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February 17, 2006

Moral Expertise?

Gerald Dworkin: February 17, 2006

A recent New York Times has a quote from Steven Levitt, the freakonomics professor.

 “As an economist, I am better than the typical person at figuring out whether abortion reduces crime but I am no better than anyone else at figuring out whether abortion is murder or whether a woman has an intrinsic right to control over her body.”

 My thoughts after reading this included the following.  First, it’s nice to see an academic being frank about what his expertise does or does not qualify him to opine about.  Being a political theorist does not make one’s views about the significance of the Hamas victorymore likely to be accurate than the speculations of a literary theorist . It may be true that the former has paid somewhat more attention to Middle East politics than the latter, and that may reflect something about the interests of those in the respective disciplines, but the content of their discipline does not make one more qualified than the other.

 The second thought was would the inverse statement be true for a moral philosopher?

 “As a philosopher I am better than the typical person at figuring out whether abortion is murder of whether a woman has an intrinsic right to control over her body, but I am not better than anyone else in figuring out whether abortion reduces crime.”

The latter part is certainly correct. And its corollaries are important to keep in mind for work in applied moral philosophy. Over the years I have made predictions in philosophical work about 1) the dangers of research into genetic differences between racial groups, 2) how likely it is that there will be a slippery slope from voluntary euthanasia to non-or-in voluntary euthanasia, 3) the consequences of allowing Universities to enforce campus speech codes.

 Some of these predictions were accurate, some not, some never allowed opportunities to test the prediction. But I might have stressed that these were my best guesses, that although I looked at various sources of data I did not evaluate them rigorously, that it all too easy to dismiss contrary evidence as motivated by (mistaken) normative views.

 In light of this there at least the following two strategies. First, only engage in conditional claims, e.g. if it turns out that the consequences of legalizing X are large and dangerous ( and there are no feasible ways of limiting this) then we should not legalize X . Or we can read as much of the relevant literature as possible, consult with those who are genuinely competent in assessing the evidence, and make our best guess (labeling it as such). I leave aside the possibility that there may be rights at issue which determine the issue independently of the likely consequences (at least below some high threshold).

But it is the first part that is more important and more difficult to think about. Are we, qua moral philosophers, better than the average person in coming to correct answers about first-order moral matters?  Well, we have been reading, thinking and writing about these issues for all of our professional lives. We are trained to evaluate and criticize arguments. Our views have been exposed to critical examination and refutation by other philosophers. Some of us serve on IRB’s and consult with physicians about what to do in difficult ethical cases. How could we not be better than the average person at figuring out these things?

 Appealing to authority, we could consider Mill’s view.

 People “must place the degree of reliance warranted by reason, in the authority of those who have made moral and social philosophy their peculiar study…[R]eason itself will teach most men that they must, in the last resort fall back upon the authority of still more cultivated minds.”

 Whether this is a particular piece of Victorian authoritarianism or not is the issue before us. First, let’s not make things too easy for ourselves.  If by the “average” person you mean a randomly picked individual walking down the street then I think it’s false that Levitt is not better at figuring out whether a woman has a right to control over her body. After all the average person does not know who the Secretary of State is, what the 2nd amendment is, doubts that evolution is true, believes in ufos ( Gallup Poll figures are about 50% for belief in ufos), etc.

 So, let us arbitrarily define the relevant average person, as a random person picked from the intersection of the two classes 1) has a college degree and 2) reads a daily newspaper.

About 25% of Americans over the age of 25 have a college degree. About 60% of those read a newspaper at least once a week. Therefore,  roughly 15% of the population falls into the intersection of the two classes—about 45 million people.

Is a randomly picked moral philosopher better at figuring out a normative issue than the average person ,as defined above?  How would we test this?  If we knew the correct answers to the moral issues facing us we could do a survey.  But, unless the question is very narrowly framed, we might find as much disagreement with the “correct” answers among philosophers as among average people.  And do we simply count correct answers, or the quality of argument given to support the answers. It’s likely that philosophers score higher on that dimension but what would that show?  Perhaps that philosophers are better at framing discussion and making distinctions. But does that (tend) to show that they get things right more often?  Isn’t there a plausible reason to suppose the philosophers have a tendency to accord more weight to argument than to sympathetic feelings,  experience with the subject matter, intuitive insight, etc.?  If you wanted someone to aid you in making a difficult ethical decision about medical treatment for your child would you be better off consulting a moral philosopher, or a physician who has dealt with similar cases for 30 years. I know whom I would choose.


