Theoretical physicists are an odd lot, always looking for that Grand Unifying Theory that explains everything. That’s why they somewhat sheepishly refer to the Higgs-Boson as The God Particle – an inside joke. But its existence would explain why some fundamental particles have mass, which was always a mystery, if you think about such things, and they just found that Higgs-Boson particle two months ago, or they think they did. They’re still trying to confirm that, and if they do, they’ll be quite happy. They’ll be on their way to figuring out how everything in the universe fits together.
No, really – this is a big deal, but long ago Douglas Adams had a great deal of fun with such thinking in his Hitchhikers Guide to the Galaxy extravaganza. That whole tale hinged on a race of hyper-intelligent pan-dimensional beings who built a computer named Deep Thought to calculate the Answer to the Ultimate Question of Life, the Universe, and Everything. The answer turned out to be forty-two. No one knew what to make of that. After ten million years of massive computer calculations no one remembered the question in the first place, so they kept trying to devise a question that would explain that odd answer. How many roads must a man walk down? They had no clue.
Douglas Adams’ tale was nicely cynical, still, given how helpless we feel in the universe, seeking something to explain it all is a natural impulse. It might be God, or the God Particle. Take your choice, or maybe the two aren’t mutually exclusive, or maybe Sartre and Camus and the rest of those dismal existentialists were right – life is profoundly absurd so just do your best to be a decent and honest person.
That is unacceptable. Only moody adolescents took those existentialist guys seriously, and then those moody adolescents grew up. One must take life seriously. It’s not absurd. Everything fits together, somehow – it’s just a matter of figuring out how. Some of those moody adolescents later found God, some turned to science and rational thought, and some of them saw hidden conspiracies everywhere, theories that explained all sorts of awful things, which is quite useful when you feel helpless. You can bypass science and theology entirely but their motives weren’t all that different from the motives of the theoretical physicists. They just bypassed all that verification business, and the math, but then so do the God folks. It’s a matter of faith, of just knowing what you know, because you just know it.
The two most recent conspiracy theories are like that. There are the Sandy Hook Truthers – the folks who just know that the whole thing was set up by the Obama administration in order to take away everyone’s guns. Adam Lanza worked for the government, or maybe he was just the fall-guy who they shot in order to cover up their own execution of twenty kids and six teachers, or maybe no one was shot at all. This is part of a larger theory of how the world works, where Obama and the liberal media are not only out to take our guns but destroy America itself, leading to a one-world government where the UN takes over everywhere. That seems to be the Grand Unifying Theory, and there are also all the conspiracy theories about the Boston Marathon bombings – “The real story behind the attack involves not a pair of radicalized brothers, but a world-spanning conspiracy of Michelle Obama, a network of Russian oligarchs, and an army of stagehands armed with fake blood.” And Tamerlan Tsarnaev was a false flag asset in the employ of the government, because Obama wants to create a police state and be the big cheese, or something.
It’s all a bit odd, and tiresome, because you can’t argue with these folks. They know what they know, and they will claim that proof that none of this is so is further proof of a massive cover-up. They’re impervious to argument of any kind.
It’s easy enough to dismiss these folks. They seem quite mad, but then others have their own Grand Unifying Theories of this and that, and they’re considered quite respectable folks, as shown in Obama’s recent press conference – where he got hammered for not working his will on Congress and making them pass the bill about background checks for gun purchases and everything else more than ninety percent of the American people want. He said that’s not how our government works, and Jamelle Bouie explained the problem nicely:
Much of Washington is in the grips of what several observers call the “Green Lantern Theory of Presidential Power.” For those unfamiliar with the comics, the Green Lanterns are a galaxy-spanning corps of space police. Each Lantern is given a power ring that emits a green energy. With it, Lanterns can do anything – the only limit is their will.
Likewise, pundits and journalists from across the spectrum seem to understand the president as a singular figure whose power flows from his willingness to “get things done.” If Obama can’t get legislation through Congress, for example, it’s because he hasn’t been willing to pressure, cajole and influence. What this ignores is that Obama can’t actually force individual lawmakers to do anything – after all, they come to Congress with their own interests and priorities.
In other words, congressional Republicans have agency, and at a certain point, they need to be held accountability for their actions. It’s not on Obama that Republicans refused to expand background checks. To treat it as if it were obscures the realities of policymaking and helps Republicans evade responsibility for their choices.
That didn’t stop the New York Times’ Maureen Dowd from once again saying it was his job to make the Republicans behave:
Actually, it is his job to get them to behave. The job of the former community organizer and self-styled uniter is to somehow get this dunderheaded Congress, which is mind-bendingly awful, to do the stuff he wants them to do. It’s called leadership.
That’s her theory and she’s sticking to it, but Slate’s John Dickerson begs to differ:
Leadership is not just about what a leader does; it’s also about who he is trying to lead.
