Obama and Teddy (Roosevelt)

Here is an excerpt from an article by Matthew Spalding in the December 31 National Review:

“But about a hundred years ago, there arose a different dream: that government could engineer a better society, rather than simply leaving the people free to create one. Progressive reformers were convinced not only that the American founders were wrong in their assumptions about man and about the necessity of limited government, but also that advances in science would allow government to reshape society and eradicate the inequalities of property and wealth that had been unleashed by individual rights, democratic capitalism, and the resulting growth of commerce and business. A more activist government, built on evolving rights and a “living” Constitution, would redistribute wealth and level out differences in society through progressive taxation, economic regulations, and extensive social-welfare programs, all centrally administered by expert bureaucrats.”

This article gets much right about Obama, his ideology, and his goals, in my opinion. I disagree with his statement that Obama is correct in denying that he is engaged in class warfare as conventionally understood, although it is possible I am missing his point here.

Note:  I was unable to preview this post; the function did not work properly and crashed my browser through repeated tries.

Update:  After posting, I see the link does not work, but I can’t spot the problem.

76 Responses

  1. If the Senate flips, the House stays the same and Obama wins, I see him adopting the Clinton strategy of going right word and working with Congress. To do otherwise would lead to a nil legacy. I don't think his ego could handle that. What do y'all think in this scenario?

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  2. He might, but I think he will double down on his use of unilateral executive power, legitimate or not, to achieve as much leftward transformation as he can.I don't think he will move rightward in any way on any big issues that would be giving up any prizes important to the left, where his heart is, like Clinton's agreement to welfare reform. I see no chance of anything like that. He won't agree to anything that could be a major or permanent rollback of the welfare state, broadly defined. No give back on Obamacare. Nothing like that imo.

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  3. Fixed the link for you qb. Will read piece from NR later.

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  4. QB, I get your point and I think he'll be tempted to do that, especially if the Democrats keep the Senate. I see Obama changing his strategy on the Unitary Executive if the R's take the Senate (and keep the House) by more than one or two votes. Also, it will be very difficult for the Democratic Presidential field, starting in 2014, to have to defend that Unitary legacy while Democratic House and Senate hopefuls run on the idea of what they can do for the constituentscountry. Their message will not be "less power for their respective chambers." I think the pressure on Obama from those fronts will be very high to moderate.

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  5. QB1, that is an unusual perspective in some ways. Lincoln had put in motion the notion of using the power of the federal government according to the concepts of the early Republican Party.The emphasis on the federal functions of interstate roadway and waterway maintenance produced major commercial projects let by the government. Then the Morrill Land Grant College Act – Lincoln's baby – put federal lands in the hands of states that would agree to make agricultural and engineering colleges. And in order to dominate the land for commerce, the federal government began using eminent domain to give land to the railroads, and sent the troops west, after Lincoln's death, to destroy Comancheria, the million square mile inland empire of the Comanche tribes, and declare the Homestead Act.The government encouraged but did not regulate railroad monopolies, which caused a visceral reaction in the very plains states the rails opened to homesteaders on previously federally owned land. The railroads were too big to fail. The populist movement and the Grange League Federation arose in response to the rail monopolies, whose locomotives sparked wildfires on ranchland and farm land across the west, and who claimed virtual immunity until western states elected populist governments, and populist judges, as well.Before 1913 we had no central bank, but bank panics could only be averted by the concerted efforts of the few major houses like Morgan and Carnegie. History has been kind to TR's efforts to regulate natural monopolies and destroy combinations in restraint of trade, to modernize the Navy and to create the National Parks. The nation was clearly strengthened by them, as it had been by Morrill Act and the Homestead Act and the intercontinental rails before. I am setting a brief stage for how history is evolutionary, not revolutionary, in that time frame, and how theoreticians had little to do with it. That Federal Reserve Ron Paul so hates was fathered as much by Morgan as by anyone, because like every other trading nation we needed a central bank.To write that 1880-1917 was driven by progressive reformers who thought the founders were wrong is an error. They thought the collusion between government and the monopolies was wrong, since they had elected their officials to serve everyone.

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  6. Mark,I would agree in some respects with what you say. Lincoln took some leaps toward consolidated federal power (and I am not a fan of some), but Lincoln was no 20th century Progressive. It is common for people on the left to claim he was a proto-labor unionist and anti-capitalist, but that is pretty much the opposite of the truth, for example. He believed in and wanted to preserve the ability of people without means to work, save, and become people of means, i.e., captitalists who made their own destinies and pursued their own economic goals.I don't think the article suggests the historiographical view that reformers necessarily drove history or at least that people like Croly and TR were not articulating ideas that were developing and current as well as forwarding them (see what I did there?). I certainly don't. For example, if we believe history as we receive has some truth to it, I think people of the era, and particularly men of a little means and education, were scientific optimists who were excited about the ongoing scientific revolution and believed that scientific thinking not only would make life better but could be applied in conscious ways to make society better. That seems to me part of what produced progressivism.If you look at someone like Croly, he articulated an explicit critique of the society from the founding as producing undesirable inequality. He didn't say that he was forwarding the ideas of the Founders but that we needed to follow a new set of ideas. Troll, If I understand what you are saying, I see Obama's ego still pushing him the other way, even if it leads to failure. I suppose you could characterize it as his ideology continuing to push him that way. I would expect him to compromise here or there, around the margins, but not on big issues. I think he would rather go down as having been too good and too ambitious for an unwilling country than to accept correction. (No, to those cringing, I still really do not like Obama.)Btw, I don't call what Obama's approach the Unitary Executive. To me, and I think this is the uncontroversial historical meaning, that is simple a term for the idea that all constitutional executive power is delegated to the President. Since that is what the Constitution says, it should not stir controversy, but in the 20th century Congress many times tried to arrogate pieces of executive power to itself, primarily by trying to set up administrative powers outside the control of the President. Simplistically stated, I think that Obama has instead used executive orders and agency action to circumvent and even contravene duly enacted law that he does not like.lms,What was wrong with my link?

