Tuesday, August 11, 2009

Dissent is *Still* Patriotic

The “debate” surrounding health care reform has caught almost everyone's attention. The vocal opponents of health care have been variously described as a “mob”, “un-American,” and even “brownshirts.” This isn't just anyone saying this, but it is (in order), arguably the leading progressive columnist (Krugman), the #1 and #2 Democratic leaders in the House, and a U.S. Congressperson. The hostility and animosity expressed during these demonstratiosn including firearms being brought to events or Sarah Palin saying that a “death panel” would euthanize her son because he has Down's Syndrome (before, gallantly calling for civility) is becoming downright scary, including the actual death threats against sitting members of Congress. But, to have the kind of people calling out opponents of health care as un-American or comparing them to fascists is downright wrong.

Although I disagree with the tactics used by those who oppose health care reform, Andrew got me thinking about what it means to denounce them. Very thoughtfully, he reminded me that the sort of “deliberative debate” that I would prefer

imply a particular kind of deliberative democratic subject:

- One who is calm, considered, rational, and deliberative. This worries me because it implies that emotion is an illegitimate way of engaging in politics. That, in turn, privileges particular kinds of people, and kinds of discourses, as a matter of form.

He is right to point out that many people, often those who I care about greatly and support, use these tactics. I have been to labor protests where the rules of civility were thrown out the window because civility favored management. Disruption hit the financial bottom line and forced the managers, who were hiding behind this cloak of civility, to take notice. There is, I suppose, nothing wrong with these protests as a tactic and, certainly nothing un-American or fascist about them (leaving any violence—real or implied—aside). Americans have a right to redress their grievances to their government; nothing ever said that the government had to like the way that citizens chose to carry out this redress.

This reminded me of a really influential passage in the book Urban Fortunes by John Logan and Harvey Molotch. The book describes the process of urban land development, providing an interesting synthesis between traditional neo-classical and human ecological models of urban growth and Marxian models of economic growth. One of their main points throughout the book is that:

The traditional academic literature on the topic tends to equate “community organization” with progressive social forces generally and to see all such groups as analytically equivalent because they are from the “grass roots” and help “empower” local people.

They go on to point out that many local organizations (their interest is in understanding the forces guiding urban development) are indeed not progressive. One can look back in history to local community forces that were, indeed, not so progressive such as the northern white block clubs that tried to maintain the starkly segregated residential color line.

I have seen the argument that there is a difference because these protests are “astroturffed”, insta-activism bought by the insurance lobby. Although it seems to be funded by the insurance lobby, I also have a hard time believing that all of these activists are bought off. I also don't think, as Paul Krugman suggests, that “the driving force behind the town hall mobs is probably the same cultural and racial anxiety that’s behind the ‘birther’ movement, which denies Mr. Obama’s citizenship.” Granted, many of the birthers are probably among the crowds, but to say that this is all about Obama's race or that the tactics are somehow un-American denies the reality that there is a substantial opposition to health care reform. I don't think that it is the result of deep-seated hatred (though, for some, this is undoubtedly the case), but is likely a fear and mistrust of the government that has a real basis in reality.

The answer to this is not to disparage and insult those who are protesting, to question their patriotism (remember the “Dissent is Patriotic” bumper stickers). It is to organize an opposition, including some who might simply be confused or nervous about changes and have real concerns about government-run programs. I'm not tilting at windmills; I don't believe that one will ever convince most of the people shouting at town halls and I think that it would be futile to do so. But there are lots of people, I would guess, who are hearing some of their concerns echoed by the vocal protesters and who see that people—fellow citizens—really care about opposing this bill. Without effective organizing to counter-act this movement and inoculation against the opposition's talking points health reform is unlikely to succeed. Reformers have the advantage is that there are many in the reform movement, including the President himself, who have learned how to build an effective organizing base from which to enact reform. If this truly is an astroturf campaign, then real organizing (with time) should be able to overcome it. I just hope that he remembers that is how he got to have the meteoric rise from a state senator to President in less than a decade and that he calls some of those advisors up to help rather than those he keeps finding from inside the Beltway.

Saturday, August 8, 2009

The Unconscionable Math of Insurance Fraud by Insurance Companies

E. and I were driving home from a family function last week and caught the end of the This American Life episode on "fine print." Among the stories was a heart-wrenching tale about the problem of rescission, which is basically where insurance companies take premiums for years and, right when you need an expensive procedure, drop your insurance because you "lied" on your application. This really affects people who get their insurance on the private market. During the episode (described in more detail by James Kwak at Baseline Scenario), the health insurance companies being grilled during congressional testimony argued that rescission affects about 0.5% of their clients.

But, in a truly amazing post, Taunter explains how conditional probability can explain why this 0.5% can sound so small but amount to an unconscionable fraud on the part of insurance agencies. Using the Monty Hall Problem (and, implicitly, Bayesian reasoning), he explains why the insurance executives essentially bank on rescinding one in two claimants for those in need of service! He points out that you have a three times better chance to survive a game of Russian Roulette. It is an amazing lesson in conditional probability and Bayes Theorem that could be an incredible teaching moment.

Until the patients needs an expensive procedure, patients are paying their premiums into the coffers of the insurance company and the pockets of their executives. The expensive procedures, of course, are why people need insurance. The insurance companies, though, get to keep all those years of premiums for all of those years even though they don't follow through on their commitment to pay out, getting rich off those years and years of premiums. The procedure goes something like this: take money from a group of people and promise them a return in the future, use the money to pay off claims of others (minus a heavy for the service), and when it comes time to pay out, renege. Taunter points out that this seems vaguely Madoffian.

The justification of this procedure is that, without it, insurance prices would rise for everyone in the system and that people should be punished for fraud. Of course, many of these people did not commit any sort of fraud and instead got confused by the leagalese and convoluted medical language which were intentionally designed to get people to slip up. It is probably true that insurance premiums would probably go up, but it doesn't really matter if people aren't getting a service that they pay for (in other contexts, that's called stealing). But, it is also an argument for why the "free market" does not always know best and why health care reform is so important. I hope that in the coming days and weeks, the Obama administration and Congress get their footing and actually start to stand up for reform.