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February 16, 2006

Academic Freedom, Catholic Education, and the Vagina Monologues

Steven Shiffrin: February 16, 2006

Freedom is freedom for truth. Error has no rights. This was the perspective of the Catholic Church for many centuries. It was used to support censorship and persecution in many countries. The same perspective was employed by Protestant countries for the same purposes and by non-religious dictatorships. The freedom was the same; the truth was different.

At least with respect to the actions of government, Vatican II changed the perspective of the Church. Vatican II respects the dignity of the individual and his or her freedom to make religious choices. It respects the right of individuals to choose error, but hopes to lead them toward its conception of truth. Liberal Catholics believe that individuals should enjoy the same freedom with respect to Church teaching. They should, for example, have been free to maintain that religious freedom was demanded by appropriate conceptions of human dignity when Church teaching was to the contrary. Traditional Catholics believe that the freedom publicly to oppose Vatican teachings by Catholics should be restricted, and that freedom of conscience within the Church is freedom for truth.

The question of what it should mean to be a Catholic university gets much discussion in Catholic circles. Among other things, I think such universities should be able to assure a dominant presence of Catholic faculty in relevant subject areas. But I do not think it should be the goal of the administration of such universities to eliminate all error from their campuses, nor do I believe any administration is committed to doing so. Nonetheless, I do think the Church has a bad record in this regard. Charles Curran should be teaching at a Catholic university; so should Hans Kung. The point is not that Curran and Kung were right (on most points I think they are); the point is that their perspectives need to be discussed and debated in a Catholic university. That debate will be sharper if the best advocates of their position are in Catholic universities.

I have two points to make about the Vagina Monologues which has most prominently been restricted at Notre Dame. First, if you want to encourage students and members of the general public to see the Vagina Monologues, tell students they can not have the show on campus or otherwise limit the ability to see the show. Students and other citizens who would never have thought to see such a production will rush to see it.

But, generously understood, I assume the real point of opposing the Vagina Monologues was to send the message that a particular university is a Catholic university. I think the better way to do that is education. The better way is to publicly discuss the strengths and weaknesses of the Vagina Monologues from a Catholic perspective. A public image of censorial tendencies is not good for Catholic education, and censorial Catholic education is not good education.

Steve Shiffrin
Comments welcome either on the trackback or to shs6@cornell.edu

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February 15, 2006

color blind?

Don Herzog, Herzog: Constitutional Rights: February 15, 2006

"Our constitution is color-blind, and neither knows nor tolerates classes among citizens."  So Justice Harlan wrote in his stirring dissent in Plessy v. Ferguson.  Harlan added that the Reconstruction amendments "removed the race line from our governmental systems."  That stirring language has been the mantra of those opposed to affirmative action.

There's other language in Harlan's dissent that suggests he worried not about any and all race-conscious legislation, but about legislation subordinating blacks.  So for instance he referred to state laws "conceived in hostility to, and enacted for the purpose of humiliating, citizens of the United States of a particular race."  And so today's patrons of affirmative action too can claim Harlan as their own.

I've been thinking about these matters again because of the Michigan Civil Rights Initiative, on the ballot for this coming November after ridiculous skirmishing about the legality of the language and the petition signatures.  (Here is the key court opinion.)  The Initiative would ban the University of Michigan from using "race, sex, color, ethnicity, or national origin" (so, amusingly, not sexual orientation) in admissions.  Since I'm a reluctant but firm supporter of affirmative action, I'm opposed.

Obviously, color-blindness has its appeal.  And it's not (quite) enough to say that in a more just society, it would be the right way to go, because it has its appeal for us, here, now.  Still, I think it's a bludgeon of sorts where we need scalpels.  So I want to step back a moment and consider the recent race riots in a jail outside Los Angeles.  In response, authorities are segregating prisoners by race.  Not a moment too soon.  So how awful is it for the state to do that?  How important a justification do they need?

