July 30, 2008

Social Welfare Is A Red Herring: The Return Of Feudalism

The policies sound good, and perhaps they would be, if not for the malignant intentions that motivate them.


I recently received a form letter from Marcia Angell's  socialist federation, "Physicians For A National Health Program," looking for support for government sponsored universal health care.  It cited the usual reasons:

As physicians, we have seen the numbers of uninsured and underinsured soar, costs skyrocket, and quality deteriorate.  Meanwhile, doctors drown in a sea of bureaucracy.

Etc.  Ok, valid if not hyperbolic points.  But that's not why she wants single payer insurance.

Only single payer would eliminate the high corporate overhead, profits, and enormous inefficiencies...
The stated reasons include reducing corporate profits.  That's not a byproduct, or a necessary result, it is a reason for doing it.


Another example I've used before.  NPR was interviewing someone over a year ago about the high price of oil (ha!) and she asked the guy how to reduce the price, and he said he actually hoped the price would go higher,  because it would curb use, decrease carbon emissions, force alternative energies to be explored, etc.  Great.  Her response, however was: oh, ok, and decreasing demand would be another way to hit oil companies where it hurts.

Get it?  That's where she was standing, lowering prices might be good for the consumer but she didn't bother to say that.  What was on the tip of her tongue was the need to punish oil companies.  This woman is not stupid, she's not unaware of the complexities of energy policy-- but where her mind went immediately was how we can hurt oil companies.  It wasn't incidental, it was absolutely vital that this happen.


In the British Times Higher Education is an article by a Harvard professor lamenting the decline of the American student.  Here's the table of contents blurb:

The banality and sense of entitlement of rich students at Harvard left John H. Summers feeling his teaching had been degraded to little more than a service to prepare clients for monied careers.
It laments the student privilege, grade inflation, consumerist attitudes, and the like.  But that turns out to be only a minor gripe.  What really got him:

Most of the students I encountered had already embraced the perspectives of the rich, the powerful and the unalienated, and they seemed to have done so with appalling ease.
He goes on to describe and deride this perspective, but when he chooses to cite an example-- you expect him to say something like "they urinated on homeless people" or "voted for Bush"--  he chooses this:

One of my less affluent students, the son of a postman, asked me once for advice about a financial investment.... I told him what I thought about this recommendation; but only later, when I learnt how little he had to invest ($2,000 was his total savings), did I allow myself to think I understood the significance of his question. No amount of money may be permitted to lie idle if something may be got for nothing.
This Harvard professor is angry that the guy wanted to invest.  Period.  "Something for nothing."  Do you understand? 


I suppose I shouldn't be surprised-- this nut was also angry that Harvard wouldn't let him teach a class he named, "Anarchist cultural criticism in America"-- but the main point is that this guy, the NPR interviewer, and Marcia Angell are certainly not the underprivileged.  Their resentment against the system isn't supposed to be this visceral.

That's why the social welfare angle is a red herring.  It's not that they want better services for the underprivileged and hurting the rich is the byproduct; it's the opposite, hurting the rich is the emotional, primary motivator, and the rest is an intellectual posture that rationalizes this resentment.  This is why it's dangerous.  That's why you can't side with them even if you agree with their policies.  Intention matters.  

Ex-Marcia these three may not be rich, but this amount of public hate and open vitriol are not expected in a properly functioning classless society.

Which simply means it's not properly functioning.  Nothing new there, except for this: it is properly functioning.  What's not working is the perception.

Summers is angry because he doesn't feel he could plug into the capitalist system, even though, obviously, he could if he tried-- the postman's son certainly is, with far less money or knowledge than the professor.  So it's not the reality, it's the perception, but perception, confidence, is what this society is based on.  Consequently, the system is failing. 

The analogy is a bank run.  As long as people think the bank is solvent, then it actually is.  But if enough people think it isn't, then it actually becomes insolvent.


So the question that needs to be answered is, "what went wrong that ordinary Americans hate people they perceive to not be in their class?"

First, education.  From grade zero through college, you are told you belong to a class.  Let's use the simple example of money:  if you're an engineering student they'll tell you how to be an engineer, but no one anywhere tells you how to be a rich engineer.  No one even tells you it is possible.   If you go into the humanities, the expectation is you'll be "poor."  Your future is defined by its limitations, not possibilities.  "You won't starve, but you certainly aren't going to be rich."   Really?  Are we still in America?   It seems to occur to no one to try to teach humanities students how not to be poor. 

You're choosing a major and a lifetime social class. There's no fluidity-- they teach you, day one, pick your life slot.  Good luck changing your mind in twenty years.

I'm not saying they should explicitly teach you how to be rich-- I'm saying they shouldn't teach you to expect to be in a slot.

Worse-- and I have seen no one anywhere make this observation, the most important one of all-- there is no generational perspective on advancement.  At no point in K-16 is there even the subtlest suggestion that you should make something of yourself so that your kids can go further than you.  Not as a byproduct, but as the actual purpose of all this education.  No: the whole thing is about you.

