• More like Krugman: My two cents

    I’ve read both Austin’s and Harold’s posts, and all of your comments with great interest. As I’ve said to Austin in email, I’m a little disappointed that when suggesting voices in HSR who could function as a Paul Krugman, many of you have offered people who (1) aren’t health services researchers and (2) don’t seem committed to that volume of writing.

    Regardless, the question that Austin asked (or at lease the one I care about) has to do with one thing and one thing only. When engaging in debate, there are times I’ve become frustrated when I start to believe that someone I’m arguing with is ignoring facts or arguments that run counter to his position. Sometimes, I have felt that someone I’m arguing with is saying things he doesn’t believe for partisan purposes. And, sometimes, I have felt like someone I’m arguing with is making wildly inconsistent arguments depending on who has made the proposal he is discussing.

    Even when I think these things, however, I hold my tongue. I respond to the best in people (or at least I try my darndest), even when I suspect their motives are less than pure.

    Paul Krugman would not. I think he would even tell me that I’m not doing my job when I hold my tongue. And, if I’m being completely honest, I sometimes feel that way, too.

    But I’m not in Paul Krugman’s position. I don’t carry his weight, and I’m nowhere near as secure in my place in the blogosphere. Moreover, I don’t want to get into the he said/she said debates that always follow ad hominem attacks. I’ve always felt that my place should be that of a non-partisan, if not unbiased, contributor. I focus on what people say, and not the people themselves.

    That’s where I plan to stay. My devotion to data, evidence, and well-constructed arguments is far stronger than any affiliation I feel to any group. But as I’ve said, and Paul said, this is not a game. Some people treat it like it is. I still struggle with how to respond to that.


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    • We talked this over at the dinner table. If you think about it, health care (and its reform) gets relatively little attention from our media and in our Congress. The right pretty much ignores it, except in response to the left. The left takes it up sporadically. If the left were really serious, they would acknowledge that the ACA was just a start and already be pushing for the next round (I am talking about the politicians here). Hence, health care is just one of many liberal causes, while it is largely ignored on the right.

      I suspect that the political scientists would tell you, you might drop a line to the guys at Crooked Timber or The Monkey Cage, that there is not a really strong constituency for health care issues, except for Medicare. Who really gains votes by supporting Medicaid? The private health care sector is divided up among many different interest groups. Most people still, I believe, are not totally aware of the costs of their employer provided insurance. Compare this with nearly every other OECD country where everyone is in the same system. Increasing costs affect everyone, and more obviously.


    • What Aaron is experiencing is what all of us who put forth arguments based on data, facts, logic and analysis experience, namely that we are engaging with people who have formed a position based on ideology rather than a position that has evolved from a rational approach to the issue.

      If one takes a position based on ideology then that person can never ever admit that the position is incorrect, because doing so invalidates the entire ideology the person believes in, and that just cannot be allowed. So the arguments of that person must contain inconsistencies and rely on bogus data, improper logic and bad analysis.

      The reason for that is that ideology must confront reality, and no ideology is consistently correct in all situations. Furthermore the questions are far more complex and cannot be reduced to the simplicities that idealogues require.

      This Forum does a great job of fighting the battle based on arguments supported by academic integrity. My Forum tries to do it based on humor and satire.

      Mr. Krugman is in an area where I also practice, economics, which is an area much more fraught with political ideology than health care. His very valid complaint is that for reasons of political philosophy, or for reason of personal ambition very smart, very intelligent and very well educated economists take positions which are contrary to any established economic theory and policy. To argue that cutting government spending for example will stimulate an economy is so absurd, so rediculous, so idiotic that those who espouse such a policy deserve only derision and scorn (which he does very nicely, thank you).

      In the health care debate, the idealogues on one side argue that the private market can best regulate costs, and that once there is private insurance in place of Medicare cost increases will be under control. To adopt this position one must ignore the overwhelming evidence in the non-Medicare sector where private insurance dominates, and where costs have not been kept under control.

      Political ideology, particularly conservative ideology is a matter of faith and as a matter of faith it cannot be defeated with facts, data and logic in cases where it is wrong. Nothing illustrates this more than the spectre of conservatives legislators mandating medical procedures and specifying speech in the case of abortion while at the same time claiming that their violent opposition to ACA is that they are opposed to government takeover of health care.

      People who can reconcile those positions will never be convinced by studies of the problems no matter how high the integrity of the data and the analysis.

