The Volokh Conspiracy

Will the Welfare State Wither Away When it Becomes Unnecessary?

Early Marxists, including Marx himself, believed that at some point after the transition from capitalism to socialism, the state would "wither away" because it would no longer be needed to maintain an egalitarian socialist society. Once the state was no longer necessary, it would disappear. Tyler Cowen advances a somewhat similar theory from a libertarian perspective:

Life without socks would be... "undignified," but no one recommends government provision or even sock vouchers. Relative to income, socks are sufficiently cheap. There is some inequality of socks, but it seems that just about everybody — even the poor — "has enough." We don't even force people to buy socks for their kids.

Might there come a time when health care and education fall under the same rubric? . . .

Of course today's poor aren't rich enough for us to remove government aid. But when will the splendid era of libertarian freedom be possible? Today's poor are much richer than the poor fifty years ago, and the poor of the future are likely to be richer yet. Won't the welfare state, at some point, simply become unnecessary?

Unlike in the case of the Marxists, it's not clear whether Tyler is making a prediction or just a normative statement about the justification of the welfare state in the future (Marx was doing both). If Tyler is predicting the demise of the welfare state as the poor become richer, I think he is wrong, and for the same reason that Marx was wrong about the withering away of the state under socialism. Government power does not disappear merely because it becomes "unnecessary." It can still be used by the politically powerful to benefit themselves at the expense of the politically weak. Orthodox Marxists learned this lesson the hard way when the establishment of a socialist government in the USSR led not to the withering away of the state, but to a vast expansion of government power and of its use to oppress the population for the benefit of a new ruling class.

We see a similar dynamic, though in much less severe form, in the history of the welfare state. Although originally intended to benefit the poor, today's welfare state has gone far beyond that. The vast majority of government-sponsored redistribution goes not to the poor, but to politically powerful interest groups such as the elderly (most of whom are not poor), large agribusinesses (which capture most of the benefits from the massive agricultural subsidies that exist in most developed nations); and of course the mostly affluent beneficiaries of various porkbarrel projects. Social Security (the vast majority of which goes to the nonpoor) alone dwarfs all means-tested programs combined. As I explained in greater detail here, the poor have little political power, and it is therefore not surprising that most programs enacted through the political process don't benefit them, and many actually cause them harm.

If Tyler is just making the normative point that the welfare state will no longer have a justification once even the poor are rich enough to provide for themselves, then I largely agree. But we don't have to wait for that to happen in order to condemn the many redistributive programs whose benefits flow to people who are not poor, and therefore can already provide basic necessities (and much else) for themselves. Even if welfare state redistribution is permissible in cases where it is necessary to aid the genuinely destitute who cannot help themselves (and I agree with Tyler that it is), that principle doesn't even begin to justify the vast majority of the welfare state redistribution that exists in the real world. As Harvard economist Jeffrey Miron points out, we can make huge cuts in the welfare state without touching even a penny of spending that goes to the poor.

UPDATE: I seem to be criticizing Tyler a lot recently (see here and here). So let me point out that I actually agree with his writings about 80 or 90% of the time. To extend the analogy to Marx, my critique of Tyler is similar to the critique of Marx by the "revisionist socialists" who basically agreed with his normative premises, but thought that some of his empirical predictions were wrong. If Tyler is the Marx of George Mason libertarianism, then I'm the Edouard Bernstein. OK, that's probably enough Marxist obscurantism for one post:).

Viscus (mail) (www):
Very interesting analysis.

On a political level, I wonder if it might not be an effective strategy to try to tie the two together. That is, reducing subsidies to the non-poor and using the revenue to fund subsidies for those who are actually poor.

Of course, it will be probably be a while before anyone with libertarian inclinations actually gets to try to implement political strategy. At least without a libertarian/liberal alliance. Which I see as possible with the Tyler Cowen type libertarians and, apparently, perhaps even the Ilya Somin type libertarians.
3.28.2007 8:50pm
Ilya Somin:
I agree with Viscus' point, and actually argued for this kind of alliance here. Unfortunately, however, I don't think it is politically likely, for reasons I elaborated in a series of posts liberaltarianism back in the fall. See here for the first post in the chain, which contains links to the others. But I'd love to be wrong about this.
3.28.2007 8:59pm
liberty (mail) (www):
Although I agree with you that being unecessary alone would not be sufficient for the state to wither away, it of course did not become unnecessary under socialism but rather became far more necessary and necessarily expansive, so you cannot really use that as evidence.

They did not learn that once the state becomes unnecessary it expands, they learned that socialism requires vast expansion of government power.
3.28.2007 9:04pm
J. F. Thomas (mail):
Well, I don't possibly see how health care is going to get more affordable. This country by far has the health care system with the least government interference of any developed country, yet we pay more and cover less people. I had three stitches in my finger a couple weeks ago and that non-extraordinary trip to the ER (absolutely nothing special, not even X-rays), cost $701.
3.28.2007 9:18pm
Fub:
Ilya Somin quotes Tyler Cowen:
Life without socks would be... "undignified," but no one recommends government provision or even sock vouchers. Relative to income, socks are sufficiently cheap.
Surely I'm not the only VC reader who grew up knowing kids who came to school in the dead of winter without socks because they didn't have any.

That's not an argument for or against anything. It's just a fact.
3.28.2007 9:23pm
DaveN (mail):
For some reason all of this reminds me of the utopian world of Star Trek, where money doesn't matter because everyone is always happy and has everything he or she needs (except, of course when those nasty Klingons or Borg are busy attacking).

Of course, Star Trek is fantasy--as is Tyler Cowen's utopian vision of the state ever withering away.
3.28.2007 9:25pm
Ron Hardin (mail) (www):
Why should _government_ spending go to the poor? Why not private spending, as in :

Q : Why do we always have the poor?

A : So we are not damned.

(Emmanuel Levinas, _Difficult Freedom_

``We have just seen that the Messiah is the just man who suffers, who has taken on the suffering of others. Who finally takes on the suffering of others, if not the being who says ``Me [Moi]''?

