Equality

There’s been a lot of talk over Martin Luther King day about equality. While we may be unable to really define what we mean by equality fully, I think we all have a sense that some situations are more equal than other. My personal belief is that, outside of a Ayn Rand fans, most people actually think equality is something to aim for. Where I think we disagree is over the question of force to bring it about and the question of what is the best way to actually improve the equality of our nation.

In the BCC discussion one thing I pointed out is that many on all sides tend to adopt rather superficial approaches to the problem. It is one thing to raise awareness about inequality. Yet it is quite an other to actually successfully change the situation.

So how do we change things?

I think it quite clear that conservative thinkers and liberal thinkers differ quite a bit here. And honestly the reasons for inequity are complex. One must be careful not to decrease inequity within the US by making the rest of the world worse off, as some have suggested. If we are talking in a gospel context the person in Mexico is just as valuable as the person in Detroit. While many attack immigration and outsourcing such attacks have always been distasteful to me since it suggests that the quality of life in the rest of the world doesn’t matter.

My personal feeling is that taxes ought be changed and simplified with fewer tax breaks as “incentives” within the US government. (These often end up not having the desired effects but worse allow the system to be gamed by the powerful and rich) I’d also increase personal taxes while decreasing corporate taxes. I’d significantly decrease depreciation schedules for capital investment within corporations. That simply hurts small businesses – especially startups in the very areas that would spur job growth.

Finally I’d increase taxes on externalities that society as a whole has to pay for. If some companies are “too big to fail” that implies the government is acting as an insurance company for them. It follows that such companies ought pay higher rates to cover that service. (This would also incentivize small business – adding some additional stability to the system)

All of this would increase the opportunities for business.

As I’d do this I’d make up for the lost revenue by increasing the taxes on individuals – primarily the marginal rates on high income earners. Yes there are some studies that this might stop some investment as individuals attempt to avoid the point where taxes go up. But I think this will be offset by the corporate taxes. Not I’d increase personal taxes across the board – making your tax base depend only upon the rich is a guarantee of volatility of taxes. Plus I strongly feel everyone should pay some taxes so as to be a part of the system. So I’d have some consumption taxes as well.

Finally I think there are societal costs to not having better education. I think that the US really needs to engage on a heavy training system with more vocational training and getting away from the current university system. (Which in a way has been gamed by the universities to take advantage of student loans but not necessarily prepare students for the workplace)

I also think that some sort of universal health care is necessary. I oppose the Democratic plan, but rather liked some of the policy proposals of McCain from the last election. I think we have to at a minimum separate out health care from ones job. This will spur entrepreneurship but also allow a more fluid work force – and that will help the poor. Not only will it help the poor but will help the rest of us.

I could go on but I figured I’d throw that out for the rest of you. I know this tends to be a conservative blog so I’m interested in what the conservative solutions to inequality are as you see them. (Note: if your answer is just that we should simply accept inequality then I think that very hard to reconcile to the gospel)

20 thoughts on “Equality

  1. I really liked David Goldhill’s suggestions for the U.S. health care system in his September 2009 article in The Atlantic.

    I don’t know what to do with corporate vs. personal income taxes. It seems to me that as long as there is any disparity in those rates, one can write down either more business income or more personal income and minimize the taxes actually paid. The menagerie of types of companies in the U.S. (e.g. S corporation, C corporation, LLC, etc.) makes for quite a zoo. Anyway I agree with you that simpler is better here.

    Daniel Hannan just wrote an interesting piece entitled Why tax cuts are bound to favour the rich, suggesting that taxing the richest drives them away. I’m not sure that actually happens, though New York state did see a large population shift from 2000 to 2008 that cost nearly $5 billion in tax revenue.

    It seems to me that people almost have to want to share with each other.

