What He Said

August 14, 2009
Posted by Jay Livingston

After I’d written yesterday’s post – and I actually spent some time trying to make my thoughts coherent – I found out that The Daily Show had made pretty much the same point two days earlier. They now have a recurring segment called “Reform Madness,” an allusion to Reefer Madness. This installment was called “White Minority” and featured Senior Black Correspondent Larry Wilmore.


This is just a screen shot. Go here to see it if you missed it earlier this week. You’ll see what I mean (and maybe what Trrish meant in her comment yesterday.

Status Politics and Anti-HealthCare

August 13, 2009  
Posted by Jay Livingston

The hard core protesters are making it clear that for them, this isn’t really about health care. It’s about something much larger.


Poor Arlen Specter. He may have wanted to talk about health care, but as the New York Times  reported yesterday, many in the crowd didn’t want to discuss coverage.

They got up before dawn in large numbers with angry signs and American flag T-shirts, and many were seething with frustration at issues that went far beyond overhauling health care. . . .
“This is about the dismantling of this country,” Katy Abram, 35, shouted at Mr. Specter, drawing one of the most prolonged rounds of applause. “We don’t want this country to turn into Russia.”

For Obama and the Democrats, it’s about getting it right and getting it passed. For several other interested parties (insurance companies, Big Pharma, and the rest), it’s about economic self-interest. But for the protesters – the people shouting down discussion at town meetings, carrying signs about “socialism,” ranting about rationing and “death panels” – the issue has taken on symbolic qualities that have nothing to do with health care and much to do with status politics.

Harold Lasswell famously said, “Politics is who gets what, when, and how.” But status politics has little to do with tangible interests. Status politics is flying the Confederate flag on the state capitol. It has nothing to do with policy and everything to do with status. Campaigns to make English the “official language” have this same quality. The question is not who gets what. Instead the question is: whose country is this?

My thinking in all this is inspired by Joseph Gusfield’s Symbolic Crusade, about the temperance movement, which grew in the late 19th century and achieved its greatest victory in the passage of the Eighteenth Amendment.

As Gusfield puts it,

Since governmental actions symbolize the position of groups in the status structure, seemingly ceremonial or ritual acts of government are often of great importance to many social groups.

Gusfield argues that while anti-alcohol laws may have been about the evils of drink, they also reaffirmed the cultural and political dominance of those who had been running the country but now felt their position threatened. Beginning in the latter part of the nineteenth century, these groups – Protestant, rural or small-town, middle class, and agrarian – saw new groups rising to challenge the position of dominance that they had long taken for granted. These arrivistes were largely urban rather than rural, industrial rather than agrarian, Catholic rather than protest, lower class or upper class rather than middle, cosmopolitan rather than local, modern rather than traditional. And they drank. They did not share the old order’s value on abstinence as a sign of virtue, nor did they deem it a necessity for respectability.

By passing laws, especially a national law, the old order could reassure themselves that America was still their country. Then, in 1929, it became clear that what they had been doing with their country hadn’t turned out so well, and in 1932 the “Roosevelt coalition” – urban, ethnic, industrial (plus the anti-Republican South) – swept them out. Notably, one of the first things on the agenda was Repeal.

With health care, the status-politics issue is less clear because private and public insurance are not important aspects of any group’s identity. But these protesters bear a strong resemblance to the temperance constituency – white, non-urban, middle class, local, largely Protestant, anti-immigrant. They are Palin’s peeps.

Ever since Obama took office, they have been looking for a battleground issue where they could show that they were still in control. The financial bailout might have been the Big Issue, but since the economy tanked when Bush had been in control for eight years, it was hard to blame the crisis on Obama or the Democrats. And Bush himself had been the one to start tossing huge sums to Wall Street. The Teabaggers didn’t really have an issue; they could never clarify what they were against let alone what they were for. Foreign policy? Most Americans would prefer to forget about Iraq. They feel that any foreign policy would be better than what Bush got us into.

So health care is where the old order makes its stand. Early on, their spokesman Rush Limbaugh said flat out that he was rooting for Obama to fail. So they protest “Obama care.” But the issue is not really health care, and not even the president. Obama – urban, non-white, cosmopolitan, with ties to both the lower class (community organizing on Chicago’s South Side) and the upper class (Harvard Law) – has become the symbol of their loss of dominance.

The protesters remind me of a spoiled child used to having his way. “Seething with frustration,” is how the Times reporter put it – frustration at losing their position of dominance. They feel that despite Obama’s getting a majority of the votes, his Presidency is still an illegitimate usurpation. The “birthers” make this claim explicitly. But the health care protesters seem to share this idea that their power has been illegitimately taken from them. “I demand my voice,” said one of the signs at the Specter meeting, implying that even if that voice was in the minority and had lost the election, it still should carry the day.

But the protesters, the followers of Fox News and Limbaugh, still can’t grasp that they were outvoted last November. They still think that the US is their country. In the Nixon, Reagan, and Bush years, they knew it was their country. Democrats were allowed to live in it as long as they accepted that dominance. If they dissented, they were accused of treason. “America – love it or leave it.”

Yet even though they are now in the minority, they still think that they are “the Real America” and that the US still belongs to them. But the Real America is coming face to face with reality.
The change has been coming for a while. – the 2006 elections were a sign of this political and cultural shift as I suggested at the time (here) . But the election of Obama and now the possibility that he will enact a real change confronts them with the reality of their loss of dominance. That’s why they see health care in such apocalyptic terms. That’s why I also fear that their tantrums may turn even uglier.