Last year, the Supreme Court ruled that California's "unwritten policy of racially segregating prisoners in double cells for up to 60 days each time they enter a new correctional facility" properly triggered strict scrutiny.  That's the most demanding level of judicial scrutiny in constitutional law, and the old quip has it that it's strict in theory and fatal in fact, though some exceptions suggest the scrutiny isn't always all that strict anyway.  The Court didn't decide whether California could meet that scrutiny.  Instead they remanded the case to the Ninth Circuit to decide.  The Circuit hasn't yet ruled.

I don't doubt that once there are race riots, the state can meet the burden of strict scrutiny.  But I wonder whether that's the right burden.  You can imagine facts on which California's "unwritten policy" would stamp blacks with a badge of inferiority, but that doesn't seem to be the actual case.  So that policy isn't color-blind, but it isn't subordinating either.  Is it properly a constitutional problem, a putative violation of the equal protection clause?  I don't think so.  That doesn't mean you'd have to be crazy to worry about it.  But the relevant worries look to me like garden-variety policy worries, of the sort that legislatures and agencies sort out all the time.

Or try this:  does it violate the Constitution when the police search for a criminal suspect described as "a young black male, around 5' 10" and 170 pounds"?  Or for "a young white male, around 5' 10" and 170 pounds"?  Check your intuition:  if you're really devoted to color-blindness, you should think those two search descriptions are equally offensive.  Does the government have to defend these routine police procedures by demonstrating they are narrowly tailored to realize a compelling state interest, the magic wand required to survive strict scrutiny?  Do you think the Constitution requires that the police search for "a young male, around 5' 10" and 170 pounds"?  Isn't the government bumbling enough already?

There may be domains in which color-blindness is a constitutional requirement.  Or domains in which color-blindness is the right policy, even if it isn't constitutionally required.  (The champions of MCRI lost the constitutional battle, after all.)  And, for all I've said here, state university admissions policies may be one such domain.  But I think the demand for color-blindness across the board, come what may, is a suffocating abstraction.  We can do better.

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February 08, 2006

What Game Would You Rather Play?

Anderson on Political Economy, Elizabeth Anderson: February 8, 2006

Let's conduct a thought experiment.  You have to play a mountain-climbing game.  The higher you climb, the better off you are.  Rarely, players climb solo.  Most of the time, they climb in teams.  The members of each team are connected by pulleys and gears in such a way that, if everyone climbs in a cooperative fashion, everyone in the team goes higher than if each just climbed the team rope in an uncoordinated way.  The job of the team leaders--those highest on the rope--is to figure out how to get everyone to coordinate their climbing so as to get the maximum total lifting force for the whole team.  However, depending on the gear setup, the lifting force of each member's step may accrue unequally to each team member.  (In most setups, those at the top get lifted higher by any team member's step than anyone below.)  The mountain face is swept by gales, although the winds tend to be milder at higher altitudes than at lower ones.  Sometimes the gales blow you or even your whole team off your rope.  Other times, the team leaders--those at the top of the team rope--eject you from the team and toss you off the team rope.  If you are lucky, your mountain-climbing skills may be attractive enough to another team that they extend you a part of their team rope before you hit the ground.  Or you will have family or friends who will toss you a saftey rope to catch you on your way down.  But you may not find a team with an open place on their rope that they will offer you, and you may not have family or friends willing to offer a rope, or the rope they are able to offer may be too frail to stop your fall.

You don't know your initial place on your rope, nor which rope it is, nor your mountain-climing skills, nor how well-off, benevolent, and numerous your family and friends are.  In this state of ignorance, you get to choose some of the rules of the game you must play.  Which rules would you prefer to play by?  Here are your choices:

1. Free Fall: if you are blown off or ejected from your rope, and find no family, friends, or other teams willing to toss you a rope, you hurtle to your death below.  The dispersion of players is very large:  some are at extraordinarily high altitudes, some are dead.

2. Safety-net: there is a safety-net placed somewhere between the ground and the lowest-altitude player that will catch you before you hit the ground.  You will be worse off than anyone still on a rope--at a miserably low altitude--but you won't die.  And you'll often, but not always, have a chance to find a new rope and start climbing again.  There is a small price to pay for the safety-net: everyone will climb at a slightly slower pace than if the net were not there.  The disperson of players is almost as large as in Free Fall, except that the worst-off players in Safety-net are better off than the worst-off players in Free Fall.

