Say what you will about the likelihood of “slippery slopes” — and I’ve said more than most people — but it’s hard to categorically deny the possibility when the supporters of legislation are touting the possibility as a positive feature. From Nancy Pelosi, quoted by Ezra Klein (The Washington Post):
My biggest fight has been between those who wanted to do something incremental and those who wanted to do something comprehensive …. We won that fight, and once we kick through this door, there’ll be more legislation to follow.
Given this, it makes sense that one should decide whether to support or oppose this proposal not just based on its own terms, but on the likely shape of the “more legislation” that will be enabled by the proposal’s enactment.
Some may see this is a trivial point, because of course there’s a risk of slippage (i.e., a risk that the first step will increase the likelihood of future, more ambitious steps), and the real questions are figuring out how much that risk is, what the value of the first step is, and what the likely harm (if any) of the future steps will be. If that’s you, then I’m glad to hear it, since the goal of my work on slippery slopes has been to establish that very conclusion, and to suggest a framework for thinking about these questions.
But I’ve talked a lot about slippery slopes, often to quite sophisticated audiences, and I’ve often read and heard arguments that simply deny the legitimacy or utility of considering such slippery slope risks. I hope that hearing from advocates such as Nancy Pelosi will lead some people to recognize that slippery slope consequences are worth thinking about. If advocates of a proposal say “if you enact our proposal A, this will increase the likelihood of our future proposals B,” it seems to me quite reasonable for others to think hard about this possibility in deciding whether to go along with A.
For shorter versions of my long slippery slope paper, see this 54-page abridgment and this 10-page adaptation by Prof. Ward Farnsworth.
Chris Travers says:
Of course more legislation will follow. This bill can’t POSSIBLY work right the first time. It’s just too complex. The result will have to be an evolutionary period where all three branches shape elements of the legislation.
March 16, 2010, 1:34 pmAllan says:
Have you considered the slippery slope of doing nothing? Could it be worse than doing something and the slippery slope in that direction?
Your post reminds me of the children’s riddle: “If a rooster lays an egg at the peak of a roof, which way will it roll?”
March 16, 2010, 1:38 pmPJens says:
I have heard that making law is a lot like making sausage, and one does not really want to know exactly what goes into it or how it is made. Well, I know that good sausage can not be made with spoiled meat via a dirty process. Furthermore, once the first sausage is made this way, those that follow from the same batch are not going to be any better.
It is a slippery slope alright. Just be careful what you swallow and try not to get sick!
March 16, 2010, 1:44 pmJMA says:
The “slippery slope of doing nothing” is actually my preference. I even have my sled ready. :)
March 16, 2010, 1:48 pmyao says:
As my Cuban-born Spanish teacher once said:
“The bridge is at the river … no … when we get to the bridge we will be at the river … no … oh … Don’t jump in front of the gun!”
March 16, 2010, 1:52 pmMalvolio says:
Wouldn’t that be a reason not to pass the bill at all, especially since “not working right” means billions of dollars being wasted and thousands of people dying unnecessarily.
The most important feature of evolution is selection: weak individual and species are selected-against and useful phenotypes are pushed to the fore. Is there anything about the legislative process that suggests that the selection mechanism has anything to do with the objectively desirable aspects of a law? If so, why can’t Medicare or Social Security improve?
March 16, 2010, 2:05 pmChris Travers says:
I would agree. There are non-disruptive reforms needed, but I am not sure they can be done on the federal level.
Medicare and Social Security are functionally serviceable at least in the present. IMO, that’s all that evolution truly requires during times of equilibrium. The times we see the process you describe in operation are during the punctuations to that equilibrium. Just as the finch’s beak will not change except during a food shortage (such as one induced by a drought), so too will it take a similar existential crisis to improve these programs.
March 16, 2010, 2:30 pmDavid Schwartz says:
There’s also the idea of deliberately creating a system that you know won’t work, because you have a particular fix in mind that isn’t palatable until the system is very broken.
March 16, 2010, 2:38 pmuh_clem says:
The billions of dollars being wasted and thousands of people dying unnecessarily is the status quo. The bill is an imperfect partial solution to exactly those issues. I don’t expect it to be perfect, hence the inevitable incremental modifications coming our way.
