I hadn’t really intended to do a post on Chick-fil-A because I regard it as a fairly unimportant sideshow, but a couple of things came up. A buddy of mine was hoping I’d address it, and Tipsy included some thoughts of mine in a piece wondering if anti-Chick-fil-A sentiment had its roots in “Christophobia.”

I never spent a lot of time thinking about Chick-fil-A. When I go to fast food joints, I never care much for chicken sandwiches, so it was never a store I was going to seek out in the first place. I had a vague understanding that the company had staked out a position in the culture war. Closed on Sundays, but not just closed, but closed so its employees could honor the Sabbath. That assumes a whole lot about your employees and your relationship to them. But, hey, whatever. None of my business, really. Hobby Lobby was more distasteful to me because of their even more rampant commercialization of their Christian-tribal affiliations. They, honest to God, sell “Test-a-Mints.”

But, then I became dimly aware that the owner of Chick-fil-A said something negative about whether our gay citizens should have equal rights. And, again, dimly aware that some big city lawmakers started showboating by threatening to use legal authority to impair the company’s ability to do business in their cities. And then very aware that conservatives were showing their solidarity by eating fast food chicken.

Meanwhile, I responded on Twitter to the event by being a smartass in the back of the classroom shooting spitballs. So, I can certainly understand Tipsy thinking I had stronger feelings on the subject than I actually do.

First, based on what I know, I can conclude that the city lawmakers are out of line; legitimately creating First Amendment concerns among those who care about such things. Second, I think gays and those who support them are acting in a perfectly rational and defensible way when they choose to oppose Chick-fil-A’s position and to seek to do the company economic harm through boycotts or whatever. Company owners aren’t inertly believing something in a vacuum. They’re taking profits and directing them to organizations and candidates with political influence which, in turn, help ensure that laws and policies harmful to gays remain on the books. You can pick a side, or not, depending on your policy preferences.

So, if you pick the side of the gays over the side of Christian culture warriors, does that make you Christophobic? No. For me, even though I don’t happen to believe in the divinity of Jesus, I’ll still happily attend the fish fry of a local church to raise money for the local homeless shelter. Some of my gay friends are devoutly religious, and I don’t shun them for that. Which, I think raises a central point in this debate: neither side of the culture wars has a monopoly on Jesus. This point was made rather well, I thought, by those taunting the Chick-fil-A solidarity people by pointing out that many of those who would routinely ignore the plight of the homeless and hungry rushed out to eat fast-food chicken in order to show their support for gay rights antagonists.

A business owner with strong religious beliefs causes me no concern; but commercializing the culture wars for political influence catches my interest, particularly when I’m opposed to your policy preferences.

The economy does not distribute wealth perfectly to the smart and hardworking and withhold wealth perfectly from the dumb and lazy. Digby takes a crack at explaining why this unremarkable fact is causing so many twisted knickers among Romney supporters.

Hard and smart work help you hedge your bets, but ultimately luck is very much a non-trivial factor in whether and how much wealth you have. However, acknowledging this fact makes it morally difficult for those who hit the jackpot to make the case that they should retain so much more wealth than others with equal or greater smarts and work ethic but with less fortune.

Personally, I think we want inequality in the system. We want a little randomness, and we want a lot of reward for being clever or hard working. That promotes incentives that complete equality can’t. But, of course, no one is arguing for complete equality. Just a recognition that wealth isn’t entirely a function of moral worth, a recognition that you can still have those incentives even if the jackpot isn’t quite as big, and a system that reduces the upside of good luck a bit in order to soften the blow from the downside of bad luck.

And, in fact, what you should see is that as a country becomes wealthier and smarter about work; the productivity of workers increases and the number of hours worked should decrease as it takes less hours of production to support a comfortable life. See this NBC news report:

Mark Keese, head of OECD’s employment division, told 24/7 Wall St. that the wealth and productivity of a nation plays a large part in the structure of employment in the country. One component of this is the technological sophistication of industry. “Generally, richer countries can and should see reductions in hours worked … basically, you have stronger productivity performance and eventually you’re replacing workers with machines, which allow you to cut back on the number of hours of work.”

I think what we see in the U.S. is that our legal structure is set up so that the wealthy are those who have most successfully appropriated the value produced by others for themselves.

