I understand astroturf to mean an organized group that purports to be grassroots (i.e. driven by broad membership) but is instead organized, funded, and run by a coterie paid by some outside entity.
It's hard to see how a post by an individual relating his own opinions and experiences can possibly fit that term. It seems like a category error.
A quick example is the obvious contradiction in the following quotes from the blog:
> With healthcare, the free market has clearly failed.
> Does this even qualify as a “free market”? I don’t think so.
Later the post pulls out some talking points about Mitt Romney and some conservative think tanks, which are definitely relevant if you are trying to score political points instead of discussing healthcare policy.
The closing section that glosses over the big problems with centralized planning systems (broken promises with no legal recourse, implementation issues caused by politics interfering with sound decision making) and finishes with enthusiastic exclamation points:
> Now this is what a free market looks like!
> Wow!
> This is a time to be proud.
It seems like political cheerleading to me, but maybe I'm missing something.
To summarize this piece, it seems like this guy felt guilty for working at an insurance company, but now he feels better because the he politically supports the ACA, which he feels is going pretty well. Is there an apolitical thesis for this blog post that I'm missing? Why was it written if not to express a political position?
EDIT: The Romney and think tank thing is clearly an association fallacy. I don't want to get into pointless political bickering, which is why I was hesitant to comment in the first place. I brought up that part of the article because it only serves this sort of tangent instead of furthering the (IMO much more interesting) discussion of healthcare costs, policy, and incentives.
It was a breakdown of various ways the incredibly distorted healthcare market fails. The word 'free' is so politically overloaded that using it in multiple ways isn't a contradiction, although you could call it sloppy if you wanted.
The post does make reference to politics, but it also has cogent argument about why market conditions lead to a downward spiral of gametheory when it comes to insurance and something you only have one of, like your body.
So that's the thesis. I think he feels better because, as a free-lancer, he finally has the ability to shop for providers, instead of being locked into one because he's terrified about what 'pre-existing conditions' have come into existence since the last time he shopped.
All opinions are political in some sense. However the author is a very well-known writer in the field of computer programming - as opposed to a political figure or someone of an unknown provenance. If you wish to dismiss his writing as fake grass roots rather than genuine, the burden of proof is on you.
> the post pulls out some talking points about Mitt Romney and some conservative think tanks
Political or not, this historical description happens to be accurate. Obamacare is ultimately intellectually rooted in the Heritage Foundation's attempt to come up with an alternative to more liberal proposals. It is also the same ideas that made Romney a name to watch nationally in political circles circa 2007.
If you're going to dismiss most/every healthcare discussion for being political then I don't think we will get very far. The guy was apparently a healthcare actuary which gives him a lot more insight than most of us. And I think it's not too controversial that ACA had a lot in common with the Romney/heritage plans.
I'd be very interested in an article about problems and solutions in American healthcare from an actuarial perspective. I'm siginificantly less interested in reading apologetics about the ACA. The article started out like the former and ended up like the latter.
It's not controversial that there are similarities between the ACA and Romney plans. Bringing it up serves no purpose outside of making political points, which was my point.
I am very interested in discussing healthcare. I just don't think this article advances the discussion. Again, a well-written actuarial perspective would probably be more interesting.
Are you arguing that the inclusion of political opinions negates the value of the author's actuarial discussions? If so, why would that be the case? If the author's statements about actuarial science are incorrect, why not just say so?
Or is it that you don't trust the author, so you suspect the factual claims underlying his argument are false? If that's the case, then why not cite outside sources to demonstrate as much?
It's not about negating his points or trusting the author.
I actually liked the piece. Until I reached the part of the article that started talking about how the free market failed. Characterizing the pre-ACA health insurance system as a free market is not a given and deserves much more discussion. I've already commented on the other issues I had with the end of the article, but at the end I felt that the real conclusion of the article (ACA! With exclamation points!) was at the end and that the points earlier served to support that conclusion.