Now, I don’t expect any Republicans to be elated over the prospect of “more to come”, but these remarks aren’t aimed at you – they’re aimed at the substantial number of liberals who are against the bill because it doesn’t go far enough.
March 16, 2010, 2:40 pmBobC says:
Wait! What is the difference between a slippery slope and ambitious steps? This post used both.
Was Neil Armstrong’s “one small step” the slippery slope to the shuttle and space stations?
March 16, 2010, 2:42 pmHarry Schell says:
I am wondering about why Pelosi has to think she is “kicking through doors”.
Additionally, I seriously doubt the “additional legislation” she promises will be confined to healthcare. The radicals think their time has come, and one of the few benefits of having elected a marxist is that people like Pelosi have dropped any pretense about who they are and what they want.
March 16, 2010, 2:44 pmgeokstr says:
Here’s are a couple videos with Obama, Frank and others admitting that what they want is “single payer” universal health care, and also admitting that they can’t get there right now, but over time it will happen. In this case, the “slippery slope” is not just a possibility, the slope is deliberately being greased by the left:
Obama on single payer health insurance
Obama IN HIS OWN WORDS saying His Health Care Plan will ELIMINATE private insurance
This is just another example of the unidirectional ratchet of the law in this country (and others); it moves towards the Collective, implacably, and will never be reversed until there is a cataclysm of some sort that totally rethinks the relationship in a democracy between government and its citizens, i.e., a total economic collapse or a violent revolution. Either one is distinctly possible in the relatively near future as long as we continue to head in this direction.
That is unless 1984 gets here first. In that case, NewSpeak will have us all thinking doubleplusgood things about Big Bro.
March 16, 2010, 2:46 pmjnheath says:
There seems to be a judicial resistance to slippery-slope arguments on the premise that later courts will prevent excesses. Here’s a tidy 1820 example:
“But it is contended, that if the States do possess this power over the militia, they may abuse it. This is a branch of the exploded doctrine, that within the scope in which Congress may legislate, the States shall not legislate. That they can not, when legislating within that ceded region of power, run counter to the laws of Congress, is denied by no one; but, as I before observed, to reason against the exercise of this power from the possible abuse of it, is not for a court of justice. When instances of this opposition occur, it will be time enough to meet them.” Houston v. Moore, 18 U.S. 1, 45 (Johnson, concurring).
Subsequently the courts addressed the slippery slope of concurrent (i.e. potentially conflicting) powers by differentiating the areas of regulation. Sometimes the state is barred from regulating a field that Congress has barely touched. But in other areas, the states may concurrently regulate provided the state law does not conflict with the federal law.
Incidentally, in the above case the majority held that the state could not legislate over the militia at all.
March 16, 2010, 2:48 pmgeokstr says:
Really?
Social Security to start cashing Uncle Sam’s IOUs
We are now calling in our IOU’s that we owe ourselves, since the administrations of both parties have been p*ssing away the taxes that were supposed to be earmarked for this “fund” for many decades. All this blather about “lockboxes” and fully solvent until 2036 or whatever that we keep hearing from certain denizens of this blog appears to be totally false.
Imagine that.
March 16, 2010, 2:56 pmJoe Kowalski says:
I think that what makes this argument not exactly work is that the bill is so big and complicated that future revisions to it could go in a couple of different directions depending on who is in power over the next few years. If the republicans take over, they could take this in one direction, or if the Democrats retain power, they could take it in another dirction. A few possibilities:
1) Wyden’s Free Choice amendment could be expanded such that the narrow sliver of eligible folks in the current bill gets opened up to nearly everyone and the state based exchanges could grow considerably until the employer based system dies. and we end up with a much more complicated version of Wyden-Bennett.
2) States on their own initiative introduce “Public Options” into their exchanges that crowd out private insurers resulting in many states effectively having single payer systems.
3) The litany of cost containment pilot programs in the Senate bill get weeded through and the effective ones get picked up and implemented on a national scale.
4) A more federalism driven system gets implemented with states being given more free reign over their exchanges and the subsidy system turned into state by state block grants.
In short, this bill, despite its awful faults, takes a ton of inertia out of the status quo and will either force Democrats to fix the worst parts of it, or put the Republicans on the spot of actually doing something major about health care. I tend to think the latter is more likely. The republicans will be campaigning this fall on an all out repeal of the health bill, but if they get into power, the only way they are going to get enough democrats on board to get 2/3 of each house to overcome a veto is to not only repeal the bill, but also to provide a credible replacement for it as well.