3. Long Bungee Cord: in addition to a safety-net for those who never get going on a rope, you have a bungee cord anchored to a point on the mountain equal to your highest achieved altitude.  The bungee cord prevents you from falling more than 60% of the way down the mountain.  That way, even if you never get another rope to climb, your previous climbing efforts will not have turned out for naught.  There is a modest price to pay for the long bungee cord: everyone will climb at a modestly slower pace than if they were not supplied with the cord.  The dispersion of players in Long Bungee Cord is almost as large as in Safety-net, except that the highest players are not quite as high, the lowest players are not as low, and there is not as much fluctuation of position for any given player.  A few players are at gloriously high altitudes; many players are at comfortably high altitudes; some are at miserably low altitudes.

4. Short bungee Cord: this is the same as the long bungee cord, except that the cord prevents you from falling more than 30% of the way down the mountain.  There is a correspondingly steeper price everyone must pay for this cord.  The dispersion of players in Short Bungee Cord is considerably smaller than in Long Bungee Cord: the highest players are lower down, the lowest players are higher up, and there is little fluctuation of position for any given player.  Almost everyone is at a comfortable altitude, few are at glorious altitudes, and it's harder than in Long Bungee Cord to climb much higher than or fall far below one's current altitude.

5. Maximin: in addition to a safety-net for those who never get going on a rope, all the ropes are equipped with a special gear assembly that works as follows: those higher on the rope don't get to ascend unless their ascent helps pull up the lowest-altitude climber to the highest altitude possible for a low-altitude climber.  In this game, the lowest-altitude climber is higher up than the lowest-altitude climber in any of the other games.  But the higher-altitude climbers are lower down than in any of the games above.  No one is at a miserable altitude; nearly all are at a just-comfortable altitude, except for a few who are little higher than this.

6. Strict Equality: all the ropes are equipped with a special gear assembly that distributes the lifting force of everyone's steps exactly equally across all players.  No matter how hard or skillfully you climb, or how well you coordinate the team if you are a team leader, you cannot get higher than those who are dead weight on the rope.  Since everyone knows this, no one wants to do much climbing, so everyone is stuck at the same miserably low altitude.

7. No Rules Dictatorship: besides the teams, there is a marauding party high above which does no climbing itself, but issues orders to the teams from a central location on how they should coordinate the movements of their members.  The party claims to have expertise in coordinating the teams, but its orders are in fact clumsy and unproductive, and wear down the mountain at a shocking rate.  The party also keeps the teams in a state of terror.  It can toss anyone or any team off the mountain at any time, for any reason or no reason at all.  There are no safety nets, no bungee cords, no rules.  You can try to keep your place on a rope by pledging to submit yourself completely to their orders.  But even that may not keep you safe.  Everyone but the marauding parties is at a low altitude.

How to choose among these games?  We can use Hayek's rule: to choose the game that "improve[s] as much as possible the chances of anyone selected at random" (Law, Liberty, and Legislation, vol. 2, 129). It's pretty clear that by this standard you'd be crazy to play by the rules of Strict Equality or No Rules Terror.  It's also pretty clear that Free Fall carries absurdly high risks for trivially small gains compared to Safety-net.  So no one would rationally choose any of these games if they had a chance to play any of the others.  I also think that Safety-net is a poor bargain compared to Long Bungee Cord: it's well worth it to pay a modest price for a guarantee that one will always have something significant to show for one's hard climbing--that, once having gotten even modestly high, one will never fall back to an utterly miserable altitude.  So, the credible options are among Long Bungee Cord, Short Bungee Cord, and Maximin.

Speaking for myself, I'd probably prefer to play a game somewhere between Long Bungee Cord and Short Bungee Cord.  I'd prefer to have a fairly solid guarantee that I'd never be at a miserable altitude; but I'd also like to have a reasonable prospect of being able to climb substantially higher than my initial placement, if it is low, even at some risk that I might fall significantly from a high placement.  Still, I can see the case for any of these three games.  They are all reasonable games to choose to play.

