republican voters approve of the way their party is handling the matter, while 47% disapprove. In terms of how this will impact upcoming elections, much depends on the approval or disapproval of the voters in those cleverly gerrymandered districts. If the majority of Republican voters in a specific district favor what has happened, then this will bode well for the incumbent. It seems likely that Tea Party voters would tend to approve of this situation, thus it seems unlikely that the Tea Party incumbents will not be re-elected. However, the more moderate Republicans who have more moderate Republican constituents could run into problems-they might end up losing to a Democrat as punishment for riding the Tea Party tiger too far. Alternatively, if a moderate Republican decides to jump off the tiger, they might be punished by the Tea Party members in their district and end up being defeated in the primary. Then again, the voters might forget about all this by the time the elections come around.

The Democrats are doing better internally: about 60% of Democrats approve of how the Democrats are handling the situation. Not surprisingly, the Democrats are hoping to cash in on this division in the Republican party in the next election cycle. If the Tea Party comes off looking bad to the general population of voters and the once moderate Republicans continue to ride the Tea Party tiger, then the Democrats might come out ahead. This might see the beginning of the decline of the influence of the Tea Party and the more moderate Republicans might decide to abandon their more radical fellows. After all, if people get that the Tea Party folks are fine with shutting down the government and taking us to the brink of ruin, people might start rethinking the matter. However, the Tea Party folks might rather like what grows from what they have sown and their influence might grow stronger. Much depends on whether the voters can see the Tea Party for what it is-and whether or not they like what they see.

As a final point, Obama is doing the best of the lot: his disapproval in this matter is at 53%. His disapproval rating increased by three points since the start of the shutdown. As such, Obama seems to be winning in approval in that he is losing the least.

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Smokescreens & Sebelius

Posted in Business, Ethics, Law, Medicine/Health, Philosophy, Politics, Reasoning/Logic by Michael LaBossiere on October 9, 2013
Official portrait of United States Health and ...

Official portrait of United States Health and Human Services Secretary . (Photo credit: Wikipedia)

On October 7, 2013 Health and Human Services Secretary Kathleen Sebelius was the guest on the Daily Show. Given that Jon Stewart is often regarded as a liberal mouthpiece, most folks probably expected that this would be a mutual admiration sort of interview. However, things certainly turned out rather differently as Stewart did what “real” journalists rarely do: he raised an important concern and refused to allow the person to shift the issue.

The question raised was one that certainly should be answered, namely the question of why large businesses were granted a delay in their implementation of Obamacare while individuals did not receive the same delay. While there should certainly be a fair and rational answer to this question, Sebelius went into verbal acrobatics to avoid answering it. This tactic is known as the smokescreen/red herring in philosophy:

A Red Herring is a fallacy in which an irrelevant topic is presented in order to divert attention from the original issue. The basic idea is to “win” an argument by leading attention away from the argument and to another topic.  A common variation on this is the smokescreen: it functions like a red herring, but the attempt at diversion involves piling on complexities on the original issue until it is lost in the verbal smoke. This sort of “reasoning” has the following form:

1. Topic A is under discussion.

2. Topic B is introduced under the guise of being relevant to topic A (when topic B is actually not relevant to topic A).

3. Topic A is abandoned.

This sort of “reasoning” is fallacious because merely changing the topic of discussion hardly counts as an argument against a claim.

In the case of Sebelius, her attempts to switch to other issues and to pile on other matters did not answer Stewart’s reasonable question. In general, people use this tactic in response to a question when they either 1) have no answer to the question or 2) have a problematic or bad answer to the question. In the case of Sebelius, I would suspect that the second option holds: she almost certainly has an answer, but it almost certainly is not a good one.

Stewart seems to have drawn this sort of conclusion regarding Sebelius’ maneuvering:

“I still don’t understand why individuals have to sign up and businesses don’t, because if the businesses — if she’s saying, ‘well, they get a delay because that doesn’t matter anyway because they already give health care,’ then you think to yourself, ‘fuck it, then why do they have to sign up at all. And then I think to myself, ‘well, maybe she’s just lying to me.’”

In terms of why this question matters, one obvious point of concern is the matter of fairness. If large businesses get a year delay, then fairness would seem to require that the same courtesy be extended to individuals.

