Wednesday, June 29, 2011

The Fallacy of Miracles

By Colin Flannery

After a tornado recently tore through Joplin, Missouri, the same thing happened that happens after every such natural disaster: people saw the hand of God all over the incident—the Christian God, of course. 

The badly injured proclaimed it a “miracle” that they had survived, the slightly injured saw a miracle in the fact that they were not more severely hurt, and those outside the path of the tornado saw God’s hands all over the event, as he lovingly directed the twister around their homes (and, therefore, by definition, into their neighbors’ homes). Each person basically looked one circle in closer to the tragedy and declared it a miracle that they were one circle out. So many miracles, overlapping and inconsistent.

Needless to say, this is nothing peculiar to Joplin. It happens every time there is a tragedy or near tragedy of any kind, anywhere in the world. Captain “Sully” Sullenberger pilots a distressed plane to land safely the Hudson River in New York City and nobody is killed, and it's a miracle from God; a young girl is found in India, totally terrorized, but alive after being abducted and raped for a week, and it’s a miracle from Rama (or Vishnu or Shiva) that she is returned to her parents; an earthquake kills 5,000 people in Tibet, and it's a fortune not of a god, but of Karma that more people weren't killed; or a family in Northern Pakistan survives an errant American drone attack, and it’s a miracle from Allah.
What all these proclamations of miraculous intervention miss is the downside of the incidents. The fact that 150 or so people were killed in Joplin, that the girl was held for seven days, raped and sodomized, and will be traumatized for the rest of her life, or the 5,000 dead and 20,000 injured in the quake, and so on.

Of course, none of these incidents really are “miracles.” They are tragedies from end to end. When the totality of facts are taken into account, miracles turn out to be nothing more than people ignoring the downside of a set of facts, focusing solely on the good and calling the quarantined “good” a “miracle.” A CEO might as well ignore the liability side of his balance sheet and declare it a miracle that his company has just doubled in value.

Soon after the disaster, a story about how the tornado did not shake people’s belief in God appeared on the CNN Belief Blog. The article painted such obdurate adherence to faith in a positive light (a cynic might quip that you can fool some of the people all of the time). The comment section soon lit up with the usual debates between atheists and believers as to the role God played in the incident.  I posted the following as a sardonic response to a Christian who suggested everybody in Joplin should thank God for their fortune:

Bereaved Parent: God, you killed my little girl. The tornado ripped her out of my arms and dashed her against a tree. Why, oh Lord? I have been a good person all my life. I have kept your commandments and attended church every Sunday?
God: It’s all part of my “grand plan” for you. Your small mind cannot comprehend such matters.
Bereaved Parent: Try me. You killed my little girl. You expect me to turn up at church next week and praise your endless love. I think you owe me an explanation. She was only five years old!
God: I was moving in mysterious ways.
Bereaved Parent:  What the f*** does that mean?
God: Well, I kill thousands of small children all over the planet every day, and if I say I am “moving in mysterious ways,” for some reason people stop asking questions and go back to worshipping me. My favorite method is starvation. I also enjoy wars, preventable disease and miscellaneous acts of violence.
Bereaved Parent: I can’t believe what I’m hearing.
God: Yeah, it’s pretty rare that I speak so frankly. Look, if it makes you feel any better, tell yourself it’s Satan’s work. Satan sent the tornado, I just sat back and did a quick miracle to save that church cross you see in all those photos to demonstrate my omnipotence.
Bereaved Parent: But you’re God! You could have stopped Satan.
God: Ok, you’ve got me there. Look kid, the truth is, I don’t exist. I never have. Wasn’t it obvious to you that you made me when I seemed to love all the same things you love and hate all the same things you hate? Haven’t you noticed that every culture that has ever existed has had its own gods and they all seem to favor that particular culture, its hopes, dreams, and prejudices? Do you think we all exist? If not, why only yours?
Bereaved Parent: That’s a shame, because I intended to give you a free pass. To still believe in you despite everything telling me you are nonsense, simply because I have nowhere else to go. I have been taught to believe in you and never to question it, and I accepted it when they told me it was wrong to doubt.
God: Well, look at it from my perspective. How long would I last if I positively promoted free thought, healthy skepticism, and independent inquiry? You people would see right through me in a minute.
Bereaved Parent: Ok.  I have to go now. My wife needs me. We have a little girl to bury.
God: Good luck. I’ll say a prayer for you. Hey – even I need a god sometimes. 