``The fact of not evading the burden imposed by the suffering of others defines ipseity itself. All persons are the Messiah.'')
3.28.2007 9:37pm
Andrew Okun:
It think it is an error to see our current vast entitlement system as a matter of redistribution to the poor. Aside from the fact that, as pointed out, it isn't distributed to the poor, the function it serves is insurance much more than aid to the destitute, more a destitution prevention system than a destitution alleviation system. The inclusion of social security and medicare in the term "welfare state" is a case of bad labelling.

As an insurance system backed by government, it has a distinct basis of rational support in the electorate separate from how poor the poor really are. The people who pay for social security and medicare and then get it may have made a reasonable calculation in continuing to support its existence.

I also think the idea that these programs don't wither away because they are a way for an elite to extract wealth is empirically problematic because (a) sometimes these programs do decrease in size and (b) they don't tend to increase inequality, which you'd think they'd do if they were a matter of an elite extracting wealth. Am I wrong about (b)? Does social security increase inequality?
3.28.2007 9:44pm
J. F. Thomas (mail):
Today's poor are much richer than the poor fifty years ago

Did it ever occur to Mr. Cowen that the poor are better off now than fifty years ago precisely because of the government programs (along with good-paying union jobs) that libertarians hate so much. Or that most of the improvements came in the first twenty-five years or so of that period and for the last twenty-five, since the election of Ronald Reagan, the lot of the poor and the middle class has become decidedly more precarious by most meaningful measures (and I'm not talking about how many TVs someone has or how nobody could afford a VCR in 1978).
3.28.2007 9:46pm
American Psikhushka (mail) (www):
I think there is a misunderstanding of communism/socialism here.

Communism and socialism require a large police state to stay in force. Price/wage controls create shortages and these shortages tend to create black markets because the shortages have driven the prices up so high. At that point a communist/socialist government basically has two choices: (a) it can let the black markets operate, in which case you are actually letting a market economy form and therefore really have a socialist economy in name only; or (b) you need to create a set of draconian laws and create an extensive police state, because you basically have to try to control the whole economy. Of course this police state is big and expensive and creates rancor with the public and eventually just accelerates the impoverishment and collapse of the whole thing. This is all laid out in this excellent article.
3.28.2007 9:51pm
Mike BUSL07 (mail):
J.F. Thomas - do you have a cite for that? And I sure hope it's for something other than growing income disparities.
3.28.2007 9:52pm
J. F. Thomas (mail):
do you have a cite for that?

Here you go. It's got a nice graph and everything showing the stagnant wages of production workers (while productivity has exploded). Add to that the well-documented explosion of higher education costs, health care, and the general lack of job stability, and the average working guy is definitely not better off.
3.28.2007 10:09pm
liberty (mail) (www):
J. F. Thomas,

So I would be wrong if I thought that the average working guy now has a bigger home, a computer, better and more household appliances, a nicer car or two, spends less on food and has a greater disposable income or greater purchasing power than he did in the 1950s?

Both general historical knowledge (or experience) combined with intellectual honesty and all the evidence would tell you that the "average working guy" or the median household is far better off today than in the 1950s.

The reason that the median wage doesn't look much higher is because of problems with CPI. In addition, remember that people start out at the bottom (in e.g. the bottom quintile) and finish at the top (e.g. top quintile) in their lifetime. And as you know the top quintile has exploded with wealth.
3.28.2007 10:20pm
Ilya Somin:
As an insurance system backed by government, it has a distinct basis of rational support in the electorate separate from how poor the poor really are. The people who pay for social security and medicare and then get it may have made a reasonable calculation in continuing to support its existence.

Social Security and similar programs cannot be considered insurance. They pay out money to all elderly people (or people defined by some other characteristic), not merely those who suffer some unanticipated catastrophic loss. Moreover, one can buy private insurance that is both cheaper and more efficient. One can also create a private IRA that has a much higher rate of return than Social Security taxes do.

I also think the idea that these programs don't wither away because they are a way for an elite to extract wealth is empirically problematic because (a) sometimes these programs do decrease in size and (b) they don't tend to increase inequality


Social Security, Medicare, and farm subsidies (the 3 largest redistributive programs in the US) virtually never decrease in size, and have grown almost continuously since their inception. Although I can't cite all the evidence here, they do indeed increase inequality. In the case of farm subsidies, the causation is pretty obvious. In the case of social security and medicare it has to do with the combination of 1) the regressive nature of social security taxes, 2) the shorter lifespan of hte poor (which means that they collect SS and Medicare for only a few years and in many cases don't collect it at all if they die before the age of 65), and 3) the greater ability of the rich and middle class to work Medicare reimbursement bureaucracy.
3.28.2007 10:33pm
J. F. Thomas (mail):
Both general historical knowledge (or experience) combined with intellectual honesty and all the evidence would tell you that the "average working guy" or the median household is far better off today than in the 1950s.


Well, the Median household income in this country is $47,000. I would imagine you have a much grander image of what half the householdsit is like to live on
3.28.2007 10:56pm
J. F. Thomas (mail):
Well, the Median household income in this country is around $47,000. I would imagine you have a much grander image of what half the households get by on than is reality.
3.28.2007 10:58pm
Ignorance is Bliss:
J F Thomas writes

...yet we pay more and cover less people. I had three stitches in my finger a couple weeks ago and that non-extraordinary trip to the ER (absolutely nothing special, not even X-rays), cost $701.


There are two problems with this. The first is that ERs do not cover less people. They are required to provide at least the minimal amount of treatment needed by anyone, regardless of whether they can pay. The second problem is that your ER treatment did not cost $701. That is the amount that you were charged, in order to cover the costs of those people that cannot pay for their own care.
3.28.2007 11:01pm
Spectral Disorder:
In light of your statement:

the poor have little political power, and it is therefore not surprising that most programs enacted through the political process don't benefit them, and many actually cause them harm.

then the statement

Of course today's poor aren't rich enough for us to remove government aid.

should read:

Of course today's poor rich aren't rich enough for us to remove government aid.
3.28.2007 11:07pm
Alan Gunn (mail):
Quite a few years ago, Bertrand deJouvenal pointed out in an odd book called "The Ethics of Redistribution" that the poor don't have enough political clout to get much from the government, so redistributive programs always had to benefit the middle classes to get adopted. Nothing I've seen since has suggested to me that he was wrong. Consider, for instance, medical care: the poor have Medicaid; the fuss about the uninsured is mostly about middle-income people who don't want to spend as much on health insurance as some people think they should. In recent years even left-leaning politicians seem to talk more about benefits for the middle class than about the poor. Maybe that's good for the poor: the "great society" did them a lot of harm; if the government focuses on running middle-income people's lives it will at least be messing with people who can defend themselves somewhat.
3.28.2007 11:08pm
J. F. Thomas (mail):
The second problem is that your ER treatment did not cost $701. That is the amount that you were charged, in order to cover the costs of those people that cannot pay for their own care.