It might be countered that there is a relevant difference between large businesses and individuals that warrants the difference in treatment. If so, Sebelius should have simply presented this difference or differences and that would have quickly settled the matter. For example, it might be the case that a large business would need more time to implement the change on such a large scale, while an individual just has to implement it for herself. But, Sebelius provided no such relevant difference and spent her time trying throw out red herrings and blow smoke. This suggests that she was either ignorant of a relevant difference or was aware that the difference did not actually justify the difference in treatment. That is, there is no legitimate relevant difference.  Given her position, the explanation based on her ignorance seems unlikely, so the reasonable conclusion is that she knew the answer, but believes that it would make things look worse than engaging in evasion. Of course, it is also possible that such evasion are just a matter of how politicians operate—like the famous scorpion being carried across the river, they cannot deviate from their nature. In any case, Sebelius’ behavior creates the impression that something is wrong here and creating this impression is, I am sure, not what she intended in her interview.

Interestingly, while this difference between businesses and individuals is a legitimate point of criticism, the Republicans seem to have little interest in engaging Obamacare in depth on points where it actually generates legitimate concerns. While the Republicans have noted that they want to defund or delay Obamacare, they seem to be unable to avoid hyperbole and other excesses of defective rhetoric. I suspect that this occurs for a variety of reasons. One possibility is that they are also like that scorpion: they simply cannot bring themselves to engage the matter of Obamacare in a rational way—instead, they have to sting away with crazy rhetoric and a government shutdown. Another possibility is that they believe that engaging in the actual issues will be bad for them in some manner. A third possibility, which is more specific than the second,  is that they believe that their target audience is best played to by such rhetoric and behavior and that they would be ill served politically by engaging on actual issues in a rational manner. As a final possibility, they might not actually care about Obamacare as such—rather, they are simply out to oppose Obama and Obamacare happens to be the point of contention. To use an analogy, they are like Meletus in the Apology—they are not concerned with what they claim to be concerned about, they are just out to get their man.

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Shutting it Down

Posted in Business, Ethics, Medicine/Health, Philosophy, Politics by Michael LaBossiere on October 2, 2013
English: President Barack Obama's signature on...

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Once again, the United States government has been shut down. As is to be expected, the politicians and pundits are engaging in the blame game. A key Republican talking point is that Obama and the Democrats are to blame because they would not compromise on the matter of Obamacare. If, say the Tea Party Republicans, Obama had been willing to defund or delay Obamacare, then they would not have been forced to do what they did.

The obvious counter to this is that Obamacare became a law via the proper constitutional process and hence this is no longer a compromise situation. It should also be noted that the proposed compromise is a rather odd one. It is as if the Republicans in question are saying: “here is our compromise: we get our way on Obamacare and, in return, we will not shut down the government.” That hardly seems like a reasonable compromise. To use an analogy, it would be like being in a bus heading to an event that was voted on by the people on the bus. Then some folks say that they do not like where the bus is going and one of them grabs the wheel. He then says “here is my compromise: we go where I want to go, or I’ll drive us into a tree.” That is hardly a compromise. Or even sane.

It could be argued that Obama and the Democrats should have done a better job in the past in terms of getting Republican buy-in on Obamacare. Or that the fact that the Republicans are a majority in the house shows that Americans want to be rid of Obamacare. These are not unreasonable points. However, they do not justify shutting down the government.

While I believe that Obamacare is chock full of problems and will have a variety of unpleasant consequences, I also believe in the importance of following the constitution. That is, I believe in the process of law. Obamacare went through that process and properly became a law. As such, there do not seem to be any grounds for claiming that it should be stopped because it is somehow an improperly passed law.

There have been claims that Obamacare is unconstitutional. There are some merits to these claims, but the matter was properly settled by the Supreme Court. Presumably the matter could be reconsidered at a later date, but the constitutional process has been properly followed. As such, the rhetorical points that Obamacare is unconstitutional lack merit. However, even if there was new and most excellent legal argument for this claim, this would not warrant shutting down the government to block the law. It would warrant having the Supreme Court consider the argument. That is proper procedure—that is how a system of government should operate. Using the threat of a shutdown against a law is certainly not how things should be done. That is essentially attempting to “govern” by threats, coercion and blackmail.

To use an analogy, imagine a night baseball game in which one side is losing. That side has argued every call repeatedly and used all the rules of the game to try to not lose. But it is still losing. So the coach of the losing team says that his team will turn out the lights, take all the balls, rip up the bases, and throw away the bats unless the other team “compromises” and gives them all the points they want. That would obviously be absurd. Likewise for the Tea Party Republican shut down.

