Seasonal Integrity

The middle of March in an election year – that’s when things get strange. That’s when the party out of power has to inspire its base, or outrage its base, or both. Do everything you can to win the party’s nomination – tell ’em what they want to hear – feed ’em that red meat – and pivot to the center for the general election, toning it all down to show that you’re not a loony-tune after all. Wild-eyed fanatics don’t win the general election, just the party primaries and thus the nomination. Ask Barry Goldwater, who kept on saying that extremism in the defense of liberty is no vice. The nation disagreed. They preferred a calm and thoughtful statesman. There wasn’t one running that year – there seldom is – but the voters rejected the self-proclaimed extremist and Lyndon Johnson won in a landslide – Goldwater carried only his home state of Arizona and the five core states of the Deep South. Yes, Lyndon Johnson was an odd guy, far from any model of what a masterful president should be – but he got things done – the various civil rights acts and Medicare and Medicaid – and voters seem to realize that he wouldn’t get us all killed. He didn’t do so well with Vietnam, but at least he didn’t nuke China and the Soviet Union to keep them from meddling there or anywhere else. Goldwater might have, as he was hinting at such things all along. Yes, that’s primary-talk. But Goldwater saw no point in any pivot to the center after his nomination – that would be selling out his principles. And you have to admire his integrity. You just didn’t vote for him. Severe integrity in the face of confounding complexities is dangerous. We knew that once, and we relearn that again periodically. George Bush taught us one more time.

But it’s primary season again, and severe integrity is what the current Republicans are selling. It’s a seasonal product, like asparagus. And all the candidates are now telling the base what they just will not abide – government spending, government debt, freeloaders who don’t pay taxes and get government benefits, freeloaders who can’t pay taxes and still get government benefits, and gay folks and Hispanics who think they should get automatic respect, and blacks too, and those who want to tax the fabulously wealthy who merely did the right thing and got rich, and women who seek abortions, and women who use birth control, and anyone who thinks Obama has the right to be president, and so on and so forth. Of course that’s only a partial list. There are many things those with integrity cannot abide. And this is the time to say so, when you don’t need their votes.

And this is the week the Republican primaries take place in the Deep South, where no one ever forgave Lyndon Johnson for all the civil rights stuff, where all the local Democrats quickly became Republicans, and now, for a generation or more, Democrats in any office other than in black districts are beyond rare. Some might see it as a land of seething resentments, where no one ever needs to tone down anything – the states Goldwater carried. And these days, given the polling, the resentment still runs deep:

Asked whether Obama is Christian or Muslim, some 45 percent of Alabama Republican respondents picked Muslim; 14 percent correctly identified him as Christian. Another 41 percent said they were unsure. In Mississippi, a majority of Republicans, 52 percent, identified Obama as Muslim; 12 percent said he was Christian and 36 percent were undecided.

Interracial marriage laws were overturned by the Supreme Court in 1967, but a significant minority of Mississippi and Alabama apparently still long for their return, or are at least ambivalent about the idea. In Alabama, 67 percent of respondents said interracial marriage should be allowed, but 21 percent said it should be illegal and another 12 percent were not sure. Mississippi Republican voters were even more divided: Only 52 percent said such marriages should be legal, versus 29 percent who said they should be banned and 17 percent who were unsure.

This is likely Republican voters in Mississippi and likely Republican primary voters in Alabama – and they want red meat from their candidates. And David Weigel reports on Newt Gingrich’s weekend in Brandon, Mississippi, where Gingrich was happy to oblige:

“We have a president who apologizes to religious fanatics in Afghanistan, while he’s attacking the Catholic Church and every pro-life group in America,” he says. “He says we’re going to respect the sacred objects of every religion? Fine. Put up all the crosses the courts have torn down!”

In my section of the crowd, I hear “Amens” and shouts of “Yes, yes, yes!” Hearing a national politician talk about this stuff is exhilarating for the crowd. Rick Santorum emotes when he talks about a war on Christians. Mitt Romney doesn’t talk about it at all. Gingrich just states it, with the same measured tone he’d bring to a talk about gas prices or (less frequently these days) some panel about education reform.

Gingrich is comfortable in the South. He knows these folks:

Gingrich demands a resignation from Defense Secretary Leon Panetta, whom he worked with when he was speaker of the House and Panetta was President Clinton’s chief of staff. Panetta’s crime: Saying that the United States would seek U.N. approval before a strike on Iran. “He’s not the secretary of defense for the United Nations!” says Gingrich.

This is a killer line. Loss of sovereignty, attacks on faith, fear of people being lulled into poverty and crime by big government – all of that plays. Before Gingrich gave this speech, he’d attended late service at the First Baptist Church, four minutes down the road. It was brief, heavy on hymns, with a fairly succinct sermon from the Rev. Scott Thomas. He compared the contract signed in the Book of Nehemiah to the Declaration of Independence. He talked about personal morality and looked directly at Gingrich as he explained the origins of marriage. God had designed a contract; He had not merely told men and women to have sex. Nobody could have missed the hint. When Gingrich held the microphone after the sermon, he took his medicine.