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  7. I might have been confusing, I see, in using the phrase unilateral executive power above. I wasn't thinking the theory of the Unitary Executive there. I heard someone say that the Unitary Executive is not a theory about the extent of executive power but a statement about who has the executive power. Perhaps that is a bit of a circular statement, but it makes some sense to me. Critics of Bush essentially tried to transform the term into an assertion of unlimited Presidential power of whatever kind he wanted to claim.Another misconception about it seems to be the common belief that "checks and balances" means that all powers of the President are subject to being blocked by Congress, but that is not the case. Suppose, for example, that Congress passed a law over veto that purported to make Presidential vetos subject to review by a bipartisan commission. Or give that power to someone else. Of course, it would be invalid. Congress can pass a law over a veto, by the constitutional means, but it can't do anything to take away or modify the veto power.

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  8. Btw, I posted this same thing at PL to see how people would respond. Predictable.

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  9. "If I understand what you are saying, I see Obama's ego still pushing him the other way, even if it leads to failure. I suppose you could characterize it as his ideology continuing to push him that way. I would expect him to compromise here or there, around the margins, but not on big issues. I think he would rather go down as having been too good and too ambitious for an unwilling country than to accept correction. (No, to those cringing, I still really do not like Obama.)"I guess we're disagreeing on where Obama's ego will lead him given certain cirmcumstances. Your description, I think, leads to a Trumanesque second term (first full term of his own.) I think Truman had the lowest level of support of any President in the 20th century, so low in fact that the party establishment begged him not to run. I don't think his legacy recovered for decades, maybe until Carter, which says a lot. Obama, I think, probably realizes this (he's not stupid, though I might argue about him being "brilliant" or "genius") and will only model his election on Truman's '48 run. What he does afterwords, if Congress is entirely Repbulican, is where we disagree. I say he needs a legacy other than Truman's and you say he gobbles up (more) power. If he keeps the Senate, I would agree with you, otherwise, no.

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  10. Troll,I hope we don't get the chance to see who is right.

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  11. QB, I emailed you some friendly suggestions about your pending post – some examples of opportunism by the subject of your post, and a little spell checking. I also wondered where you would take that post because I thought it was intriguing, as I wrote in the email. But I think you have tipped your hand with this post, and the comments!Like TMW, I think BHO will be very limited by a R HoR, especially, no matter how much he tries to concentrate power in the executive. I don't see him going to war anywhere in concentrated numbers and I don't see him moving away from a free trade "bias". I would guess an outreach to India as the logical counterbalance in South Asia, and maybe in Asia, period. Beyond that, I haven't a clue.Maybe he would surprise me and ask the Congress to repeal the authority granted the Executive Branch to declare me an enemy of the state. Probably not.

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  12. Quote that may be fitting here:""Of all tyrannies a tyranny sincerely exercised for the good of its victim may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies.The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated, but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience." – C.S. Lewis

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  13. Also, I assume you've seen this. If not, then it's a good rebuttal of premise of progressive governance. Some of Sarah Palin's Ideas Cross the Political Divide"She made three interlocking points. First, that the United States is now governed by a “permanent political class,” drawn from both parties, that is increasingly cut off from the concerns of regular people. Second, that these Republicans and Democrats have allied with big business to mutual advantage to create what she called “corporate crony capitalism.” Third, that the real political divide in the United States may no longer be between friends and foes of Big Government, but between friends and foes of vast, remote, unaccountable institutions (both public and private).In supporting her first point, about the permanent political class, she attacked both parties’ tendency to talk of spending cuts while spending more and more; to stoke public anxiety about a credit downgrade, but take a vacation anyway; to arrive in Washington of modest means and then somehow ride the gravy train to fabulous wealth. She observed that 7 of the 10 wealthiest counties in the United States happen to be suburbs of the nation’s capital.Her second point, about money in politics, helped to explain the first. The permanent class stays in power because it positions itself between two deep troughs: the money spent by the government and the money spent by big companies to secure decisions from government that help them make more money.“Do you want to know why nothing ever really gets done?” she said, referring to politicians. “It’s because there’s nothing in it for them. They’ve got a lot of mouths to feed — a lot of corporate lobbyists and a lot of special interests that are counting on them to keep the good times and the money rolling along.”Because her party has agitated for the wholesale deregulation of money in politics and the unshackling of lobbyists, these will be heard in some quarters as sacrilegious words.Ms. Palin’s third point was more striking still: in contrast to the sweeping paeans to capitalism and the free market delivered by the Republican presidential candidates whose ranks she has yet to join, she sought to make a distinction between good capitalists and bad ones. The good ones, in her telling, are those small businesses that take risks and sink and swim in the churning market; the bad ones are well-connected megacorporations that live off bailouts, dodge taxes and profit terrifically while creating no jobs.Strangely, she was saying things that liberals might like, if not for Ms. Palin’s having said them.“This is not the capitalism of free men and free markets, of innovation and hard work and ethics, of sacrifice and of risk,” she said of the crony variety. She added: “It’s the collusion of big government and big business and big finance to the detriment of all the rest — to the little guys. It’s a slap in the face to our small business owners — the true entrepreneurs, the job creators accounting for 70 percent of the jobs in America.”"