Upon the slightest reflection, God’s “miracles” in Joplin quickly disappear. In any such tragedy, there will be victims and lucky survivors. Children will be gone, the elderly crushed, and the most deserving members of society struck down with the same barometric indifference as the least admirable. It could not be any other way, but the mind of the believer is a forgiving beast.

Let me make a prediction. The next time there is a tragedy anywhere in the world, be it in India, China, the United States, Egypt, South America, or anywhere else, the local population will proclaim that the miraculous intervention of their god(s) saved the day. Over the course of the next year there will be miracles from God, Brahman, Vishnu, Allah, and scores of other contemporary deities. The next time a mine or church collapses anywhere in poor South America, it will be a miracle from the Christian god that nobody was killed. If only a few people die, it will be a miracle that more weren't killed. If all die, it will be a miracle that a statue (or painting) survived. People will pray to it.  
Who knows, perhaps competing gods are all sitting up in the sky, watching the Earth and selectively intervening with miracles in the geographical areas of the planet where their believers enjoy a majority and ignoring all other parts of the world. Perhaps the many Hindu gods are drumming up miracles in India, Allah is intervening to kill Americans in Iraq, while God protects Americans over the Hudson.  
Or perhaps, just perhaps, all this is just silly. Isn't it more likely that the millions of daily miracles and the gods who perform them exist solely in our minds? That we see miracles in tragedies because we so want to see them? We as a species are distraught by tragedy and cannot stand the thought that there is no divine justice, nobody there to punish the bad and reward the good, no ying to balance the yang. If we ourselves survive a disaster, we feel a need to thank our god, lest it consider us ungrateful and the next time we might not be so lucky. It’s Human Psychology 101.
If a god really wanted to reveal itself through a miracle, what would be easier than making a big public display of it so as to remove doubt—such as descending over an earthquake and stopping the tectonic rumbling with a wave of his mighty hand or having a guardian angel appear and stop the Joplin twister in its tracks? Of course, this never happens, and it is so far-fetched that it seems silly to even suggest it, but the supposed god doing exactly the same thing, hidden behind perfectly explicable natural events, is accepted. 

Maybe it's time to grow up as a species. Maybe, as a child eventually sheds its Santa Claus, we adults should intellectually outgrow our invisible, wish-granting sky fairies. Imagine for a moment, as John Lennon implored us to do, a world without religion. Imagine if all the billions of dollars in time, effort and hard cash that we spend worldwide on religion each year were instead funneled into something real and worthwhile, like reducing poverty, improving education or protecting the environment. We could probably make huge strides toward curing the chosen ill.
Now that would be a miracle. 

Colin Flannery was born in Australia and now lives in Raleigh, North Carolina. He is a lawyer by profession and an admitted science nerd by choice.

Thursday, June 16, 2011

Here’s some interesting food for thought…

June 15, 2011

Our Lefty Military


As we search for paths out of America’s economic crisis, many suggest business as a paradigm for cutting costs. According to my back-of-the-envelope math, top C.E.O.’s earn as much as $1 a second around the clock, partly by cutting medical benefits for employees. So they must be paragons of efficiency, right?

Actually, I’m not so sure. The business sector is dazzlingly productive, but it also periodically blows up our financial system. Yet if we seek another model, one that emphasizes universal health care and educational opportunity, one that seeks to curb income inequality, we don’t have to turn to Sweden. Rather, look to the United States military.

You see, when our armed forces are not firing missiles, they live by an astonishingly liberal ethos — and it works. The military helped lead the way in racial desegregation, and even today it does more to provide equal opportunity to working-class families — especially to blacks — than just about any social program. It has been an escalator of social mobility in American society because it invests in soldiers and gives them skills and opportunities.

The United States armed forces knit together whites, blacks, Asians and Hispanics from diverse backgrounds, invests in their education and training, provides them with excellent health care and child care. And it does all this with minimal income gaps: A senior general earns about 10 times what a private makes, while, by my calculation, C.E.O.’s at major companies earn about 300 times as much as those cleaning their offices. That’s right: the military ethos can sound pretty lefty.

“It’s the purest application of socialism there is,” Wesley Clark, the retired four-star general and former supreme allied commander of NATO forces in Europe, told me. And he was only partly joking.

“It’s a really fair system, and a lot of thought has been put into it, and people respond to it really well,” he added. The country can learn from that sense of mission, he said, from that emphasis on long-term strategic thinking.

