A better world is impossible without demilitarization and an end to war

Image: Martin Luther King breaks his silence about the Vietnam War at Riverside Church in New York City, April 4, 1967. (source: public domain)



Note: Throughout, this series, I put the word "enemies" in scare quotes. I do this in keeping with the socialist tradition which notes that the ruling classes make wars to enrich or entertain themselves, while sending those they rule to fight and die in them. A slogan of the 1916 Irish Easter Rising was:

The socialist of another country is a fellow patriot! The capitalist of my own country is a natural enemy!

This post is an introduction to a series on antiwar issues. There is a tendency among liberals to view all left-of-center movements as independent--particularly movements against war and in favor of disarmament. What does an end to the war in Afghanistan have to do with, say, disparities in primarily education? This view was most famously criticized by Martin Luther King:

Over the past two years, as I have moved to break the betrayal of my own silences and to speak from the burnings of my own heart, as I have called for radical departures from the destruction of Vietnam, many persons have questioned me about the wisdom of my path. At the heart of their concerns, this query has often loomed large and loud: “Why are you speaking about the war, Dr. King? Why are you joining the voices of dissent?” “Peace and civil rights don’t mix,” they say. “Aren’t you hurting the cause of your people?” they ask...

I come to this platform tonight to make a passionate plea to my beloved nation. This speech is not addressed to Hanoi or to the National Liberation Front. It is not addressed to China or to Russia. Nor is it an attempt to overlook the ambiguity of the total situation and the need for a collective solution to the tragedy of Vietnam. Neither is it an attempt to make North Vietnam or the National Liberation Front paragons of virtue, nor to overlook the role they must play in the successful resolution of the problem. While they both may have justifiable reasons to be suspicious of the good faith of the United States, life and history give eloquent testimony to the fact that conflicts are never resolved without trustful give and take on both sides. Tonight, however, I wish not to speak with Hanoi and the National Liberation Front, but rather to my fellow Americans.

Since I am a preacher by calling, I suppose it is not surprising that I have seven major reasons for bringing Vietnam into the field of my moral vision. There is at the outset a very obvious and almost facile connection between the war in Vietnam and the struggle I and others have been waging in America. A few years ago there was a shining moment in that struggle. It seemed as if there was a real promise of hope for the poor, both black and white, through the poverty program. There were experiments, hopes, new beginnings. Then came the buildup in Vietnam, and I watched this program broken and eviscerated as if it were some idle political plaything on a society gone mad on war. And I knew that America would never invest the necessary funds or energies in rehabilitation of its poor so long as adventures like Vietnam continued to draw men and skills and money like some demonic, destructive suction tube. So I was increasingly compelled to see the war as an enemy of the poor and to attack it as such.

Perhaps a more tragic recognition of reality took place when it became clear to me that the war was doing far more than devastating the hopes of the poor at home. It was sending their sons and their brothers and their husbands to fight and to die in extraordinarily high proportions relative to the rest of the population...

To update this message for current levels of military spending, Demos created a striking graphic to drive this point home:

Actually, I don't find that graphic as striking as it could be. Circular graphs tend to be misleading, so I made a fan graph:

Also: we're set to spend $1 trillion on nuclear weapons (emphasis added):

Isn’t it rather odd that America’s largest single public expenditure scheduled for the coming decades has received no attention in the 2015-2016 presidential debates?

The expenditure is for a 30-year program to “modernize” the US nuclear arsenal and production facilities. Although President Obama began his administration with a dramatic public commitment to build a nuclear weapons-free world, that commitment has long ago dwindled and died. It has been replaced by an administration plan to build a new generation of US nuclear weapons and nuclear production facilities to last the nation well into the second half of the 21st century. This plan, which has received almost no attention by the mass media, includes redesigned nuclear warheads, as well as new nuclear bombers, submarines, land-based missiles, weapons labs and production plants. The estimated cost? $1,000,000,000,000.00 — or, for those readers unfamiliar with such lofty figures, $1 trillion.

Critics charge that the expenditure of this staggering sum will either bankrupt the country or, at the least, require massive cutbacks in funding for other federal government programs. “We’re… wondering how the heck we’re going to pay for it,” admitted Brian McKeon, an undersecretary of defense. And we’re “probably thanking our stars we won’t be here to have to have to answer the question,” he added with a chuckle.

Obamacare was a failure

With Obamacare sure to be repealed by President-elect Donald Trump and a Republican Congress, it's worth considering what Obamacare's legacy will be: a demonstration of both the folly of health care reforms that preserve the profit motive or emulate free markets, as well as the urgent need for single payer.

