Krugman – Page 3 – Sheila Kennedy

“Those People”

If there is any lesson to be learned from the current pandemic, it is that the U.S. population has suffered unnecessarily because we have stubbornly refused to do what every other modern Western nation has long done: provide universal health care.

Not only have we resisted any version of a single-payer system, we’ve thrown five million plus people off health insurance during this pandemic. And the “very stable genius”–our idiot President–has weighed in on a Supreme Court case challenging the Affordable Care Act, asking the Supreme Court to strike down a measure that provides health insurance to some twenty-three million Americans.

During a global pandemic.

So what accounts for America’s outlier status? For decades, the accepted answer to that question was some form of our individualism or our devotion to a market economy. But that excuse never really held water, because–as most of the world’s market economies understand–some areas of the economy are simply not suited to market transactions, which require a willing buyer and a willing seller, both of whom are in possession of all information relevant to the proposed transaction.

That clearly does not describe medical services.

The real answer–the real reason American government has been so unwilling to provide universal health coverage–is the same reason the rest of our social safety net is both inadequate and deliberately punitive, constructed to “weed out” anyone who can’t adequately demonstrate both need and moral worth.

I receive Paul Krugman’s newsletter (no URL of which I am aware) and awhile back, he addressed the real reason for our disinclination to offer medical care and basic sustenance to all our citizens:

Non-American friends sometimes ask me why the world’s richest major nation doesn’t have universal health care. The answer is race: we almost got universal coverage in 1947, but segregationists blocked it out of fear that it would lead to integrated hospitals (which Medicare actually did do in the 1960s.) Most of the states that have refused to expand Medicaid coverage under the Affordable Care Act, even though the federal government would bear the great bulk of the cost, are former slave states.

The Italian-American economist Alberto Alesina suddenly died on March 23; among his best work was a joint paper that examined the reasons America doesn’t have a European-style welfare state. The answer, documented at length, was racial division: in America, too many of us think of the beneficiaries of support as Those People, not like us.

There’s a significant body of social science research that confirms Alesina’s thesis.

Americans are finally grappling with the institutional racism that has distorted our society. Unlike the civil unrest of the 60s, we’ve seen significant white participation in the Black Lives Matter protests. There is finally widespread–although certainly not universal– acknowledgment of America’s “Original Sin.”

It is also finally dawning on the “chattering classes” that America’s social problems are interrelated–that the reason Grandma doesn’t have health insurance might have something to do with the fact that Grandpa and his friends have always believed they are intrinsically superior to “those people”–people who definitely don’t deserve access to services funded by Grandpa’s tax dollars.

They’re willing to forego health insurance and other benefits of a social safety net if that’s what it takes to ensure that “those people” can’t take advantage of them.

America: where we cut off our noses to spite our faces–and call it “freedom.”

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The Virus Is An Externality

Well, I see the “President” has restarted his pandemic “briefings,” and–wonder of wonders–said everyone should wear a mask. Whether that will convince any of the dangerous idiots who are refusing to do so (because “freedom”) remains to be seen.

My two favorite economists, Joseph Stiglitz and Paul Krugman, are both Nobel prizewinners. I find both to be logical and persuasive–and I’m sure that a great deal of their persuasive power is their ability to explain things clearly to non-economists, of whom I am definitely one. Krugman stepped up to the plate again in a recent column for the New York Times, in which he explained what is at stake in the mask controversy with an analogy to the economic concept of externalities.

Krugman notes that there are a number of possible reasons for rejecting the wearing of a mask.

Some of this is about insecure masculinity — people refusing to take the simplest, cheapest of precautions because they think it will make them look silly. Some of it is about culture wars: liberals wear masks, so I won’t. But a lot of it is about fetishization of individual choice.

Many things should be left up to the individual. I may not share your taste in music or want to do the same things you do with consenting adults, but such matters aren’t legitimately my business.

Other things, however, aren’t just about you. The question of whether or not to dump raw sewage into a public lake isn’t something that should be left up to individual choice. And going to a gym or refusing to wear a mask during a pandemic is exactly like dumping sewage into a lake: it’s behavior that may be convenient for the people who engage in it, but it puts others at risk.