A possible approach to warranting the shutdown is based on the idea of popular democracy. Some have argued that Obamacare is unpopular with most Americans. While this seems true, it also is true that most Americans do not seem to have enough of an understanding of Obamacare to have a rational opinion and much of the alleged dislike seems to stem from how the questions are asked. Interestingly, many people seem to really like things like the fact that people cannot be denied coverage because of pre-existing conditions and that children can stay on their parents’ insurance until they are 26.

Since this is supposed to be something of a democracy, considering the will of the people (however confused and ill-informed the people might be) seems reasonable. However, this would need to be a consistent principle. That is, if the Tea Party Republicans say that they are warranted in shutting down the government because a majority of Americans are opposed to Obamacare, then they would need to accept that the same principle applies in the case of other laws as well. So, if most Americans believe that X should be a law or that X should not be a law, then that is what must be done—and if it is not done, the government must be shut down. Given the overwhelming support for certain gun control laws that congress refused to pass, if this principle is accepted then these laws must pass—or the government must be shut down.

However, the Tea Party Republicans are clearly not operating on a principle here, unless it is the principle of “we’ll shut down the government if we don’t get what we want”—but that is hardly a reasonable or democratic principle.

Another plausible approach to countering this is to argue that a shutdown can be justified on the grounds that a legitimately passed, Supreme Court tested law is so bad that action must be taken. While this could not be warranted on constitutional grounds, it could be justified on moral grounds, most likely utilitarian grounds. The idea would be that the consequences of allowing the law to go into effect would be so dire that the consequences of shutting down the government are offset by the achievement of a greater good. Or, rather, the prevention of a greater bad.

Interestingly, this could be seen as a variation on civil disobedience. But, rather than have citizens breaking an unjust law to get arrested, there are lawmakers breaking the government—or at least the parts that don’t pay their salary.

Since I find Thoreau’s arguments in favor of such civil disobedience appealing, I have considerable sympathy for lawmakers deciding to serve the state with their consciences. However, what needs to be shown is that the law is so unjust that it warrants such a serious act of civil disobedience.

Ted Cruz and other Tea Party Republicans have made various dire claims about Obamacare—it will result in people being fired, it will cause employers to cut hours so that workers become part-time workers, and so on. Cruz even brought out a comparison to the Nazis, which did not go over well with the Republican senator John McCain. Interestingly, Cruz and others have attributed backwards causation powers to Obamacare: the stock talking points well before Obamacare went into effect included claims that Americans were already suffering under Obamacare—despite the fact that it was not in effect.

When pressed on the damage that Obamacare will do, the Tea Party Republicans tend to be rather vague—they throw out claims about how it will come between a patient and her doctor and so on. However, they never got around to presenting an obective coherent, supported case regarding the likely harms of Obamacare. This is hardly surprising. As a general rule, if someone busts out a Nazi analogy, then this is a fairly reliable sign that they have nothing substantial to say. This is, I think, unfortunate and unnecessary: Obamacare no doubt has plenty of problems and if it is as bad as the Tea Party Republicans claim, they should have been able to present a clear list without having to resort to rhetoric, scare tactic, hyperbole and Nazi analogies. So, I ask for such a clear case for the harms of Obamacare.

As a final point, Obama has made the reasonable point that he has been asking the Republicans for their input and their alternative plan for health care for quite some time. Some Republicans have advocated the emergency room, which I wrote about earlier, but their main offering seems to be purely negative: get rid of Obamacare. In terms of a positive alternative, they seem to have nothing. But, I am a fair person and merely ask for at least an outline of their alternative plan.

 

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Cruzing & Obamacaring

Posted in Business, Ethics, Law, Medicine/Health, Philosophy by Michael LaBossiere on September 27, 2013
English: Logo of The Goldman Sachs Group, Inc....

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Ted Cruz undertook an almost marathon talking session against Obamacare. Not surprisingly, he does not have any need of Obamacare. As a senator, he already has access to government funded healthcare. However, he also does not need this coverage as, apparently, he falls under his wife’s Goldman Sachs’ coverage. Interestingly, while one of the anti-Obamacare talking points is that the cost of providing insurance will destroy business, the top executives at Goldman Sachs have their $40,500+ family premiums paid for by the company. As a point of comparison, the median household income in the United States is $50,000.

Naturally, to attack Cruz’s claims by pointing out his health care situation would be a mere ad homimem. However, his situation does serve to illustrate the incredible health care gap between the wealthy pundits and politicians attacking Obamacare and average Americans. It is certainly a thing of beauty to see a man with incredible coverage provided for by his wife’s employer rail against a law that would require almost many employers to provide lesser coverage to their employees.

