With supporters arguing it would make coverage more affordable, lawmakers began considering a bill Wednesday that would open Florida to stripped-down health insurance policies from other states.
The bill, which was approved by a House subcommittee, could undergo major changes in the coming weeks. But at a minimum, the proposal refueled a long-running debate about whether coverage requirements --- known as "mandates" --- drive up the cost of insurance in Florida.
Friday, March 25, 2011
Money, Meet Mouth
Earlier this month, I mentioned that while states have the power to enact certain proposals--like allowing out-of-state health insurance policies to be sold in their markets--none were yet putting their money where their mouth is. Well, one state edged its way a little closer to that possibility this week (though it's still a long away away from actually allowing this):
Friday, March 18, 2011
State Symbols
Utah recently designated the nation's first official state firearm , choosing the Browning M1911 pistol. I say Ohio shows everyone who's got the bigger balls (figuratively and literally) and makes their state firearm "the Dictator" from the American Civil War.
I don't know if the Dictator could technically be classified as a "firearm", but then again choosing a state firearm is ridiculous anyway so who cares.
Friday, March 4, 2011
Why Conservatives Hate Trains
A recent piece by conservative columnist George Will—which is earnestly subtitled “Why Liberals Love Trains”—offers this delightful bit of analysis:
Though obnoxiously written, Will’s article gets at the great philosophical schism of our time, of the modern era, perhaps in all of human history: man vs.wild society, individual vs. the collective, E Pluribus Unum.
A slightly more useful tool than trains for thinking about that difference, I think, is from this summary of a report, “Thoughts and Feeling About Health Differences Across Populations in the United States,” which appears as Appendix A in this document. Through interviews with Congressional staffers and health policy folks affiliated with one party or the other, the authors attempted to identify the prevalent frames that shaped the thinking of partisans on the social determinants of health.
The conclusion was that Democrats understand health and the social factors influencing it in terms of a system:
Republicans, on the other hand, conceptualize these factors in terms of a journey:
I can certainly understand that; I'm partial to path metaphors myself. But extrapolating this out a bit beyond health issues, it's an apt way to think about the philosophical gulf between the left and right.
The right sneers that the liberals are "collectivists" because the left tends to think systemically and conceptualizes the individual as being embedded in a broader structure, a structure that inexorably binds the fates of all those who share it. Liberal thought thus often focuses on how to improve various systems. The world is a project, one in which mandatory busing is a plausible mechanism for overcoming centuries of pervasive racism and segregation; publicly-supported low-income nutrition and early education programs coupled with a strong public school system and diversified, subsidized post-secondary education is key to building the well-functioning workforce of tomorrow; and one in which a comprehensive law with multi-faceted moving parts working in concert is a conceivable avenue toward higher quality, lower cost health care.
The left, on the other hand, marvels at the right's uncompromising understanding of liberty and individualism. To the right, "society" as an emergent structure with a meaning and existence independent of the myriad interactions between individuals is a fiction--or at least an unsubstantiated myth. Thus the supremacy of markets is beyond doubt, as they are the embodiment of the journey concept. They revolve around individuals acting in accordance with personal preferences; even the hint of some sort of centralized component, such as the fact that federal legislation is compelling the creation of new health insurance markets as we speak, will raise suspicion among the right.
Crude caricatures through these may be, we can see them playing out even now. The liberal's systems-eye view of power differentials between workers and corporations or, yes, even governments lends itself to an affinity for organization: collective bargaining provides the counterweight in the system that's needed to ensure fair remuneration for labor. The conservative's journey frame reassures him that the determination or negotiation of wages and benefits is a part of the personal journey, to be based on the individual's merits. The phrase "collective bargaining" is enough to give him chills.
And so I find that, despite my initial revulsion at Will's column, it has a certain element of truth to it. Trains are invariably part of a system; something's got to keep them running on time. Cars, on the other hand, are closer to the conservative's individualistic journey metaphor. Of course, I don't think liberals inherently dislike cars. But notice that the pretexts for high-speed rail that Will dismisses as flimsy--combating climate change, bolstering national security, reducing congestion, and rationalizing land use--all imply pursuing rail as part of a collective solution to a collective problem. Each of those issues is a problem to be addressed by tinkering with systems, not by us taking it on individual-by-individual, one at a time, like villains in a Jackie Chan movie. But more narrowly, transit itself is an issue of systems: we're talking about the connections that network our cities, the fabric that binds out society. Roads are part of that same system, of course, but alone in his car and choosing his favorite radio station, the conservative can forget that his journey is only possible because it's embedded in a broader structure (dare I say system yet again?) of crisscrossing, well-defined roads. But no one would accuse cars of being part of a coherent system for collectively achieving a goal.
Forever seeking Archimedean levers for prying the world in directions they prefer, progressives say they embrace high-speed rail for many reasons—to improve the climate, increase competitiveness, enhance national security, reduce congestion, and rationalize land use. The length of the list of reasons, and the flimsiness of each, points to this conclusion: the real reason for progressives’ passion for trains is their goal of diminishing Americans’ individualism in order to make them more amenable to collectivism.