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  14. Mark,I will look at your questions of course. I've been procrastinating today, though, and shamelessly. I have a writing project way overdue for West that I have to work on tonight, and a busy day tomorrow.The draft post is not polished, obviously. I just started throwing some ideas in there after a discussion over at PL in which wb and I (bitter enemies!) were riffing on Obama's opacity and ways of being noncommital and on many sides of an issue. I at one point said that Obama is engaged in superpositional politics–his position exists in both states until someone looks (or perhaps after the election). So I was taken by my own metaphor and thought to try to follow it out.I planned to let the idea simmer a bit and develop the post for a few days, and am not sure yet what I ultimately think. Is he doing something different from Clinton triangulation? Yes, I think so, but I haven't thought it completely through. I've just been tossing ideas in there as they occur to me (and I procrastinate on real work).Glad you looked at it though, and will look at your comments with interest. On his position(s) on SSM, for example, I obviously have a cynical view. I'm trying to find a good way of explaining what I think he is doing, beyond, "he's a cynical fake and poser."

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  15. jnc4p,Good stuff. I had forgotten the quotation from CS Lewis.

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  16. Glenn Greenwald gets the Plum Line treatment from other progressive bloggers when he doesn't toe the "support President Obama" party line:The evil of indefinite detention and those wanting to de-prioritize it Also note the unintentional irony here from Digby:"Liberalism is and has always been about intervention. It is the opposite of libertarianism, and always has been. Liberals understand that power corrupts, and absolute power corrupts absolutely."No, Stoller and Sullivan: there is no liberal conflict over Ron PaulI'd say that based on their preference for an ever larger and unaccountable government, liberals do not understand the premise of Lord Acton's quote.

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  17. This comment has been removed by the author.

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  18. That Digby piece is a masterpiece of confusion, and typically so. I don't know who that author is, but Digby is reliably a source of some of the dumbest e-punditry. That person doesn't even understand the roots of the ideology he claims as his own. Modern liberalism and progressivism aren't based on a belief in inherently flawed. I see people say this a lot today, though. I think they are very confused.

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  19. belief in inherently flawed human nature.

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  20. jncp4, thanks for the SHP article. Made me remember why I liked her before I did not like her. Dave! will recall my early fascination followed by my disillusionment, so to speak.

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  21. Mark, she'll take you Back.She's very forgiving.

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  22. Okay, so I read the Spalding piece. I can't help but wonder how many "progressive" presidents we've had now since TR considering all the winners and losers every president has chosen in the last 100 years. The problem with our government is not progressivism IMO, it's that it has been taken over by special interests and complex economic models that have noting to do with The related principle that each has a right to the rewards of his own labor makes possible a dynamic social order in which every member of society can work hard and advance based on individual talent and ability. The primary obligation of government is to secure property rights, break down artificial barriers to opportunity, and uphold the rule of law. This is sound economic theory. When property is protected, there is an incentive to earn, save, and invest in opportunities for the future. When guaranteed to reap what they sow, more people will sow and reap. When economic reward is available to all, and the protection of property extends to all, the amount of wealth throughout society increases exponentially.Seriously, we no longer live in this world. The rule of law was thrown out the window during Bush's term and Obama is following in the same footsteps. Economic reward available to all……tell that to the 47% of Americans who don't make enough money to pay Federal Income Tax. And nowhere in the piece did he even bother to mention the perpetual war machine or how we're supposed to pay for A basic safety net formed by civil society and public assistance at the appropriate level of government can then protect those who are unable to care for themselves and just what it would look like if we actually went back to pre TR times. Another piece that blames the wrong entity and lives in a land that time forgot.

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  23. qb, just realized I didn't answer your question re the link. If you're working in the old interface (I think that's what it's called) you forgot the quotes around the URL. If you're working in the new interface, all you have to do is click the link button at the top of the box and then in the first blank box put in your title and the second one the URL.