The reference to “going to a gym” was prompted by the stubborn idiocy of Florida Governor Ron DeSantis. Krugman had opened his column with a discussion of Florida’s soaring Covid-19 case count, and the Governor’s culpability for that rise.

Florida has, of course, become a Covid-19 epicenter, with soaring case totals and a daily death toll now consistently exceeding that of the whole European Union, which has 20 times its population. But DeSantis won’t contemplate any rollback of the state’s obviously premature reopening; he even refuses to close venues that are perfect coronavirus incubators.

In particular, he insists on letting gyms — closed spaces full of people huffing and puffing — stay open. Why? Because “if you are in good shape you have a very low likelihood of ending up in a significant condition.”

As Krugman points out, this isn’t true–but the fact that healthy people can and do contract the virus is almost beside the point: gyms should be closed because the people we are trying to protect aren’t the people working out, but the people with whom they will come into contact. As he says, even gym rats have families, friends, and co-workers.

And that brings us back to externalities.

Unregulated free markets simply cannot solve the problem of externalities. Externalities are defined as costs imposed on non-consenting others, on people who have no say in the matter. Pollution is the classic example–the factory that dumps its waste in the local river in order to save the cost of proper disposal requires a government cleanup paid for with our tax dollars. Spreading a virus raises precisely the same set of issues yet, as Krugman notes, many conservatives seem unable or unwilling to grasp this simple point.

And they seem equally unwilling to grasp a related point — that there are some things that must be supplied through public policy rather than individual initiative. And the most important of these “public goods” is probably scientific knowledge.

The people who refuse to wear masks are clones of the lawbreakers willing to dump industrial waste into our rivers, and spew harmful chemicals into the air we all breathe.

The pandemic has simply allowed them to advertise what and who they are: self-centered and illogical ignoramuses polluting the environment we all must share.

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Denial Isn’t Just A River In Egypt

Sorry about that bad pun, but these day, even pathetic humor is a respite from the daily news…

And speaking of the daily news–according to one recent report on the pandemic, new cases have increased by 84% in states that don’t require the wearing of masks, and fallen by 25% in states that do.

You might consider that a clue-just a small hint that we should trust science.

After all, those numbers would seem to confirm what all those doctors and epidemiologists have been saying: mask-wearing protects us (or more accurately, protects other people from being infected by those of us who are asymptomatic). Evidently, however, America’s tribal polarization has overwhelmed sanity.

The polls tell us that a sizable majority of Americans strongly favor measures to control the spread of the pandemic over efforts to “reopen” the economy. When those numbers are broken down, however, Republican voters disagree—prioritizing the economy.

Self-identified Democrats are significantly more likely to wear a mask and engage in social distancing than self-identified Republicans.

The polling reminds me of a survey I saw a couple of years ago—well before the pandemic—in which significant numbers of Americans who would not object to their children marrying across racial or religious lines strongly disapproved of the prospect of that child marrying someone of the opposite political party.

Talk about “identity politics”!

In today’s highly polarized America, an individual’s self-identification as Republican or Democrat has come to signify a wide range of attitudes and beliefs not necessarily limited to support for a political party. Political scientist Lilliana Mason has argued that “A single vote can now indicate a person’s partisan preferences as well as his or her religion, race, ethnicity, gender, neighborhood and favorite grocery store.”

Democrat and Republican have become our new mega-identities.

The fact of extreme partisan polarization doesn’t, however, explain why identifying as Republican means being substantially less likely to believe the science that tells us Covid-19 poses a genuine threat. Of course, there’s President Trump’s determination to ignore the threat—to insist it is an artifact of testing (!), or a Democratic “hoax,” but in a recent New York Times column, Paul Krugman offered a different theory, arguing that the G.O.P.’s coronavirus denial is rooted in a worldview that goes well beyond Trump and his electoral prospects. Krugman argued that Covid-19 is like climate change: It isn’t the kind of menace the party wants to acknowledge.