As far as facts go, I don't have much factual issue with the piece except for the reliance on anecdote and his errors in omission.
Yes, because when discussing the history of healthcare in this country, Mitt Romney and conservative think tanks had nothing to do with the direction of policy. You can't rebut anything he's said, but you're obviously upset that he said it anyway.
You said you were trying to offer a rebuttal. So I aim to show that the counterarguments presented do not rebut the author's main point.
His main point is, roughly: 1) a variety of factors, including fear and antiselection, made for a broken health insurance market prior to the ACA, and 2) the ACA has substantially mitigated some of those problems.
> A quick example is the obvious contradiction in the following quotes from the blog:
The author is using the term in subtly different ways in different contexts. Not the best rhetoric, I admit. Yet, does his failure to define or consistently use the term "free market" undermine his thesis? I would venture not, but I'd be open to a counterargument. Otherwise this objection seems like just so much caviling.
> Later the post pulls out some talking points about Mitt Romney and some conservative think tanks, which are definitely relevant if you are trying to score political points instead of discussing healthcare policy.
The Heritage Foundation and Mitt Romney both played significant roles in the history of healthcare in the US. Historical background is often very useful in a policy essay. That appears to be the reason the author mentioned them. You're free to disagree with the author's characterization of their roles. But you didn't.
> The closing section that glosses over the big problems with centralized planning systems (broken promises with no legal recourse, implementation issues caused by politics interfering with sound decision making) and finishes with enthusiastic exclamation points:
"Broken promises with no legal recourse" would be a pretty good characterization of pre-ACA health insurance, by the author's account. Why would you expect the ACA to be any worse in this regard?
My experience has been that private companies very often fall victim to "implementation issues caused by politics interfering with sound decision making." I've seen symptoms of that malady in every private health insurance company with which I've dealt. So, again, what evidence is there that this problem will be more acute under the ACA?
> It seems like political cheerleading to me, but maybe I'm missing something.
Yes, I believe you did. The article included much substantive information about the inner workings of health insurance companies and the economic forces that drive their behaviors. Indeed, there is much more of this sort of thing than there is political cheerleading, the latter being confined to the final section.
The presence of some political cheerleading does not indicate the absence of a valid argument. The fact that the author feels strongly about a certain political issue cannot be used to rebut his argument about that issue.
> To summarize this piece, it seems like this guy felt guilty for working at an insurance company, but now he feels better because the he politically supports the ACA, which he feels is going pretty well. Is there an apolitical thesis for this blog post that I'm missing? Why was it written if not to express a political position?
The author offers technical arguments concerning a matter of public policy. He then states a political opinion which follows logically from those technical arguments. There's nothing invalid about this pattern of reasoning or argumentation.
> Yet, does his failure to define or consistently use the term "free market" undermine his thesis?
Yes, since one of his main points was that the free market failed in this case. Even allowing that he imprecisely described a distorted market pre-ACA, he clearly prefers a differently-distorted market post-ACA without much justification about why this time it will work out in the end. Anecdotal evidence about quoted premiums (not even considering out-of-pocket expenses going forward) is not convincing.
> Historical background is often very useful in a policy essay.
He cherry-picks his historical background then. A better background would discuss the employer-provided healthcare mess, the financial insolvency and increasing costs for Medicare and Medicaid, and the perverse incentives of related programs like Social Security Disability. Even if going into the Republican/Democrat history, it's a limited view. He left out more piecemeal initiatives like Medicare Part D, health insurance co-ops, and subsidized high-risk pools.
So I disagree that the limited historical background the author provides is value-added. On the contrary, that talking point detracts from his thesis.
> Broken promises with no legal recourse" would be a pretty good characterization of pre-ACA health insurance, by the author's account. Why would you expect the ACA to be any worse in this regard?
You can sue an insurance company if it advertises one thing and then changes the deal after you sign up. People, the author included, are not keeping their plans and doctors. I was pointing out that this bait-and-switch will happen in either system, but companies can be held civilly liable for making bad promises.