“I was the kind of kid who got the book on Lucifer descending to Hell,” said Gingrich. He’d sinned. “I come to you as a citizen who has sought redemption. I know that you have to shelter under the cross to have any hope of having a full life.”

The crowd loved it, and Weigel reports the minister later explained he wasn’t talking about Gingrich and his many successive wives at all – everyone falls from grace. He was talking about Mormons and polygamy, and Mitt Romney. Mormons once practiced polygamy. Newt is cool. That’s not.

And a little farther north:

Rick Santorum, speaking in Missouri this weekend, stopped to thank the voters around the country who believed in him – but made it clear there were some voters whose ballots he wasn’t interested in.

“I kept saying, you just stick with us, you go out and vote for your values and trust what you know,” Santorum said Saturday, fresh off his victory in the Kansas caucuses. “Because you don’t live in New York City. You don’t live in Los Angeles. You live like most Americans in between those two cities, and you know the values you believe in.”

He wants the votes of Real Americans – not votes from New York or Los Angeles. Of course the Los Angeles area, specifically Hollywood, produced Ronald Reagan. And Nixon is from just down the way in Yorba Linda. But it is primary season and such things must be said. Should Santorum win the nomination he may find a way to say nice things about people who live on the coasts, which is where a whole lot of voters live. But for right now New York and California are just not America, nor is Massachusetts. Both Santorum and Gingrich say that Romney is a “Massachusetts moderate” – not a true conservative, and thus not a Real American. There are none of those in Massachusetts.

Saying such things in a general election could prove disastrous, although Sarah Palin gave it a go last time around. She didn’t win, but of course there were other variables at play. Still this time around there seems to be a much more extensive list of things that folks with real integrity – the Real Americans – won’t abide. And it’s getting a little silly:

The elected county commissioners in New Hanover County, N.C. are sick and tired of using taxpayer funds to assist women who can’t keep their legs closed. And so on Monday they voted to reject a state grant designed to cover family-planning services.

The Wilmington, N.C. Star-News reports the commission in the coastal county has “unanimously voted to turn down a state family planning grant that would cover contraceptive supplies along with other medical services related to family planning.”

The commissioners didn’t think it was right to use taxpayer money to pay for women who want to have sex for non-procreative purposes.

And the direct quote from the Star-News is this:

Chairman Ted Davis said he thought it was a sad day when “taxpayers are asked to pay money for contraceptives” for women having sex without planning responsibly.

“If these young women are being responsible and didn’t have the sex to begin with, we wouldn’t have this problem to begin with,” Davis said.

Are there a lot of votes to be won by holding that position? (Don’t think of the implied pun there.) But they do want you to admire their integrity. It’s the season for that, and asparagus.

Of course much of this will just go away by the time the general election rolls around. Politicians know better than to ride such tigers – people on the coasts vote – and young women do too, and many of them might actually be sexually active – not promiscuous, not sluts, and probably married – just normal. And not everyone is impressed with proud Jesus talk mixed with talk of how the South will rise again, and how the rich are very special. They just want the economy fixed and want the potholes filled.

Still there is one issue that probably won’t go away. All the candidates want to repeal Obamacare – the Affordable Care Act – all of it. Somehow that too became a matter of integrity. But once again, severe integrity in the face of confounding complexities is dangerous, and this is a complex matter. And Ray Fisman, the Lambert Family professor of social enterprise and director of the Social Enterprise Program at the Columbia Business School points that out:

There are currently tens of millions of Americans without health insurance. Some can’t afford coverage at going rates. But as recently as 2009, one in seven applicants were rejected by the four largest insurance companies, who refused to sell them insurance at any price. Uninsurable Americans are mostly sick to begin with: They have heart disease, diabetes, cancer, and other pre-existing conditions that set off alarm bells for insurance sellers.

Ask why the already-sick can’t buy insurance and you get an immediate and seemingly obvious answer – their health costs are too high. But just because covering people with pre-existing conditions might be more expensive doesn’t explain why they can’t buy insurance at all. At any price. Shouldn’t they be able to buy insurance at a higher rate than healthy people, a rate that would protect the insurance company from the greater costs of their coverage?

Well maybe, but it’s not that simple, and Fisman points to the work of Nathaniel Hendren:

According to Hendren’s argument, not only are sick people a lot more expensive to care for, but they also know a lot more about what their cost of care is likely to be in the future. And it’s this inside information that makes the market for covering pre-existing conditions break down.