Let's draw some lessons from this thought experiment for different systems of political economy.  No rules dictatorship is communism; Strict Equality is pure egalitarianism.  Maximin is Rawls' preferred system in A Theory of JusticeFree Fall represents Robert Nozick's preferred system in Anarchy, State, and Utopia. Safety-net represents F. A. Hayek's preferred system.  Here's a representative statement from The Road to Serfdom:

There is no reason why in a society which has reached the general level of wealth which ours has attained the first kind of security [against physical privation] should not be guaranteed to all without endangering general freedom. . . . There can be no doubt that some minimum of food, shelter, and clothing, sufficient to preserve health and the capacity to work, can be assured to everybody. . . .  Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision.  Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance--where, in short, we deal with genuinely insurable risks--the case for the state's helping to organize a comprehensive system of social insurance is very strong. . . . There is no incompatibility in principle between the state's providing greater security in this way and the preservation of individual freedom [pp. 120-1].

Hayek contrasted this "first kind of security," which he endorsed, with a second kind, designed to protect people from any falloffs in their income, relative to what they were accustomed to receive, or which would change their accustomed position relative to others.  This entails a rejection of any Bungee Cord game where the cord is of zero length, as well as any game that forbids some climbers from overtaking or falling below others.  Hayek correctly argued that any game of the latter sort would return us to a status-based society, in which everyone has their position fixed.  He also correctly argued that any attempt to fix incomes on the basis of some judgment of individual desert would violate the rule of law and be incompatible with a free society.

What's missing from our canonical list of major theorists of political economy in the post-WWII era is anyone who has defended, as a primary theory of justice, any form of Bungee Cord.  This is ironic.  For the capitalist democracies that currently exist have implemented social insurance schemes most closely analogous to games of this form.  Anglo-American forms of capitalism are closer to Long Bungee Cord; continential European forms of capitalism closer to Short Bungee Cord.  The structures of social security retirement, disability insurance, survivor's insurance, and unemployment insurance in nearly all of these countries pays more to those who earned more before  retirement/ disability/ unemployment (in return for having paid higher taxes into the system), although all pay considerably less than 100% of previous earnings.  The fact that all advanced democracies have converged on some form of Bungee Cord suggests that it has strong attractions.  One main attraction seems to be that, once people get used to a particular standard of living, they have a very hard time adjusting to drastic falloffs.  Another seems to be that once people have worked hard to attain a particular standard of living, they have a strong interest in protecting what they have built up.  But these and other possible attractions of Bungee Cord have been undertheorizedTheorists to the left of Hayek, such as Rawls, have tended to jump toward some form of egalitarianism like Maximin, skipping over the inegalitarian elements of Bungee Cord.

Some Hayek fans I have talked to seem to think that any system beyond Safety-net will send us sliding inexorably down the slippery Road to Serfdom to No rules dictatorship.  I have even heard one suggest that the difference between capitalism and communism lies somewhere between Long Bungee Cord and Short Bungee Cord--i.e., between the US and, say, France.  These thoughts are absurd.  The rule of law governs all systems up to and including Maximin.  All of these systems implement a form of pure procedural justice (as Hayek himself recognized in the case of Maximin), in which what one receives is determined by the impersonal operations of the market as constrained by the rules of the game.  That is why all of the social insurance systems from Saftey-net through Maximin are called entitlement systems:  what one is entitled to is not up the discretion or judgment of any bureaucrat, but defined by impersonal rules set out in advance, independent of any moral judgments of desert or responsibility.  All of these systems, including even Maximin, permit individuals' relative incomes to be influenced by their own choices and efforts, as well as by the outcomes of market competition.  Individuals' incomes in all of these systems may change relative to others'.  So none create a status-based society.  In all of these systems, ownership of the means of production lies overwhelmingly in private hands.

Fans of Nozick and Hayek may complain that I have rigged my case by failing to consider the availability of private insurance to fill the role that Bungee Cord fills for all on a universal basis.  Private insurance, however, cannot fill the role of Bungee Cord, as I have previously argued.  In addition to the previously mentioned problems, complete reliance on private insurance suffers from the following defects:

1. To avoid the problem of adverse selection, private insurers either refuse to insure those judged to be most at risk of needing the insurance, or charge draconian premiums that are beyond the reach of lower-income workers.  In general, the private deals available to lower-income workers are worse than those available to higher-income workers--exactly the reverse of social insurance.

