24 March 2010

On Health Care Reform

14 state attorneys general, all but one Republicans, have filed suit to block health care reform from going into effect. While I have only actually read Virginia A.G. Ken Cuccinelli’s complaint, both actions (the other A.G.s filed jointly) are premised on the notion that the United States Constitution’s Commerce Clause cannot be used to compel citizens to purchase health insurance. The Commerce Clause, situated in Article I, § 8, states that “The Congress shall have the power…[t]o regulate commerce…among the several states….” This Clause, which has been interpreted broadly by the Supreme Court since the New Deal Era, allows Congress to regulate channels of interstate commerce, persons or things in interstate commerce, or activities arising out of or connected to commercial transactions. As the Court held in Wickard v. Filburn, and recently affirmed in Gonzales v. Raich, an activity needn’t be expressly “interstate” in character to fall within Congress’s regulatory ambit; rather, it need only have a non-tenuous effect on interstate activity.

No one, of course, seriously contests the fact that health insurance is, itself, a thing in interstate commerce. What opponents of the health care bill argue is that persons who will be required to obtain health insurance, or face a tax penalty, are not, by merely existing, themselves participating in interstate commerce. As Cuccinelli’s complaint contends, the “status of being a resident or citizen of…Virginia…is not even a non-economic activity affecting interstate commerce. It is entirely passive.” The logical extension of the argument (not made by Cuccinelli in his filing) is that if Congress can, by operation of the Commerce Clause, compel you to buy health insurance, why can’t it compel you to buy, say, a car from GM or Chrysler? Where does the line suggested by cases like United States v. Lopez (invalidating the federal Gun Free School-Zones Act of 1990) and United States v. Morrison (invalidating, in part, the Violence Against Women Act) ultimately get drawn?

Unless the courts (and, ultimately, the Court) elect to virtually repeal the New Deal by returning to a pre-Wickard reading of the Commerce Clause, this argument is unlikely to find purchase. Whether the mere fact of residence or citizenship is an activity affecting interstate commerce is not the relevant inquiry. What the courts are likely to find relevant is that all people are consumers of medical services. Indeed, what distinguishes compulsory purchasing of health insurance from, say, compulsory purchase of an automobile is that people are fulling capable of declining to purchase a car. However, people do not choose to use medical services in the way that they choose, or choose not to, buy a car. If an uninsured person suffers a heart attack, chokes on a fishbone in a restaurant, or gets injured in car accident, he or she will likely receive medical treatment. The cost of treating this uninsured person is a) borne by people who do have insurance in the forms of higher premiums, and b) shouldered by the taxpayers, who subsidize hospital’s emergency treatment of persons unable to pay; these are negative externalities which undoubtedly affect interstate commerce, and ergo fall comfortably within Congress’s regulatory ambit. Granted, there are libertarian arguments that we either ought to leave uninsured persons in medical distress untreated, or that we shouldn’t require hospital emergency rooms to treat all comers, or that we should simply refuse to subsidize such treatment (and consequently let many hospitals slide into bankruptcy); however, these policy ships have sailed. As long as we permit uninsured people to seek emergency medical treatment, not having health insurance will be an activity touching upon interstate commerce.

A broader philosophical point - one that would doubtlessly be rejected by conservative opponents of broad government regulation - is that health care is precisely an area where we should want the government to act. Our present health care crisis is nothing less than an epic collective action problem, and the transaction costs of fixing it privately are far too high to be surmounted. Doctors, patients, hospitals, medical schools, insurers, medical device manufacturers, and pharmaceutical companies all have competing, yet interrelated agendas that serve to drive the cost of health care higher and higher; this matrix of interests (perhaps analogous to the tangled, invisible web of toxic assets that dragged the global financial industry to its knees) is far too complex for the players to effectively unravel themselves. In such a situation, government is precisely the mechanism that we should turn to; only it is sufficiently empowered and democratically legitimate to impose a workable solution.

I suspect that among actual Republican policymakers that this is not, in and of itself, a controversial view. After all, many of them vociferously defended Medicare, basically government-run single-payer care, in their opposition to the far more market-friendly Democratic health care reform bill. However, congressional Republicans have, of late, been channeling their supporters in the Tea Party movement, an ideology so inarticulate and incoherent that it is hardly worth of the descriptor. Tea Partiers and their congressional sycophants view government with poisonous levels of suspicion; any expansion is not only regarded negatively, put as a violation of the Tenth Amendment to the Constitution, which simply announces that the federal government’s powers are limited. The Tea Partiers chronic mistrust of government goes well beyond healthy skepticism; it is the Reagan view that government is incompetent per se taken to its logical extreme.