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  24. lms,First, it seems to me that in haste to argue about the right course you miss what is the only real claim of the article, which is simply to put Obama's ideas in a historical context. Since this is the same historical context that Obama has himself recently claimed, I don't find that controversial. This writer is just bringing out more of that context.Second, a central feature of the critique of progressivism or modern liberalism is precisely that it opens the way for power to be taken over by special interests and special pleaders. Progressivism was a paternalistic idea that with the "right" people holding power they could engineer a better society. I think it still is the same today. When those powers are given to the government, special interests will find them and coopt them. That is part of the whole point of the critique.Seriously, we no longer live in this world. The rule of law was thrown out the window during Bush's term and Obama is following in the same footsteps.I don't follow. You earlier implied that all our Presidents have been progressives since the Progressive Era, which would mean we haven't lived in the prior world for at least 100 years. Bush and Obama certainly haven't represented that world.Economic reward available to all……tell that to the 47% of Americans who don't make enough money to pay Federal Income Tax. Not to be picky, it isn't that they don't make enough to pay something but that "we" have chosen not to require them to. In any event, since the implication of the article is that we made a progressive (and wrong) turn 100 years ago and have recently turned more sharply in that direction, I don't think this argument works. Stagnation and loss of opportunity are just what critics of progressivism predict. As you yourself say, we haven't lived in the pre-progressive world in a long time. It is hard to see how the problems of the 47% are the fault of a lost world.

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  25. qbI understood the historical aspect of the piece but my point was that it doesn't matter which kind of a rhetorical turn Obama makes or any other President for that matter. Neither progressivism nor conservativism has a chance to be truly tested or implemented in an economic and political world dominated by favorable industries and revolving door politics.

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  26. jnc:That quotation from Digby is precious.

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  27. lms:Neither progressivism nor conservativism has a chance to be truly tested or implemented in an economic and political world dominated by favorable industries and revolving door politics.It is the premises upon which progressivism is founded – eg that government can properly order society – which allow for the existence and dominance of "favorable" industries and creates the incentives for revolving door politics. So I disagree. Progressivism has been tested, and what you seem to loathe is the (inevitable) result.I am sort of reminded of the old defense of communism when faced with the realities of the Soviet Union and China, namely that "real" communism has yet to be tried.

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  28. Oh please Scott………….bailing out the banks was hardly progressive and neither is the way we treat the health insurance industry, the oil industry, or the MIC in this country. If you guys think it's productive to undo the safety net for the more vulnerable and that that is the problem, make that point, but don't try to blame progressivism.

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  29. lms:Oh please ScottYou haven't addressed my point. I didn't say that you, or progressives more generally, advocated for everything that government does or has done. Progressives believe government should play a very significant role in ordering society. In order to do so, government must have a great deal of power, which progressives are happy to give it. The fact that other interests have been able to, in turn, use that power for their own, perhaps non-progressive, ends does not change the reality of what I said: Progressive premises (government involvement in ordering society) lay the groundwork for the very result that you don't like.

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  30. Progressives believe government should play a very significant role in ordering society.Except that era ended in the 1920's. I doubt you'll find similar policies formulated now or in the past several decades that are progressive in nature. Obama is using a progressive rhetorical flourish by quoting TR to entice his base to come home to him. And yet his policies have been anything but progressive. There are essentially only a handful of true progressives alive and well in the three branches of government and they certainly don't have, and haven't had, the votes to pass progressive policy now or in the more immediate past, and it's doubtful the future will favor them either. AFAIC, anyone who claims or pretends that Obama is a progressive is akin to claiming Romney is a man of the people…..lol

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  31. lms:I doubt you'll find similar policies formulated now or in the past several decades that are progressive in nature.Again, I am not talking about specific policies. Whether or not progressive policies have been implemented is irrelevant (although ACA does not count as progressive policy, I don't know what does.) The power required to implement progressive policies, power which progressives are happy to grant (indeed must necessarily grant, given the nature of the policies they want implemented) can be, and have been, and will be, used for all manner of things including things to which progressives object. Put another way: Progressives want government to exercise lots of power, but only towards achieving particular ends to their liking. The fact that, once granted, progressives cannot always control the ends towards which the power is used doesn't change the fact that progressives want the government to have that power in the first place.I'd prefer the government not be given that much power in the first place. Which is one reason I am not a progressive.

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  32. " Progressives want government to exercise lots of power, but only towards achieving particular ends to their liking."It is my perception that progressives are focused on outcomes and view gov't as the most efficient way to achieve those outcomes. In my Utopian ideal, conservatives would balance progressives by finding alternate paths to the same outcomes. As a wishy washy moderate, I think the left & right work best when they're working in tension. Too much of one or the other spoils the outcome. Its a Yin -Yang thing.

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  33. Like Brian, I am suspicious of the reliance on government, but I am most suspicious of trying to nationalize local problems. I like it when we find private pathways to solve problems. I like seed money projects which take a small government supported initiative and grow and work because people want to make it work privately, or which die because there was no crop anyone wanted seeded. The seed money wasted is 1/100th of what we would have wasted on a full blown government project.Jack Kemp was a proponent of these "small" initiatives and pilots as opposed to "all in" thinking. I do know many persons who act as if the federal gummint can solve anything spend anything. But I include those who think invading Iran might be cost efficient in that crew, so I won't characterize that big gummint view as "progressive" or "conservative".In this, Ron Paul is closer to me than not. But I do not think he even likes pilot projects and seed money. And I think his fixation on the Federal Reserve is…a fixation.