My ER bill was $701, that is what it cost me (or rather my insurance company, although I am sure they will actually pay considerably less). Do you not understand the concept of money and bills?

That said, I understand your point, but how will a free market, perfect libertarian system, solve the problem of high medical costs. I guess the emergency room wouldn't be burdened with people who couldn't afford to pay (they would presumably die on the street) so my personal bill would be lower, but it would kind of suck for the poor heart attack victim with no money.
3.28.2007 11:13pm
J. F. Thomas (mail):
Maybe that's good for the poor: the "great society" did them a lot of harm

How exactly did the great society do the poor a lot of harm? This seems to be an article of faith among the right, but where is the empirical data to prove this?
3.28.2007 11:16pm
Spectral Disorder:

That is the amount that you were charged, in order to cover the costs of those people that cannot pay for their own care.

No, that is the arbitrary amount the hospital charged because when you are in need of emergency care, you don't try to pre-negotiate a price. That $701 charge is substantially more than medicare or any insurance company would pay for the service. While hospital ERs do generate a lot of unpaid bills, they wouldn't be around if they didn't generate a profit.

Also, Medicare is primarily a redistribution of wealth from the young/future generations to the elderly. While it is true that wealthier people live longer than the poor and therefore disproportionately benefit from the medicare program, i think the impact of the generational redistribution creates a net benefit to the old and poor.
3.28.2007 11:19pm
Andrew Okun:
Social Security and similar programs cannot be considered insurance. They pay out money to all elderly people (or people defined by some other characteristic), not merely those who suffer some unanticipated catastrophic loss.

Too narrow a view of what insurance is. Insurance is not just about catastrophic loss, but also about smoothing out anticipated variation arising from all kinds of factors.

Moreover, one can buy private insurance that is both cheaper and more efficient. One can also create a private IRA that has a much higher rate of return than Social Security taxes do.

Private insurance certainly can be cheaper and more efficient, but is also exposed to the creditworthiness of the insurer and, depending on the terms of the insurance, your own ability to keep paying in. And the rate of return of any private IRA may be higher, and may not be. If it turns out to be dreadful, there is no insurer of last resort like the government.

I'm not say the system is optimal, merely that it functions more like insurance than welfare and the public generally has a reasonable basis for keeping it going. The public might be better off without it, but it has decided otherwise.

Also, the fact that it is less efficient than private investment by itself argues against it being an extraction tool of the elite.

Social Security, Medicare, and farm subsidies (the 3 largest redistributive programs in the US) virtually never decrease in size, and have grown almost continuously since their inception.

Farm subsidies are different. They _are_ the extraction of wealth by a political elite. They are a product of the undemocratic and foul equal senate franchise.

For the rest, think wider. Many welfare, medical and pension programs in many countries have been cut when a financial or political crunch hits. Sweden, UK under Thatcher, and I think Chile, come to mind. We had our whole workfare thing, too.
3.28.2007 11:19pm
Ak:
That said, I understand your point, but how will a free market, perfect libertarian system, solve the problem of high medical costs.

Emergency medicine is a particular weakness of libertarian consumer medicine, but even this area is needlessly burdened by overly broad government regulation. For example, do you know why your trip cost over 700 dollars? This is because it is ILLEGAL for them to charge you less than they charge Medicare, and since the billings system are so byzantine and claims so often rejected (though this is more an issue with private insurance) they have to throw everything against the wall to see what will stick. It's possible that free market medicine would not be a stunning success, but nobody has ever bothered making the fairly non-invasive steps to make it feasible for people to buy health care rather than health care insurance. Not that, you know, there are any powerful interest groups that might have a reason to fight that.
3.28.2007 11:24pm
J. F. Thomas (mail):
No, that is the arbitrary amount the hospital charged because when you are in need of emergency care, you don't try to pre-negotiate a price.

Which is exactly why medicine is not subject to market forces. Even with my rather minor injury, I wasn't about to call around trying to cut the best deal as I bled all over the floor. Just imagine if it was life-threatening.
3.28.2007 11:26pm
Bleepless (mail):
Government programs arise, are maintained and even grow absent any showing of necessity or even desirability. No, the welfare state will not wither. It will grow, thanks to the greed of liberals, the weakness and hypocrisy of conservatives and the cannibalizing sectarianism of libertarians.
3.28.2007 11:47pm
SeaLawyer:
J.F. Thomas,
Your story highlights a number of problems with health care. Your bill does indeed cover all the people that show up to the emergency room that don't have coverage. You probably had a doctor stitch you up which is a waste of resources and adds to the cost. Giving someone stitches is not a skilled labor that you need to go to 8+ years of school to do. You also went to the emergency room to get 3 stitches that you could have taken care your self with some steri strips for 5 dollars. All of that increases health care costs for everyone.
3.28.2007 11:58pm
J. F. Thomas (mail):
You also went to the emergency room to get 3 stitches that you could have taken care your self with some steri strips for 5 dollars.

I assume because you call yourself "SeaLawyer" you are not a Doctor. Even if you were I doubt you could diagnose the seriousness of my laceration over the internet and whether steri-strips were indeed enough to close it. Give me your number and if I have chest pains you can advise me whether I should take a couple tums or perhaps fashion a defibrillator out of a car battery and a couple of ping pong paddles.
3.29.2007 12:13am
SeaLawyer:

I assume because you call yourself "SeaLawyer" you are not a Doctor. Even if you were I doubt you could diagnose the seriousness of my laceration over the internet and whether steri-strips were indeed enough to close it.


No I am not a doctor but I have stitched up my far share of cuts and 3 stitches is nothing. I also only use high quality medical equipment.