The military is innately hierarchical, yet it nurtures a camaraderie in part because the military looks after its employees. This is a rare enclave of single-payer universal health care, and it continues with a veterans’ health care system that has much lower costs than the American system as a whole.

Perhaps the most impressive achievement of the American military isn’t its aircraft carriers, stunning as they are. Rather, it’s the military day care system for working parents.

While one of America’s greatest failings is underinvestment in early childhood education (which seems to be one of the best ways to break cycles of poverty from replicating), the military manages to provide superb child care. The cost depends on family income and starts at $44 per week.

“I absolutely think it’s a model,” said Linda K. Smith, executive director of the National Association of Child Care Resource and Referral Agencies, which advocates for better child care in America. Ms. Smith, who used to oversee the military day care system before she retired from the Defense Department, said that the military sees child care as a strategic necessity to maintain military readiness and to retain highly trained officers.

One of the things I admire most about the military is the way it invests in educating and training its people. Its universities — the military academies — are excellent, and it has R.O.T.C. programs at other campuses around the country. Many soldiers get medical training, law degrees, or Ph.D.’s while in service, sometimes at the country’s finest universities.

Then there are the Army War College, the Naval War College and the Air War College, giving top officers a mid-career intellectual and leadership boost before resuming their careers. It’s common to hear bromides about investing in human capital, but the military actually shows that it believes that.

Partly as a result, it manages to retain first-rate officers who could earn far higher salaries in the private sector. And while the ethic of business is often “Gimme,” the military inculcates an ideal of public service that runs deep. In Afghanistan, for example, soldiers sometimes dig into their own pockets to help provide supplies for local schools.

Granted, it may seem odd to seek a model of compassion in an organization whose mission involves killing people. It’s also true that the military remains often unwelcoming to gays and lesbians and is conflicted about women as well. And, of course, the opportunities for working-class Americans are mingled with danger.

But as we as a country grope for new directions in a difficult economic environment, the tendency has been to move toward a corporatist model that sees investments in people as woolly-minded sentimentalism or as unaffordable luxuries. That’s not the only model out there.

So as the United States armed forces try to pull Iraqi and Afghan societies into the 21st century, maybe they could do the same for America’s.

Monday, June 13, 2011

Medicare Saves Money

June 12, 2011


Every once in a while a politician comes up with an idea that’s so bad, so wrongheaded, that you’re almost grateful. For really bad ideas can help illustrate the extent to which policy discourse has gone off the rails.

And so it was with Senator Joseph Lieberman’s proposal, released last week, to raise the age for Medicare eligibility from 65 to 67.

Like Republicans who want to end Medicare as we know it and replace it with (grossly inadequate) insurance vouchers, Mr. Lieberman describes his proposal as a way to save Medicare. It wouldn’t actually do that. But more to the point, our goal shouldn’t be to “save Medicare,” whatever that means. It should be to ensure that Americans get the health care they need, at a cost the nation can afford.

And here’s what you need to know: Medicare actually saves money — a lot of money — compared with relying on private insurance companies. And this in turn means that pushing people out of Medicare, in addition to depriving many Americans of needed care, would almost surely end up increasing total health care costs.

The idea of Medicare as a money-saving program may seem hard to grasp. After all, hasn’t Medicare spending risen dramatically over time? Yes, it has: adjusting for overall inflation, Medicare spending per beneficiary rose more than 400 percent from 1969 to 2009.

But inflation-adjusted premiums on private health insurance rose more than 700 percent over the same period. So while it’s true that Medicare has done an inadequate job of controlling costs, the private sector has done much worse. And if we deny Medicare to 65- and 66-year-olds, we’ll be forcing them to get private insurance — if they can — that will cost much more than it would have cost to provide the same coverage through Medicare.

By the way, we have direct evidence about the higher costs of private insurance via the Medicare Advantage program, which allows Medicare beneficiaries to get their coverage through the private sector. This was supposed to save money; in fact, the program costs taxpayers substantially more per beneficiary than traditional Medicare.

And then there’s the international evidence. The United States has the most privatized health care system in the advanced world; it also has, by far, the most expensive care, without gaining any clear advantage in quality for all that spending. Health is one area in which the public sector consistently does a better job than the private sector at controlling costs.

Indeed, as the economist (and former Reagan adviser) Bruce Bartlett points out, high U.S. private spending on health care, compared with spending in other advanced countries, just about wipes out any benefit we might receive from our relatively low tax burden. So where’s the gain from pushing seniors out of an admittedly expensive system, Medicare, into even more expensive private health insurance?