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  34. The thing I find so unusual about this line of reasoning scott is that even conservatives want government intervention when they want it. I actually agree with bsimon, a balance between the two is really more along the lines of what we need. The era of progressivism you guys keep referring to was a response to the Gilded Age/Robber Barons, a depletion of natural resources at the time, labor relations and the rights of women. The only reason progressive ideas are making a comeback right now is in response to some of the same problems and many on the left see income inequality and lack of opportunity as a reason for government intervention again. Perhaps progressives opened the door to a larger federal government but some Americans would say…….thank God, especially when you consider the alternative.Regarding ACA, handing the Insurance Industry millions of more customers at the cost of some new and overdue reforms is hardly progressive in nature. Progressives in the Administration, if there were any, would have fought for lowering the age for Medicare entry at the very least.

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  35. lms:even conservatives want government intervention when they want it.True. Which is why conservatives are not libertarians. But I think conservatism is by its nature more suspicious of government power, prticualrly on a grand scale, than progressivism, which embraces it as an instrumental vehicle for change. That is one reason why I find conservatism much more attractive than progressivism. (And why, probably, in a system dominated by 2 ideologies, libertarians tend to ally themselves with conservatives rather than liberals/progressives.)

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  36. ScottAll three ideologies taken to their extreme would not be inherently beneficial, IMO. In general, I think they surge and resurge in response to overreach by either government elite, the financial elite or a perceived degradation in the functionality of our government. I tend to lean more progressive, but more so now than say 10 or 15 years ago as a way to balance reform and or protect policies that I believe in. I do agree though that government manipulation, in many forms from both ideologies, is running rampant. Unfortunately, neither political party or even Libertarians seem to be functioning in a progressive (as in moving forward) fashion. I just think it's a little disingenuous to blame progressives for all our miscalculations of the past 100 years.

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  37. lms:Regarding ACA, handing the Insurance Industry millions of more customers at the cost of some new and overdue reforms is hardly progressive in nature.That's kind of like saying that the guaranteed student loan program is not a liberal program because it gives more business to banks.ACA is most definitely a progressive policy. The fact that the progressive utopian ideal cannot be achieved in one immediate, uncompromising step, and instead must be implemented in various stages, does not render the policy unprogressive.I'll just pose a simple question to you: As a progressive, did you support or oppose the passage of ACA?

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  38. "Progressives in the Administration, if there were any, would have fought for lowering the age for Medicare entry at the very least." But the debate was on their terms, in so much as that government is involved with health care at all. 100 years ago, if you ask a "what should government do for health care" I think "nothing" would be an acceptable answer. progressives changed that and now were arguing over the scope of involvement.

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  39. lms:I just think it's a little disingenuous to blame progressives for all our miscalculations of the past 100 years. I blame progressives for wanting to increase the power that government posesses and for wanting to expand the role that the federal government plays in the lives of individuals and communities.

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  40. NoVA:progressives changed that and now were arguing over the scope of involvement. Precisely.

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  41. "As a progressive, did you support or oppose the passage of ACA?"Many progressives did not & do not support the ACA because it falls short of being the single-payer ideal (theirs, not mine).In fact, it has many characteristics that should appeal to conservatives, like leaving implementation to the states & maintaining a competitive market for health insurance. It is a good example of an area where the two sides should be working to hold each other in check.

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  42. "Regarding ACA, handing the Insurance Industry millions of more customers at the cost of some new and overdue reforms is hardly progressive in nature. Progressives in the Administration, if there were any, would have fought for lowering the age for Medicare entry at the very least."The structure of Obamacare may not be to your liking, but the concept that access to, and the provision of healthcare is a right that the federal or state government sshould guarantee is unarguably progressive. I think that's the "meta" that Scott is talking about.

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  43. bsimon:Many progressives did not & do not support the ACA because it falls short of being the single-payer idealI understand. But not being progressive enough is not the same as not being progressive.

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  44. I'm reminded of the Churchill quip — we've established what we are, now we're haggling over the details.

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  45. I'm reminded that the tax code was changed in favor of employer provided health coverage in 1954. Hmmmmmmm

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  46. And we already have Universal Coverage in the least cost effective manner possible. Visit any emergency room in the US to see how that's working out. If we've already determined to treat people regardless of insurance status doesn't it make more sense to do it in a more efficient manner? Would any of you really deny access to someone in dire need of medical care? Somehow I doubt that.I'm not wedded to single payer although I think it is probably going to be what we'll end up with considering the alternatives. And no ACA hasn't improved things much, I knew it wouldn't and said as much during the health care debate. Although it clearly isn't the progressive over reach most of you like to depict it as.

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  47. lms:I'm reminded that the tax code was changed in favor of employer provided health coverage in 1954. HmmmmmmmI don't understand your point.If we've already determined to treat people regardless of insurance status doesn't it make more sense to do it in a more efficient manner?No. Government action must consider things other than simple efficiency.Would any of you really deny access to someone in dire need of medical care?Since I am not a provider of medical care, I am in no position to deny it to anyone. But if you are asking if I would endorse laws prohibiting someone from getting medical care, of course I wouldn't.Although it clearly isn't the progressive over reach most of you like to depict it as. I haven't portrayed it as any kind of overreach. I have simply portrayed it as a policy inspired by progressivism. Which it is.