You kinda missed a little of the point. You had a doctor making 6 figures stitch you up. It takes more skill to hem your pants than it does to give someone stitches but the last time I checked it didn't cost $700 or take 8+ years of school.
3.29.2007 12:28am
J. F. Thomas (mail):
I'll also note that ten years ago I tore my ACL skiing in Canada. My entire emergency room bill, which included, x-rays, doctor, crutches, and an immobilizing knee brace, was CN $400 (US $300 at the time). An er visit in Washington DC 8 months later after a bicycle accident (that time it was 27 stitches in the chin, cut all the way to the bone, hope it was okay with you Sealawyer) was $2000.
3.29.2007 12:30am
SeaLawyer:

I'll also note that ten years ago I tore my ACL skiing in Canada. My entire emergency room bill, which included, x-rays, doctor, crutches, and an immobilizing knee brace, was CN $400 (US $300 at the time).


If it was in Canada why you get charged?


An er visit in Washington DC 8 months later after a bicycle accident (that time it was 27 stitches in the chin, cut all the way to the bone, hope it was okay with you Sealawyer) was $2000


Once again you paid for other peoples bills and a doctor to give you those stitches.
3.29.2007 12:39am
J. F. Thomas (mail):
You kinda missed a little of the point.

And I think you missed my point. Granted, this time three stitches was not a big deal. Although the last time it was because the last time I dropped a knife in the kitchen (this is the second time I have done this), the knife nicked an artery and I was bleeding profusely. How many blood soaked towels do you recommend before I give up on the steri-strips and seek professional help? But you're right, there are lots of routine procedures that could be performed by a PA or a nurse. And of course once you get past routine cuts and scrapes, self-diagnosis becomes a very dangerous game.

Then again, there are lots of routine legal functions that a paralegal or legal secretary is perfectly capable of performing that the State Bar insists only an Attorney is qualified to do.
3.29.2007 12:45am
J. F. Thomas (mail):
If it was in Canada why you get charged?

Because I am not covered by Canada's national health insurance program. I assume if I was a Canadian citizen, it would have cost me nothing.
3.29.2007 12:48am
SeaLawyer:

Because I am not covered by Canada's national health insurance program. I assume if I was a Canadian citizen, it would have cost me nothing.


That must have changed. I have not been to Canada in about 14 years, but back then even for an American or other nationality the health care did not cost anything.
3.29.2007 12:56am
SeaLawyer:

Then again, there are lots of routine legal functions that a paralegal or legal secretary is perfectly capable of performing that the State Bar insists only an Attorney is qualified to do.


Well maybe that should change as well.
3.29.2007 12:57am
SeaLawyer:

And of course once you get past routine cuts and scrapes, self-diagnosis becomes a very dangerous game.


That is true, even experienced doctors diagnose things incorrectly.
3.29.2007 1:00am
hopi (mail):
The more money poor people have to spend, the more they buy. And then the rich people make more money than if poor people don't have money to spend. I thought this was pretty basic thinking that was proven in the Great Depression.
3.29.2007 1:10am
eric (mail):
The left often accused libertarians of ignoring the impact of social welfare programs on the poor while attributing a very large portion of the improvement of the situation to social welfare programs and ignoring other economic development.

Looking at the statistics and my own experience growing up in a really poor area in a lower middle class family, the problem with the very poor, i.e. the both 1/5 of household incomes, is that these people either do not work or have other serious problems (single parents, drugs, alcohol, mental issues). If you want to work, and are able-bodied, you can easily make 30,000 a year (15 bucks an hour) in this country. For a family to fall in the bottom 1/5 one income earner must make less than 10 bucks an hour and/or work less than 2000 hours per year. For two income earners, minimum wage and full time work pulls you out of the bottom 1/5. These people are simply disfunctional.

The problem with the next 1/5, i.e. the 20-40 percentile, most have no clue how to manage money. No clue.

The poor, and some others, need money management skills. How many "poor" people drive a $25,000 vehicle and live in a shack? How many people have credit cards with 20% interest rates? How many use payday loans? How many spend 100+ bucks a month on smokes?
3.29.2007 1:20am
Riskable (mail) (www):
Technological progress will always out-pace human adaptation to said progress. Thus; when a technology can supplant people in any given task, humanity will benefit but the economy will suffer (since many of the replaced humans will now have to seek new employment and/or new skills only to suffer the same fate all over again).

Following this idea to it's natural conclusion: Eventually there will be no requirement for people to perform any task, making all non-original work a commodity (there will always be niches and extreme specialties). As we draw closer to this reality, the role of government will need to change drastically.

Playing to the crowd here for a moment, imagine if an artificial intelligence were able to replace lawyers for just about everything except for, say, providing a human face for courtroom representation (still referring to a machine for the actual legwork). What occupation would you retrain to? Would you even have the wherewithal to undergo what it takes for such a transition in a society of extreme specialists?

Some lawyers would still be able to get by on their own. The best of the best will always be in-demand and you'll always need a few to help the programmers. However, that leaves a lot of mediocre folks with unemployment. What will they do? How will they earn a living? Will they even need to?

In such a highly advanced technological future where food, shelter, and nearly all non-finite resources have become a commodity, how will society deal with those who are perfectly capable of working but cannot realistically expect to find jobs? We're already on the cusp of this world and it is only going to become more of a problem for our government to deal with.

The government may not need to provide any welfare at all in such a society where machines can take care of a human's every basic need. Thus; leaving the welfare society behind in technology's wake. However, will we merely redefine welfare? I can imagine scenarios where the government only provides a military and funds research and entertainment (i.e. Endowment for the Arts). Would it be a libertarian utopia, or a libertarian distopia?

-Riskable
http://riskable.com
"Fighting for freedom is an admirable cause. Fighting for the freedom to oppress is not."
3.29.2007 1:55am
Dan Simon (mail) (www):
Of course today's poor aren't rich enough for us to remove government aid. But when will the splendid era of libertarian freedom be possible? Today's poor are much richer than the poor fifty years ago, and the poor of the future are likely to be richer yet. Won't the welfare state, at some point, simply become unnecessary?

Not only that, but since health and longevity--even for, say, the least healthy quintile of the population--have been improving steadily over time, we can look forward to the day when everyone lives forever, and the entire field of medicine is no longer necessary!