Wait, it gets worse. Not every 65- or 66-year-old denied Medicare would be able to get private coverage — in fact, many would find themselves uninsured. So what would these seniors do?

Well, as the health economists Austin Frakt and Aaron Carroll document, right now Americans in their early 60s without health insurance routinely delay needed care, only to become very expensive Medicare recipients once they reach 65. This pattern would be even stronger and more destructive if Medicare eligibility were delayed. As a result, Mr. Frakt and Mr. Carroll suggest, Medicare spending might actually go up, not down, under Mr. Lieberman’s proposal.

O.K., the obvious question: If Medicare is so much better than private insurance, why didn’t the Affordable Care Act simply extend Medicare to cover everyone? The answer, of course, was interest-group politics: realistically, given the insurance industry’s power, Medicare for all wasn’t going to pass, so advocates of universal coverage, myself included, were willing to settle for half a loaf. But the fact that it seemed politically necessary to accept a second-best solution for younger Americans is no reason to start dismantling the superior system we already have for those 65 and over.

Now, none of what I have said should be taken as a reason to be complacent about rising health care costs. Both Medicare and private insurance will be unsustainable unless there are major cost-control efforts — the kinds of efforts that are actually in the Affordable Care Act, and which Republicans demagogued with cries of “death panels.”

The point, however, is that privatizing health insurance for seniors, which is what Mr. Lieberman is in effect proposing — and which is the essence of the G.O.P. plan — hurts rather than helps the cause of cost control. If we really want to hold down costs, we should be seeking to offer Medicare-type programs to as many Americans as possible.

Friday, June 10, 2011

Rule by Rentiers

June 9, 2011


The latest economic data have dashed any hope of a quick end to America’s job drought, which has already gone on so long that the average unemployed American has been out of work for almost 40 weeks. Yet there is no political will to do anything about the situation. Far from being ready to spend more on job creation, both parties agree that it’s time to slash spending — destroying jobs in the process — with the only difference being one of degree.

Nor is the Federal Reserve riding to the rescue. On Tuesday, Ben Bernanke, the Fed chairman, acknowledged the grimness of the economic picture but indicated that he will do nothing about it.

And debt relief for homeowners — which could have done a lot to promote overall economic recovery — has simply dropped off the agenda. The existing program for mortgage relief has been a bust, spending only a tiny fraction of the funds allocated, but there seems to be no interest in revamping and restarting the effort.

The situation is similar in Europe, but arguably even worse. In particular, the European Central Bank’s hard-money, anti-debt-relief rhetoric makes Mr. Bernanke sound like William Jennings Bryan.

What lies behind this trans-Atlantic policy paralysis? I’m increasingly convinced that it’s a response to interest-group pressure. Consciously or not, policy makers are catering almost exclusively to the interests of rentiers — those who derive lots of income from assets, who lent large sums of money in the past, often unwisely, but are now being protected from loss at everyone else’s expense.

Of course, that’s not the way what I call the Pain Caucus makes its case. Instead, the argument against helping the unemployed is framed in terms of economic risks: Do anything to create jobs and interest rates will soar, runaway inflation will break out, and so on. But these risks keep not materializing. Interest rates remain near historic lows, while inflation outside the price of oil — which is determined by world markets and events, not U.S. policy — remains low.

And against these hypothetical risks one must set the reality of an economy that remains deeply depressed, at great cost both to today’s workers and to our nation’s future. After all, how can we expect to prosper two decades from now when millions of young graduates are, in effect, being denied the chance to get started on their careers?

Ask for a coherent theory behind the abandonment of the unemployed and you won’t get an answer. Instead, members of the Pain Caucus seem to be making it up as they go along, inventing ever-changing rationales for their never-changing policy prescriptions.

While the ostensible reasons for inflicting pain keep changing, however, the policy prescriptions of the Pain Caucus all have one thing in common: They protect the interests of creditors, no matter the cost. Deficit spending could put the unemployed to work — but it might hurt the interests of existing bondholders. More aggressive action by the Fed could help boost us out of this slump — in fact, even Republican economists have argued that a bit of inflation might be exactly what the doctor ordered — but deflation, not inflation, serves the interests of creditors. And, of course, there’s fierce opposition to anything smacking of debt relief.

Who are these creditors I’m talking about? Not hard-working, thrifty small business owners and workers, although it serves the interests of the big players to pretend that it’s all about protecting little guys who play by the rules. The reality is that both small businesses and workers are hurt far more by the weak economy than they would be by, say, modest inflation that helps promote recovery.