Rescission, Decision, Division

August 12, 2009
Posted by Jay Livingston

Mike at Pragmatic Idealists may have had a similar reaction to mine when he heard the “Fine Print” episode of This American Life. Patients testifying before Congress told of how their health insurance companies had rescinded their coverage and refused to pay their claims. These patients were desperately ill and in need of expensive care. But the insurance companies found mistakes in documents submitted when they applied for insurance years earlier and used these minor errors to cancel coverage. It’s called rescission.

Then we heard from insurance company executives testifying before the same committee. They all said that rescission affects only about 0.5% of their policy holders.

Here was my problem: how could I square this statistical reality with the anecdotal data from the woman with aggressive breast cancer whose coverage they rescinded because she had once been treated for acne? How could I balance 0.5% against my absolute knowledge that these executives were heartless bastards?*

Mike points to a post by Taunter that has the answer, and I was a bit embarrassed not to have realized it myself. Both Mike and Taunter see it in terms of Bayesian probability and the Monty Hall problem, and they are right. But there’s a simpler way – not Bayes, but fifth grade arithmetic.

A rate, like the rescission rate, is fraction. So we have a division problem. But what are we dividing by what? What is the numerator, and, more important, what is the denominator?

Let’s say that the Vulcan Fire Insurance company covers 1000 houses. Last year, none of those houses had a serious fire. A very few had small fire damage costing much less than the owners had paid in premiums over the last few years. Is Vulcan going to scan anyone’s documents looking to rescind coverage? Of course not. Those customers are paying premiums in and not taking anything out. But suppose that this year, one house is completely destroyed by fire, with damages of $300,000.

Now Vulcan gets out its magnifying glass and scans the fine print trying to find some basis for rescission, but just for this one customer. They find their pretext, they rescind the coverage, and they don’t pay a dime.

And when the CEO of Vulcan is called before Congress, he says, “Rescission affects only one-tenth of one percent of our customers.”

True enough. One rescission divided by 1000 policy holders equals 0.1%. But if you do the division differently, if you change your denominator from “all customers” to “policy holders whose houses burned down,” the rescission rate is 100%.

With health care, the question isn’t what percentage of all patients are rescinded. The question, which nobody on the Congressional committee thought to ask, is what is the rescission percentage of patients filing expensive claims – people with conditions that require expensive and continuing treatment and care. Taunter estimates that if you draw the line at the top 5% of patients (“top” in terms of medical costs), the rescission rate is more like 10%. And if you look at the top 1%, it’s closer to 50%. **

Check out Mike’s post and the links in it for a more thorough presentation and analysis of the problem.

The fine print problem takes other forms besides rescission. As a Consumer Reports study concluded, “Many people who believe they have adequate health insurance actually have coverage so riddled with loopholes, limits, exclusions, and gotchas that it won't come close to covering their expenses if they fall seriously ill.” Read here about a woman who thought she had health care and wound up paying over $20,000 for a normal pregnancy and childbirth.

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 * Opponents of the public option and “government run” health care, try to scare us by suggesting that “faceless bureaucrats” will be making life-and-death decisions about us. I’ll take a faceless bureaucrat over a heartless bastard any day.

** Another statistic. Several bloggers linked to Taunter’s post – bloggers at important places like Reuters and The Atlantic. Views of Taunter’s posts rarely reach three figures. But this one post got nearly 10,000 hits.

The Conspiratorial Mind

August 11, 2009
Posted by Jay Livingston

“I wanted to punch the guy,” said my son, a young man not given to violence. The guy in question was standing outside the 72nd St. subway entrance wearing a sandwich-board sign that said, “9/11 Was an Inside Job. Prove Me Wrong.”

We had been talking about the Birthers, and that had reminded him of this other conspiracy theorist.


It got me to wondering about conspiracy believers, specifically what they think of other conspiracists. Are they like some religious believers, whose rejections of one another’s ideas about God are so intense they can lead to mass slaughter? Or are they more like New Age religionists who allow that “there are many paths up the mountain”?

I don’t expect that the 9/11 believers also share the specific beliefs of the Birthers, though there’s a remarkable symmetry, as Brendan Nyhan shows in this graph he created with data from different surveys.


Graphed on belief in the two conspiracies, the proportions of Democrats and Republicans are mirror images of one another. And about 5% of each group accepts both conspiracies (I’m assuming that the Democrat Birthers also believe that 9/11 was an inside job; similarly for Republicans who accept the 9/11 story.)

But what about the Birthers who do not themselves believe the 9/11 conspiracy, or the 9/11 “Truthers” who don’t believe the birth idea? Are they more tolerant of other people’s conspiracy theories?

Those of us in the mainstream view both of them as wackos who spend a lot of effort ignoring reality. But do the Birthers reject the 9/11 believers as wackos, or are they generally more tolerant of any conspiracy theory? Or is this purely a partisan thing, as Nyhan implies, with each side accepting the theory that makes the other side look bad?

My hunch is that there’s a conspiratorial mentality that makes any conspiracy seem more reasonable. Conspiracists of all sorts share the assumption that “they” (some powerful cabal) are hiding the truth from the rest us in order to further their quest for political or economic domination. So a Birther seeing the guy with the sandwich board would not think, “What an outrageous and ignorant insult to the families of the victims,” as my son did, but, “Maybe he’s on to something. You never know.”

Surely there is already research on this question. It’s just that I don’t know about it. They must be hiding it from me.