It's not about epistemology

You may wonder, gentle reader, what the heck is "epistemology," besides a funny looking big word that is fun to say in order to impress your friends? It is, very simply, that part of philosophy that is devoted to studying what we know and how we know that what we know is true.

This is a very important question. I think I know all kinds of things--that all people should have equal rights and power, that climate change is a serious problem and needs to be stopped, that US military intervention always makes things worse rather than better. There are large numbers of people who think I am exactly wrong about all of those things. How do I know that I am right and they are wrong?

Yes, that's an important question, but as you read in the title of the post, this is not about epistemology, so we'll take that question up at another time.

This post is actually about the Affordable Health Care Act, which has made its way to the Supreme Court. Right-wing opponents of the law have challenged its constitutionality, saying that the federal government doesn't have the right to require citizens to purchase health insurance. Liberal supporters of the law say that it provides a huge step forward in making health care available to all citizens.

As for myself, I just don't know. I expect that the law is constitutional, but I don't think it fixes what's broken about the US health care system. The US health care system is designed to allow private companies to make enormous profits by providing services that cost lots of money but may (or may not) improve anyone's health. Despite its name, I'm not sure the health care act will really make health care more affordable.

Robert Reich has written a blog post that expresses very well my reasons for ambivalence about the ACA. (You may recall that Reich served as secretary of labor under Bill Clinton. Reich is now a professor of public policy at UC Berkeley.)As Reich writes:

The dilemma at the heart of the new law is that it continues to depend on private health insurers, who have to make a profit or at least pay all their costs including marketing and advertising.

Yet the only way private insurers can afford to cover everyone with pre-existing health problems, as the new law requires, is to have every American buy health insurance – including young and healthier people who are unlikely to rack up large healthcare costs.

This dilemma is the product of political compromise. You’ll remember the Administration couldn’t get the votes for a single-payer system such as Medicare for all. It hardly tried. Not a single Republican would even agree to a bill giving Americans the option of buying into it.

But don’t expect the Supreme Court to address this dilemma. It lies buried under an avalanche of constitutional argument.

Now Republicans are using this compromise in order to whip up resentment from far-right Tea Party supporters who don't want the government to tell them what to buy. Some of this resentment probably comes from people who, even with subsidies, cannot afford to buy health insurance or pay a fine for not having it.

It seems like a lose-lose situation. If the Affordable Health Care Act is struck down by the Supreme Court, we are left with the same broken system, with all of its skyrocketing costs and inadequate coverage. Plus, it's a big defeat for the whole idea of universal health care. If the ACA is upheld, more people have some kind of coverage, but most of the problems of the existing system are left in place.

Reich, however, sees a silver lining in the possible overturn of the ACA. He argues that no one objects to mandatory participation in Medicare by people over 65, because this is a government program that works well and is universally popular.

So why not Medicare for all?

Because Republicans have mastered the art of political jujitsu. Their strategy has been to demonize government and seek to privatize everything that might otherwise be a public program financed by tax dollars (see Paul Ryan’s plan for turning Medicare into vouchers). Then they go to court and argue that any mandatory purchase is unconstitutional because it exceeds the government’s authority.

Obama and the Democrats should do the reverse. If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions.

When this happens, Obama and the Democrats should say they’re willing to remove that requirement – but only if Medicare is available to all, financed by payroll taxes.

If they did this the public will be behind them — as will the Supreme Court.

I would like to believe that Reich is right.

I have only one minor quibble about what he has to say.

The court debate started off with an argument about whether this is the right time to hear this case. This was a procedural issue based on an interpretation of an 1867 law that says that you can't file a legal challenge to a tax until you've had to pay that tax. People who don't buy health insurance won't need to pay a penalty for several years. The Supreme Court spent the whole first day of argument considering whether the 1867 law applies to this case.

Reich describes this argument thusly:

Not surprisingly, today’s debut Supreme Court argument over the so-called “individual mandate” requiring everyone to buy health insurance revolved around epistemological niceties such as the meaning of a “tax,” and the question of whether the issue is ripe for review.

Um, no. This procedural argument had nothing at all to do with epistemology, it had to do with the way the word "tax" is defined. Maybe Reich meant to use the word "etymological," which has to do with tracing the history of words.

If we had an epistemological discussion about the ACA, we would be discussing whether we have any reliable way of predicting exactly what its effects are going to be. This is not a "nicety," but a very substantial problem. Even big words have meanings, and you can't just throw them around at random to prove how smart you are.