  2. I think that I am still boycotting M*, but since this is a response the conversation over at my post, I will chime in real quick. I tend to think that the best solution (and this is really too complicated to much justice to in the blogging format) is thinks like more robust public education and universal health care. Now these things might lead to higher taxes for some, but not particularly so since was already spend considerable amount on them anyways. These areas are what I call background justice. If we have a decent level of equality in these areas, then we will not have to worry so much about inequality.

    BTW, I think that none of this can really come about unless there is actual political equality. There seems to be a growing gap in this area as well.

  3. New Jersey had a similar exodus. I’m certainly not advocating the idea that the rich can provide all the services people want. I think tying your tax base to the rich is just plain stupid – as I think California learned. Their income is affected by cycles too much. However if the rich have structural access others don’t then it seems like that additional service ought be paid for. I just think the amount of money you’ll be able to get from taxing the rich is less than liberals tend to portray it for many reasons. (For one I have zero faith in liberal ability to write a bill that is simple and uncompromised by lobbyists and special interests)

    One problem with health is that there are structural problems there that mean it’ll always get more expensive. The problem is that the public wants unlimited health care that is simultaneously cheap. That’s just logically impossible. There’s also the problem that health care is primarily about people who can’t be eliminated due to technological innovations. So as compared to say autobuilding or the like you’ll have the same amount of people over time. That means relative to other products the cost of health care will increase. (Because we normalize our economy around other products and productivity – so computers and televisions are constantly getting cheaper and more productive whereas this doesn’t happen in nearly the same degree in health care)

    I think we can reduce the rate of expansion. But health care is just inherently problematic and the only solution is rationing.

  4. Good to see you here, Chris. I think that if the public education system could actually provide a world-class education, that would be a great start toward equalizing opportunity. I recently heard a presentation from a PhD working for the Ohio Department of Education on essentially how dismally under-15 U.S. students perform on a couple of validated standardized tests relative to under-15 students in other countries (at or after 15 years of age is when children in many countries leave school to work). Methinks the public education system has been too warped by the “progressive education” movement to actually teach practical skills to children. I think particularly of the sorry state of mathematics education, based not at all on mathematics education research, but rather on what education administrators think is appropriate.

    But health care is just inherently problematic and the only solution is rationing.

    I would much prefer that such rationing took the form of better preventive health education rather than rationing based on age, condition, or prognosis. This would help people stay generally healthier and self-diagnose e.g. a cold instead of making a trip to the doctor, or pickup a bottle of Mexican antibiotics when they self-diagnose an ear infection, or whatever. Self X-rays? Not so much.

  5. While preventive care will help a bit, it really at best only lowers how much above inflation health care costs go. At some point the only way to keep costs under control is to ration. However look at how people freak when insurance companies deny coverage. And that’s with a richer and typically healthier bunch. Throw in the whole population and it’s a mess. Plus the economic realities of the manpower needed for health care and the poor increase in productivity and health care is doomed to continue its high rate of increase.

    Ben, there actually is a fair bit of research on good pedagogy in schools. The problem is one has to deal with the realities of who is teaching and the structures in place. Science and math in particular often isn’t even taught by people who love science and math. Especially in Elementary.

  6. I appreciate your point about inflation, and I think it’s correct. I suggest preventive care partly to keep people from visiting the doctor for every sniffle or owie. But insurance is a much bigger problem. Goldhill talks about this in his article.

    Currently the average insured American uses insurance to cover everything possible, which drives prices up in at least two ways: 1) we have to cover the overhead costs of an entire industry of insurance paperwork people in doctor offices, dentist offices, eye clinics, hospitals, and so on, and 2) as the prices are shielded from view we have no incentive to look for the best deal, allowing widespread price gouging. I don’t use my car insurance to pay for gas and then pay the company whatever they are unwilling to cover. I only use it for catastrophic things like collisions. In the same way, paying cash to a primary care provider for looking down my throat and listening to me wheeze (the prices of which procedures could be on a poster in the waiting room or on a website) would keep prices down, because I would go to the M.D. who does the best job for the best price, or however I like to optimize it. Our current system is madness.