Great article in the Atlantic by Barbara Kiviac entitled “The Big Jobs Myth: American Workers Aren’t Ready for American Jobs.”

Americans seem to have a deep hunger to regard one’s economic situation as a morality play. If you’re rich, it’s because of your drive and skill. If you’re poor, it’s because you’re dumb and lazy. This allows us to complacently let the rich stay rich and absolves us of any duty to the poor.

Kiviac goes into more detail, but this dynamic is part of what makes the jobs/skills myth so popular. She also notes that, strangely, the problem with the labor market is rarely descried as a pay mismatch. Want the skills? Pay for them. Individuals don’t acquire such skills for free.

Except the ones they do. She notes that a couple of the skills noted as lacking in employer surveys aren’t really the kinds that come from more education — particularly the types of education marketed as getting you a job:

A 2011 employer survey from the Manufacturing Institute found that the top skill deficiency among manufacturing workers was “inadequate problem-solving skills.” No. 3 on the list was “inadequate basic employability skills (attendance timeliness, work ethic, etc.).

In any case, she says, the skills mismatch trope serves many ideological masters:

As sociologist Michael Handel points out in his book Worker Skills and Job Requirements, in the skills mismatch debate, it is often not clear who is missing what skill. The term is used to talk about technical manufacturing know-how, doctoral-grade engineering talent, high-school level knowledge of reading and math, interpersonal smoothness, facility with personal computers, college credentials, problem-solving ability, and more. Depending on the conversation, the problem lies with high-school graduates, high-school drop-outs, college graduates without the right majors, college graduates without the right experience, new entrants to the labor force, older workers, or younger workers. Since the problem is hazily defined, people with vastly different agendas are able to get in on the conversation–and the solution.

The skills mismatch trope also offers a little something for everyone politically. Those on the right get to talk about taking personal responsibility for upgrading one’s skills, while those on the left get to emphasize how we must do a better job with education, that great pathway to an egalitarian society. Between the two sit the nation’s employers, who get an argument for sharing labor-training costs with government agencies, non-profits, and institutions of higher education; it would hardly be fair to expect them to bear the full burden if the American workforce itself is defective. Finally, a fast-growing industry of for-profit colleges get reassurance that their student pipeline will stay full.

I hope Tom LoBianco didn’t write this headline. I really like Tom, and the article is good, but I really hate the headline: “Legislators Use Patriotic Language To Help Bills Become Law, Some Say.” Some say?!?! Of course they do.

Using measures labeled “right to work” and “freedom to work” as examples of similarly named but very different pieces of legislation using the same rhetorical trick, the article goes to Kristen Sheeler:

“The intended response is a visceral or emotional response. If you can get at someone’s emotions, then they’re going to be more likely to react,” said Kristina Sheeler, chairwoman of the Department of Communication Studies at Indiana University-Purdue University Indianapolis.

By using words like “right” and “freedom,” which call to American cultural values, politicians try to win over as many people as possible while alienating as few as possible, she said.

“The words have power because they’re strategically ambiguous,” she said. “They’re so full of meaning, but the very specific meaning is not there.”

At LSA, we used to joke about this when drafting bills. “This law may be referred to as the Puppies and Kittens are Cute Bill of 2012.” Nevermind that it’s a pro-vivisection measure.

And, I think, the “Some Say” in that headline is part of why the trick works. Journalists generally do not feel free to call b.s. on a law’s title when it’s disingenuous. They have to resort to a bland, “he said/she said” faux objectivity. “Some say puppies won’t really be cute while being cut open.”

The big news of the past few days while I’ve been on the road is the mass murderer in Aurora Colorado who shot up a Batman screening, killing something like 12 and injuring something like 50. I’ve only paid general attention to the details.

One place I heard some discussion was the beginning segment of the Dave Ramsey Show. His main thrust was that it wasn’t “society’s” fault and he didn’t know and wasn’t terribly interested in whether it was the parent’s fault. Crazy has always been crazy, things aren’t worse now than they were in the past, and the only thing that has changed is the intensity of media coverage.

I tend to agree with that, but I also think he was being conspicuously silent about an important variable. Crazy may have always been crazy, but crazy didn’t always have access to assault rifles. The capacity for violence has increased.

One argument I’ve heard, which I think is inane, is to the effect that more armed people in the theater would have made things safer. Cross fire in a smoky, confused theater where it’s difficult or impossible to distinguish the good guys from the bad guys would have done nothing to make things safer. Probably just would’ve gotten more people killed.