2. The kinds of insurance that would be needed to substitute for social insurance are very complicated financial instruments that are difficult for the financially unsophisticated to understand.  This opens up opportunities for insurers to bury complicated loopholes and rules in their policies, cast in legal language that is nearly unintelligible to most people, who have a hard time reading a 35 page single-spaced small print document while those capitalist gales of creative destruction are whipping around their faces and they are just trying to hang on.  The loopholes and complicated rules are designed to enable insurers to deny or delay coverage for losses the insured were led to believe were covered.

3. The loopholes and complicated rules are different for each insurer, generating vast arrays of options. This seems like an advantage, since consumers supposedly can choose a set of options tailor-made for their tastes and circumstances.  But in fact these complications make it very difficult for consumers to compare competing policies, especially given their relative ignorance of the risks they are likely to face in the future.

4. Even financially sophisticated consumers lack something insurers have:  experience with the product before they need to use it.  Consumers are very good at learning about products with which they have lots of experience.  But they don't know how well insurance will work until the time comes to make a claim.  By then, it's too late to switch to a better product if the purchased one didn't work out.

My point is not to deny the value of private insurance altogether.  Often, it offers excellent value, especially for simple risks, as for life insurance.  But the more complicated the risks, the worse the deals available through private insurance.  We are witnessing problems 2-4 in spades today with respect to the botched private Medicare prescription drug plans.

My point is rather that, given the uncertainties and defects of private insurance, people have a strong interest in insuring against the frequent failures of private insurance to meet their needs at a reasonable cost.  This is a major purpose of social insurance schemes that take the form of Bungee Cord.

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February 02, 2006

Health Savings Accounts: A View from the Trenches

Elizabeth Anderson: February 2, 2006

What can be done to control health care costs while extending access to care to the uninsured?  The Bush Administration's strategy is to move health insurance from comprehensive to catastrophic coverage, and make sick people pay out-of-pocket for less-than-catastrophic costs.  They would get some assistance in the form of tax-sheltered health savings accounts, in which they could deposit funds up to the amount of their deductible, dedicated solely to health care expenditures.

Nifty idea?  Not according to Paul Krugman, who argues in his January 16, 2006 column that this scheme creates perverse incentives to insurers to withhold coverage of routine preventive care for people with chronic illnesses such as diabetes, even if this leads to medical catastrophe later on.  ("[T]he administration is saying that we need to make sure that insurance companies pay only for things like $30,000 amputations, that they don't pay for $150 visits to podiatrists that might have averted the need for amputation.")

That's the supply side.  What about the demand side?  Do workers of modest means find health saving accounts helpful?  One administrator told me of her experience:  when her firm started offering tax-sheltered dependent-care and health-care savings accounts, she was responsible for explaining this new benefit to the employees.  She saw them as wonderful opportunities to save money, and actively promoted them to the staff.  What happened?

None of the lower-level staff signed up for the accounts.  She found this baffling.  Why give up a great tax break?  Set aside the fact that the tax break is not so great for low income people, who face lower marginal tax rates, than for wealthy people.  That didn't seem to be the main issue.

The main issue was that lower-level staff couldn't afford the float:  in a given month, they'd have to pay $250, say, to a dependent caretaker and $250 into their dependent care account.  That's $500.  They'd have to submit paperwork for reimbursement of the $250 from their account.  But they couldn't afford to wait for the money to come back.  The timing was delicate:  if the paperwork was rejected for some reason, they could find themselves out $750 or $1000.  This was way over their heads.  If they resorted to their credit cards to cover their expenses in the meantime, the interest on their credit card debt would swamp any tax savings they might have realized from the account.

The problem could be even worse for health care accounts, depending on the timing of health care expenses.  On top of monthly or biweekly deductions into the accounts, a staff member might have to front $500 for some necessary treatment on a cash-only basis and then wait for $500 to accumulate in the account before being able to get it all back.

What appears to be a potentially attractive deal for people with plenty of cash reserves is not so for people who are living paycheck to paycheck.  My worry is not simply that Bush's proposal is unlikely to do much for exactly the people who most need insurance--the working poor who lack employer-provided health insurance but make too much to qualify for Medicaid.  It is that the Bush administration appears not to have bothered consulting the people for whom the program is supposedly designed, to see whether it meets their needs.  This is either a gross failure of democratic practice, which requires consultation with those affected by one's policies, or else a cynical PR ploy to persuade the public that one is serious about the health insurance crisis, without really doing anything significant.

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