    Also, the system should be designed to reward doctors who have healthy patients, not doctors who perform the most procedures. But then again the latter method is exactly how auto repairs go, so I don’t know.

    On math education, I know the research is there. The problem is that it is often ignored by those who prepare curriculum, perhaps because they don’t necessarily have the same goals or priorities as the researchers.

    Science and math in particular often isn’t even taught by people who love science and math. Especially in Elementary.

    It’s even worse. Science and math are often taught by people who actively avoided the subjects while they were in school. Especially in Elementary.

    This is why the head of my research group, Lillian McDermott, will always be a hero of mine. She has worked for over three decades with pre-service and in-service K-12 physics, math, and science teachers, developing an outstanding research-based, inquiry-style curriculum that builds their content knowledge, reasoning ability, and subject confidence. But in the end it’s still a band-aid on the teacher-preparation system.

  7. Clark,
    Rationing is indeed inevitable and can only be done equitably when done openly. Rationing by socioeconomic status, as we currently do, is certainly not going to meet any definition of equality. On the other hand, pooling our resources to help the greatest number of people we can with a single payer system, and ensuring that we take care to the degree we can of the sickest and poorest among us is a good first step. The looks I get relating this heresy of an opinion to fellow saints who ask my opinion as a doctor of this whole healthcare mess– priceless!

  8. “I suggest preventive care partly to keep people from visiting the doctor for every sniffle or owie. But insurance is a much bigger problem.”

    I thought the idea of preventative care was that people do go see the doctor about little things, so the little things don’t become bigger things. Spreading ointment on little cuts, so they don’t become infected cuts. Treating infected cuts, so they don’t become systemic infections. Or was it just a way of reminding people that’s its their own stupid fault they’re suffering from whatever ails them, and we wish they would stop trying to make us care?

  9. Clark, I agree with you on about 90 percent of this post. I think this line is worth addressing, considering this is a Mormon blog:

    “(Note: if your answer is just that we should simply accept inequality then I think that very hard to reconcile to the gospel).”

    Personally, I don’t think the Gospel addresses government taking on economic inequality. In fact, nearly every single reference to the government and taxation in the scriptures is negative (Re-read about King Noah) or neutral (leave what is ceasar’s to ceasar). Personally, I think a lot of governmental efforts to end inequality actually ended up hurting the poor more than helping (although I agree that some programs, like Social Security, have overall been helpful). However, having said that, there is no doubt that we have a commandment to help the poor on a personal, one-on-one basis, so if that is what you meant, so be it. In addition, I would like to point out that I look forward to Zion and “having no poor among us.”

    And also having said that, I think it is better for society to have some minimum standard of relief provided (hopefully) on a local basis. There is no reason for anybody in a country as rich as the United States to starve, and to the extent that our governmental efforts address that, I support them fully.

    Regarding taxation, I agree in general with your prescription. I would suggest that the best way to ensure that everybody pays some taxes and that the rich pay a greater share is through a flat income tax with a minimum amount of deductions. You will find that such a system would mean that the truly rich would pay more taxes than they pay today. Of course corporate taxes need to be cut. I agree with you that McCain’s plan would have been much better, and it’s too bad the Dems didn’t latch onto it — we would have real health care reform adopted and moving forward right now rather than the current standoff.

    So, overall, you have addressed the issue in a thoughtful and realistic way.

  10. I thought the idea of preventative care was that people do go see the doctor about little things, so the little things don’t become bigger things…. Or was it just a way of reminding people that’s its their own stupid fault they’re suffering from whatever ails them, and we wish they would stop trying to make us care?