I have full faith that eventually we will enjoy a bi-partisan health care reform. But it will take several swings of the political pendulum to get there.
March 16, 2010, 2:56 pmepluribus says:
In my opinion, the important question is not whether the slope is slippery, but whether the slope is upward or downward. If you believe, as I do, that healthcare in the US is in need of massive reform; that the reform should aim to cover as many of the uninsured as possible and to reduce the present, unsustainable upward trajectory of healthcare costs; then legislative efforts in that direction must be regarded as upward rather than downward. When Congress began to pass civil rights legislation in the 1950s, manay regarded the slope as upward. Strom Thurmond, George Wallace, Orval Faubus, Ross Barnett, and those who thought like them regarded it as downward, and would probably have characterized each civil rights bill that came along as part of a “slippery” slope downward. But the first bills were followed by subsequent bills. It really is impossible, especially in the present political climate, to achieve a massive but much-needed reform in one fell swoop. Pelosi is saying that maybe we won’t accomplished everything that needs to be accomplished; this time around, but we will continue our efforts to achieve the reform in the future. The allusion to “kicking down doors” applied very well to the civil rights struggles. There were strong doors closed off to civil rights reforms. They were “kicked down” by courageous legal and judicial action. I hope the same result will apply to healthcare reform, and that the doors that are now closed tight against reform will be “kicked down.”
March 16, 2010, 3:05 pmMalvolio says:
Well, that’s a perfectly sound factual assertion. It would be nice if there were a scintilla of evidence to support it.
March 16, 2010, 3:12 pmMalvolio says:
“Something must be done, this is something, therefore we must do it.”
I am willing to believe the current state of US health care is suboptimal, but the operative assumption of many people here is that it is pessimal, that it is the worst possible situation, and therefore any change, no matter how political and ill-conceiving is necessarily step in the right direction.
“There are those who think the world is improving because it is constantly changing.”
March 16, 2010, 3:17 pm– GB Shaw Don Juan in Hell
Thorley Winston says:
Not really, if anything the bill in question puts the current problems with health care financing and puts them into overdrive by:
1) Imposing a mandate on employers to provide health insurance while at the same time creating incentives to add more people to the public dole (more third-party payer problem).
2) Ratcheting up the problem of benefit mandates by adding federal ones on top of them (which unlike State mandates aren’t usually preempted by ERISA) so that consumers in the individual market are still forced to buy prepaid health care instead of health insurance.
3) Adopting the same regulatory regimes (e.g. community rating, guaranteed issue, etc.) that have made health insurance prices in New York and Massachusetts so affordable.
4) Pushing more “first dollar” coverage so that consumers have less incentive to control their health spending while creating disincentive for high-deductible plans and Health Savings Accounts.
5) Medicare still goes broke under the bill but only faster because $500 billion that could or should have been used to shore up Medicare will be diverted to fund a new entitlement so when Congress is forced to revisit Medicare (again), the job will be that much harder.
About the only trend in health care that is likely to get changed by the bill is the pace of medical innovation. Seriously, how frigging stupid do you have to be a target a tax increase on pharmaceuticals, medical devices and clinical laboratories unless your intention (as some of Obama’s health care reform advisors like Gregg Bloche have admitted) is slow down the pace of medical innovation.
March 16, 2010, 3:29 pmNunzio says:
Pelosi is a bit optimistic. There are no permanent majorities in Congress.
She might be fishing with Hastert and Newt at this time next year.
Nonetheless, I prefer slippery slope to the parade of horribles.
March 16, 2010, 3:31 pmMark Field says:
I’m not much impressed by this form of slippery slope argument. What it amounts to is saying “I want to control the future. Someone may someday pass by majority rule a law I don’t like. Therefore I should not allow those future people to govern themselves, but should block them from doing so.”
March 16, 2010, 3:34 pmWidmerpool says:
Malvolio, quit picking on uh_clem because I want to argue that there will be trillions of dollars wasted and millions of people killed if Obamacare does pass. Indeed, those millions of lives saved by not passing Obamacare will be able to continue to work and constitute “jobs saved” under the Stimulus Bill. It’s a win-win for everyone!