At various times, the president’s supporters and detractors alike have called on him to schmooze Republicans, or, if that fails, twist their arms. But can a president flatter Republican senators with dinners at swish hotels if they know they’re going to get a pasting when they return home to their constituents? Can he twist arms effectively when Republican lawmakers are more scared of voters than they are of him? No harm in trying, perhaps, but to properly evaluate the gambit we’ve got to understand the outcomes that are even possible. And sometimes there is harm in trying. While active, public engagement from the president is crucial in some situations, in others it’s the exact wrong thing to do. If a president’s association with legislation makes those he’s trying to convince less likely to vote for it, then a smart president shouldn’t twist arms to get votes, he should fold his own and stand by.
He should, and what Dowd and others say is dangerous:
If a president is dunned for not leading, he gets some or all of the blame when policies get stuck. This relieves public pressure from Congress: It’s not their fault for dithering – it’s the president’s for not prodding them into action. In the current context, the more Obama’s weakness is the story, the less coverage there is of the dysfunction in the House of Representatives. Occasionally, both sides will get a share of the blame in the coverage, but the result is the same: Everyone throws up their hands and nothing gets done.
Given that, Obama has had to be careful:
Obama has tried to adapt. For several years, in interviews with his staff as they craft the State of the Union speeches, this has been a running theme. How much can the president make a big deal about policy without fear of sinking it? That’s partially why the president didn’t publicly embrace Simpson-Bowles (there were other reasons) and it’s what’s governing his immigration work now. The president has tried to be more hands-off while the Gang of Eight does its work in order to show he understands the mess he could make of things if he meddled. This isn’t to say a president should do nothing on some issues; just that he should know which ones require him to work in the background.
Kevin Drum just throws up his hands at the “Green Lantern Theory of Presidential Power” crowd on all the issues:
How can any of them still believe that Republicans will ever agree to real revenue increases? George Washington himself could rise from the grave and the House Republican caucus wouldn’t agree to pass a revenue increase for him. What then? Would Dowd… sigh theatrically and mourn the fact that Washington just isn’t the leader he used to be?
Republicans aren’t going to let Obama raise revenues. They aren’t going to let Obama pass a gun bill – even a watered-down one. They aren’t going to let Obama close Guantánamo. They aren’t going to let Obama fill the vacancies on the DC Circuit Court. They aren’t going to help Obama implement Obamacare. They aren’t going to let Obama address climate change. Period.
They’ve made this crystal clear to anyone who asks. They are true believers and there’s nothing Obama… or anyone else can offer them that would break through their glinty-eyed zealotry. There are no deals to be made, no leverage that can be used, and no schmoozing that will change their minds. This isn’t an Obama problem. It’s a Republican Party problem. Why is such a simple and unambiguous fact so hard to acknowledge?
Why is such a simple and unambiguous fact so hard to acknowledge? That would be because it is a fact that the press cannot acknowledge. One must be fair to both sides. The Republicans can’t be all bad, or even if they are, Obama must be just as bad as they are, in his own particular way. That rule applies everywhere but MSNBC and Fox News. It’s another Grand Unifying Theory.
It only gets worse with healthcare, which is something the government should assure – affordable healthcare coverage for all citizens, in the national interest – or something the private sector should handle, as free-market competition will drive down costs and assure the best possible care, because the insurance folks want to make as much money as possible, so they’ll offer the best possible deal at an amazingly low cost that will destroy the competition. That’s two grand theories, endlessly offered, with no way to prove either theory, until now, as Ezra Klein explains:
The Oregon Medicaid experiment is an academic miracle born out of a human tragedy.
A few years back, Oregon found the money to add 10,000 residents to the state’s Medicaid program. The only problem was that there were 90,000 residents who qualified for the program and desperately wanted in. So the state held a lottery. Welcome to the American health-care system. Greatest in the world, folks.
But 80,000 Oregonians’ loss was science’s gain. The lottery gave researchers an opportunity that’s almost never available in policymaking: They could create a randomized controlled study – the absolute gold-standard of experimental design – comparing the health outcomes of the lucky Oregonians who received Medicaid to those who didn’t. It would be the first time that kind of study had even been used to compare the insured and the uninsured.
Klein notes that the initial results were released in August 2012, covering the first year of the Medicaid expansion and showed nothing surprising – those on Medicaid were getting more care and reporting better health and seeing fewer financial problems than the unlucky people who weren’t on Medicaid. But the second set of results was just released, and that’s where it got interesting:
Here’s what we can say with certainty: Medicaid works as health insurance.
That might seem obvious. It’s actually not. A big criticism of Medicaid is that it pays doctors so little that it’s essentially worthless because no doctor will see you. But the Oregon residents who won the Medicaid lottery got much more health care – including preventive health care – than the residents who lost it. They also saw catastrophic health costs basically vanish.
“People who gained access to Medicaid did use more health care,” says Harvard’s Katherine Baicker, one of the study’s authors. “We can eliminate the story that Medicaid is so lousy you can’t get in to see a doctor.”
But the study didn’t see much improvement in the health indicators it was tracking. Blood pressure and cholesterol readings were mostly unchanged. Diagnosis of diabetes went way up, and the use of medicine to control diabetes also went up, but, again, there wasn’t much difference on the relevant blood tests. The big exception, surprisingly, was mental health: depression rates fell by 30 percent.