    No, John, that’s the Republican plan! :) I admit to being a bit careless (and it’s my own stupid fault). First, I do think that the responsibility for my personal health lies foremost with me. But society ought to have a safety net for those who cannot take responsibility for themselves, and even for those who refuse to take responsibility for themselves, particularly when family and friends can’t do it. Part of responsibility for self health should include people knowing basic first aid and getting a better sense of what calls for a doctor and what does not. As an alternative, I can’t find it now, but a couple of years ago I read about a particular woman in (IIRC) India who was one of many preventive health nurses placed in communities to help local people with minor things like first aid and basic obstetric care, so that they didn’t have to pay or travel to see a full-fledged doctor.

    Second, when I originally mentioned preventive care, I was actually thinking of reducing risk factors for chronic and fatal health problems, e.g. maintaining a healthy body weight, eating right, getting regular exercise to potentially lower the risk of type II diabetes, obesity, heart disease, stroke, various cancers, and so on.

  11. From what I understand preventive care gives much less “bang for the buck” than was initially expected. At least in countries like Canada where there was a big push. It still obviously has an effect but from what I recall reading suffers the false positive problem that besets early screening for cancer. (You’ll remember the controversy over breast and colon screenings) What people forget is that surgery and medicine have side effects and can be dangerous. So you can’t just think in terms of what you catch but also what gets diagnoses and treated by mistake. And those things add up.

    From what I understand the best improvements to avoid extra (expensive) illness is checklists for doctors and nurses (which inexplicably some doctors don’t like), better antibiotic treatment especially during surgery, and a few other things like that. (All very doable)

    That said the US might be somewhat different because we have so many uninsured who wait until things are very bad and then go to the emergency room. All of which contributes a huge expense (and ends up being a hidden tax since hospitals pass those expenses on to the general cost which gets picked up by other people’s insurance) So reducing emergency room visits by having more clinics is just cost effective. (I note IHC here in Utah has been doing that a ton)

  12. Geoff, regarding inequality in general. I’d note that none of the governments in the Book of Mormon were democracies but were generally oriented along totalitarian lines. (As was typical in the ancient world) Benjamin in particular is in that setting of Kingship and the danger of the King doing anything new. Yet as societies they were constantly told to focus on equity.

    The problem of focusing on local relief rather than national is that states can’t float debt whereas the federal government can. Now I’ll be the first to yell about how the feds have abused this. But I think you only need look at state funding for medicaid and what happens during recessions to see that isn’t a very good model. Likewise you end up with states like Mississipi having people get radically different care. Now I can understand the states rights argument here. But let’s at least admit that on practical grounds it’s a very inefficient model.

    The issue of “force” (which you didn’t raise but which is lurking in the background) I just don’t buy i the least. After all if we’re going to allow roads, police, fire, and a lot of other common goods to be financed by the general public via taxes I don’t think there’s much of an argument against medical care. While the government doesn’t have a mandate to reduce inequity neither does it have a mandate against it. And arguably the government is supposed to deal with public needs. So if, in a democratic government, the public decides this is a need then I think the government ought address it.

    I’d also note that we, as a people, get quite upset at the perception of inequity in government services. For instance we don’t think the police ought treat someone better just because they drive a nice car and wear nice clothes. We recognize that such inequity is unjust and against the principles of good government. (Even though obviously it happens) The main anger against special interest groups and lobbyists is this same inequity. (I think that more complex mind you than the populist attitude) Ditto for education, police and so forth. So if the government is involved in medicine, shouldn’t it be tied to that sense of equity?

  13. Clark, as I say, we are 90 percent in agreement, so no reason to concentrate on the 10 percent. As I say, we agree that the McCain plan is a good alternative, and that does involve govt subsidies and targeted tax breaks. So I am not saying there is no role for government in medical care — that is a battle you will need to have with someone else. :) You bring up some other issues that are certainly worth exploring, but I don’t have time to do it now. Thanks for this post.

  14. Clark, I was disappointed that they shut down your discussion at BCC, but not surprised.

    You make good arguments. I agree that our society can make some key open-market changes that encourage equality, without forcing it down people’s throats.