To progressives, the best thing about railroads is that people riding them are not in automobiles, which are subversive of the deference on which progressivism depends. Automobiles go hither and yon, wherever and whenever the driver desires, without timetables. Automobiles encourage people to think they—unsupervised, untutored, and unscripted—are masters of their fates. The automobile encourages people in delusions of adequacy, which make them resistant to government by experts who know what choices people should make.
Though obnoxiously written, Will’s article gets at the great philosophical schism of our time, of the modern era, perhaps in all of human history: man vs.
A slightly more useful tool than trains for thinking about that difference, I think, is from this summary of a report, “Thoughts and Feeling About Health Differences Across Populations in the United States,” which appears as Appendix A in this document. Through interviews with Congressional staffers and health policy folks affiliated with one party or the other, the authors attempted to identify the prevalent frames that shaped the thinking of partisans on the social determinants of health.
The conclusion was that Democrats understand health and the social factors influencing it in terms of a system:
Broadly, the system-deep metaphor refers to the unification and organization of separate entities into a whole. The unity of a system means that the parts are interdependent; these connected parts often operate in a predictable and recurrent pattern with certain results.
For Democrats in particular, the system frame operates on two levels. First, American society as a whole is a complex system that unifies all citizens. As such, all individuals, from the poorest person in the Bronx to the wealthiest person in Manhattan, are interdependent, even if this is not readily apparent. [...]
The second level on which the deep metaphor system operates is that Democrats view poor levels of health as emerging from a complex and interrelated system of social, cultural, economic, and biological factors.
Republicans, on the other hand, conceptualize these factors in terms of a journey:
Where system forms the fundamental lens through which Democrats view society and health, the deep metaphor journey is the predominant frame through which Republicans view American society and health issues. Broadly, journey often frames our discussion of life itself. Journeys can be fraught with challenge or can be smooth sailing; they can be direct or divergent. Some journeys are unpredictable, where others focus on a series of steps that, if followed, will take you to a predetermined place or goal.
The type of journey that a group describes can yield much insight into how they view a given topic. For Republicans, American society as a whole is on a long, unpredictable health journey through time. They use metaphors of winding paths and stress the importance of adaptability in the face of an unknown future direction. [...]
Much as they see America and health care as a whole on a journey through time, Republicans see individuals as on their own health journeys. Echoing the common theme of “individual responsibility,” Republicans view poor health as arising from bad choices along one’s path and the inability to overcome obstacles to health that one encounters along the way.
I can certainly understand that; I'm partial to path metaphors myself. But extrapolating this out a bit beyond health issues, it's an apt way to think about the philosophical gulf between the left and right.
The right sneers that the liberals are "collectivists" because the left tends to think systemically and conceptualizes the individual as being embedded in a broader structure, a structure that inexorably binds the fates of all those who share it. Liberal thought thus often focuses on how to improve various systems. The world is a project, one in which mandatory busing is a plausible mechanism for overcoming centuries of pervasive racism and segregation; publicly-supported low-income nutrition and early education programs coupled with a strong public school system and diversified, subsidized post-secondary education is key to building the well-functioning workforce of tomorrow; and one in which a comprehensive law with multi-faceted moving parts working in concert is a conceivable avenue toward higher quality, lower cost health care.
The left, on the other hand, marvels at the right's uncompromising understanding of liberty and individualism. To the right, "society" as an emergent structure with a meaning and existence independent of the myriad interactions between individuals is a fiction--or at least an unsubstantiated myth. Thus the supremacy of markets is beyond doubt, as they are the embodiment of the journey concept. They revolve around individuals acting in accordance with personal preferences; even the hint of some sort of centralized component, such as the fact that federal legislation is compelling the creation of new health insurance markets as we speak, will raise suspicion among the right.
Crude caricatures through these may be, we can see them playing out even now. The liberal's systems-eye view of power differentials between workers and corporations or, yes, even governments lends itself to an affinity for organization: collective bargaining provides the counterweight in the system that's needed to ensure fair remuneration for labor. The conservative's journey frame reassures him that the determination or negotiation of wages and benefits is a part of the personal journey, to be based on the individual's merits. The phrase "collective bargaining" is enough to give him chills.
And so I find that, despite my initial revulsion at Will's column, it has a certain element of truth to it. Trains are invariably part of a system; something's got to keep them running on time. Cars, on the other hand, are closer to the conservative's individualistic journey metaphor. Of course, I don't think liberals inherently dislike cars. But notice that the pretexts for high-speed rail that Will dismisses as flimsy--combating climate change, bolstering national security, reducing congestion, and rationalizing land use--all imply pursuing rail as part of a collective solution to a collective problem. Each of those issues is a problem to be addressed by tinkering with systems, not by us taking it on individual-by-individual, one at a time, like villains in a Jackie Chan movie. But more narrowly, transit itself is an issue of systems: we're talking about the connections that network our cities, the fabric that binds out society. Roads are part of that same system, of course, but alone in his car and choosing his favorite radio station, the conservative can forget that his journey is only possible because it's embedded in a broader structure (dare I say system yet again?) of crisscrossing, well-defined roads. But no one would accuse cars of being part of a coherent system for collectively achieving a goal.