What's that you say--despite improving health, the sickest people, and certainly the dying, are in no less need of medical care than the sick and dying of days gone by? Indeed, they demand even more medical care than in the past, despite the population's improved average health, because expectations of health and longevity have risen along with the averages?

No matter--the rising tide of overall improving health will eventually make even the moribund perpetually healthy, by any standard!

I honestly don't recall ever reading anything written by Tyler Cowen that didn't strike me as the work of a complete moron. (Here's one that I even called him out on.) Why on earth does anybody still read him, and how does he keep his job?
3.29.2007 2:31am
Dave Hardy (mail) (www):
For whatever personal experience is worth:

1. Healthcare is indeed a problem with the poor. Or, in fact, anyone who isn't especially rich.

2. It's likely that government, while the principal body doing much with that, also fouls up. A friend who practices psychiatry points out that the regulators require the use of obsolete drugs because they are cheaper (and conversely less effective, but the bean counters who pay for medication are different from the bean counters who pay for mental committments).

3. An ER for three stitches? I've strapped myself together for that sort of thing. And skipped it for two cases of stings from bark scorpions. The supposedly deadly ones. What could a doc tell me except that I'd been stung by a scorpion, which I already knew, and that antivenom was reserved for those at greatest risk, which I wasn't?

4. Prosperity 1950s vs. now ... we're really talking perceptions here, and that is very hard to judge. My perception as a laboring class kid in the 50s seems to be happier and more prosperous than my kids' of today, when I am making far more than the average income. But in the 50s kids were prosperous if they had, as my family did, one BW television. Today, without several $600 Gameboys and high speed internet access and such, a kid feels destitute.

5. I suppose the bottom line is that humans are humans, whether they are prosperous or not, whether they have power or not. Promoting someone to power in the government, or telling them to become the average person again, does not change their level of selfishness, stupidity, or whatnot. The problem both with pure libertarianism and pure, dare I say it, socialism, is that both assume that humans in one capacity or the other will behave differently. A private individual will behave rationally or irrationally and selfishly. Give the same person a GS-15 and they will suddenly behave unselfishly, and abjure empire-building, or become perfectly rational.
3.29.2007 3:35am
Ron Hardin (mail) (www):
Social Security is an inflation-protected annuity, against the possibility of your outliving your assets. Few can save enough for retirement lasting until they're 100, but they can easily save enough for an average retirement. What to do? Buy insurance against living to 100.

Over the period of 30+ years it has to operate, no private entity can be trusted to stay in business, the inflation-protection being an uninsureable risk, not to mention general market collapse.

Most people don't collect all they put in, but that's the deal. That's like your house not burning down after you buy fire insurance. You could have done better spending the premiums on other things
3.29.2007 5:07am
Ignorance is Bliss:
One of the reasons that the poor will never be able to afford adequate healthcare is that we have no fixed definition of adequate heathcare. If we could fix the definition of adaquate healthcare to 'the best medical care available in 2007', then fifty years from now, the poor will be able to afford it.

Instead, we define adequate healthcare as some some significant percentage of the best medical care available at that time. Since the best medical care will always be driven by what the very richest people can afford, the poor will never be able to afford it unless we significantly reduce the income gap.

Note however, that a set of policies that reduce the income gap could put such a drag on the economy that while the rich end up less rich, the poor also end up poorer. In such a case, the 'adequate healthcare' that they can now afford would be inferior the the perceived inadequate healthcare of the current system.
3.29.2007 9:24am
AppSocRes (mail):
J. F. Thomas: Since you like to nitpic professional details: You have consistently and incorrectly used the word cost to refer to the price that your insurance company was billed for treating your boo-boo. The cost of giving you your stitches was $20-$30. The price your insurance cvompany was charged was much higher because of government policies and the incredibly wasteful prevalence of private medical insurance in this country.

In a true fee-for-servce system with no government intervention and very limited medical insurance, the price and cost would have been about equal, as it was in this country before WW II. In this situation you might have thought twice about wasting medical resources on a cut that would have been better treated at home.

In the Canadian system as it currently operates, the price for basic medical treatment is the same as the cost. There is no cross-subsidization for non-basic medical treatment but the provincial governments keep their costs down by holding prices (what they provide to the medical system for non-basic medical care) way below actual costs.

As a result non-basic medical care is rationed and only the wealthiest Canadians get such care in a timely fashion (by coming to the US and apying out-of-pocket for it). By the way, Non-basic care includes procedures that are provided speedily and universally in this country, e.g., hip replacement and other orthopedic surgeries, cardiac surgery, reconstructive surgery of face, mouth, throat, hands, feet, etc., etc.!!! The situation has gotten so bad that the Canadian Supreme Court has declared the current operation of the system illegal. Yet there is no margin in federal or provincial budgets to repair the badly broken system. The situation gets worse and worse from year to year as fewer and fewer talented individuals are willing to become MD-slaves in the Canadian medical system.

This is an inevitable result of socializing medicine. Socialized medical systems in all the developed countries that have them are facing similar problems. Meanwhile our mixed system stumbles along providing more than adequate medical care to almost all persons in the country, with most problems due to too widespread insurance programs and government intervention.

The main reason that government programs will not fade away is that they support enormous numbers of upper-middle class professionals whose mouths are firmly attached to the government tit. Many of these are hidden in the woodwork, e.g., labor lawyers. Others are directly employed by the government, e.g. the federal civil service. If you look at government dollarws spent to "help the poor", about 4$ out of every $5 goes to middle and upper middle class persons who are paid directly or indirectly by the government. These persons will fight to the death to keep their entitlements and they have the political clout to prevail every time.
3.29.2007 9:30am
Bruce Hayden (mail) (www):
In the Canadian system as it currently operates, the price for basic medical treatment is the same as the cost. There is no cross-subsidization for non-basic medical treatment but the provincial governments keep their costs down by holding prices (what they provide to the medical system for non-basic medical care) way below actual costs.
Most of your explation made sense, but this part really didn't. I would think that any time that you keep prices below costs, you are going to misallocate resources.

But splitting the system into essentially two system does a good job at explaining what we see these days with the Canadian system: very low prices and good availability for what are deemed "essential"; and rationing, through either unavailability or long lines, for anything else.

What is scary to me about the Canadian and British system is what they don't cover. Stuff that I think I might need some day, ranging from bypass surgery to knee replacements. I skied yesterday with someone who had a quintuple bypass last year, and both my parents had knee replacements.