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  48. Just a point of clarification, it's my understanding that ER's are required to perform emergency life saving measures and stabilize patients without regard to their ability to pay. It doesn't prevent them from attempting to collect reimbursement from treated patients nor does it require them to, for example, provide chemotherapy to a cancer patient. Those types of services are often performed in indignant county hospitals as well as charity hospitals. The county hospitals, by the way, also attempt to collect from patients and can be quite aggressive in doing so.

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  49. CMS testimony on hospital billing/collection for the under/uninsured. http://energycommerce.house.gov/108/Hearings/06242004hearing1299/Kuhn2104.htm

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  50. NoVa,Thanks for the link, I'm slowly making my way through it. I'd forgotten the "unintended consequences" of the Medicare/aid "best price" rules and how that keeps costs to the poor artificially high. Thanks for that. Part of me thinks that this requirement will never be altered because it keeps healthcare out of the reach of many low income Americans thereby keeping pressure on the government to address this "crisis" with more Federal programs.

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  51. Bad debt and what to do about is a problem. but it starts to get way into the weeds, with DSH payments to hospitals, section 1011 funding for illegals, etc.

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  52. NoVa,to your knowledge, does the Federal government bill foreign governments for the cost of treating their aliens in the U.S.? If not, has it ever been proposed legislatively?

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  53. I'm positive that the US does not bill foreign governments. And it has been proposed. The one that comes to mind is the PAYBACK Act — Preventing All Your Bucks from Aiding non-Citizens is Key Act. http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.4026:

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  54. I actually thought it would be kind of funny if the a fed went door-to-door on embassy row here in DC dropping off invoices. I used to do more immigration health care work. It's more of a problem of illegals not seeking care due to fears of deportation. Illegals crowding ERs is more of a myth. http://content.healthaffairs.org/content/29/3/544.abstract

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  55. scottSorry to be so late in responding. My point re 1954 is that it was passed during a Republican Administration, it is also my understanding it was heavily lobbied by the insurance industry. It has been the largest, by far, tax expenditure in history and has done more to shape the health insurance industry than any other policy. I doubt it could be called a progressive policy, but I suppose someone could try.The rest of you, all I'm saying is that we've already determined that health care, at least in life and death matters is a right. Now, we can either argue that we need to unwind this provision or move forward with the most efficient processes to cover the most people at the least cost while still being effective. If we want people to have skin in the game we need to make sure they can afford it. Just from looking around at the seniors I work with, not a single one of them could afford medical care during retirement without medicare. I don't believe it's possible to remove the Federal governments participation or influence, especially based upon what I know of the instincts of the insurance industry. I believe it is imperative that we keep working on this though……..certainly ACA shouldn't be the last word. I think Mark has a lot of good ideas for local improvements which is fine by me but until we really tackle the costs, we're in a dead end street. I don't think arguing over progressive or conservative blame, if that's what we're doing, will really get us anywhere but more status quo.

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  56. lms, I'm not sure that granting emergency life saving medicine that can and should be billed back to the patient/patient family is the same as a right to healthcare. Also, I do favor Ryan's voucher plan for Medicare as a start in unwinding the notion that healthcare is a right. Once that plan is in place, we can move to an inherited cash transfer to Medicare eligibles that can eventually be wound down.

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  57. we can move to an inherited cash transfer to Medicare eligibles that can eventually be wound down.I don't know what this means. Do you really think a voucher will cover the cost of insurance for an ill senior? We're spending almost $20K a year just for insurance and it's not even on the individual market……..and we're healthy, just getting older. That's for two people btw. Once we retire we won't have $20K to spend on insurance and even less to spend on care if we need it. I'd prefer to die in my sleep, thank-you very much, but no one knows what health issues are just around the bend much less how much it might cost. It's the costs that are driving the problems not Medicare.

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  58. lms, I'm not sure that granting emergency life saving medicine that can and should be billed back to the patient/patient family is the same as a right to healthcareWhat does the fact that a hospital can bill, often in vain, a patient have to do with whether or not it is a right? Qualifying hospitals are required to provide stabilizing care regardless of whether or not they will get paid. If they don't they can be fined or kicked out of Medicare. At least from the hospital's perspective it seems like a right. Anyway, I'll echo lmsinca with her complaints about the cost of health care. Since my wife is not going back to work, we had to switch to my firm's crappy insurance and it amounted to an $8,000 pay cut for me, when you add it my firm's contribution and my inevitable out of pocket expenses, it's well over $10,000 to insure a family of 3 without any major medical conditions.

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  59. lms:Sorry to be so late in responding.No worries. The longer you take to respond, the longer I get to believe that I've finally convinced you.My point re 1954 is that it was passed during a Republican Administration…I'm not sure what legislation you are talking about, but the tax treatment of employer-provided health insurance was established during the wage and price control era of World War II.I doubt it could be called a progressive policy…I'm not sure who, if anyone, suggested that the tax treatment of employer provided health care a progressive policy. Certainly not me. I called ACA a progressive policy.all I'm saying is that we've already determined that health care, at least in life and death matters is a right.I don't think this has been determined.