But government programs are not de facto inferior to private solutions; a superior view is that government programs ought only to exist when there is no adequate private solution. This explains, for instance, the necessity for a Defense Department, or public schools, or Social Security: private alternatives on their own are not merely inferior; they are not feasible altogether. But note that none of these systems is wholly exclusive of private industry or actors: private military contractors are integral to the national defense; private schools serve those who prefer an alternative to the public model; and private retirement vehicles supplement Social Security income, and vice versa. So it is with health care reform: the government has eliminated certain insurance industry practices, will create a regulated exchange, and will impose the individual insurance purchasing mandate. Yet, at the core of all of this reform remains the existing network of private insurance companies, as well as the rest of the nation’s preexisting health care infrastructure. Indeed it is telling that Republicans have spent much of their energy launching wholly fictive attacks on the bill, claiming that it constitutes a government takeover of one-sixth of the economy, or that it will empower government “death panels” to deny health care to the elderly or the disabled. When you actually examine the bill itself, what you see is basically glorified regulation, coupled with the mandate and some subsidies; as President Obama himself noted, this may be “major reform,” but it is hardly “radical reform.”

All of this is not to say that there are no credible bases upon which to attack the bill. Cost is obviously a major concern: health care is projected to be a trillion-dollar expense over the next decade; its much bruited-about deficit-reducing qualities are largely dependent on Congress sticking to its guns and actually enacting the broad-based taxes needed to achieve those savings targets. Another interrelated concern is that it will not adequately control costs; the price of health care will continue unabated and taxpayers will be on the hook for a larger portion of the bill.

However, it is not credible to attack this bill as an assault on freedom, liberty, capitalism, or whatever other content-neutral value-laden buzzword one wishes to use. Government should act when markets fail, as the American health insurance market inarguably has. This is the entire purpose of having a government in the first place: in exchange for surrendering a certain amount of personal autonomy, we gain an institution capable of solving problems that we alone cannot. To assert that by its mere action government imperils our liberty and welfare is unsquarable with government’s very purpose.

25 December 2009

The Best Albums of 2009 (in Haiku!)

The Sound of Young America

50 records I enjoyed this year; as always, the ordering is arbitrary, and had this list been published yesterday or tomorrow, there's about 10–15 records bubbling under the surface that could have made the cut. And this year it's all haikus!

50. Sunset Rubdown – Dragonslayer (Jagjaguwar)

Is it possible?
Wolf Parade a side project?
All signs point to "yes"

49. Camera Obscura – My Maudlin Career (4AD)

Belle and Sebastian
Could stand to learn a lesson
From their fellow Scots

48. Dave Bazan – Curse Your Branches (Barsuk)

Au revoir Jesus
Goodbye Pedro the Lion
Life is full of doubt

47. Lil Wayne – No Ceilings (mixtape)

Stop selling albums
Lil Wayne gives it all away
Unbeatable price

46. Neko Case – Middle Cyclone (Anti-)

Crouching Neko Case
On a Mercury Cougar
No hidden dragon

45. Cass McCombs – Catacombs (Domino)

Keep on keeping on
Karen Black guests on a track
Like Family Guy

44. Yeah Yeah Yeahs – It's Blitz (Interscope)

Brooklyn survivors
She's probably not dating
That guy from Liars

43. Sonic Youth – The Eternal (Matador)

Zombie alt-rockers
Do not bury until dead
Put that shovel down

42. The-Dream – Love vs. Money (Def Jam)

Sexy, humorous
But that hyphen in "The-Dream?"