March 16, 2010, 3:36 pmThorley Winston says:
I think that’s an excellent point and one reason why I favor a more incremental approach to health care reform (which is largely health care financing reform). Do the things you do well better and improve on the things you don’t do so well.
The bills that Republicans offered (and Democrats blocked) when they controlled Congress tried things like allowing purchasers to buy health insurance from any State in the country, expanding Health Savings Accounts, and allowing small businesses to form Association Health Plans. Even the Bush administration, for all of its flaws on domestic policy, pushed for granting more demonstration waivers to States to experiment with Medicaid.
What they had in common and what differs so sharply from the current legislation is not just their more incremental approach but that they were focused on empowering as many decision makers and stakeholders (patients, employers, providers, State governments, etc.) as possible rather than trying to centralize the decision-making authority.
March 16, 2010, 3:45 pmyankev says:
Or as Speaker Pelosi said, “We’ll have to kick down the door so that you’ll see what’s behind it.”
March 16, 2010, 4:21 pmyankev says:
If your define “imperfect impartial solution” to mean taking all of the existing imperfections and making each one of them worse, then adding some new ones.
March 16, 2010, 4:24 pmadam in california says:
The legislation has been hashed out in such a way that it -
1) does nothing to address fee for service;
2) provides no incentive to curb excessive consumption by the insured;
3) raises the risk profile of risk pools in ways that insurers cannot control (pre-existing conditions);
4) has portability mechanisms that, given the above, will punish any insurer for being the low cost competitor.
I first viewed this as an economic/entitlement train wreck given our demographics here in the US.
Now I see Pelosi’s point – this will pour gasoline on the fire that are out of control health costs and service consumption such that the whole system will have to be nationalized to repair it.
March 16, 2010, 4:28 pmyankev says:
Does the bill still lower the cap on Flexible Spending Accounts?
As to new problems, such as slowing the pace of innovation, the bill also puts quotas on the employment and training of medical professionals of the wrong ethnicity.
March 16, 2010, 4:29 pmDave Marney says:
At one point, the President said that “95% of what I want is in this bill.” That phrase really struck me, and I’ve been turning it over in my mind ever since. How could he possibly say it has “what he wants”, since what it had was changing, practically daily? A real head-scratcher of a comment.
But what if the “slippery slope” is what the President “really wants”? What if the primary goal of the HC bill is to forever federalize health care insurance, with no hope of turning back. What if it actually doesn’t matter, for now, what details are in the bill? Once the takeover is complete, all details will be worked out in the new context of a state-controlled system.
The ultra-complexity of the HC bill now makes sense. A bill running 2,400 pages would be a FEATURE, not a problem, from this point of view. The more complex, the more impossible it would be to undo.
Speaker Pelosi’s comment that we need to “pass this bill so we can see what’s in this bill” would also now make sense. The key thing is to pass it, federalize HC. Then we can work out the details in the new context. Yes, she literally means, “just pass it”, nothing else matters.
I think this “slippery slope” observation is spot-on.
March 16, 2010, 4:49 pmChris Travers says:
I made no claims as to the future. However people are getting benefits now, so Congress can kick the can a bit further down the road. My point was that the equilibrium may or may not be unstable, but it isn’t punctuated yet…..
March 16, 2010, 4:56 pmAllan says:
Sorry guys. Elections have consequences.
We had an impending crisis in 2002, when Republicans ruled. Nothing happened. We had one in 2008 when Republicans lost the House and the presidency, nothing changed until that point. We even had an impending crisis in 1994, when Clinton’s plan was defeated.
Up until now, I have heard not a peep about incremental changes from Republicans. Only when monumental changes are imminent is there a complaint.
To me, regardless of the apparent reasonableness of the arguments, any thought of supporting the arguments is tempered with massive skepticism.
Color me jaded, but Republicans have no credibility on this issue.
March 16, 2010, 5:18 pmorca says:
Oh, we’re not Republicans, we’re Conservatives who just happen to vote straight ticket Republican every single election.
There’s a big difference, you know.
March 16, 2010, 5:32 pmThorley Winston says:
Yes, IIRC the Senate bill caps them at $2500 per year (don’t know if it would also lower the cap for dependents which I believe is $5000) down from no cap. It would extend the new federal mandated benefits to HSA plans (which sort of defeats the purpose of getting a high deductible policy that covers catastrophic illnesses), impose new limits on what sort of medical expenses you can use them for, and would apply the amount of the HSA against the limit before the new health insurance tax kicks in.