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  60. "I don't know what this means. Do you really think a voucher will cover the cost of insurance for an ill senior? We're spending almost $20K a year just for insurance and it's not even on the individual market……..and we're healthy, just getting older. That's for two people btw. Once we retire we won't have $20K to spend on insurance and even less to spend on care if we need it. I'd prefer to die in my sleep, thank-you very much, but no one knows what health issues are just around the bend much less how much it might cost. It's the costs that are driving the problems not Medicare."Lms, I believe there will be plenty of basic policies available that will come close to what the Medicare voucher will eventually be, and if more/better care is wanted, out of pocket spending will have to occur. I believe that vouchers and eventual inherited cash transfers to Medicare recipients (more on that in a minute) is the only thing that can bring down expenses. Right now, it's projected that the average retiree will recieve over 1 1/2 times what they put into Medicare. What cannot continue, won't. If HCP's and insurance companies know the average voucher is, say $7,000 per year, I believe that policies for that price will develop. Think about it, Aetna could sell, say, half a million $20k/year policies or 35 million $7k policies at a much lower margin. I think they'll opt for the lower margin/higher volume. And yes, many if not all elderly, are going to be spending much, much more for their healthcare, but to paraphrase Willie Sutton, that's where the money is. Demographically, retiree's are the richest demographic in the country. It doesn't now, nor did it ever make sense that we tax the hell out of workers (genrally younger and much poorer than retirees) for the benefit of those who have accumulated assests (generally retirees.)My inherited cash transfers idea involve migrating from a voucher to just handing a Medicare recipient the cash equivalant to do with as they please, even allowing a portion of that to be willed to survivors should they not live to some "average" age. This will incentivize self rationing and forgoing of expensive, minimally helpful life saving technology. Right now, there is zero incentive not to do everything one can medically. When the direct cash transfer kicks in, the program, and the taxes required to transfer this money from the less wealthy to most wealthy can be phased out. Easy peasy.

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  61. "What does the fact that a hospital can bill, often in vain, a patient have to do with whether or not it is a right? Qualifying hospitals are required to provide stabilizing care regardless of whether or not they will get paid. If they don't they can be fined or kicked out of Medicare. At least from the hospital's perspective it seems like a right."My point is that while emergency stabilization is healthcare, healthcare is not emergency stabilization. Further, charging for that service, to a certain extent, undermines the arguement that healthcare is a right. Do you have to pay when you vote? When you speak?

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  62. No worries. The longer you take to respond, the longer I get to believe that I've finally convinced you.Not a chance buddy, I'm old and set in my ways, lol.And the tax treatment changed in 1954 (code 106a) even though employer provided health insurance came about as a result of wage controls during the war. My point is that government intervention to obtain desirable outcomes is not just a function of progressivism. And even you said:But if you are asking if I would endorse laws prohibiting someone from getting medical care, of course I wouldn't.

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  63. My point is that while emergency stabilization is healthcare, healthcare is not emergency stabilization.Agreed. Although, I am not sure the fact that other health care treatments exist beyond life saving care means health care isn't a right. I'm terrible at this type of argument but I'll give this a try anyway: We have the right to vote, the fact that the government isn't required to drive us to the voting booth if we want to vote doesn't make it not a right. Further, charging for that service, to a certain extent, undermines the arguement that healthcare is a right.I agree that it undermines it to a certain extent.Do you have to pay when you vote? When you speak?No, but those of us with the means to do so are required to pay taxes. Some of which goes to protecting us from those who would invade us and stop us from enjoying those rights (insert Obama joke here). Taxes are certainly a more abstract form of payment than a bill from a hospital, but in both cases those who have the means are required to pay. If we don't pay taxes we can still vote (assuming our failure to pay isn't a crime). Likewise if we don't pay for the medical bills hospitals are still required to pay the care.

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  64. *pay* should be *provide* in the last sentence.

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  65. McWingDemographically, retiree's are the richest demographic in the country.I'd love to see statistics on this. I agree thought that paying for something out of pocket with limited funds cuts down on usage. Regarding health care though, I'm not so sure that's the best way to achieve reduction in costs. Your theories are interesting but I've dealt with insurance companies, extensively in the last four years, and I have trouble swallowing this part:If HCP's and insurance companies know the average voucher is, say $7,000 per year, I believe that policies for that price will develop. Think about it, Aetna could sell, say, half a million $20k/year policies or 35 million $7k policies at a much lower margin.I've not seen any evidence this would occur voluntarily.

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  66. "We have the right to vote, the fact that the government isn't required to drive us to the voting booth if we want to vote doesn't make it not a right." True, but voting doesn't require someone else to provide a service regardless of payment. What I mean by that is that healthcare is a service that has to be provided by someone. The equivalant, as I see it, would be forcing your neighbor to drive you to the polling place."No, but those of us with the means to do so are required to pay taxes. Some of which goes to protecting us from those who would invade us and stop us from enjoying those rights (insert Obama joke here). Taxes are certainly a more abstract form of payment than a bill from a hospital, but in both cases those who have the means are required to pay. If we don't pay taxes we can still vote (assuming our failure to pay isn't a crime). Likewise if we don't pay for the medical bills hospitals are still required to pay the care."That's true for indigint medical care (Medicaid) but Medicare is, supposedly, a special tax that is dedicated to Medicare only, as in current taxpayers pay for recipients. My income tax pays for all sorts of things, from farm subsidies to college loans to defense spending. However, if care above stabilization is wanted, a hospital is not required to provide it sans payment.And, as you can see by my very scatalogical response, I'm terrible at these type of arguments as well.