It also illustrates an interesting inconsistency, namely that he seems to hold to the position that his wife should receive health care benefits from her employer but that the same is not true for other Americans. Of course, it is consistent with the view that the wealthy should be treated differently from everyone else.

It might, however, be objected that Cruz is right. After all, Goldman Sachs is incredibly profitable and can easily afford such premiums as part of the very generous (some might say excessive) compensation packages they offer to their “top talent.” Lesser businesses, those run by and employing the little people, cannot afford to provide even the minimum health care benefits required by Obamacare and, apparently, the employees do not deserve such coverage. As such, health care benefits from employers are for the wealthy but not for the little people.

While this approach has some merit when it comes to small businesses, the obvious counter is that the smaller businesses are exempt from this requirement. However, the potential economic impact of Obamacare is worth considering. As is the potential economic damage of the threatened government shut down.

It has been claimed that the cost of implementing Obamacare will cause businesses to fire people and to cut employee hours so that they are not full time employees. Presumably this will not impact the wealthy—Cruz did not seem worried that Goldman Sachs would fire his wife or cut her hours so they would not need to provide healthcare benefits.

While cost is a point of concern, there is the obvious question of whether businesses actually need to fire people and reduce hours or not as a rational response to Obamacare. That is, would the increased cost be so onerous that the firing and cutting would be a matter of survival? Or would it merely be a matter of slightly less profits?  After all, some businesses obviously believe they can afford to provide extremely generous health care benefits to some people, so perhaps those affected can afford to provide lesser benefits to their workers.

This does, of course, raise some interesting questions about what benefits employees should receive and what constitutes economic necessity. However, these matters go beyond the scope of this essay. However, I will note that I do agree that health care should not be linked to employment and that I do agree that it should not be the responsibility of businesses to provide health care coverage. Unfortunately, the structure of health care benefits in the United States is such that having businesses as the provider is the main viable option. The other is, of course, having it provided by the state. Unless, of course, health care could be reformed to the point where average individuals could afford quality health care on their average incomes.

Oddly enough, Cruz and others have spoken of all the terrible damage that Obamacare has done and is doing. While this might be merely a slip of tenses, Obamacare cannot be doing any damage yet—it has not gone into effect. As such, it is an error to speak of the damage it has done—at least until it starts doing damage.

Cruz also made use of hyperbole and a rhetorical analogy by trotting out the absurd comparison of Obamacare to the Nazis. In the past, I have advocated a bi-partisan ban on this (Democrats use it, too) and I still support this proposal. As a general rule, only things that are comparable in badness to the Nazis should be compared to the Nazis. Even if Obamacare does all the awful things that certain Republicans claim it will do, it will obviously fall far short of starting a world war and engaging in genocide. Making the Nazi comparsion seems to show that a person has nothing substantial to say or that he has an impaired grasp of reality.

While Obamacare will certainly have problems, Cruz and his fellows have not offered any alternative plan of any substance. For the most part they make vague claims about market reforms and some even advance the absurd idea that people can just rely on the emergency room. While it is fair to be critical of a law when one does not have an alternative, the Republicans need to offer something other than threats to shut down the government. This makes these Republicans seem rather crazy.

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Is the Emergency Room a Viable Alternative?

Posted in Ethics, Law, Medicine/Health, Philosophy by Michael LaBossiere on August 30, 2013
Typical scene at a local emergency room

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As Obamacare marches onward, its opponents are still endeavoring to stop its advance and send it packing. Of course, the opponents need to provide an alternative system. Interestingly, certain Republicans such as Rick Perry and Jim DeMint have claimed that uninsured Americans are better off relying on the emergency room for treatment. While the battle over Obamacare is largely ideological, the viability of using the emergency room would seem to be an objective matter.

On the positive side, anyone can go to the emergency room and hospitals cannot refuse to treat people with legitimate medical needs—even people who lack insurance or cannot pay.

However, there are numerous problems with the uninsured (or even the insured) relying on the emergency room. The first is the matter of cost. The emergency room is generally more expensive than the non-emergency options. It is certainly more expensive that routine preventative care that can keep a person out of the emergency room. The high costs are problematic because of the burden on the uninsured (medical bills is a leading cause of bankruptcy in America) and also because when the uninsured cannot pay, the cost is passed on to the rest of us (most often in the form of higher health insurance premiums). Thus, relying on the emergency room to treat the uninsured places a heavy burden on everyone and is actually a form of highly inefficient socialism in which those with insurance pay for needlessly expensive treatment for the uninsured. From a purely economic standpoint, if we are going to have medical socialism, we should at least go with the more economically efficient version.