Before we take each of Obamacare's fundamental failures in turn, it's worth pointing out that--not only would single payer have avoided all of the failures of Obamacare, but it would have cost far, far less. I've covered at length the mammoth inefficiencies of Obamacare, the American health care system generally, and any market-based system for social welfare provision, in comparison to slim and efficient universal social welfare systems like single payer.

Failure #1: Uninsurance
The biggest goal of health care reform was to reduce the United States' massive uninsurance rate, a problem without parallel in the developed world.

Yet Obamacare was never intended to be a universal health care system. The framers of Obamcare intended to leave a large portion of Americans without health insurance. I've written at length about how Obamacare was expected to--at best--only cut in half the uninsurance rate. There's no need to rehash these arguments here.

But as President Obama himself acknowledged in an article he wrote for the prestigious Journal of the American Medical Association (JAMA), Obamacare failed to even cut the uninsurance rate in half; it was reduced from 16% in 2010 when the law was passed to 9% in 2015:

Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law’s reforms.

There's not really anything else to say here. Single payer would have achieved a 0% uninsurance rate. As Obama himself said in 2009, nearly a year before he signed Obamacare into law,

I want to cover everybody. Now, the truth is that unless you have what's called a single-payer system in which everybody is automatically covered, then you're probably not going to reach every single individual.

Obamacare failed on uninsurance, but, then again, it never really set out to succeed.

Failure #2: Underinsurance
In a critique of Obama's JAMA article, Adam Gaffney notes:

One issue Obama does briefly address is the frequently heard critique that the ACA has bolstered the rise of health-care cost-sharing: the payment due at point of use that includes things like copayments, deductibles, and coinsurance. High cost-sharing means the underinsured frequently avoid going to needed doctor’s appointments, having important tests run, or even visiting the emergency room. When they do, they are often left with punishing bills.

While admitting that deductibles have been rising, Obama asserts that the rate of increase has not changed. But he misses the point: the argument isn’t that the ACA created “underinsurance” — it’s that it didn’t reduce it, much less eliminate it, which should be our real goal.

Not much more to say here either. Single payer would have reduced the underinsurance rate to 0% instead of continuing the trend of shifting more and more of the cost of health care upon ordinary Americans.

Failure #3: Only government insurance was effective
Obamacare expanded insurance in two ways--a boring way, and a sexy, innovative way.

The boring way was simply allowing more people to enroll in Medicaid.

The sexy, innovative way was giving people who couldn't get health insurance through their employer (or through the government) a cash subsidy to purchase private health insurance. This caused significant buzz in 2009, because--in theory--once ordinary people were able to afford coverage for themselves and their family, they would be empowered to choose the private insurance plan that was right for them. In this way, Obamacare was supposed to harness the power of free markets to reduce health insurance costs. When people could purchase the best plans for the lowest cost, those insurers would be rewarded with more customers and their competitors would be forced to improve their products or else go out of business for want of customers.

This system of subsidies for beneficiaries and competition for private plans was called the Health Care Exchanges, which were most famously accessible online through a state Exchange (like NY State of Health, KYnect, etc), or the federal Exchanges (healthcare.gov) for residents of states that did not set up a state Exchange.

Which was better? Boring old Medicaid or the innovative Exchanges?

While considerable attention has been paid to the exchanges, they have so far contributed only modestly to the aggregate increase in coverage—accounting for 11 percent of the 8.38 million-person net increase in health insurance enrollment during the first three quarters of 2014. The other 89 percent of net enrollment growth during that period came from the expansion of Medicaid.

Yes, anxiety about the economy explains the rise of Donald Trump

Updated below

Digby rounds up some links arguing that economic anxiety does not explain the rise of Trump.

She blockquotes Philip Klinkner:

You can ask just one simple question to find out whether someone likes Donald Trump more than Hillary Clinton: Is Barack Obama a Muslim? If they are white and the answer is yes, 89 percent of the time that person will have a higher opinion of Trump than Clinton.

That’s more accurate than asking people if it’s harder to move up the income ladder than it was for their parents (54 percent), whether they oppose trade deals (66 percent), or if they think the economy is worse now than last year (81 percent). It’s even more accurate than asking them if they are Republican (87 percent).

Those results come from the 2016 American National Election Study (ANES) pilot survey. My analysis indicates that economic status and attitudes do little to explain support for Donald Trump.