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  67. And, as you can see by my very scatalogical response, I'm terrible at these type of arguments as well.haaahaaa, me too. At least you have scott, who's good at them, on your side. Ashot and I are all alone out here.

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  68. True, but voting doesn't require someone else to provide a service regardless of payment. What I mean by that is that healthcare is a service that has to be provided by someone.A much better example by me would have been abortion. It's a right and it requires people to pay to exercise it. It also requires someone else to provide a service.

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  69. Thanks McWing, I'll check them out later.

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  70. It would be interesting McWing to see what it's like today, that USA Today was from over four years ago. There's a lot of food for thought in there though.The old are richerMost wealth accumulation happens rapidly and late in life — after the kids leave, when income is high, debts drop, 401(k) accounts fatten and home equity swells, according to Fed data.The safety net — Social Security, pensions and Medicare — also has resulted in big increases in income for the elderly and a sharp decline in the rate at which they dissipate their assets in old age. Most people over 60 have no mortgage debt, no credit card debt and no car loan.Trends for younger people have gone in the opposite direction. Mortgage debt peaks for people in their late 30s, the same time they have the most kids at home. About 11% are at least 60 days behind paying on some debt.Younger generations now delay the start of wealth accumulation. They postpone careers to get more education. They marry later (delaying the financial benefit of a shared household), have children later (delaying the arrival of lower-cost, kid-free days) and inherit money later (their parents live longer).Younger people may not look poor. They have more stuff than ever — more valuable houses, cars and other assets. But they are so much deeper in debt than their parents — student loans, credit cards, mortgages, car loans — that their net worth has shriveled.What's not clear is whether today's younger people will catch up. Will they reap financial rewards late in life as their parents did?"Young people have a great future ahead of them, but the rules of wealth creation have changed," says economist Kay Strong of Bowling Green State University in Ohio. She says young people will have to work longer and switch jobs more often than their parents for financial success."The baby boomers were the last generation able to ride the old industrial economy that let you hold one job for a long time and retire with a pension," says Strong, 54. "The new economy is going to require people to adapt, hold more jobs over a lifetime and give up the concept that you will retire at 62."

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  71. McWingHere's another, more current report, based on the 2010 census and it looks like equity and home values account for most of the discrepancies, and while they have also lowered retirees net wealth, there is still a large gap. It's no wonder the OWS kids are frustrated. It's an interesting and sad dynamic though that young people are struggling so much. I don't see anything in the pipeline to reverse the falling incomes and net worth of younger people do you? I suppose taking it away from those who are retired now makes some sense if we all want to just be in the boat together. Otherwise, we need to figure some way out of this mess.

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  72. If you look at the chart on poverty, it shows the dramatic effect of SS and Medicare in reducing poverty in the 65 and older crowd. What a failure the overall economy has been for others age groups though. Very depressing.

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  73. Disappointing game so far…………blech

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  74. ashot:A much better example by me would have been abortion. It's a right and it requires people to pay to exercise it. It also requires someone else to provide a service.I don't think abortion is a good example. There is a difference between the legal right to obtain something from a willing provider and the legal right to obtain something regardless of the willingness of someone else to provide it.The former are generally characterized by the absence of laws. The legal right to abortion is guaranteed by the absence of laws outlawing abortion. If you want an abortion, and you can find someone to provide it to you (whether for free or for a fee is irrelevant), you are legally able to obtain it. But there is nothing that legally compels anyone to provide you with an abortion. The latter are necessarily characterized by the existence of legislation, either making it illegal for a provider to deny you a service (eg emergency care) or forcing taxpayers to pay for the service you desire (eg medicaid/medicare).BTW, this distinction highlights exactly why I always say that health care cannot sensibly be said to be a right in a moral (as opposed to legal) sense. Natural or moral rights establish grounds for freedom of action, but cannot require the action of others. If they did, then it could not be said that rights inhere in everyone equally, which rather undermines the case for the existence of any such rights in the first place.

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  75. The rest of you, all I'm saying is that we've already determined that health care, at least in life and death matters is a right.I don't think this is true, if we thought we had done this it would be nonsensical. A claimed right to things that have to be provided by or taken from others is an incoherent concept. Moreover, if we repealed the federal law that requires emergency stabilization, would we have abolished this right? That doesn't seem to me to be much of a right. It certainly isn't an unalienable one (well, it can't be unaliendable if it has to be enacted by law anyway).Now, we can either argue that we need to unwind this provision or move forward with the most efficient processes to cover the most people at the least cost while still being effective. I think this just highlights why it is in no coherent sense a right. How can it be a right if we have to figure out how to ration it?The other day someone at PL linked to a column arguing that libertarian theory is incoherent because it posits absolute rights to use property however one seens fit, even if it destroys someone else's property. This was a silly argument based on a straw man, since that isn't what any version of libertarianism I've ever seen claims. Libertarianism says, I can do what I want with my stuff unless it hurts you or your stuff. You can agree or disagree that it is a good philosophy, but it is as logically coherent as any. I have never seen a defense theories of "positive rights" that I thought could say the same thing, because everyone has the right to everyone else's stuff and person.

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