I don’t think that’s quite true (but the practical effect isn’t that far off particularly in schools that only have a limited number of admission slots). The bill does require that the Secretary of HHS give preferential treatment to entities (read: medical and nursing schools) who recruit minority applicants in awarding grants and contracts. So technically I suppose it’s a setaside not a quota.
March 16, 2010, 6:00 pmarch1 says:
Mark Field says:
Mark,
I disagree. Of course voters and advocates want to control (well, influence) the future, to the extent that their vote/advocacy enables them to do so. There’s nothing wrong with this; and slippery slope arguments are no more inherently nefarious than other arguments concerning the likely consequences of a legislative point at issue.
Indeed, as a first approximation slippery-slope arguments are just that – a special case of consequence-based decision making, which is an eminently rational thing to attempt.
(A second approximation is that what’s “special” about slippery slope arguments is that their “consequence[s],” by definition, involve the likelihood and nature of potential follow-on legislation – notoriously difficult things to predict.
For this reason, I do think that slippery-slope arguments in general merit significant scrutiny. But that’s not because they are by nature anti-democratic or otherwise morally suspect, as you seem to suggest; rather, it’s because they crucially involve assertions about an exceedingly complex system.)
March 16, 2010, 6:05 pmepluribus says:
The kind of health care reform posters on this board would favor if they had their way is, I suppose, mildly interesting. The kind of health care reform I would favor if I had my way might fall into the same category. Even the kind of health care reform Dennis Cucinich might favor if he had his way (he is dead set against the current bill because it doesn’t go far enough) might have some interest, as would the kind of health care reform Mitch McConnell or John Boehner might favor if they had their way (do they actually favor any genine reform at all?). Even the kind of health care reform Obama, Reid, or Pelosi would favor if they had their way might be of modest interest. But what really matters is the kind of health care reform that Congress can pass in the current political climate; the kind of health care reform public opinion will, if not support, at least tolerate; the kind of health care reform that can withstand repeated Republican filibusters; the kind of health care reform that can endure 24/7 attacks from Fox News; the kind of health care reform that all of the hundreds of millions of dollars of political advertising and lobbying by the health insurance industry can’t bring crashing down to defeat. We live in a democratic republic where success must be attained on a practical level, not on the level of abstract theorizing. McConnell has vowed that he and the Republicans will do everything in their power to see that the present bill fails, and so far they are doing just that. Senator De Mint has said that if the Republicans can defeat this bill, Obama’s presidency will be a failure, and they can defeat everything he proposes. On the basis of practical politics, the current bill is probably all that can be done–for now. It’s not optimal, of course, but what bill that could pass Congress in 2010 would be? I hope that the current bill succeeds. Not because it is the best of all conceivable bills, but because it is the best of all possible bills. If it passes, it will represent a giant and unprecedented step toward reform of a large and growing segment of the American economy that desperately needs reform, a step that has been frustrated every other time it has been attempted.
March 16, 2010, 6:09 pmThorley Winston says:
Of course “nothing changed.” Republicans offered their health care proposals when they controlled Congress but Democrats blocked them and essentially said “no thanks, we want to wait until we’re back in charge so we can put our own bill forth.”
So I guess the only ones “no credibility on this issue” are the ones pushing the current legislation while trying to pretend that Republicans never offered their own health care reform proposals when they had (nominal) control of Congress.
March 16, 2010, 6:09 pmepluribus says:
Thorley Winston says:
Funny I don’t remember that. Maybe that was the afternoon I took a nap back in 2003. Care to offer particulars on this big battle?
March 16, 2010, 6:46 pmsofa says:
Deem we already voted them out.
Deem we voted on the jury and found them guilty of treason.
To deem, is to do. Or doo-doo.
Who may deem? How many might a deem encompass?
March 16, 2010, 6:57 pmIs deeming a right, privilege, enumerated power, finding, process, what?
leo marvin says:
My concern is if you entertain one slippery slope argument you’ll being pressured to entertain two, then four, then eight, and eventually every argument will have a slippery slope.