    One thing we need to also look at is the effect on monopolies that harm society’s growth. In this instance, I point especially at groups like the teacher’s union. This group has done more to harm the education system than any other, all in the name of protecting their teachers.

    American business and education have to realize a few things. First, not everyone in the USA is geared towards a high level job. We are not like Lake Wobegone, where all the children are above average. 49% of all people are under the 50% intelligence mark on a Bell Curve. This means we cannot keep allowing manufacturing jobs to all go overseas, with the belief that everyone will get higher and higher level jobs here to replace them. In fact, China and India now are almost equal with the USA on technology, and given they can hire at a much lower wage, we will not be able to compete forever on a global level.

    Our Education system is based upon 19th century concepts. Not all are college geared. We are so geared towards upward promotion that Johnny still cannot read. And now he can’t do math, either. We need two tracks for high school: one focused towards college and the other for trades. Why go through 4 years of high school, and then have to learn how to fix cars or be a carpenter? Let’s give a test at 8th grade, and see which direction each kid wants to go. For those wanting trade school, let’s put them into 2-4 years of trades during high school. Send them off to work with professionals in the area, as part of their journeyman experience. When they’ve graduated from high school, they will be ready for a decent paying job. Education also needs a voucher program.

    While I agree that as LDS,we need to think of people worldwide, we can help all people by requiring other nations to raise their standards in order to trade with us. It doesn’t help us or others if we buy items from China made by prisoners or made in harsh conditions with little pay or no benefits for their people. How about we require any imports to be such that the workers make 50% of American salaries in the same field, or face tariffs on the products? It would improve things overseas, and/or stimulate/return jobs to the USA.

    For health care, how about a voucher system for every family to give them basic care? Insurance companies would be required to accept all vouchers for a basic proscribed level of insurance, which the companies can then compete by offering a bit more. When provided with a health care patients’ bill of rights (can’t be denied, etc), tort reform, and with buying insurance across state lines for competition. This would allow for competition, full coverage to a certain level of care, and allow people to buy additional insurance if they wish. It would keep people from overusing expensive emergency rooms. It would keep costs down, as it would not try to be everything for everyone, but would give everyone the basics in a competitive form – a good start.

  15. I don’t care in the least for the Teacher’s Union and really do want more choice in schools. That said, I think conservatives overestimate the effect of the Teacher’s Union. I think the issues are much broader than that.

    The issue of how to deal with the “average” is a good one. I’m not sure that’s quite the way to think about it. I think the population below say half a standard deviation from average are the problem. There’s lot of people with average IQ who can be amazingly productive as salespeople and even great entrepreneurs. I think the real issue are those who simply don’t have the skills to cope in our economy except in the low paid service sector. I don’t think Protectionism will help there.

    I also don’t think your characterization of China is quite accurate. That’s not to say we shouldn’t push for less corruption and better working conditions there. Just that I think that explains at best a small part of the problem. The fact is that labor in the developing world will be considerably cheaper than here. To block the ability of those people to labor by Protectionism is immoral (IMO).

  16. Clark wrote: To block the ability of those people to labor by Protectionism is immoral (IMO).

    Ram: Even if their current pay is substandard wages, or are suppressed by the Chinese government tinkering with keeping the Yuan low? Is it the USA that would be immoral for placing stipulations on trade, or China for abusing the global system?

    As it is, those people in China labored for 1/2 a century with little input of American money. We’re speaking now of an expansion of their economy. Is it wrong to expect China to play decently with the rest of the world? What if by establishing such criteria, China improves the livelihood of its people? Then is it still immoral? Or what if China refuses to budge, and we send our money to Vietnam and India, where they are willing to make societal adjustments in order to trade with the USA (but Vietnam and other small nations are now being crowded out by China’s massive Walmart effort)?

    I don’t see it as immoral as you suggest. Had I said that we require Chinese to receive less pay for their work, THEN I’d agree it would be immoral.

