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11/21/2010

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Paul

Bill, Thanks for the response. Just one thing first. I think you put it accurately--and the word choice matters--when you say I was suggesting you were *being* indifferent to the fate of Texan children. I would never suggest that you *are* indifferent. I was just suggesting that perhaps the stance you were taking in your blog post was not necessarily in line with what I assumed to be your ongoing concern for the welfare of the children of Texas.

With that said, I'll just note the slight change in view you have articulated in this last post. In the earlier post, you concluded with:

[1] "It's often said that state-by-state experimentation will lead us, in the long run, to discover and converge on what works best. That won't happen, however, if we are not pursuing the same goals."

In this post, you conclude with:

[2] So perhaps the best hope for persuading them may be having socialized medicine succeed in Vermont.

These conclusions are arguably at odds. [1] suggests that that we should not even make the case to Texans that they *ought* to converge with (for example) Vermont, since their values would not be promoted by such a convergence. [2] suggests that it's OK to engage Texans on this issue, and OK to argue that they're missing something important; it's just that this is likely to backfire because of their liberty concerns, so we should just do our thing in Vermont and hope that Texans later see the light. In other words, [1] seems to make a moral claim against engaging Texans on this issue, where as [2] seems to make more of a pragmatic claim about what kind of engagement with them is likely to "work." Is my reading here fair?

Finally, I think that after I clicked through the links you provided in your first post, and after doing a bit more reading, I see that one argument for refusing Medicaid dollars and dismantling Medicaid in Texas is that everyone who doesn't get employer-provided care would then be eligible for the Federal subsidies for purchases made on the exchange. Although the federal government will pick up most of the tab in the early years of the Medicaid expansion, states are surely right to be worried about the ongoing fiscal pressures imposed by participation in Medicaid. If they can "game" the system by dumping all potential Medicaid-eligibles onto the exchanges, one has to admit that there is a certain logic to that.

Still, at the end of the day, I think I'm much more willing than you are to defend federally-imposed mandates on the states to get their acts together in anticipation of the 2014 exchanges and Medicaid expansion. When concern about these measures are put in terms of threats to liberty, as you suggest they often are, then I am quite happy to take on that argumentative fight. If, as I suspect, a majority and/or plurality of Texans are in favor of warrantless wiretapping and/or indefinite detention, then that gives one all the room one needs to question the basis upon which Texans claim to be worried about the Affordable Care Act. But that's another blog post altogether, I suppose.

Thanks for kickstarting the conversation.

Bill Gardner

Paul,
Thanks for a comment that is both longer and more thoughtful than my original post. BTW, I didn't take any offense at your comment.
I agree with your take on these matters. However, I didn't mean to imply that we _shouldn't_ argue with, say, Tea Partiers. What I think is that there are more productive things to do with my time (did you happen to click through to the post by the Texan doctor? Where would you start?). You are right, however, that my argument shifts across the posts. The spirit of the first was, kind of, "_Let_ them secede, or if not, can we?" Your comment shifted my feelings, leading to the pragmatic argument you read correctly.
I can't write anything about 'libertarians' who defend indefinite detention, torture, etc. I just get too angry.

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