The other argument I think is suspect is that gun laws wouldn’t do a thing to make us safer. I disagree. I don’t think it’s coincidence that, compared to other countries, the U.S. has some of the laxest gun laws and some of the biggest problems with gun violence. Would passing gun laws help? Now, there I share the suspicion of the gun enthusiasts — it may well be that the genie is already out of the bottle; that guns are so pervasive culturally and physically that laws might not be of a lot of practical use. I don’t know that, but I at least appreciate skepticism on that score.

And, perhaps more importantly, whatever the most effective policy choices might be, I also think our hands might be tied by the Second Amendment in ways not applicable to countries with less gun violence.

Finally, I disagree with the notion that “now is not the time to talk about gun violence.” That it’s ghoulish political opportunism to discuss these things after people are dead. When a mine collapses and kills people, it’s an appropriate time to take a look at mine safety concerns. This is similar. Waiting until people are no longer focused on the problem doesn’t make a lot of sense.

Adam Mann, writing for Wired Magazine, has an article on the 50th anniversary of Telstar-1.

Telstar, a collaboration between U.S., French, and British broadcasting agencies, was the world’s first active communication satellite, enabling TV programs to be broadcast across the Atlantic. The 3-foot-long satellite was also the first to send the television signals, telephone calls, and fax images through space.

Before Telstar was launched, microwave towers could flash TV shows and other communication information from point to point through the air, supplementing the landlines that already crisscrossed the globe. But once these signals reached the ocean, they reached their limit.

(Maybe most astounding is that we used to collaborate with the French; not mock them for their adequate health care while we fattened ourselves up on Freedom Fries.)

Anyway, satellites? How cool is that? Humanity has been on the planet for millions of years (never mind what the Biblical literalists might tell you) and only for the last 50 have we been able to put communication devices in space. And we have the privilege of living in such a time.

With that, I give you Louis CK. Everything’s Amazing and Nobody’s Happy:

Fareed Zakaria has an opinion entitled Curbing the cost of health care.

“[T]he situation on the ground suggests that markets work imperfectly in this realm.”

Ya think?

He notes that France seems to get better results treating lung cancer at 1/8 of the cost. If my math is right, that means France spends 12.5 cents for every dollar we spend on treating lung cancer and gets much better results. He notes that Britain spends 1/5 what the U.S. does on diabetes treatment (20 cents per dollar) and gets better results.

This doesn’t seem to be the voice of a socialist hater of free markets. He seems almost apologetic. But one of the problems seems to be that the market incentives for health care providers aren’t in favor of efficiency or wellness.

France and Britain are better at tackling diabetes and lung disease because they take a systemic approach that gives all health-care providers incentive to focus on early detection and cost-effective treatment and that makes wellness the goal. “In America,” he said, “no one has incentives to make quality and cost-effective outcomes the goal. There are so many stakeholders and they each want to protect themselves.

We spend twice as much on health care as any other country and get outcomes that are the same or worse. That has to mean there are horrible inefficiencies in the system; and the market’s invisible hand isn’t doing a lot to sort things out. This isn’t a simple transaction where a consumer compares easily analyzed widgets and makes purchasing decisions based on clear information about quality and price or simply walks away from the transaction if there are no satisfactory offerings. Health care is complicated; quality can be subtle and delayed; price is only loosely based on cost and both are horribly opaque to the consumer. And, so often, the transaction is anything but voluntary. It’s often a matter of, literally, life and death.

I myself have an uneasiness about the Affordable Care Act. It’s a Rube Goldberg machine that might not work well if at all. But, for political reasons, it’s all we could get. The status quo is broken, cruel, and awful. Politicians demanding a return to the status quo (usually with a call for repeal and only vague mumblings about a replacement) are, at best, being petulant because “their side” lost.

Reposting from years past, but in light of the holiday, that might be appropriate.