> So, again, what evidence is there that this problem will be more acute under the ACA?
What evidence is there that it will be less acute? To me the convincing prima facia case is that ACA will at least be more of the same in this regard.
> The fact that the author feels strongly about a certain political issue cannot be used to rebut his argument about that issue.
I think you're missing my point. I actually thought the first half of the piece was interesting. But by the time I reached the end of the piece, it seemed to me that the beginning of the piece was just a roundabout setup to his final point about how ACA is great and cathartic to the author.
> The author offers technical arguments concerning a matter of public policy.
Some. But he also offer personal anecdotes about how he felt guilty that a family friend couldn't get insurance. And many of his arguments are appeals to fairness more than they are descriptions of incentives and outcomes.
> He then states a political opinion which follows logically from those technical arguments.
That's the thing. It's a political opinion, so it doesn't follow logically. Even his logic is suspect. There are matters of fact that aren't considered (employer-provided healthcare, healthcare costs for state governments, healthcare subsidies, price regulations, policies changing between states). There are arguments that aren't, strictly speaking, logical (association fallacies, false dichotomies, straw men).
A logical conclusion would be more modest, technical, and have fewer exclamation points.
> he clearly prefers a differently-distorted market post-ACA without much justification about why this time it will work out in the end.
He very precisely describes how parts of the ACA address different modes of market failure he observed. The existing-condition regulations prevent the bandwagon effect and corporate freeloading (only covering healthy people). The individual mandate prevents individual freeloading (retaining fallback benefits without paying into the system).
See, health care markets have a long history of failing (or at the very least failing to deliver value in comparison to their single-payer counterparts). We already know "undistorted" markets where care providers sell directly to patients don't work for emergency services (you have consent issues with unconscious people AND the nearest hospital is always an effective monopoly and can price gouge accordingly). The "undistorted" market already failed to deliver value. Health insurance companies tried to fix the problem but it turned out that deceiving customers into buying shit plans was a better business strategy than legitimate innovation. Again, the "undistorted" market already failed to deliver value.
The US strategy amounts to trying different permutations of regulations until we find one that allows the free-market to work. So far, it has been a whack-a-mole experiment that costs ~$1.5T and >40,000 lives per year (in comparison to single-payer systems). When does it end? Do you really want to pay 2x for care today in order to gamble on the possibility that eventually the correct combination of regulations will be discovered that creates an efficient free-market system?
> companies can be held civilly liable for making bad promises.
Then why were they getting away with it?
His observations of what the companies were getting away with contradict your claim that the courts were able to keep them in check. The ACA attempts to keep them in check by making it harder for them to dupe users in the first place (that's what the standardized silver/gold/platinum plans are all about).
> it seemed to me that the beginning of the piece was just a roundabout setup to his final point about how ACA is great
He uses evidence to support his thesis. How does that detract from his argument?
> [In addition to technical arguments,] he also offer personal anecdotes
Anecdotal evidence doesn't invalidate his technical arguments. Also, the support it provides his arguments can only be ignored in the face of better evidence. Do you have any?
> many of his arguments are appeals to fairness more than they are descriptions of incentives and outcomes.
Outcomes are judged by fairness. The "technical arguments" you just referred to describe incentives. The hell are you complaining about?
> It's a political opinion, so it doesn't follow logically.
One of the funny things about logic is that it knows its own limits (Godel Incompleteness). Unless you have a strict logical rebuttal, why should I discard his argument for yours (which, as far as I can tell, is based on faith rather than observations, experience, anecdotes, and analysis)?
> A logical conclusion would be more modest, technical, and have fewer exclamation points.
A logical conclusion that suffices to guide policy decisions doesn't exist. We must get over ourselves and make do with the best that we have.
I haven't found a paper-aggregation of comparable quality for the "other side" of the argument (I'm familiar with the 1989 Heritage Foundation memo, not much else). If you could reciprocate with such an aggregation, I'd be much obliged.