They both misunderstand the meaning of these data.

Klinkner argues that if anxiety about the economy explains the rise of Trump, then everyone worried about the economy should support Trump. For those who answered 'yes' to the economic anxiety question ("...if it’s harder to move up the income ladder than it was for their parents"), only about half (54%) support Trump. That's statistically meaningless--a coin flip. Klinkner interprets this to mean that economic anxiety cannot explain the rise of Trump; among people with high economic anxiety, about half support Trump and half don't. There's no relationship between economic anxiety and support for Trump.

But this conclusion is ridiculous. Noting that half the people who are worried about the economy support Trump does not mean that Trump supporters aren't motivated by anxiety over the economy. It might mean that one's views on the economy are unrelated to support for Trump, but it could also be that about half of the people worried about the economy have been driven to the far right--to Trump--and everyone else worried about the economy has reacted in other ways.

Indeed, in times of economic crisis, societies sometimes undergo left-right polarization. These data are consistent with a left-right polarization: the reason that only half of the people worried about the economy support Trump is not because support for Trump is unrelated to the economy, but rather because the other half has lurched leftward, towards Sanders.

An analogy might be helpful. Let's substitute "vitamin C deficiency" for the economy, "oranges" for Trump, and "green peppers" for Sanders.

Two of the best sources of vitamin C are green peppers and oranges. Instead of asking people if they are worried about the economy, we've asked who is worried about vitamin C deficiency. Let's say exactly 100 respondents say they are worried about vitamin C deficiency. Of those, 54 respondents report eating extra oranges, while most of the remaining 46 report eating extra green peppers.

By the logic of Klinkner and Digby, eating oranges in unrelated to vitamin C deficiency: since only half of respondents worried about vitamin C deficiency are eating extra oranges, vitamin C deficiency cannot be motivating people to eat extra oranges. But that's clearly ridiculous; about half of people worried about vitamin C deficiency have chosen to eat extra oranges while the other half decided to eat extra green peppers instead. Just because only half the people have chosen oranges does not mean that their decision is not motivated by anxiety over vitamin C deficiency.

Let's cut and paste that above paragraph with economy, Trump, and Sanders sprinkled in:

By the logic of Klinkner and Digby, eating oranges in unrelated to vitamin C deficiency. Since only half of respondents worried about vitamin C deficiency (the economy) are eating extra oranges (supporting Trump), vitamin C deficiency (the economy) cannot be motivating people to eat extra oranges (support Trump). But that's clearly ridiculous; about half of people worried about vitamin C deficiency (the economy) have chosen to eat extra oranges (support Trump) while the other half decided to eat extra green peppers (support Sanders) instead. Just because only half the people have chosen oranges (support Trump) does not mean that their decision is not motivated by vitamin C deficiency (the economy).

If so, this means that Klinkner's causality is all wrong. He notes high levels of racial resentment predict support for Trump. He and Digby interpret this to mean that high levels of racial resentment is causing support for Trump, while economic concerns are unrelated. But the data don't show that. These data on racial resentment would also be consistent with left-right polarization. Among those worried about the economy, about half have begun blaming their problems on minorities and immigrants, and find an outlet for their racist/xenophobic beliefs in Trump. The other half has begun to blame capitalism for their problems and has found their outlet in Sanders' socialism. If left-right polarization is occurring, this is exactly what we would expect: a large portion of respondents with anxiety over the economy, and the half that blames minorities and immigrants supports Trump whereas the half that blames something else are against Trump. All that racism and xenophobia didn't just appear out of thin air.

Actually, paternalism in factor income is not at all unprecedented

Matt Bruenig has an interesting post on his Demos blog. In a nutshell, he asks why so many people believe transfer income should be treated very differently than wages. He quotes a Washington Post editorial by Michael Strain:

If we take money from John to give to Matthew, who would starve without it, then we owe it to John to make sure that his money is appropriately spent on Matthew’s food and shelter, not on Matthew’s alcohol and gambling.

And Bruenig asks why the same paternalism shouldn't apply to wages spent on alcohol or gambling?

But wait! Paternalism used to be the norm for waged labor!

Here's a 1931 article on Henry Ford's "shotgun gardens," so-called because employees were forced to keep them or they would be fired. Here is a quote from Henry Ford's actual press release introducing the policy:

"Next year, every man with a family who is employed at the plant will be required to have a garden of sufficient size to supply his family with at least part of its winter vegetables. Those who do not comply with the rule will be discharged. The man too lazy to work in a garden during his leisure time does not deserve a job. When the people of our country learn to help themselves they will be benefited far greater than they would be by employment insurance. If our agricultural plan is adopted throughout the country, the dole need never be thought of."

