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Emergency Rooms & Obamacare

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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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The Day After

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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

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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

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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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Adjuncts & Walmart Workers

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A recently renovated Walmart store in Clinton,...
(Photo credit: Wikipedia)

The September, 2013 issue of the NEA Higher Education Advocate featured an infographic comparing working at Walmart with working as an adjunct/contingent faculty member.  Having worked as an adjunct, I can attest to the accuracy of the claims regarding the adjunct experience.

In the usual order of things, a college degree provides a higher earning potential. This is not, however, true for the typical adjuncts. In the United States, a retail cashier makes an average of $9.13 an hour, resulting in a yearly income of $20,410. By way of comparison, Goldman Sachs’ health  coverage for a higher end employee (such as Ted Cruz’s wife) amounts to almost twice that amount. An adjunct who is working 40 hours a week will make on average $16,200 a year (which is $7.78 per hour). Running a cash register sometimes requires a high school degree, but not always. Being an adjunct typically requires having a graduate degree and many of them have doctorates. I did and I made $16,000 my first year as an adjunct. That was teaching four classes a semester for two semesters. Adjuncts generally do not get any benefits, although some of them do get insurance coverage—as graduate students. I had health insurance as a graduate student (at a very low rate) but not as an adjunct—fortunately I had no serious injuries and only minor illnesses during my insurance free time. If I had had my quadriceps tendon tear when I was an adjunct, it would have cost me almost $12,000—leaving me only $4,000 for the year (less after taxes).

The typical workers for corporations like Walmart tend to be no better off—they do not get much (or any) benefits and hence often do not have health care coverage. It might be wondered how people survive on such low wages and with no benefits. In some cases, people simply do without. When I was an adjunct, I did not have a car, I bought only what food I could afford, I lived in a one bedroom apartment and did all I could to live frugally. I do admit that I splurged on luxuries like running shoes and race entry fees. Fortunately, I did make some extra money writing—which helped support my gaming hobby.

This approach can work for a person who has no dependents, can get by without a vehicle, and has no health issues. However, those who cannot do the obvious: they turn to the state for aid. In the case of Walmart, the taxpayers provide support to their employees. For example, in the state of Wisconsin Walmart employees cost the taxpayers $9.8 million a year in Medicaid benefits alone. Adjuncts would also often qualify for state support. Out of Yankee pride, I did not avail myself of any such aid—I could survive on what I was making, albeit at a relatively low quality of life in Western terms. However, many people do not have the luxury of pride—they need to care for their families or address health issues.

As might be imagined, these low salaries and lack of benefits are a point of concern. Laying aside concerns about fairness of wages (which actually should not be done), there is the fact that the low pay of many workers is subsidized by the taxpayers. That is, the taxpayers pick up the difference between what the employers pay and what people need to survive. As I have argued before, this is a form of corporate and university socialism: the state support allows schools and corporations to pay low wages and thus generate greater profits. Or, in the case of non-profit schools, funnel the money elsewhere—most likely to administration and things like bonuses for the university president. For example, the previous president of my university was guaranteed a yearly bonus that that was about twice the average yearly adjunct salary.

Obamacare is supposed to, in some degree, shift the burden of health care costs from the taxpayer to the employer. The idea is that larger employers will need to provide health care benefits to full time employees or pay a fine. This, as might be imagined, has caused some people to threaten dire consequences. To be specific, some employers, including universities, have stated that they will reduce employee hours so that they fall just under the line for full time employment. Some have even threatened to fire people on the grounds that they cannot afford to pay.

One stock counter to the idea that employers should provide such benefits is that the state has no right to impose such costs on businesses, especially when doing so will cause businesses to fire people and cut their hours. This does have some appeal. However, there is still the question of who will provide the workers with the resources they need to survive.

One view is that the employers have an obligation to provide a living wage to those who do their job and do it competently. Few would argue that an employer is obligated to just hand people money for not working or doing terrible work—after all, a person who can earn his way should do so. As might be imagined, many employers (including universities) would rather not do this. After all, increasing wages to an actual living wage would cut into profits. In the case of universities, such increases would mean cuts in other areas of the budget (but surely not presidential bonuses).

Another view is that private citizens or organizations of private citizens (such as church groups) have the obligation to provide assistance to others via charity. That is, individuals should voluntarily subsidize the employers by providing the employees with the resources they need to survive, such as food. Of course, if private citizens have this obligation, it would seem that the employers (being citizens as well) would also have this obligation. One clever way around this is to contend that corporations are people, just not the sort of people who have moral obligations. Obviously, people do provide such support—but it would certainly be a challenge for private citizens to adequately support all the working people whose wages are not adequate.

A third view is that the state has the obligation to provide the resources for people to survive. This is, for the most part, the current situation. However, since the state gets most of its income from the citizens, this is effectively having private citizens subsidizing the employers, only with the state organizing the charity. Once again, if the state is obligated to do this, this merely comes down to the citizens having this obligation.

A fourth option is that no one has an obligation to provide people with the resources they need to survive, even when those people are actually working full time and generating enough value to allow their employer to pay them living wages. One might make references to the morality nullifying powers of the free-market: while people might have moral obligations, these do not hold in economic relations. One might also reject the idea that people have any such moral obligations to others at all: people must make it on their own or perish, unless someone freely decides to provide assistance.

Overall, it comes down to the question of what, if anything, people owe to each other. My own view is that the market does not nullify morality and that we do have obligations to each other. These obligations include an obligation to not allow other people to suffer or die simply because others are unwilling to pay them a fair, living wage. To head off the usual attacks, I am not claiming that able and competent people should simply be handed resources earned by the toil of others for doing nothing. Rather, my view is about fair wages and ethical behavior. This is why I am against both just handing people stuff for nothing and for people profiting off the labor of others. Both are cases of people who are getting the value of others’ work and not earning the value themselves.

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Shutting it Down

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English: President Barack Obama's signature on...
(Photo credit: Wikipedia)

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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