And that is part of why I pay to carry health insurance. Despite all the hype and misinformation to the contrary, experience with socialized medicine strongly suggests that those of us who do pay to carry health insurance are being asked to give up our knee replacements and bypass surgeries in order that those who would prefer to spend their money on other things, (such as beer for many of the uninsured 20 somethings), can get equivalent health care.
3.29.2007 10:43am
Bruce Hayden (mail) (www):
I read somewhere a year or so ago social security and medicare described essentially as massive intergenerational income transfer programs from the productive to the non-productive segments of the economy cleverly disguised through the addition of minimal welfare provisions. The fig leaf is the welfare side, and the incentive to voters is the income transfer side.

Yes, well, maybe many people can't expect to live on their savings and investments until 100. But then, someone who lives that long has lived on social security for 1/3 of their life. Is that realistic (that they be unproductive for the last 1/3 and the first 1/5 of their lives)?

What is really scary right now is seeing how many people in their early fifties are retiring with nice pensions - most often it seems from public sector employment (such as teaching). To think that many of them will be collecting benefits for far longer than they worked for them (and at public expense) is a bit scary. When my grandkids are paying for my social security, they will also be paying for pensions for the teachers for my kid's generation. All this while trying to raise a family on what is left.
3.29.2007 10:57am
Bruce Hayden (mail) (www):
How exactly did the great society do the poor a lot of harm? This seems to be an article of faith among the right, but where is the empirical data to prove this?
One thing that it did do was to institutionalize fatherless families by subsidizing such for some thirty years.

I am not sure what you want in emperical data - That the level of illegitimacy and single parent (i.e. mother only) families skyrocketed during this time? That there weren't financial incentives for that behavior? That growing up in such a family is one of the surest ways of either ending up in prison (for the males) or repeating it (for the females)? Or, indeed, of spending their lives in poverty? That over a trillion dollars was spent on it?
3.29.2007 11:04am
rarango (mail):
With respect to income disparity, I wonder how the statistics distinguish between wealth versus income; right now, as I have gotten older, my income has declined dramatically, but my net worth (wealth) allows for a comfortable lifestyle; and wouldnt upward mobility by an individual or individual family between income quintiles be the real measure of improvement. In my view simply looking at numbers of people in a given quintile, while a starting point, doesn't get you very far until you dissaggregate the data and look at numbers of people moving between quintiles over time.

With respect to withering away of the state: Weber is much more relevant than Marx, IMHO.
3.29.2007 11:08am
Bruce Hayden (mail) (www):
I think we may be somewhat going where Tyler is suggesting. The basic real living standard (taking into account all the stuff that isn't included in the wage figures that J.F. was touting above) of the working poor is pretty good any more. When air conditioning, food, multiple cars, multiple color TVs, computers, etc. have become ubiquitous for this class, it is harder and harder to justify more support for them. Even most of those on welfare live fairly well these days - you often see people in nice cars using food stamps. Nicer cars than I drive working as an attorney.

But the solution isn't another huge government bureaucracy that primarily benefits those working in it, but rather Dr. Friedman's negative income tax. That would efficiently and economically provide a safety net for the least advantaged in our society, without providing all the step-wise disincentives that we now see (or paying the overhead of that bureaucracy, typically installed to minimize cheating).
3.29.2007 11:17am
J. F. Thomas (mail):
One thing that it did do was to institutionalize fatherless families by subsidizing such for some thirty years.

Ahh, that old canard. That welfare payments to single mothers is the sole cause of the breakdown of the family. Changing social mores, the increasing mobility of society, job insecurity, increasing urbanization, increased job opportunities for women, and a myriad of other factors had nothing to do with it. Of course the fact that rising divorce rate and fatherless families is a phenomenon that is not just limited to the poor but is spread across all socioeconomic classes cannot be explained by welfare payments can be conveniently ignored in the effort to blame "great society" programs for all the nation's woes.
3.29.2007 11:18am
David M. Nieporent (www):
But it is not "spread across all socioeconomic classes," except under the most narrowly literal meaning of those words -- that there is some person from each class who is a single mother. In fact, broken families are concentrated disproportionately among the poor, not "spread" throughout the income spectrum.

And second, your logic is flawed. The fact that a rich person gets divorced does not mean that welfare is not responsible for a poor person getting divorced. (Or, more likely, not married in the first place.) You assume that the same incentives face each group.
3.29.2007 12:59pm
Toby:
Speculating on a complete change in human nature is fairly far out there (in terms of radical leftist) for this BLOG.

Throughout the 20th century, we watched as radical utopians attempted to re-write human nature. At simplest analysis, these attempts just failed. A deeper analysis lays some of the worst excesses on these efforts, and the belief that 1 (or 10) generations would create “The New Man”.

See, once we accomplish “it”, then we will have created utopia not just for one generation, but for all generations. And even the smallest smattering of Fletcherism suggests that we are then comparing 1,000 (or 1,000,000 – why not?) generations of Utopia against the inconvenience/suffering of the relatively few, members of this generation and the next. And when we weight this against the whole future, well, any sacrifice is worthwhile…

Large scale genocide such as that in the Ukraine, or the Cultural Revolution, or even in the Killing Fields of Cambodia are all easily justified once you go down this route. Stalin recognized this point, the malleable nature of humanity, that he doomed the Soviet Union to even more starvation by throwing the full weight of the CPSU behind Lamarckian inheritance, mandating that the ministry of agriculture use this approach in preference to the Mendellian genetics of green revolution.

I like to think that the reason conservatives of a religious bent tend to acknowledge Original Sin (or perhaps vice versa) is because a recognition of the core imperfectability of man is tied to both stances.

Conversely, many liberals rebel against any aspect of original sin as they spin out new programs that are justified because they will fix [racism, sexism, classism, disrespect of alternative life-styles, … perhaps even dandruff]
3.29.2007 2:25pm
Mark Buehner (mail):

Social Security is an inflation-protected annuity, against the possibility probability of your outliving your assets.


Social Security was created when the life expectancy was 20 years younger than it is today. The retirement age hasnt remotely kept pace. Hence the raison d'etre has radically changed. Instead of a program to prop up the destitute elderly, it has become a program to allow people to retire while in fine health while the younger foot the bill in hopes of doing the same to their grandkids.