      • Well intentioned people can agree that a fact or set of facts is accurate, disagree wildly on the signficance of a particular fact or set of facts.

        This is particularly true when dealing with complex phenomena like social or encomic processes. Even in those cases where one can make a robust statistical association between two variables at a given time, there’s still room to argue about the practical/real implications of that association, not to mention the fact that unlike in physicial systems, these associations can and do vary widely over time.

        I don’t read the comments on every thread, but I would be surprised if you get many comments where the authors are disputing facts that have been incontestably settled, and where the fidelity of the data to a particular model has been so thoroughly established that it will admit no reasonable dispute. Anyone disputing the germ theory of disease in the comments here?

        I’d be interested in which specific policy claims you have determined are beyond principled dispute. Perhaps you could post a few salient examples, along with the comments that best illustrate your frustrations to illustrate your case.

    • “Even when I think these things, however, I hold my tongue. I respond to the best in people (or at least I try my darndest), even when I suspect their motives are less than pure. Paul Krugman would not….And, if I’m being completely honest, I sometimes feel that way, too.”

      I think you need to make your case from efficacy and here is where the writers of this blog have an advantage. What percentage of readers has P. Krugman actually convinced about any specific point? Passion is great but one doesn’t get points for self-righteousness.

      TIE has a far smaller audience but the number of people who don’t share your ideological priors that you (and the rest) have convinced using your methods is larger than P. Krugman’s I would bet. In any sort of public policy discussion, that is the most valuable conversion. People likely to respond to Krugman’s style (basically, one’s own partisan side) are not really that valuable given that they are likely to be your supporters anyway…

      To David R.–

      “People who can reconcile those positions will never be convinced by studies of the problems no matter how high the integrity of the data and the analysis.”

      This is a dangerously complacent way of thinking. Conservatives represent ~50% of the population and so if you can’t convince them to at least be neutral on a policy, you have a huge problem. I think by not engaging with the arguments that they make you feed the narrative of elite disinterest and even if disingenuous, their arguments need to be countered.

    • @ V

      I agree with your comments, and my position was not that you should not engage these people (I do so on my site, The Dismal Political Economist which does discuss health care policy among other issues) but that Aaron’s frustration can be explained exactly as he states.

      It is important that people like Aaron who are making an honest attempt to engage in honest dialogue understand that it is not their fault that they are unable to convince many people who hold opposite views because those views are held out of ideology and faith, not reason and logic. And yes, they should call those people out on their biases and inconsistencies. That is not making a personal attack.

      Also after I wrote my earlier post Mr. Krugman posted this commentary (by coincidence I am sure, Mr. Krugman probably did not read my comment and decide to write his in response) on his blog which illustrates Aaron’s point about confronting opponents who methodology is lacking integrity.

      “After all, you could view Greece as being like a family that overspent, got itself into debt, and whose members now have to do all the things families do when they get in that position: slash spending on inessentials, postpone medical care and other big expenses, quit their jobs and reduce their incomes — oh, wait.

      That’s the key point, of course. When a family tightens its belt it doesn’t put itself out of a job. When a government tightens its belt in a depressed economy, it puts lots of people out of jobs; and this is a negative even from the government’s own, narrowly fiscal point of view, since a shrinking economy means less revenue.

      Now, you might argue that slashing government spending doesn’t actually cost jobs — that is, you might argue that if you spent the past few years in a cave or a conservative think tank, cut off from any information about how austerity is working in practice. For the results of austerity policies in Europe have been as good a test as you ever get in macroeconomics, and without exception big cuts in government spending have been followed by big declines in GDP.”

      Note that his scorn is delivered against people who would make false equivalences and deny results from policies they support.
      I don’t have a good answer to Aaron’s concerns, but I do know that unless erroneous logic and arguments are confronted and labeled for what they, (which is that they are erroneous), the chances of their positions becoming policy are heightened, with results similar to Greece in economics as the expected outcome for health care in the U. S.

      So Aaron and others on this Forum should continue to make arguments that “focus on what people say, and not the people themselves.” But like Mr. Krugman they also need to call out people when the arguments they make are not objective and unbiased, because the standards must be raised.

      Those of us who feel we are correct welcome an honest dialogue supported by facts and data. And if those fact supported arguments convince us that we are wrong, we are more than happy to say so. The same cannot be said for the people that are frustring Aaron.