Stop Blaming America’s Poor for Their Poverty

The US political spectrum is such that many Democrats are right wing by European, or at least Nordic, standards. What people tend to characterize as "utopia" is the socialist welfare state, where means are tested to a much lesser degree. What countries like Norway have increasingly done is to move from that system to a more liberal one. That is where you find yourself "begging the government for help", because you don't fit into the market.

This is a bit of a long paste, but people don't generally understand the differences:

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There are three measures for welfare-state regime stratification: conservative, liberal and social democratic. For the conservative welfare-state regimes, the traditional societal class model is a prevalent idea, but also the rejection of capitalism. Which leaves conservatism between the market based ideology of liberalism and the social democratic wish for social leveling. EspingAndersen distinguishes between two branches of conservatism: corporatism and etatism. Corporatism is described as a response to industrialism and its effects: social fragmentation and individualization. In modern societies, corporatism is described as "...built around occupational groupings seeking to uphold traditionally recognized status distinctions and use these as the organizational nexus for society and economy". Corporatism was mostly influential in the continental European nations, as a response to the Church’s strong position. Etatism, on the other hand, focuses on the primacy of the state. Esping-Andersen illustrates etatism with Bismarck’s wish to tie workers directly to the state with social benefits, instead of tying workers to the guilds, as in the corporatist model. Today, etatism can be traced in two areas of welfare state stratification, where one is giving generous welfare provision to civil servants, giving state servants an elevated position in society, as in countries such as Austria, Germany and France. The other area where etatism can be noted today is the relatively generous poor-relief or income protection, based on the idea of noblesse oblige.

The liberal response to the conservative ideas of etatism was the opposite. The state and the stratified society were seen as something that had gotten in the way of market emancipation, and in extension, individual liberty. Social policy were to be replaced by the market in order to achieve social leveling, not to eliminate aid, but to have a less active state. Today, liberalism does accept income-tested social benefits, although it is associated with social stigma to be a social assistance beneficiary. Due to the core liberal idea of the smallest state possible, benefits are usually means-tested and modest, given only to those that are genuinely poor, creating the stigma. The liberal welfare-state system is based on the notion that those who are entrepreneurial and self-reliant should be rewarded. Social insurances exists, but they are privately held and paid for.

The socialist movement started as a response both to conservative and liberal reforms. The most important notion of socialism was to change the societal stratification and achieve social leveling. The primary target was to change the means-tested poor laws since they created a stigma within the proletariat and that beneficiaries were disenfranchised. The social democratic idea of universal benefit system as a prolongation of democratic rights was most evident in the Scandinavian countries and particularly in the Swedish "People’s home". The universal benefit system came to include even the middle-class in order to "preserve the solidarity of a universalistic welfare state". A universal benefit system denotes a system where social aid is for everyone. This picture is somewhat simplified, although benefits are universal in general, and more general than the means-tested system where only a limited group qualifies for benefits. Moreover, the socialist movement focused on the concept of solidarity and in extension, one of its most distinctive features: centralized bargaining trough trade unions.

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Do Capitalist Welfare States Still Consist of ”The Good, the Bad and the Ugly?” http://lup.lub.lu.se/luur/download?func=downloadFile&recordO...

I don't think Democrats (or Republicans when they take power) are clever/smart/kind/honest enough to offer universal single-payer healthcare without rationing. Is there an intent to take my health care choices away, and is that intent benevolent or malicious?

You paint a very abstractly wonderful picture, so let's assume yes and benevolent if rationing is to be expected given the finite tax base. I still need more details before I get on board with your plan.

First of all, my employer and I pay through the nose for my decent healthcare right now. Under your universal single-payer healthcare system, will I still be able to pay quadruple-through-the-nose to buy supplemental insurance such that I can still continue to get halfway decent service when I want it? Or, am I going to be stuck with everyone else waiting for rationed care out of fairness?

Also, are you planning to cap salaries of doctors and profits of hospitals and insurance companies out of fairness? (You think it's hard to get quality specialist care now??)

A different opinion from yours goes something like this: US health care is so expensive and inaccessible to 10% of the population because government got involved. The federal government twisted the HC system into a bureaucratic pretzel with no market forces to control costs. The absurd system we have now is a consequence of letting busybody crusaders and insurance company cronies write the laws.

I am not saying that viewpoint is accurate, but it's worth getting diverse voices into the discussion so that we don't wind up with an unhealthy progressive monoculture here on HN.

If we talk to each other like friends that have differing opinions, then we can find lots of little improvements that a majority of us can agree on, like maybe up-front pricing in hospitals or tort reform. If we can bring costs down and make health care more accessible to more people, then maybe we won't feel forced to take risky steps like forcing everyone to cede their personal health care choices to indifferent government pencil pushers.

Reaching out to you as a friend, I feel we both want the same thing - to have the maximum number of people possible receive quality care. I feel we're both frustrated that the current system is so unfair in so many ways.

I'm not opposed to setting up a safety net, as long as it doesn't get out of hand cost-wise or turn into a racket for the cronies. I'm thinking like mending broken bones, treating infections, vaccinations, most generics, and addiction treatment all should be abundant, cheap and/or free. Panacea it would not be with a fixed budget so that as a program it cannot grow to crony levels. You could sell me on providing basic health services like that because it just makes sense economically and public health-wise.

And I hope you're not opposed to weeding out waste, fraud, and abuse as one approach (of many) to fix a broken system. If we can get costs demonstrably down, maybe you'd even be open to deep cuts in existing nondiscretionary programs like medicare that have insane unfunded liabilities and will eventually crush us.

Maybe there is a middle ground that satisfies between us politically such that we can move forward together rather than lurching crazily right and left every 8 years.

shrug People freak out about national id numbers, even though SSNs are already that.

I don’t know why Americans react worse to certain things, but they clearly do, even in the face of lots of education.

That is something has always confused me a bit. Many people tend to object to universal system on the basis that it leaves it up to the government. But if you don't have universal systems the government, and the companies operating in the market, have little incentive to take care of its citizens. Because the cost of not doing so is left to you. Even if you want to argue that a health care system is a factor of how healthy people are, it is the universal systems that have the incentive that people are healthy. It is those systems that more often regulate things like transportation or drugs as public health issues.

> For what it's worth, the ambition on the left over here (in the US) is to eliminate means testing for programs as much as possible.

No, it's not.

There's a subset of the left that has that ambition, but there's a subset of the left that subscribes very hard to the idea that doing so is improperly aiding the wealthy (even though “eliminate means testing” mostly means “consolidate means testing into the tax system rather than duplicating the income verification function redundantly across various programs plus the tax system”.)

Now, it's true that the thought leadership on the left is mostly in the former group, and the public figures talking up the latter position are mostly center-right neoliberals. But they are using the specific rhetoric they are using because it appeals to a wide swathe of the rank-and-file left and allows them to seem progressive when what they are actually doing is defending the ability of the rich to preserve advantages that exist for them in the status quo system while blocking progress to universal access. (And that's true whether it's healthcare or college funding or whatever else.)