The entire system is lunatic- who would voluntarilly save money at a lousy interest rate that you cant touch until the government doles it out to you month by month in your old age, and if you die too early your family isnt likely to see a dime of it? Who's in for that plan?
3.29.2007 2:26pm
gasman (mail):
The welfare state will fight withering away.
The greatest beneficiaries of the welfare state are the tens of millions of employees of the state. These folks have spent their lives clawing up the heap toward the salary and security of middle-management and the very generous retirement benefits associated with government service. The welfare state of government employment knows how to keep each congressman under firm control so that revenue to the bureaucratic machine can continue to run. That there might not be any requirement for their services at some future time is irrelevant; the effective bureaucrat knows how to shift their mission to a newly created threat or worry.
3.29.2007 2:58pm
Ron Hardin (mail) (www):
To Mark Buehner,

Social security is an annuity, which precisely reduces its cost by not letting you bequeath it to heirs. It supplies exactly what you need, in other words, if you want to insure against outliving your assets.

As for fixing Social Security, you're right, but it's simple to fix, namely raise the retirement age so that the number of retirees is small enough compared to the number of workers. Don't reduce the benefits, however ; the point is to be able to live on them, past the retirement age, whatever it needs to be.

If you want to retire earlier, it's a simple matter to save enough to live on between your actual retirement and social security kicking in. That's a number of years you know about in advance
3.29.2007 3:11pm
Bruce Hayden (mail) (www):
Ron Hardin said:
Social security is an annuity, which precisely reduces its cost by not letting you bequeath it to heirs. It supplies exactly what you need, in other words, if you want to insure against outliving your assets.

As for fixing Social Security, you're right, but it's simple to fix, namely raise the retirement age so that the number of retirees is small enough compared to the number of workers. Don't reduce the benefits, however ; the point is to be able to live on them, past the retirement age, whatever it needs to be.
That solution ignores the question of why does SS payout to multimillionaires in the first place? I know plenty of people who are on SS right now who have no realistic expectation of ever running out of their pensions and savings.

Yes, some people who live to 100 do run out. But not that many people live that long in the first place. Rather, most who take SS die quite a bit earlier - likely in their 70s and 80s. I would suspect that the most likely reason to run out is long term nursing care (which can be insured against...)

Your suggestion that it is an annuity is also I believe falacious. For one thing, there is nowhere near a linear relationship between the amount put into the system, and the amount received, even of people of the same age. Worse, the effective interest rate keeps dropping, as more recipients depend on ever fewer contributors, presumably going negative in the near future.

Which gets me back to my previous post. It is primarily a huge intergenerational wealth transfer scheme. It transfers money from those working and trying to raise families to the leasure class. And from the poorer parts of society demographically, to the richest. In short, many of the families working to raise families need the money far more than the recipients do.

But it is rare that anyone really looks into how many SS (etc.) recipients really need the money because that would undermine the arguments that we have seen above that it is there to take care of those elderly (and disabled) in real need. Most recipients aren't. But it is this minor "welfare" role for the programs that is the hook that morally justifies the programs.

(In this context, it is humorous to note how often the more secure SS recipients pass some of this largess back down through the generations to their kids, and then via them to their grandkids, who are often the ones who need it most).
3.29.2007 3:51pm
Bruce Hayden (mail) (www):
Ahh, that old canard. That welfare payments to single mothers is the sole cause of the breakdown of the family. Changing social mores, the increasing mobility of society, job insecurity, increasing urbanization, increased job opportunities for women, and a myriad of other factors had nothing to do with it. Of course the fact that rising divorce rate and fatherless families is a phenomenon that is not just limited to the poor but is spread across all socioeconomic classes cannot be explained by welfare payments can be conveniently ignored in the effort to blame "great society" programs for all the nation's woes.
Other posters have also addressed this. First, I never said that "welfare payments to single mothers is the sole cause of the breakdown of the family". I appologize if you got that impression. And that fact that the situation extends throughout the different economic strata does not mean that it is distributed evenly thereof, or, indeed, that welfare payments to single parents didn't skew it.

Rather, there is a large, well documented, positive relationship between wealth and number of parents. If a girl wants to spend her life poor, the best thing (outside of drug usage) she could probably do is start having kids out of wedlock while still a teenager. On the other hand, the best way for her to avoid it is to wait until after college to marry and then have kids. One problem with the War on Poverty was that it rewarded the former behavior by subsidizing it. It obviously wasn't the only cause, but rather just a large cause (esp. as noted above, the strong correlation between poverty and early fatherless childrearing).
3.29.2007 4:06pm
DeezRightWingNutz:
Is anyone else concerned about how accident prone JF Thomas appears to be? Warren Meyer at Coyoteblog has frequently commented on how government paid or government run healthcare invites totalitarianism and nanny statism. Once we have gov't health insurance, I'll be the first to propose law that bars Mr./Mrs. Thomas from using sharp objects, power tools, and non-pedestrian means of locomotion.
3.29.2007 4:48pm
Andrew Okun:
The welfare state will fight withering away.
The greatest beneficiaries of the welfare state are the tens of millions of employees of the state. These folks have spent their lives clawing up the heap toward the salary and security of middle-management and the very generous retirement benefits associated with government service. The welfare state of government employment knows how to keep each congressman under firm control so that revenue to the bureaucratic machine can continue to run. That there might not be any requirement for their services at some future time is irrelevant; the effective bureaucrat knows how to shift their mission to a newly created threat or worry.


Are you talking about the United States? If so, I think this isn't right. First of all, the number of government employees that can be said to be employed running the welfare state is not close to 10s of millions. I'd be shocked if it came anywhere near a million. Certainly the size is limited if you are talking about proper civil service jobs with benefits and pensions, which seems to be what you're talking about. Total civilian federal employment is, I think, 1.9 million, not counting uniformed military and postal workers, with another, I don't, two million at state level, 2.5 million at county. Most of welfare scut work is done at federal and county level, and most of those four million workers are in education, law enforcement and judicial, hospitals and the like.