March 16, 2010, 7:27 pmMark Field says:
I certainly agree that we all want to influence the future by our actions; I’d even go further and say we can’t not influence the future. I also agree with your other (i.e., other than the one I’ve quoted) comments on slippery slope arguments.
What I object to in the “we must not do X today because if we do they might do Y in the future” argument is its anti-democratic nature. Implicit in it is the claim that we can’t let future voters decide for themselves what they want to do (repeal it, expand it, whatever). That’s not trying to influence the future, it’s trying to control it. If people in the future want to do X, then the time to debate that will be then, when those affected by it get to vote on it, not now when they (or at least some of them) don’t.
March 16, 2010, 7:33 pmadam in california says:
Epluribus -
You must be completely unaware of Health Savings Accounts and Medical Savings Accounts. Must have been a long nap. And yes – there are all sorts of hyperpartisan attacks on MSAs and HSAs on-line for you to peruse and link so as to score partisan points if you choose. Democrats came prepared to fight MSAs/HSAs and constituents in the GOP have no interest in defending them.
MSAs were out in the 90s followed by HSAs. I used to have an MSA as did many of my employees. Worked out great for those in the program but enrolment was limited and the program was undermined both by Democrats and many Republicans. The intention was simple – make consumers of health care price conscious while providing for catastrophic coverage. Theory is, if the next fee-for-service item directly affects the consumer’s pocket she will be careful of what she has the provider do. So running a battery of tests on a young, healthy person at an annual check up gets nixed whereas someone with a “Cadillac Plan” would say “Go for it – nothing to lose”.
The GOP has only offered half hearted reform because it has had, in the past, a pretty reliable constituency in the AMA along with big pharma and insurers. Obama managed to peel of big pharma which loved the windfall from Bush’s prescription drug entitlement and sees the opportunity of getting every respiring human on US soil on a prescription. So they are now gone from the GOP fold and probably permanently as congress moves on to further tweaking patents and FDA regulations in favor of pharma, consistent with the fact that these firms footprints are in blue states. Insurers are quite happy with Obama now too since they get many mechanisms by which they get to pretty much set prices as they like, plus every respiring individual on US soil will be compelled by force of law to consume their products. So they are probably gone from the GOP fold now too, up until the system bankrupts itself which (demographically) can’t be that far off. That leaves practitioners. I suppose many doctors will stick with the GOP brand because individuals are slow to move. That will change when the next crisis comes and we go single payer – the doctors will have a union and go on strike from time to time (like they do in France whenecer the taxes on luxury cars are increased).
March 16, 2010, 7:47 pmyankev says:
Except that if you set aside a given number of slots for group a, you put a ceiling on the slots for group-not-a. This bill is not good for anyone who is Jewish or Asian and aspires to medical school.
March 16, 2010, 7:49 pmepluribus says:
adam in california says:
I’m not going to argue this with you, adam, because you are right–I know next to nothing about MSAs and HSAs. If you think I am here to score partisan points, you misunderstand me. I am not a member of any political party and reserve the right to criticize both Democrats and Republicans, which I have done here. If I am more critical of Republicans now it is because it seems to me that they are the strident partisans now. They have lined up in military formation to defeat the first effort to effect comprehensive health care reform in the history of the US, and they have openly declared their intention to do just that. Am I a partisan because I take them at their word?
I will defer to you on this point, again because I don’t know enough about it to argue with you. But if the Democrats were opposed and the Republicans had “no interest in defending them,” where was the Republican effort to reform healthcare? The battle that is underway now is massive and historic. What you describe here–Democratic opposition and Republican disinterest–doesn’t sound to me like a real battle over healthcare reform.
March 16, 2010, 8:24 pmMichelle Dulak Thomson says:
yankev,
This bill is not good for anyone who is Jewish or Asian and aspires to medical school.
Because if you are Jewish or Asian, you may belong to what is admittedly a minority; you may, in fact, belong to a minority whose history and culture merits its own subdepartment in many universities; but no way, no how, will you be regarded as a “minority applicant” at any university or professional school. I mean, there are limits. And that’s the first one.
March 16, 2010, 8:27 pmMichelle Dulak Thomson says:
epluribus,
I don’t have a HSA/MSA, but it seems to me too that something like insurance for, well, things people normally insure against, like catastrophic losses, plus something like tax-free savings against smaller medical expenses, makes a lot of sense. The major complexity is that there are things that are cumulatively very expensive but incrementally don’t present crippling expense. Diabetes is the obvious one. People have proposed spinning that sort of situation into a Medicare analogue. I gather that France does something of the kind.