And that’s the problem:

To understand Hendren’s theory, it’s useful to think about an extreme case. Consider the agonizing decision of whether or not to treat terminal cancer with costly and painful chemotherapy, which often provides only a small chance of remission. If you ask me what I, a healthy 41-year-old, would do, I have no idea – I’ve never really thought much about it, and in any event I have no real basis for weighing the costs and benefits. How painful would treatment actually be? And how would I face my own end-of-life decision?

Someone who already has cancer, by comparison, has a much greater appreciation for the treatment options available and presumably he has a much clearer sense of how far he’s willing to go for a chance at survival. Different people will have reached different decisions after going through this difficult calculus, and the outcome has significant financial implications for any insurance company that’s agreed to provide coverage.

So now let’s consider the problem facing an insurance company, say a Blue Cross, that wants to offer coverage to cancer patients with similar diagnoses. While they may look similar to the company’s statisticians, different patients may choose very different courses of treatment. Some may decide to pursue aggressive options. Others may opt out of what’s expected to be a long and painful fight. The patients’ medical expenses will be drastically different, despite their similar prognoses.

Now suppose the Blue Cross offers them all the same policy for, say, $10,000 per year, based on data showing that the annual medical costs of cancer victims is about $8,000 on average. Who is going to take the insurer up on the offer? A patient who expects his expenses to cap out at just a few thousand dollars won’t sign up – for him, the coverage isn’t worth it. But the patients who have already decided that they’ll take advantage of aggressive and expensive treatments will enroll. The cost per person of all patients with a cancer diagnosis may be $8,000, but if the only patients who enroll are the ones who expect their costs to be more than $10,000, that’s a money-losing proposition for the insurer.

If you work through the logic, the whole system collapses:

Suppose the Blue Cross goes through with higher-priced coverage for cancer survivors anyway, and finds that the policyholders end up with medical expenses of $15,000 per year on average – could it solve the problem simply by raising the price to, say, $20,000? It can’t, because that would only make the problem worse by getting rid of the relatively cheap-to-insure customers who were willing to pay $10,000 for coverage but no longer find it worthwhile at a price of $20,000. Each time it raises the price, the insurer gets stuck covering an ever more expensive set of cases. It’s a no-win situation for insurers, so they choose not to offer coverage at all.

In a roundabout way, this is the argument for the individual mandate. Having people free to just not buy insurance leads to the collapse of the insurance market. Everyone must be forced to play:

If a voluntary market for insurance for pre-existing conditions is doomed to unravel, what’s to be done to accomplish the Obama administration’s goal of accessible health care for all? For the time being, there’s a government-run Pre-Existing Condition Insurance Plan that covers those denied coverage in the recent past. But that program’s history hints at the enormous – and unexpected – costs that come from insuring people who have already had cancer, heart attacks, and strokes. The cost per participant of PCIP is projected to be nearly $30,000 in 2012, more than double what government actuaries projected. This is exactly what Hendren’s model would have predicted: Only the highest-cost cases choose to purchase the insurance.

Come 2014, the Affordable Care Act will prevent insurers from discriminating based on pre-existing conditions: cancer victims and stroke survivors will be able to buy insurance at the same price as otherwise similar applicants. Insurance companies may take a hit to profits, but part of the cost will surely be passed on to the lower-cost counterparts to this high-cost pool. Healthy people might be tempted to opt out, but under the new law, they’ll be required to have insurance. This individual mandate is a natural fix to the problem of adverse selection in health insurance: It keeps the lowest-cost participants from opting out, and as a result the market doesn’t unravel.

Yeah, but try telling that to voters. It’s not the season for such talk. Severe integrity in the face of confounding complexities may be dangerous, but that’s what is being offered, and admired – at least for now. So Obamacare must go – all of it. And we will be left with a train-wreck of a healthcare system – with the inevitable individual choice of bankruptcy or early death, and for many, both. But Obama is a Muslim, and young women are sluts who have sex, and California isn’t America, and the South will rise again.

But in late August, or perhaps earlier, the Republicans will have sorted things out and have a candidate. And it probably won’t be Barry Goldwater, doubling-down on the nonsense. Or it may be. And then we’ll see if we’ve learned anything, again.


About Alan

The editor is a former systems manager for a large California-based HMO, and a former senior systems manager for Northrop, Hughes-Raytheon, Computer Sciences Corporation, Perot Systems and other such organizations. One position was managing the financial and payroll systems for a large hospital chain. And somewhere in there was a two-year stint in Canada running the systems shop at a General Motors locomotive factory - in London, Ontario. That explains Canadian matters scattered through these pages. Otherwise, think large-scale HR, payroll, financial and manufacturing systems. A résumé is available if you wish. The editor has a graduate degree in Eighteenth-Century British Literature from Duke University where he was a National Woodrow Wilson Fellow, and taught English and music in upstate New York in the seventies, and then in the early eighties moved to California and left teaching. The editor currently resides in Hollywood California, a block north of the Sunset Strip.
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