Yes, bureaucracies push legislatures for more funding, but their power is limited and sometimes funding is cut. It happens all the time. The theory that government programs inherently create a political base so strong that they are never cut or ended is quite simply falsified by reality. Sometimes programs are ended, funding is cut, public employees are put out of work. It happens.
3.29.2007 7:26pm
American Psikhushka (mail) (www):
DeezRightWingNutz-

Is anyone else concerned about how accident prone JF Thomas appears to be? Warren Meyer at Coyoteblog has frequently commented on how government paid or government run healthcare invites totalitarianism and nanny statism. Once we have gov't health insurance, I'll be the first to propose law that bars Mr./Mrs. Thomas from using sharp objects, power tools, and non-pedestrian means of locomotion.

I couldn't agree more. I'm concerned about Mr./Mrs. Thomas' safety was well. Perhaps the mandatory wearing of a day-glo orange Nerf suit is in order as well. It's for the children.
3.29.2007 10:18pm
markm (mail):

Relative to income, socks are sufficiently cheap. There is some inequality of socks, but it seems that just about everybody — even the poor — "has enough." We don't even force people to buy socks for their kids.

Might there come a time when health care and education fall under the same rubric?

Socks can be produced by machines. If the labor required to keep the machines running costs too much, the machines can be moved to third-world countries where the standard of living is much, much lower. Ultimately, the only labor required will be on the receiving and shipping docks, with the fiber going from the trucks into the machine, and a machine at the other end loading crates of socks into trucks. OTOH, health care and education for Americans nearly always must be delivered by highly skilled human workers living in the USA, who expect a proportionately generous paycheck. General prosperity that raises the income of the poor along with everyone else won't help, since skilled workers such as doctors and teachers will quite rightly expect that their salaries will keep up with the general rise in incomes.

Can the price of skilled labor relative to the wages of the working poor be lowered? Only if the poor become skilled workers themselves. I don't think we're headed in that direction, in fact from what I can see we're getting further from it. On the one hand,I see statistics showing that many, if not most, urban schools serving mostly poor children have greater than 50% dropout rates and a large percentage of functional illiterates in those that do graduate. On the other hand, I have seen for myself attitudes and habits in many young adults from poorer backgrounds such that, even if a first-rate medical school (or other professional) education could be injected right into their heads, they'd still fail to hold a job. Knowing how to do the job isn't enough; you've got to get to work on time, be sober, maintain a personal appearance such that people will trust you with their lives, avoid legal infractions that get you judged as untrustworthy, and actually settle down and work intensely for hours at a time. Kids from the average welfare family learn nothing of these things...

Can medical work and teaching be outsourced to poor countries? It does happen to some extent. Wealthy Americans may fly to a first-rate hospital in a third-world country for a scheduled operation that costs somewhat less than in the USA because the doctors work for less, and a much more comfortable recovery because the hospital can cheaply hire enough unskilled workers to make one's hospital room seem like a resort hotel room - but I doubt poor Americans will ever benefit from this. Students can communicate over the web with a tutor in India who is probably as well educated as the kid's schoolteacher, and who is happy to work for much less - but once again, I think this will far more often be a supplement bought by the upper middle class than something useful to the poor. More practically, X-rays may be electronically transmitted to India for interpretation. It helps, but it doesn't go far to solve the main problem of doctor's and nurses rightfully expecting high wages in this country. Finally, outsourcing of these kinds require a poor country with a good educational system and communications infrastructure - so we can only outsource skilled work to the countries with the best chance of pulling themselves out of poverty. Eventually, their professionals will be able to demand higher wages to perform these same services for their own people, and I don't think anarchic and uneducated countries such as Afghanistan or the Sudan will be able to replace them.

Can kids learn without a teacher? I've helped homeschool some of my grandkids. There's a lot of software that helps, but there still needs to be an adult maintaining order and giving some direction - and the adult has to be in the room, not on the internet from another country. Well-educated parents can do a better job of teaching just a few kids than trained teachers do with a full classroom, and without spending all their time at it. That's great for educated middle-class parents that want to spend less time working and more time taking care of their kids and home (or that can juggle kids and at-home work), but what does it do for poor people that dropped out of school, or graduated illiterate?

Can doctors be replaced by technology? Maybe in 50 years, but there will have to be major legal changes and even bigger changes in how medical services are delivered before it becomes possible to start working towards a robot doctor. First, no sane equipment maker will sell a machine that could be construed as replacing a doctor's medical judgment or skills in today's tort environment - they'd get sued every time anything goes wrong. It's not just that it's easy to blame the new element in the equation for problems that aren't new at all, but in truth the machine would not be objectively as good as a doctor, until it had a decade or so of use and improvements. What can be delivered right now is a database that a physician or physician's assistant could enter symptoms and test results into, that would suggest some possible diagnoses and treatments. This would improve care because it would catch possibilities the doctor missed, know about obscure tropical diseases that the doctor only heard about once in medical school long ago, etc., and yet the doctor would still have the final say so the many errors made by the database would not hurt patients. However, few doctors would be willing to use it. They've had too much training in acting god-like...
3.30.2007 2:03pm
Mr L (mail):
That solution ignores the question of why does SS payout to multimillionaires in the first place?

Means-testing was proposed around the 2004 (?) election, and honestly I think it would have easily passed; rich folks really aren't giving up very much, and it greatly improves our long-term prognosis. As I recall, it was killed by Teddy Kennedy, on the (probably accurate) grounds that making SS into a non-universal de facto welfare program for the old would reduce its popular support.
3.31.2007 10:55am
The Real Bill (mail):
OTOH, health care and education for Americans nearly always must be delivered by highly skilled human workers living in the USA, who expect a proportionately generous paycheck.

LMAOROTF! I would not consider a single K-12 teacher I had highly skilled, and maybe half of my college professors.

making SS into a non-universal de facto welfare program for the old would reduce its popular support

I've asked dozens of people this question: Would you support reducing SS and Medicare taxes along with means-testing of these programs, as long as the poor and disabled kept their safety net? Every single one, across the political spectrum, said yes. I don't buy this argument for a minute. Maybe some of you folks that think differently should talk to some "real" people, instead of getting your ideas from the likes of Ted Kennedy.

I generally also suggest that we combine all of the programs into a single welfare program for anyone poor or disabled at any age. I get almost unanimous agreement on this.
4.2.2007 10:18am