Two hundred and thirty-one thirty-two thirty-six years ago, some Virginia planters with dissonant views of liberty (“How is it that we hear the loudest yelps for liberty among the drivers of negroes?” – Samuel Johnson) got together with some Boston smugglers and rabble rousers who had lost respect for their leader. And, thank goodness they did. They founded a nation based on a radical notion that all men are created equal. They were audacious enough to declare this truth “self-evident.” Think of what a departure this was. There was no automatic deference to anyone else based on their station in life. Governments, they declared, derived their just power from the consent of the governed. They felt so aggrieved by a hereditary leader who had abused his authority so egregiously they felt that he could no longer be tolerated. They felt that his tenure in power was “a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these States.” Among the abuses were deprivation of trial by jury and an inclination to raise the military authority above the civil authority. Humble petitions for redress were met only with further injury. I’ll leave drawing parallels to more modern events as an exercise for the reader.

As always, I think it is valuable to read the whole text of the Declaration of Independence, so, here you go:

The Declaration of Independence of the Thirteen Colonies
In CONGRESS, July 4, 1776

The unanimous Declaration of the thirteen united States of America,

When in the Course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. –That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, –That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security. —Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government. The history of the present King of Great Britain [George III] is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these States. To prove this, let Facts be submitted to a candid world.

He has refused his Assent to Laws, the most wholesome and necessary for the public good.

He has forbidden his Governors to pass Laws of immediate and pressing importance, unless suspended in their operation till his Assent should be obtained; and when so suspended, he has utterly neglected to attend to them.

He has refused to pass other Laws for the accommodation of large districts of people, unless those people would relinquish the right of Representation in the Legislature, a right inestimable to them and formidable to tyrants only.

He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their public Records, for the sole purpose of fatiguing them into compliance with his measures.

He has dissolved Representative Houses repeatedly, for opposing with manly firmness his invasions on the rights of the people.

He has refused for a long time, after such dissolutions, to cause others to be elected; whereby the Legislative powers, incapable of Annihilation, have returned to the People at large for their exercise; the State remaining in the mean time exposed to all the dangers of invasion from without, and convulsions within.

He has endeavoured to prevent the population of these States; for that purpose obstructing the Laws for Naturalization of Foreigners; refusing to pass others to encourage their migrations hither, and raising the conditions of new Appropriations of Lands.

He has obstructed the Administration of Justice, by refusing his Assent to Laws for establishing Judiciary powers.

He has made Judges dependent on his Will alone, for the tenure of their offices, and the amount and payment of their salaries.

He has erected a multitude of New Offices, and sent hither swarms of Officers to harass our people, and eat out their substance.

He has kept among us, in times of peace, Standing Armies without the consent of our legislatures.

He has affected to render the Military independent of and superior to the Civil power.

He has combined with others to subject us to a jurisdiction foreign to our constitution and unacknowledged by our laws; giving his Assent to their Acts of pretended Legislation:

For Quartering large bodies of armed troops among us:

For protecting them, by a mock Trial, from punishment for any Murders which they should commit on the Inhabitants of these States:

For cutting off our Trade with all parts of the world:

For imposing Taxes on us without our Consent:

For depriving us, in many cases, of the benefits of Trial by Jury:

For transporting us beyond Seas to be tried for pretended offences:

For abolishing the free System of English Laws in a neighbouring Province, establishing therein an Arbitrary government, and enlarging its Boundaries so as to render it at once an example and fit instrument for introducing the same absolute rule into these Colonies:

For taking away our Charters, abolishing our most valuable Laws, and altering fundamentally the Forms of our Governments:

For suspending our own Legislatures, and declaring themselves invested with power to legislate for us in all cases whatsoever.

He has abdicated Government here, by declaring us out of his Protection and waging War against us.

He has plundered our seas, ravaged our Coasts, burnt our towns, and destroyed the lives of our people.

He is at this time transporting large Armies of foreign Mercenaries to compleat the works of death, desolation and tyranny, already begun with circumstances of Cruelty and perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the Head of a civilized nation.

He has constrained our fellow Citizens taken Captive on the high Seas to bear Arms against their Country, to become the executioners of their friends and Brethren, or to fall themselves by their Hands.

He has excited domestic insurrections amongst us, and has endeavoured to bring on the inhabitants of our frontiers, the merciless Indian Savages, whose known rule of warfare, is an undistinguished destruction of all ages, sexes and conditions.

In every stage of these Oppressions We have Petitioned for Redress in the most humble terms: Our repeated Petitions have been answered only by repeated injury. A Prince whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a free people.