March 16, 2010, 8:39 pmJoseph Slater says:
Leo Marvin (at 7:27) wins the thread.
March 16, 2010, 9:35 pmDave Marney says:
For a three-year period during my career, I had the equivalent of an HSA/MSA: a high-deductible plan with 100% coverage for truly serious conditions. The plan was very inexpensive compared to my payroll deductions. I loved being able to choose any doctor I wanted. I went over the deductible one year out of the three due to an accident and a short hospital stay. All said and done, I came out ahead compared to an employer-provided plan, and would have loved to continue it, but sadly, I got a “regular” job.
My family was a lot more choosy about our medical care, getting two and sometimes, three opinions. We never would have done that at an employer-provided HMO.
The market can work, if we let it.
March 16, 2010, 10:17 pmgeokstr says:
And precisely what other choice did conservatives have all these years? To vote for the far leftists as they gradually took over the Democratic Party?
But we liberals, we didn’t always just happen to vote for the Democrats, now did we? We voted for Republicans too, right?
What was that anyway, an absurd attempt to top SirCastro?
March 16, 2010, 11:24 pmThorley Winston says:
I don’t think that we disagree on what the practical effect* of this sort of racist policy being pushed by Congressional Democrats and the Obama administration will be and I think that I said as much in my original post. The explanation you gave is pretty succinct and it does a good job of educating readers as to another of the many bad features of this bill. Given how this bill’s supporters have worked overtime to try to discredit critics, I think we need to try to be as accurate as possible to avoid giving them any more ammunition than necessary.
* If past affirmative action programs are any guide, I think another likely effect is going to be that unqualified and marginally qualified school applications will get admitted under this sort of setaside program but be more likely to drop out thereby leading to a further shortage of doctors and nurses.
March 17, 2010, 10:22 amarch1 says:
Mark Field,
I don’t know yet if I share your view yet but (on 2nd repetition:-) it has at least got me thinking about the tension that slippery slope arguments do seem to present between the principles of majority rule and individual advocacy; thanks.
On a somewhat related note, I think that the principle “in the future we shall know more” is greatly underappreciated, especially wrt profoundly progressive fields such as science and technology. This would tend to lend extra weight to your concern.
March 17, 2010, 12:57 pmAdam Sullivan says:
I am cynical and jaded – former member of each of the two major parties. Please pardon me for jumping on you.
At play, IMO, is that republican proponents of the MSA/HSA cost approach were the free marketeers within the party. The Republican house leadership has been and continues to be made up of “deal cutters” and they look out for the interests of their coalition members, with pharma, providers and insurers all having been part. those constituents get no upside from cost conscious consumers, so leadership has always restrained cost driven approaches. Democrats have now peeled off members of that coalition by abandoning an earnest cost approach, and this “reform” has no substantive mechanisms for lowering costs. So republicans have not delivered because pharma and insurers didn’t want them to, and now Dems (now with pharma and insurers in their pockets) aren’t going to either.
Perhaps the free marketeers will now have more power within the Republican camp with pharma and insurers gone. We’ll see.
March 17, 2010, 5:48 pmreadery says:
The problem with the slippery slope argument is not its intrinsic merits. It’s the consequences that could occur if it were regularly used. Virtually every idea or program or state of affairs could potentially make another, more extreme, undesirable state of affairs more likely. Banning abortion could make a police state more likely, but then again permitting it could lead to making it mandatory (and to a police state). Virtually anything could, potentially lead to disaster. The chain of possible causes and effects is endless. Obsessing over it could lead to disaster. After all, the slippery slope argument assumes we can predict the future, and we won’t know until we get there. We can really be sure about the paths not taken and what would have happened. We can only speculate.
In short, the slippery slope argument itself has a slippery slope. It is its own refutation.
March 17, 2010, 9:48 pmMark Field says:
Thanks.
March 17, 2010, 10:50 pmThe terrible, horrible, no-good, very bad bill « Internet Scofflaw says:
[...] is designed to fail, thereby justifying future government action to meddle [...]
March 19, 2010, 11:37 am