Can one make anything of that? Yes, one can, as in More Bad News for Obamacare: Study Finds Medicaid Has No Effect on Measured Health Outcomes:
This is huge, and stunning, even for critics of Medicaid: A randomized-controlled study published in the New England Journal of Medicine by a group of the nation’s top health policy scholars has found that Medicaid has no measurable effect on any of the objectively measured physical health outcomes the study examined.
And from the Cato Institute there’s Oregon Study Throws a Stop Sign in Front of Obamacare’s Medicaid Expansion:
Today, the nation’s top health economists released a study that throws a huge “STOP” sign in front of Obamacare’s Medicaid expansion. The Oregon Health Insurance Experiment, or OHIE, may be the most important study ever conducted on health insurance. Consistent with lackluster results from the first year, the OHIE’s second-year results found no evidence that Medicaid improves the physical health of enrollees.
Yeah, but there’s the abstract of the study:
This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.
That’s not chopped liver, and Kevin Drum comments:
First, the study found that Medicaid patients had lower rates of depression. That’s a good health outcome! Second, Medicaid “nearly eliminated catastrophic out-of-pocket medical expenditures.” This suggests that poor people without Medicaid do get treated for catastrophic problems, but mostly in emergency rooms. Medicaid is certainly an improvement here even if the health outcome is the same. …
Overall, I’m a little unclear about what the conservatives who are crowing over this study really think. They obviously believe that access to healthcare is a good thing for themselves. (At least, I haven’t heard any of them swearing off doctor visits.) But you can’t have it both ways. If it’s a good thing for us middle-class types, it’s a good thing for poor people too. Conversely, if it’s useless for poor people, then it’s useless for the rest of us too. So which is it?
Paul Krugman sees the same thing:
Those who got Medicaid suffered much less financial distress and less depression; they received more preventive care; but on some (not all dimensions) their health wasn’t significantly better than those who lost out in the lottery.
Somehow, conservatives think this is a big win for their opposition to universal health insurance. Why? What it suggests is that the health benefits of ANY kind of health insurance are somewhat hard to identify over a two year period; so, are you about to give up your own insurance, or is your best bet that having that insurance is still a very good idea? And the financial benefits are a big part of that! Since you are going to treat your illnesses, better not to bankrupt yourself in the process, right?
Oh, and until now the claim of right-wingers has been that Medicaid actually makes you sicker; serious researchers have always said that this was a case of selection bias, because sicker people got Medicaid – and now we have confirmation: those who got Medicaid were at least somewhat healthier than those who didn’t.
Above all, you should bear in mind that if health insurance is a good idea – and you are nuts if you let this study persuade you otherwise – Medicaid is cheaper than private insurance. So where is the downside?
It is hard to see a downside, as Klein explains:
So here’s what happened in the first two years of the Oregon Medicaid experiment: Medicaid proved itself good health insurance. The people who got Medicaid used more health care, and seem to have done so smartly – they got preventive care, they got their diabetes diagnosed and began managing it, treated their depression, and so on. But the health care itself didn’t work as well as we hoped – at least not in terms of cutting rates of hypertension and cholesterol.
There are a number of possible spins you can put on that finding. One is that the study was simply too small, with too few sick people, to show the kind of quick health changes the researchers were looking for. Sharply increasing the number of people who are managing their diabetes and mental health, getting colonoscopies and mammograms, and making regular trips to the doctor sure seems like the kind of thing that will improve long-term health outcomes. Perhaps the study was just too small, or too short, to tell. …
Another is that the Medicaid enrollees are getting bad health care – but there’s no actual evidence for that argument. In fact, the study mostly seems to blow up that argument. Medicaid’s critics have long worried that the program pays so little that the people on it don’t actually get care. But Medicaid recipients were getting care, and the care they were getting appears to have made sense.
A third and more radical interpretation is that health care – or at least the kind of routine health care insurance buys you – simply doesn’t work that well. After all, it’s not as if the Oregon study contradicts past randomized studies pitting the insured against the uninsured. It’s the only study of its kind. In that way, it’s a unicorn.
My view, after speaking with a number of the study’s authors and outside experts, is a mixture of one and three. There’s voluminous evidence that managing diabetes and treating depression and being able to go to the doctor improves health. You have to be willing to throw quite a lot of existing theory and evidence out the window to believe that stuff won’t pay off down the road.
Yes, but who would be willing to throw quite a lot of existing theory and evidence out the window to believe only what they want to believe? That would be those with a Grand Unifying Theory, of Life, the Universe, and Everything – but even the guys at CERN aren’t yet sure that what they saw was the Higgs-Boson, and they only joke about it being the God Particle. Maybe there will be a way to figure out how everything in the universe fits together, but that’s a long way off – not now. This Medicare study is also just a bit more data. It doesn’t prove government-sponsored healthcare doesn’t work. “It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.” Remember your Sherlock Holmes. And get your facts straight too. Obama isn’t the Green Lantern.
Ah, but the answer is forty-two. Now go figure out the question.