This sort of thing was really common. In The Invention of Capitalism, Michael Perelman quotes the welfare secretary of the steel giant American Iron and Steel Institute: 

regulation of his meals, the amount, the character and the mastication of them, the amount and character of drink, the hours of rest and sleep, the ventilation of rooms . . . washing of hands before meals, daily washing of feet, proper fitting of shoes, amount and kind of clothing, care of the eye, ear and nose, brushing of the teeth, and regularity of the bowel. (cited in Montgomery 1979, 40)

Yes, this company had a welfare committee (or in other words, a paternalism committee).

Why such paternalism? An early economist, James Steuart, calculated that a two full days' work at the going wage rate in Scotland was enough to support that worker (not the worker's family--just the worker) for one day. Families had to support themselves by gardening and selling products they could make by hand, such as handloom weaving. (For the record, Steuart didn't consider such sub-poverty wages a problem; he viewed it as a great efficiency, a triumph of the free market).

No, the United States does not have the best health care in the world

In the popular imagination, the United States provides very high quality health care services--but only to those who can afford it. In the popular imagination, health care is the one shining exception of the American social welfare state--the one area of social welfare where the United States boasts higher quality services than the rest of the world. This is a myth.

First, the United States is middling at best among peer countries for rates of disease survival. And second, care is demonstrably of very low quality:

According to a recent RAND study published in the New England Journal of Medicine, uninsured patients receive only 53.7 percent of the care experts believe they should get—that is, appropriate, evidence-based treatment. But according to the same study, patients with private, fee-for-service insurance are even less likely to receive the proper care...

In addition to overtreatment and undertreatment, there is also flat-out mistreatment. Consider the following statistics: The Institute of Medicine estimates that lack of health insurance among people aged twenty-five to sixty-four causes 18,000 premature deaths annually, which is appalling. But the Institute of Medicine also estimates that up to 98,000 Americans are killed in hospitals every year by medical errors. In 2006, the IOM issued a new study that found that hospital patients in the United States experience an average of at least one medication error, such as receiving the wrong drug or the wrong dosage, every day they stay in the hospital.

All told, according to the RAND study, Americans receive appropriate care from their doctors only about half of the time, and the results are deadly. In addition to the 98,000 killed by medical errors, another 126,000 die from their doctor’s failure to observe evidence-based protocols for just four common conditions: hypertension, heart attacks, pneumonia, and colorectal cancer...

Actually, even rich people would be better off in a social democracy

It's often assumed that rich families have nothing to gain from a social democratic social welfare system. To see if that's actually true, I'm repeating the analysis I did for a median income household for richer households. These are the key tables for a median income family:

Clearly, median income households are much better off in social democracy than in the American social welfare system. Though taxes are much higher in the social democratic system, the enormous out-of-pocket spending American households must spend on social welfare easily outweighs those higher taxes. Once we account for the private, out-of-pocket spending in the American social welfare system, it becomes obvious that the high taxes of the social democratic social welfare system are a very good deal for most families.

However, the same might not be true for rich families. Perhaps rich families can afford high out-of-pocket spending and would actually be financially better off with the high out-of-pocket spending and low taxes of the American social welfare system.

To find out, let's repeat this analysis using the exact same methods as median income, but for a rich household. We'll do the analysis for a household at exactly the 90th percentile for income. If over 90% of Americans would be better off under social democracy, that should be pretty convincing.

Revisiting the cost of the welfare state for individual households in the United States and the social democracies

Image: But can your social welfare spending buy this?!?!? (Northern lights over Saurbaer, Iceland / flickr user benhusmann)



I'm revisiting this 2014 post for two reasons. First--and most importantly--I did not realize when I first wrote it how important it was, so I outlined general trends and was not super careful about my analysis. My aim was to point out the hypocrisy of crying foul at the high tax rates of the social democracies even though a typical American is far worse off due to the high cost of private social welfare services. 40% taxes may seem high, but a median income American family can expect to spend over 60% of their income on federal (income plus payroll) taxes, employer-sponsored health insurance, and recommended savings for retirement alone--and this doesn't even include student loans payments (an additional 11% of income on an income-based repayment plan), day care services (up to 30% of income depending on the state), or other common social welfare costs. You don't need super careful analysis to make this point.