Nor have We been wanting in attentions to our British brethren. We have warned them from time to time of attempts by their legislature to extend an unwarrantable jurisdiction over us. We have reminded them of the circumstances of our emigration and settlement here. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred to disavow these usurpations, which, would inevitably interrupt our connections and correspondence. They too have been deaf to the voice of justice and of consanguinity. We must, therefore, acquiesce in the necessity, which denounces our Separation, and hold them, as we hold the rest of mankind, Enemies in War, in Peace Friends.

We, therefore, the Representatives of the united States of America, in General Congress, Assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by the Authority of the good People of these Colonies, solemnly publish and declare, That these United Colonies are, and of Right ought to be Free and Independent States; that they are Absolved from all Allegiance to the British Crown, and that all political connection between them and the State of Great Britain, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. And for the support of this Declaration, with a firm reliance on the protection of divine Providence, we mutually pledge to each other our Lives, our Fortunes and our sacred Honor.

I know, suddenly it’s all health care all the time with me. But the Medicaid Expansion was completely off my radar, and I’m learning. It’s also suddenly more of a state issue than it was before the Supreme Court decision because the court made the expansion much less compulsory.

The Urban Institute has a helpful paper (pdf) on how failure to adopt the expansion would affect health care for people making 138% of the federal poverty level or less. The scheme of the health care reform bill pretty well assumed this expansion of the Medicaid system. So, in those states that opt out, there are some pretty dramatic holes. Apparently those at poverty level up to 138% might be eligible for some subsidies if the extension isn’t adopted. But people below the poverty level but not eligible for Medicaid under the current scheme are in bad shape.

They give some numbers for Indiana: 410,000 below the poverty line; 108,000 between the poverty line and 138% of the poverty line; 517,000 affected by the Medicaid expansion; 947,000 uninsured and 54.6% of the uninsured are potentially Medicaid eligible under the expansion.

Christine Vestal, writing for Governing’s Stateline blog, discusses the likelihood that Medicaid expansion would ease the cost of providing medical care to inmates.

Typically inmates do not qualify for Medicaid. And, until somewhat recently, simply being incarcerated was a reason for disqualification. (“The reasoning was that states and local governments had historically taken responsibility for inmate health care so the federal-state Medicaid plan was not needed.”) The fact of incarceration was eased as a reason for disqualification in 1997, but, in its current form, most inmates don’t qualify for Medicaid anyway. “That’s because all but a few states limit Medicaid to low-income juveniles, pregnant women, adults with disabilities and frail elders.”

That would change with the adoption of a Medicaid expansion. As I understand it, most people making under 133% of the federal poverty level would qualify. (About $15,000 for your average, unmarried inmate.) Why would you, as a law abiding citizen, want to pay for the health care of a good for nothing scofflaw? Doesn’t matter – you already are. Under IC 11-12-5-5.5 county jails are required to reimburse hospitals and medical providers for care given to inmates at 104% of the Medicare rate. State prisons are also required to provide medical care to inmates.

This is a big deal and a big expense for jails. You see a lot of people with big health problems coming into jail. Because they lack health insurance (and, to be honest, a lot of other life skills), a lot of times the only treatment they get is in jail. Or, if they have gotten treatment, it is sporadic and they frequently don’t do a good job managing their illnesses when they’re out of jail. See, e.g., this from the Indiana Law Blog about DuBois County:

June 26, 2012 – Monday afternoon, the Dubois County Council met and heard from Sheriff Donny Lampert on a request for a standard appropriation for medical expenses for inmates at the Security Center.

The $150,000 appropriation is a standard amount, but one inmate has racked up a bill of about $80,000 for medical treatment that could not be disclosed due to privacy laws. The inmate is doing better now, but the result is a high bill from an Evansville area hospital.

Neera Tanden, has noted that this sort of dynamic might put a lot of municipal leaders at odds with state leaders who take a dogmatic stand against the federal Medicaid expansion.

Mayors might recognize a “big windfall” for communities in the Medicaid expansion as currently uncompensated local costs born by municipalities begin to be eased with the new Medicaid funds from the federal government. And they might turn against their governors if they see them getting in the way of easing one strain on tight local budgets, Tanden suggested.

In any case, making jails the medical providers or medical insurers of last resort for marginal elements of our society is a horribly inefficient way to deliver health care. I expect a lot of local officials would like to get out of that part of the health care business to the extent possible. Ideological rejection of the Medicaid expansion by state officials might make that impossible.