No, the only real beneficiaries of Pain Caucus policies (aside from the Chinese government) are the rentiers: bankers and wealthy individuals with lots of bonds in their portfolios.

And that explains why creditor interests bulk so large in policy; not only is this the class that makes big campaign contributions, it’s the class that has personal access to policy makers — many of whom go to work for these people when they exit government through the revolving door. The process of influence doesn’t have to involve raw corruption (although that happens, too). All it requires is the tendency to assume that what’s good for the people you hang out with, the people who seem so impressive in meetings — hey, they’re rich, they’re smart, and they have great tailors — must be good for the economy as a whole.

But the reality is just the opposite: creditor-friendly policies are crippling the economy. This is a negative-sum game, in which the attempt to protect the rentiers from any losses is inflicting much larger losses on everyone else. And the only way to get a real recovery is to stop playing that game.

Thursday, June 9, 2011

Wis. Elections Board Certifies Recalls Against Three Dems — After Long Debate About Republican Election Fraud


Eric Kleefeld | June 8, 2011, 7:23PM



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2011 Elections, Dave Hansen, Jim Holperin, Recall, Robert Wirch, Wisconsin , Wisconsin State Legislature

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The Wisconsin Government Accountability Board, which oversees elections in the state, has now green-lit three recalls targeting Democratic state Sens. Dave Hansen, Jim Holperin and Robert Wirch -- but it was a close call, as the board grappled all through the day with a topic that isn't discussed too much in the media: Alleged election fraud that is perpetrated by Republicans.

The state Democratic Party and the three incumbents had filed extensive challenges to the petitions that were filed by the Republicans, triggering an extensive debate among the board members (retired judges who are selected through a mostly non-partisan process), the GAB staff lawyers, and Democratic and Republican Party attorneys over what the threshold was to disqualify petitions based on claims of fraud.

Adding to the political dimension the GAB had already certified six other recalls, all of them spearheaded by the Democrats to target Republicans who voted for Gov. Scott Walker's anti-public employee union bill, but had to receive an extension of the review time from a judge for these three recalls, because the Dems had filed much more extensive challenges. As a result of the extension, these new recalls (or any necessary primaries) will take place on July 19, a week after the July 12 date for the recalls targeting GOP legislators.

The board faced a conundrum, in that the Dems' challenges outlined a significant number of signatures that were the products of apparent fraud. But even without all the signatures that the Dems were able to question within their ten-day review period, there would still be enough signatures left to trigger recalls.

However, as the Milwaukee Journal Sentinel reports, the GAB's staff laid out several options for the board. The first option would be to green-light the recalls, on the grounds that enough signatures remain that have not been challenged. The other options, for which the staffers cited various precedents in other states, would be to disqualify all petition pages collected by certain signature-gatherers who had exhibited a pattern of fraud, beyond just a few disqualified signatures that normally occur -- which would shut down the three recalls in question -- or even to throw out all the petitions entirely as the ultimate sanction.

Democrats had used their ten-day response period, after Republican activists had submitted the completed petitions, to conduct extensive phone surveys of the people whose names were on the forms. Along the way, they produced affidavits from people alleging various dirty tricks, ranging from claims that they were misled into signing -- being told that it was to support the legislator in question, or to recall Walker, etc -- to claims from some individuals that they did not sign their names at all, but were forged as having done so (possibly by getting their names from the phonebook).

Most notoriously, the Dems found the purported signature of a man who had been dead for 20 years, but whose name was still in the phonebook (by peculiar circumstance, he was the father of a very liberal current Democratic state representative). In addition, they found a married couple for whom the signatures were clearly written in the same hand -- but both people have signed affidavits that neither of them actually did sign.

As one might expect, the Republican attorney Eric McLeod argued before the board that only specific, identified signatures should be tossed, preserving the state's constitutional right for voters to sign recall petitions. On the other side, both Democratic attorney Jeremy Levinson and GAB staff attorney Shane Falk have each been arguing in their own ways that petition efforts involving crooked circulators have to be held accountable in some way, in the name of protecting the process.

To be clear, this was a very serious decision, with major implications either way that were thoroughly discussed throughout the GAB's meeting. To throw out all of a crooked circulator's pages would very likely disenfranchise the signatures of many other people who had legitimately signed the papers in good faith, and might have helped constitute a sufficient number of people to hold a recall election against a legislator. But to leave the petitions in could potentially make it virtually impossible to disqualify future recalls that might entail extensive fraud, involving too many signatures for the opposition to effectively screen out.