Second, some OECD links I used are now broken and so it's no longer clear where the data are coming from.

I'm keeping the original post up because it has some research which I don't need to repeat. But here, I'm going to be less sloppy on my analysis of labor costs and social welfare contributions.

You can read this page alone and consult the original post for links that didn't make it into this post. Before beginning, recall that median income in the United States is pretty similar to the social democracies. Here is the revised table for median income households (click for unobscured image):

The blue percentages at the top of the table are expressed as a percentage of gross labor costs. For the American side, this means:

At first, it might seem reasonable to consider at what a typical family earns in income, then consider what percentage of that income they pay in taxes and for social welfare. But this is misleading, for two major reasons. I call this the "sticker price" of the social welfare state--the cost of the social welfare state that a typical individual or family sees, but not the cost that they actually pay.

The first reason why the sticker price is misleading is because it comes nowhere near the total cost of the welfare state for this family. The sticker price ignores many costs that support this family's social welfare benefits and services: the cost of employer contributions to Social Security, Medicare, and employer-sponsored health insurance, for example. Since these are costs that support the social welfare needs of this family, it makes no sense to ignore them.

Second, it simply makes no sense to think of individual labor costs as somehow different from each other. It makes no difference to an employer--whether American or Scandinavian--if a dollar is spent on cash wages, mandatory social security contributions, or fringe benefits; to an employer, a dollar spent on labor costs is a dollar spent on labor costs, no matter the final destination of that dollar. Indeed, in the social democracies, 90% of social security tax burden falls on workers; in other words, for every dollar an employer is forced to contribute to social security programs, a worker's wage falls 90 cents. Thus--on paper--employers pay 100% of the employer contribution to social security, but in reality, employees pay for nearly all of those contributions because their wages would be higher if the employer's social security taxes did not exist. And in the United States, a similar phenomenon occurs with employer-sponsored health insurance: employees accept lower wages at jobs that offer health insurance. Clearly, looking at one form of labor costs (cash wages) while ignoring all the others makes no sense since the line between wages, benefits, and mandatory employer social security contributions is blurred, to say the least.

In sum, it makes no sense to point to the sticker price as being a complete accounting of the social welfare costs of a typical family; it ignores too many costs of the social welfare state and ignores several forms of labor costs.

Thus, the only way to fairly estimate the total cost of the welfare state is to sum every component of welfare spending and express it as a percentage of every dollar spent on labor costs--and so I've done this for both the American and social democratic columns (the blue percentages at the top of the first table). This is captured for the American side in the immediately preceding table (the social democratic side is covered below), which is a complete accounting of the cost of the welfare state to a median income American family. The left column is every dollar that this family's employers spend on them: this includes wages, benefits, and mandatory contributions to Social Security. On the right is every dollar that goes to taxes or social welfare: all taxes and social security contributions paid by both employer and employee on wages or labor, and all money spent on social welfare benefits paid by both employer and employee (discussed in greater detail below). Obviously, some items are in both columns--for example, employer contributions to health insurance and employer contributions to Social Security are both labor costs to the employer and are social welfare costs. This table is the total cost of the welfare state for this median-income individual family: all taxes, social security contributions, and spending on private social welfare benefits as a percentage of every dollar an employer must spend to employ this family.

Here is a table of the cost of other common social welfare benefits and services, alongside their out-of-pocket cost in the American social welfare system--in dollars, as a percentage of income for a median income family, and as a percentage of gross labor costs for a median income family:

There is a range for child care because the cost of high quality child care services varies wildly by state. In nearly all states, however, annual child care costs exceed the cost of tuition at a public university.

The above three tables is this blog post. Before proceeding, please return to the three above tables. Clearly, the American social welfare system is a phenomenally bad deal for a typical family compared to the social democratic model.

Here's the outline for the rest of this post:

1. As bad as the American side looks in these tables, it's actually worse than these basic numbers suggest. This is because the American side forces individual households to bear enormous risks in health care, retirement, and long term care. Also, the social welfare services available to a median income American family are of far lower quality than those same social welfare services available to a median income family in the social democracies. If we only look at the raw numbers, we lose sight of enormous financial risk and poor service quality of the American social welfare system.
2. The research or calculations behind each cell of all three of the above tables.

The horrors of the American long term care system
Long term care refers to health care equipment or services for patients who are grievously injured or very, very sick. These patients will never get better; they will be sick or badly injured until they die, and they will likely die from their injury or illness.