The second is the matter of preventative medicine and ongoing treatments, such as routine checkups and dialysis. The emergency room hardly seems to be set for these medical matters, although people who are unable to avail themselves of them stand a significant chance of ending up in the emergency room, thus taking us back to the first problem. As such, the emergency room option does not seem to be a viable alternative to Obamacare. This is not to say that Obamacare is the only option or even a good option—just that it is better than the emergency-room-for-the-uninsured option.

The third is the matter of compassion. While hospitals cannot deny people necessary medical care, such care is certainly not charity: either the patient must pay or the cost is passed on to the rest of us. As such, relying on the emergency room as a matter of social policy is essentially saying to people that they can get treatment, provided that it is an emergency and that either the patient can pay or the cost can be passed on to everyone else. It is generally agreed that we should collectively protect each other from terrorism, foreign enemies, and our own criminals. This same concern should also extend to protecting each other from disease and injury. After all, whether Sally is dead because of cancer, a criminal’s bullet or a terrorist’s bomb, she is still dead. So, if we can have a huge collective defense against these other threats, we surely can have a developed collective defense against medical threats—one that is better than the emergency room.

 

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Contingent Faculty

Posted in Universities & Colleges by Michael LaBossiere on January 16, 2013
Tenure (film)

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When I began my career as a professor, I worked as an adjunct. There are many downsides to being an adjunct, not the least of which is that employment is entirely contingent. That is, an adjunct can be let go simply by not offering a contract for the next semester. It is also not uncommon for adjuncts to begin work with only the promise of a contract-a promise that sometimes turns out to be empty.

After being an adjunct, I became a visiting professor. This is rather better than being an adjunct, since it comes with better pay, benefits and the contract length is longer (a year or sometimes longer). However, visiting professorships are (by their very nature) limited in duration. Visiting professors also do not, as visiting faculty, earn tenure.

After being a visiting professor, I was able to get into a tenure track line and eventually earned tenure. There are various misconceptions about tenure, such as the notion that tenured faculty cannot be fired. This is not true-tenured faculty can be fired. Unlike contingent faculty, a tenured faculty member can not be simply let go. Rather, a tenured faculty member can only (in general) be fired for cause.

While tenure is presented as its detractors as a means by which inept faculty can avoid being fired as they coast towards an easy retirement, this is not its intended or actual purpose. One purpose of tenure is to serve as an incentive for success. That is, if a faculty member works hard for the better part of a decade and achieves professional success, then she can get the security of tenure. Naturally, this is not as lucrative as the rewards ladled out to comparable levels of success in the financial or business sectors-but people who go into academics tend to have somewhat different values. To steal a line from the folks who argue relentless against depriving the wealthy of even a fraction of their wealth, to remove tenure would punish success and destroy incentive. After all, if the job creators would be broken and demoralized by tax increases, then presumably the faculty would also be broken and demoralized by the loss of tenure. But perhaps significant incentives are only fit for the job creators and no one else.

A second reason for tenure is to protect academic freedom. Once a faculty member has tenure, then she has a degree of protection that can allow her to express intellectual ideas without (much) fear of being simply disposed of in retaliation. To be honest, once a person has spent years grinding away towards tenure, she has obviously learned to work within the system. One rarely sees a faculty member suddenly emerging from the caterpillar state of being tenure earning to become a radical butterfly once getting tenure. However, tenure still serves a valuable purpose by protecting intellectual freedom more than a lack of tenure would.

As might be imagined, some are opposed to tenure. These people tend to favor the business model of academics in which one key goal is to reduce labor costs. By removing tenure, faculty can be let go and replaced with cheaper faculty as needed. Also, faculty perceived as “troublesome” (such as union organizers) could be fired, thus reducing the threat of a powerful faculty union.

Some people also oppose tenure on more philosophical grounds. One common view is that employers should have the right to fire employees at any time, even without cause or reason. Going along with this view, obviously enough, is the idea that employees do not have any right to be employed. Interestingly enough, many of the same folks who hold this view also contend that the risk-takers in business should have the chance for massive rewards because of the risks they take. Interestingly, they seem to fail to see that people working without job security are rather big risk takers. After all, everyday is a day they risk being fired because their employer wants to cut expenses to boost profits.

Folks who support this view often tend to point to live outside of academics where most workers lack job security. A standard refrain is “why should tenured faculty have the job security that other workers lack?” But, a better question might be “why should other workers lack the opportunity to earn the job security that faculty enjoy?”

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