As one judge on the board said: "I think I'm discovering what a Hobson's Choice is."

Ultimately, the board voted to send a message for future recalls, by voting to strike individual pages that were circulated by some of the more offensive petition-gatherers, on the pages that showed a pattern of fraudulent conduct. This still left enough signatures to certify those recalls to move forward.

(Special thanks to Wisconsin Eye, the state equivalent of C-Span, for live-streaming the meeting.)

Monday, June 6, 2011

Vouchercare Is Not Medicare -
June 5, 2011
Vouchercare Is Not Medicare

What’s in a name? A lot, the National Republican Congressional Committee obviously believes. Last week, the committee sent a letter demanding that a TV station stop running an ad declaring that the House Republican budget plan would “end Medicare.” This, the letter insisted, was a false claim: the plan would simply install a “new, sustainable version of Medicare.”

But Comcast, the station’s owner, rejected the demand — and rightly so. For Republicans are indeed seeking to dismantle Medicare as we know it, replacing it with a much worse program.

I’m seeing many attempts to shout down anyone making this obvious point, and not just from Republican politicians. For some reason, many commentators seem to believe that accurately describing what the G.O.P. is actually proposing amounts to demagoguery. But there’s nothing demagogic about telling the truth.

Start with the claim that the G.O.P. plan simply reforms Medicare rather than ending it. I’ll just quote the blogger Duncan Black, who summarizes this as saying that “when we replace the Marines with a pizza, we’ll call the pizza the Marines.” The point is that you can name the new program Medicare, but it’s an entirely different program — call it Vouchercare — that would offer nothing like the coverage that the elderly now receive. (Republicans get huffy when you call their plan a voucher scheme, but that’s exactly what it is.)

Medicare is a government-run insurance system that directly pays health-care providers. Vouchercare would cut checks to insurance companies instead. Specifically, the program would pay a fixed amount toward private health insurance — higher for the poor, lower for the rich, but not varying at all with the actual level of premiums. If you couldn’t afford a policy adequate for your needs, even with the voucher, that would be your problem.

And most seniors wouldn’t be able to afford adequate coverage. A Congressional Budget Office analysis found that to get coverage equivalent to what they have now, older Americans would have to pay vastly more out of pocket under the Paul Ryan plan than they would if Medicare as we know it was preserved. Based on the budget office estimates, the typical senior would end up paying around $6,000 more out of pocket in the plan’s first year of operation.

By the way, defenders of the G.O.P. plan often assert that it resembles other, less unpopular programs. For a while they claimed, falsely, that Vouchercare would be just like the coverage federal employees get. More recently, I’ve been seeing claims that Vouchercare would be just like the system created for Americans under 65 by last year’s health care reform — a fairly remarkable defense from a party that has denounced that reform as evil incarnate.

So let me make two points. First, Obamacare was very much a second-best plan, conditioned by perceived political realities. Most of the health reformers I know would have greatly preferred simply expanding Medicare to cover all Americans. Second, the Affordable Care Act is all about making health care, well, affordable, offering subsidies whose size is determined by the need to limit the share of their income that families spend on medical costs. Vouchercare, by contrast, would simply hand out vouchers of a fixed size, regardless of the actual cost of insurance. And these vouchers would be grossly inadequate.

But what about the claim that none of this matters, because Medicare as we know it is unsustainable? Nonsense.

Yes, Medicare has to get serious about cost control; it has to start saying no to expensive procedures with little or no medical benefits, it has to change the way it pays doctors and hospitals, and so on. And a number of reforms of that kind are, in fact, included in the Affordable Care Act. But with these changes it should be entirely possible to maintain a system that provides all older Americans with guaranteed essential health care.

Consider Canada, which has a national health insurance program, actually called Medicare, that is similar to the program we have for the elderly, but less open-ended and more cost-conscious. In 1970, Canada and the United States both spent about 7 percent of their G.D.P. on health care. Since then, as United States health spending has soared to 16 percent of G.D.P., Canadian spending has risen much more modestly, to only 10.5 percent of G.D.P. And while Canadian health care isn’t perfect, it’s not bad.

Canadian Medicare, then, looks sustainable; why can’t we do the same thing here? Well, you know the answer in the case of the Republicans: They don’t want to make Medicare sustainable, they want to destroy it under the guise of saving it.

So in voting for the House budget plan, Republicans voted to end Medicare. Saying that isn’t demagoguery, it’s just pointing out the truth.