  17. I’m rather late to the party but since I’m interested in the subject, I thought I’d chime in.

    I agree that equity is desirable, but only in the sense of equality of opportunity. I think trying to guarantee equality of outcomes is foolish and harmful and, ultimately, inhuman.

    Even if we confiscated all the wealth in the country and divided it so that each citizen received precisely the same amount, in ten years income disparity would be back. This would not be due to some people having an advantage over others in terms of wealth, but to differences between people in terms of in talent levels, character and temperament.

    As long as there are differences between individuals, there will be differences in wealth. The only way to permanently guarantee complete income equality would be to either genetically engineer people so that we’re all the same, or else prohibit people who are more talented or energetic or courageous than others, from profiting by their talent, energy and courage. I hope it’s obvious that either option would utterly sap creativity and initiative, resulting in greater poverty for everyone.

    That being said, I agree with Clark that rationing is the only way to stop skyrocketing healthcare premiums. There are various ways of doing this.

    One is for the government to take control of the healthcare industry, and pay for all healthcare with taxes. As distasteful as this is to me, it does have an upside, since people have some say, however indirect, in how much they are taxed: When they start feeling like they are being overburdened, they can vote in people who promise to lower taxes.

    When the people refuse to pay increased taxes for healthcare, then healthcare providers, including drug companies and medical equipment manufacturers, will stop inventing and selling drugs and machines that cost more than the government is able to pay. This will result in de facto rationing.

    The other way of rationing healthcare is to put the cost of healthcare back into the hands of consumers. As someone has mentioned (I think), medical procedures that are not covered by insurance, such as Lasik, tend to become less expensive over time, because the providers of such services know that the more they cost, the less people will be able to pay for them. So they work to improve efficiency and thereby lower the price.

    Dental care costs, too, have been rising more slowly than healthcare costs, at least during my adult life. This (I believe) is because dental care is paid for by the consumer directly more often than healthcare is. So dental care providers have to keep their prices accessible to the masses in order to keep paying customers.

    Once I was offered a dental service that was going to cost, say, $2,000 (it’s been a while, I’m not sure of the exact numbers any more). They told me that with my insurance it would cost me $1,000. When they later found out my insurance wouldn’t cover it, they said they would let me have it for something like $900. So the cost was magically cut in half when an insurance company was not paying for it. It’s not that the dentist was being charitable towards me. It’s the simple fact that if an insurance company is able and willing to pay twice as much, then by gosh that’s how much they’re going to charge. (I believe it’s the same principle with regard to the cost of higher education.)

    I think if insurance companies and the government were removed from the healthcare equation, two major things would happen: First, healthcare would get cheaper, and second, healthcare would get rationed. But the rationing would not be imposed by the government, but by what people could afford to pay. If they could not afford machines costing $100 million, then either $100 million machines would get cheaper, or they would stop being made.

    Everything else in our society is rationed in exactly the same way: People don’t get to have any car they want, no matter how much it costs. The government doesn’t make everyone pay into a car-buying pot so that everyone can have a Cadillac, rather than the way it is currently, with some people having Rolls Royces and others being stuck with Corollas. People get what they can afford. I know, I know, healthcare is different, it’s cruel to deprive poor people of decent care just because they’re poor. But the point is that cars at varying price points are plentiful in this country, because they are allowed to be priced at whatever level people can afford: Some can afford BMWs, some Acuras, some Toyota Camrys, some Toyota Yarises. People who can’t afford new cars can almost always find a used car in their price range.

    The healthcare system has grown into something where everyone insists on a brand-new Cadillac since they don’t have to pay the full cost of it. As a result everyone’s costs are going up, to the point where everyone is forced to pay the price of a Cadillac even though some people would be content with a Corolla. And some people just flat can’t afford the price of a Cadillac, whereas if they were allowed to purchase a Corolla it might be within their range. But Corollas aren’t being made any more.

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