“It’s not that the right is averse to fearmongering. But it doesn’t want you to fear impersonal threats that require an effective policy response, not to mention inconveniences like wearing face masks; it wants you to be afraid of people you can hate — people of a different race or supercilious liberals.”

As Adrian Bardon of Wake Forest University recently wrote in The Conversation, Americans increasingly exist in highly polarized, informationally insulated ideological communities occupying their own information universes, and engage in what political scientists call “motivated reasoning” to dismiss inconvenient or unwelcome facts.

In all fairness, this phenomenon isn’t limited to today’s GOP; the “anti-vaxxers” and “anti-GMO” activists tend to come from the left side of the political spectrum and are equally dismissive of science that doesn’t fit with their ideological preferences.

In his book, The Truth About Denial, Bardon reminds us that our human “sense of self” is intimately tied to our tribal membership and our identity group’s beliefs. We are all prone to engage in confirmation bias (what we used to call “cherry picking”), accepting expert testimony that confirms our prejudices and rejecting facts and data that contradict them.

Unfortunately, in some situations, ignoring facts can kill you. Or grandma.

https://www.alternet.org/2020/06/how-a-cognitive-failing-explains-why-so-many-people-reject-the-facts-about-the-pandemic/?utm_source=&utm_medium=email&utm_campaign=4865

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Path Dependency And Political Naiviete

One of the lessons we should–but don’t–learn from history is that revolutions almost never succeed in replacing the systems being rejected with those that are more to the liking of the revolutionaries.

Revolutions can and do change the identity of the people in charge. The American Revolution got rid of King George and English authority, for example–but it didn’t change fundamental attitudes about individual rights, or a legal system based on common law, or accepted ways of doing business.

Short of revolution, efforts to effect big changes in the way a society functions inevitably come up against social inertia and stubborn resistance to changes in habitual ways of seeing and doing. Paul Krugman–no apologist for neoliberalism–was recently interviewed by Ezra Klein, and explained why he supports the more incremental, less radical proposals on health care.

A lot of things we think of as being very left-wing are actually extremely popular — like higher taxes on rich people. But other things requiring ordinary middle class people to change aren’t ever easy to do.

Systems that are very different from our own on health care all have deep historical roots. There is enormous path dependence in policy. The systems that countries have on health care, retirement, and most other stuff has a lot to do with decisions that were made generations ago. And it’s very hard to shift to a radically different path. So incrementalism tends to rule everywhere.

Krugman points to polling that says that a public buy-in to Medicare is very popular, but a replacement of private insurance that is not voluntary is not.

The international evidence is that it’s just very hard for to make radical changes in social programs. The shape of them tends to be fixed for a really long time. US Social Security is widely held up as a role model of doing it right because we got it right at a time when things were still pretty amorphous and uninformed. On the other hand, our health care system is a mess because of decisions we made around the same time that left us with bad stuff entrenched in the system.

The operative word is “entrenched.”

Wikipedia begins its discussion of “path dependency” thusly: “Path dependence explains how the set of decisions people face for any given circumstance is limited by the decisions they have made in the past or by the events that they experienced, even though past circumstances may no longer be relevant.”

Multiple studies of path dependence confirm that previous policy decisions that have since become “the way we do things” generate enormous inertia. Studies of welfare policies, especially, have concluded that significant changes can be made only in exceptional situations. (It isn’t only politics. Studies of how technologies become path-dependent demonstrate that so-called “externalities”–habits, really– resulting from established supplier and customer preferences can lead to the dominance of one technology over another, even if the technology that “loses” is clearly superior.)

It is one thing to compare the mess that is America’s health system with the far better systems elsewhere and acknowledge that we got it wrong. In an ideal world, we would start from scratch and devise something very different. But we don’t live in an ideal world; we live in a world and country where most people fear and resist change– even change to something that is clearly superior.

No president can wave a magic wand and effect overnight transformation. FDR and Truman both pushed for forms of national health insurance and failed. Nixon also favored it. President Kennedy supported Medicare and Johnson finally got that done in 1965–after the trauma of an assassination. All other efforts failed until 2010, when Obama and Pelosi (barely) managed to get the Affordable Care Act passed. Even that compromised legislation triggered ferocious opposition, including bills that weaken it and litigation that aims to overturn it.