41. Pajo – Scream With Me (Black Tent Press)

I love the Misfits
Sure enough, so does Pajo
Four-track recordings

40. The xx – The xx (Young Turks)

Dry and hollow sound
Why listen to that racket?
But you would be wrong

39. Micachu & the Shapes – Jewellery (Rough Trade)

The new bricolage
No one cares if it will last
The English love it

38. Morrissey – Years of Refusal (Lost Highway)

What about The Smiths?
Stop asking about The Smiths
Go ask Johnny Marr

37. JD Twitch – 60 Minutes of Fear (RVNG)

Yeah, it's a mixtape
But in the future, format
Is irrelevant

36. Pink Mountaintops – Outside Love (Jagjaguwar)

Black Mountains are great
This guy has another band
Pink Mountains are great

35. Mos Def – The Ecstatic (Downtown)

No more bad movies
Please stick to the rivers and
Streams you are used to

34. The Pains of Being Pure at Heart –
The Pains of Being Pure at Heart (Slumberland)

Band's name is too long
I'm stupid for choosing an
All-haiku format

33. Condo Fucks – Fuckbook (Matador)

Oh fictional bands
Still, they are funnier than
Flight of the Conchords

32. Double Dagger – More (Thrill Jockey)

As in "Baltimore"
When someone says "Drum 'n' Bass"
They do not mean this

31. The Rural Alberta Advantage – Hometowns (Saddle Creek)

Saddle Creek, you say?
And not a Bright Eyes album?
Hope for the future

30. Bibio – Ambivalence Avenue (Warp)

Everything falls into place
The Campfire Headphase

29. Bonnie 'Prince' Billy – Beware (Drag City)

Lots of weird photos
The music is not so weird
Mr. Consistent

28. The Thermals – Now We Can See (Kill Rock Stars)

Perfect power pop
Move to Portland, Oregon
And stack that paper

27. jj – No. 2 (Sincerely Yours)

One million dollars
For a picture of jj
Please do not redeem

26. Green Day – 21st Century Breakdown (Reprise)

Obama's in charge
Everyone said "chill out," yet
The war continues

25. Yo La Tengo – Popular Songs (Matador)

Across the river
No Hanukkah shows this year
Is it Chanukkah?

24. Depeche Mode – Sounds of the Universe (Mute)

They're printing euros
Best Mode since Violator
Goth love never dies

23. Nirvana – Live at Reading (Geffen)/
Bleach Deluxe Edition (Sub Pop)

They were awesome live
The greatest rock band ever
At last, evidence

22. El Perro Del Mar – Love is Not Pop (Licking Fingers)

El Perro Del Mar
What does that mean in English?
"The dog of the sea"

21. No Age – Losing Feeling EP (Sub Pop)

Half the length of Nouns
I enjoyed it twice as much
Just my opinion

20. Mount Eerie – Wind's Poem (P.W. Elverum & Sun)

Hey Phil Elverum
Your underground secret lair
Must be a nice place

19. Reigning Sound – Love and Curses (In the Red)

Back to the garage
Where do these guys park their cars
Out in the driveway?

18. The Horrors – Primary Colours (XL)

Remember Strange House?
Well neither do The Horrors
Gravy train whistle

17. Bill Callahan – Sometimes I Wish We Were an Eagle (Drag City)

Dark, light, dark again
Who needs molasses indie?
This guy is funny

16. Best Coast – When I'm With You 7" (Black Iris)/
Make You Mine 7" (Group Tightener)

Suburban sprinklers
Let's give Real Estate a prize
While we ignore this

15. Amesoeurs – Amesoeurs (Profound Lore)

A marriage of French,
Black metal, and The Cure, that
Ended in divorce

14. Lady Gaga – The Fame Monster (Interscope)

Is she a genius?
Inauthentically brilliant
Like a bad romance

13. Handsome Furs – Face Control (Sub Pop)

At last Bruce Springsteen
Indie rock gives you your due
Skip Sam's Town, buy this

12. The Raveonettes – In and Out of Control (Vice)

White Stripes stole thunder
Not better than White Blood Cells
Better than Horehound

11. Cold Cave – Love Comes Close (Heartworm/Matador)

Signed to Matador
Interpol, or Early Man?
Only time will tell

10. Animal Collective – Merriweather Post Pavillion/
Fall Be Kind EP (Domino)

You could have slept through
All of Two Thousand and Nine
Wouldn't have mattered

9. Raekwon – Only Built 4 Cuban Linx 2 (Ice H2O)

Branding failed Jay-Z
Better than The Blueprint 3
In Raekwon we trust

8. Hunx and His Punx – Gay Singles (True Panther Sounds)

More like "yes homo"
Beats Reatard at his own game
Not Monopoly

7. Brilliant Colors – Introducing (Slumberland)

Girls, girls, girls j'adore
Twenty-eight minutes and out
Leave 'em wanting more

6. Sunn O))) – Monoliths & Dimensions (Southern Lord)

Play this record loud
No one can live forever
Sonic Death Monkey

5. Phoenix – Wolfgang Amadeus Phoenix (Glass Note)

Yes, Phoenix are French
Hey, Mozart was Austrian
Pop or rock, who cares?

4. Girls – Album (True Panther Sounds/Matador)

Jerry Lee Lewis
If he were raised in a cult
Lover, not Killer

3. Emeralds – What Happened (No Fun)

Hypnagogic pop
Inapposite to describe
The beautiful float

2. Fever Ray – Fever Ray (Rabid/Mute)

More people would care
If this were released under
The Knife moniker

1. The Dutchess and the Duke – Sunset/Sunrise (Hardly Art)

Sounds like Side A of
The Rolling Stones' Aftermath
This year's number one