States' Rights
The 2010 election was a tidal wave that swept the Republican Party into power. I'm not talking about at the federal level (though the U.S. House elections could be described similarly), I'm talking about state-level elections. Take a look at where things stand at the state level now, in the wake of the 2010 elections:
Governors
State legislatures
And to condense that information into a single map I've put together myself (instead of stealing it from NCSL) with some shading to indicate the degree of Republican control over the levers of state power:
So now we've got an interesting situation. The Republican Party is typically--particularly during the 2010 election cycle--considered to be a conservative party. That often manifests itself as a declaration that the size of the federal government ought to be reduced and its powers and responsibilities pared down. "Let the states run their own affairs!" some of them exclaim. Their bias, rhetorically at least, is to leave governmental functions to state governments unless it's absolutely necessary for the federal government to assume them.
That party is now in a position of tremendous power in state governments across the nation (a reality that traditionally blueish states like Wisconsin are just waking up to now, apparently). So one might expect some of the Republican standby policy suggestions to be implemented in at least some states. Taking health care as an example, the national Republican party often likes to push suggestions such as insurance market deregulation, tort reform, and across-state-lines health insurance purchasing.
Good news for them: all of these things can be done at the state level. To take a Republican favorite: any state may allow out-of-state insurance policies to be sold in its insurance market. That would bring the insurer competition to the state's market that Republicans claim to desire and it doesn't require any federal action. So I perused the websites of the state legislatures of the red-tinted states to see what kind of action is happening on this front now that Republicans have such a prominent role in the nation's state-level politics.
As near as I can tell, interstate purchasing bills have been introduced in the legislatures of only six states (and of them, only the bill in Missouri seems to have actually made it as far as having a committee hearing thus far):
A bit of an anemic showing given the alleged Republican affection for this idea. Perhaps the Party of the Tenth Amendment is waiting for action at the federal level? Time will tell.
But the fact remains that the Republicans now hold power in quite a few states and they supposedly have a philosophical predilection toward letting states handle most kinds of policy reforms, leaving the federal government out of it. It will be fascinating to see how much of their erstwhile national agenda (e.g. the federalization of tort law or federal laws allowing interstate insurance purchasing) they push in the states. My guess is that it won't be quite as much as one might expect.
Governors
State legislatures
And to condense that information into a single map I've put together myself (instead of stealing it from NCSL) with some shading to indicate the degree of Republican control over the levers of state power:
So now we've got an interesting situation. The Republican Party is typically--particularly during the 2010 election cycle--considered to be a conservative party. That often manifests itself as a declaration that the size of the federal government ought to be reduced and its powers and responsibilities pared down. "Let the states run their own affairs!" some of them exclaim. Their bias, rhetorically at least, is to leave governmental functions to state governments unless it's absolutely necessary for the federal government to assume them.
That party is now in a position of tremendous power in state governments across the nation (a reality that traditionally blueish states like Wisconsin are just waking up to now, apparently). So one might expect some of the Republican standby policy suggestions to be implemented in at least some states. Taking health care as an example, the national Republican party often likes to push suggestions such as insurance market deregulation, tort reform, and across-state-lines health insurance purchasing.
Good news for them: all of these things can be done at the state level. To take a Republican favorite: any state may allow out-of-state insurance policies to be sold in its insurance market. That would bring the insurer competition to the state's market that Republicans claim to desire and it doesn't require any federal action. So I perused the websites of the state legislatures of the red-tinted states to see what kind of action is happening on this front now that Republicans have such a prominent role in the nation's state-level politics.
As near as I can tell, interstate purchasing bills have been introduced in the legislatures of only six states (and of them, only the bill in Missouri seems to have actually made it as far as having a committee hearing thus far):
| State | Legislation |
| Arizona | SB1593 |
| Indiana | HB1063 |
| Maine | LD226 | Missouri | HB 262 Foreign Health Insurance Purchase Act |
| Montana | HB445 Allow health care choice thru out-of-state policies |
| New Hampshire | SB150 |
A bit of an anemic showing given the alleged Republican affection for this idea. Perhaps the Party of the Tenth Amendment is waiting for action at the federal level? Time will tell.
But the fact remains that the Republicans now hold power in quite a few states and they supposedly have a philosophical predilection toward letting states handle most kinds of policy reforms, leaving the federal government out of it. It will be fascinating to see how much of their erstwhile national agenda (e.g. the federalization of tort law or federal laws allowing interstate insurance purchasing) they push in the states. My guess is that it won't be quite as much as one might expect.
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