People who think we just have to elect a candidate who recognizes what a better system would look like, and empower that person to wave his or her magic wand and give us a “do-over,” aren’t simply naive. They’re delusional.

The question–as always–isn’t just what. It’s how.

All of the Democrats running for President know we need single-payer. Not all of them are willing to acknowledge that we face enormous barriers to getting it done. And only one, to my knowledge, has outlined a plan to overcome path-dependency and get us from here to there.

That isn’t being “moderate.” It’s being realistic.

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Red States, Blue States…And Death Rates

The other day, during a political discussion (these days, pretty much every discussion gets political) my youngest son wondered aloud whether it had been a mistake to win the Civil War. The red states of the South have been an economic drag on the blue states for a long time–they send significantly fewer dollars to Washington than they receive courtesy of blue state largesse.

My son was being flip, but his characterization of Red and Blue states wasn’t far off. As Paul Krugman wrote in a recent column in the New York Times, “the political divide is also, increasingly, an economic divide.”

Democratic-leaning areas used to look similar to Republican-leaning areas in terms of productivity, income and education. But they have been rapidly diverging, with blue areas getting more productive, richer and better educated. In the close presidential election of 2000, counties that supported Al Gore over George W. Bush accounted for only a little over half the nation’s economic output. In the close election of 2016, counties that supported Hillary Clinton accounted for 64 percent of output, almost twice the share of Trump country.

Evidently, however, we don’t just live in different economies–lately, we also die differently.

Back in the Bush years I used to encounter people who insisted that the United States had the world’s longest life expectancy. They hadn’t looked at the data, they just assumed that America was No. 1 on everything. Even then it wasn’t true: U.S. life expectancy has been below that of other advanced countries for a long time.

The death gap has, however, widened considerably in recent years as a result of increased mortality among working-age Americans. This rise in mortality has, in turn, been largely a result of rising “deaths of despair”: drug overdoses, suicides and alcohol. And the rise in these deaths has led to declining overall life expectancy for the past few years.

What I haven’t seen emphasized is the divergence in life expectancy within the United States and its close correlation with political orientation. True, a recent Times article on the phenomenon noted that life expectancy in coastal metropolitan areas is still rising about as fast as life expectancy in other advanced countries. But the regional divide goes deeper than that.

It turns out that the “death divide” Krugman is addressing is closely correlated with political orientation.

I looked at states that voted for Donald Trump versus states that voted for Clinton in 2016, and calculated average life expectancy weighted by their 2016 population. In 1990, today’s red and blue states had almost the same life expectancy. Since then, however, life expectancy in Clinton states has risen more or less in line with other advanced countries, compared with almost no gain in Trump country. At this point, blue-state residents can expect to live more than four years longer than their red-state counterparts.

There are a number of possible explanations: blue states expanded Medicaid while most red states didn’t, for example. The gap in educational levels is probably implicated as well; better-educated people tend to be healthier than the less educated, for a number of reasons.

Krugman also notes differences in behavior and lifestyle that affect mortality. (Although obesity has dramatically increased all across America, obesity rates are significantly higher in red states.)

Krugman references–and debunks–conservative explanations for the death divide:

Conservative figures like William Barr, the attorney general, look at rising mortality in America and attribute it to the collapse of traditional values — a collapse they attribute, in turn, to the evil machinations of “militant secularists.” The secularist assault on traditional values, Barr claims, lies behind “soaring suicide rates,” rising violence and “a deadly drug epidemic.”

But European nations, which are far more secularist than we are, haven’t seen a comparable rise in deaths of despair and an American-style decline in life expectancy. And even within America these evils are concentrated in states that voted for Trump, and have largely bypassed the more secular blue states.

Although he doesn’t mention it, I’d also be interested in seeing a comparison of gun deaths in Red and Blue states.

Actually, conservatives like Barr inadvertently make a point: culture and values matter. Just not the way they think.

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