Certainly people want their kids to do well, they put them in violin lessons, but what is missing is this explicit mantra:  they need to go further than me.  If you're a doctor reading this, answer honestly: you've mused about whether you want your kid to become a doctor or not, but do you expect them to be more than that?  Not equivalent-- e.g. lawyer-- but more?  Are you raising them for more, or the same?

Here's a word you will never hear taught as a goal: dynasty.  No.  What they teach you is feudalism:  here's your fief, bring me homage.

It's not totally the parents' fault: the entire system, education and onwards, has grossly diminished expectations of its people and encourages, necessitates a self-focused, ahistoric worldview.  They want you to plug into the Matrix, and then die.  When you do, return all your stuff, someone else will use it.

Second, of course, is psychiatry. 
If you think of psychiatry as Zoloft, you're missing its scope.  Psychiatry and culture are the same.  It backs it, it supports it, it helps set expectations and values.  It was more obvious with Darwinism or Freudianism because those were clearly articulated theories you could put in a book; psychiatry is more nebulous, but it is no less powerful a cultural force.  Here's its mission statement: "you are different.  And we will try hard to get you back up to the level of almost normal, but, state of the art, that's about as good as we can get." 

But psychiatry doesn't just reduce expectations for humanity, it diverts attention away from real expectations, onto a pointless biologic outcome.  If it really wanted to help, say, foster kids, it would say, "what are the ways we can actually change their lives?  Options: we can send them to big orphanages with skill immersion programs; or we can spend a trillion dollars and give them all individual tutors/case managers to follow them every day, etc--"  But since it can't have this complex debate, because it requires way too much money, it shifts the expectations to "managing symptoms."

The classic counterargument to my position is: you may be right, but psychiatry is better than nothing.

Yeah, so was your first husband.   "Better than nothing" is almost always worse than "nothing."  Defaulting to psychiatry legitimizes not pursuing actual solutions.

The patient is bleeding, your solution is to mop up the bloody floor so it doesn't look as bad.  How long will this work?  At what point do you become so deluded by the system that you think the "real" solution is better mops?


Absolutely stunning. Thank ... (Below threshold)

July 31, 2008 3:08 AM | Posted by demodenise: | Reply

Absolutely stunning. Thank you.

I have an argument somewhat along these lines frequently with my social work professors. It is apparently impossible to be a social worker without a) being poor and b) absolutely despising anyone who is *not* part of the severely oppressed. I'm constantly amazed at how much anger and resentment is part of a profession that is supposed to be about acceptance.

No, I take that back. I'm not amazed, I'm appalled.

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I'm not sure I agree with y... (Below threshold)

July 31, 2008 3:43 AM | Posted by Jade: | Reply

I'm not sure I agree with you about the causes of this jumbo mess, but for the final paragraph: thank you.

The patient is bleeding, your solution is to mop up the bloody floor so it doesn't look as bad. How long will this work? At what point do you become so deluded by the system that you think the "real" solution is better mops?

It "works" until the patient is dead. No more problem. How does a human being get to the point at which appearance of lack of a problem is as good as fixing an actual problem? I'd love to know the answer to that.

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If these people simply hate... (Below threshold)

July 31, 2008 2:09 PM | Posted by Oliver M: | Reply

If these people simply hate the rich, why did The Pursuit of Happyness make 300 million dollars? Sane people don't resent the rich, they resent that the gap between the rich and poor is widening. Supporters of single payer health care are usually trying to help the poor, not trying to hurt the rich.

You ignore the fact that there are legitimate problems with the current capitalist system. Oil companies cause immense environmental damage without compensation for those affected, and are making record profits as people are suffering the effects of higher fuel prices. You may disagree on what the best system would be, but having differing opinions does not mean that every detractor is as crazy as the Harvard professor. However, you do make a good point about education slotting people into a class, and about "better than nothing" solutions distracting from real ones.

Alone's response: I'm not saying they hate the rich-- Angell is rich!-- but they are resentful of some abstract "other" that they can't be a part of. Though I do think the Harvard prof is a nut, my real issue with him was how he, an educated, worldly person, could be so disgusted that the postman's son was looking for a shortcut to wealth. The prof wanted him to go through the system step by step-- a system the professor controls. The student might want to be a lawyer, but if the professor doesn't think he's good enough (in his class) he'll be able to grade him poorly-- he can control the destiny of this student. But the student found a loophole in the system. The prof wants a quasi-meritocracy based on his values. The kid is opting out.

All of this resentment is about power differentials, that's why the Harvard and Angell examples are so important. These are not weak, oppressed, underprivileged people-- they have considerable power in certain fields, but in other things they have absolutely no power-- and these other things encroach on their territory.

So that there are legitimate problems with this current capitalist system is _exactly_ my point. These power differentials should not exist-- indeed, many times they actually don't exist-- but they are perceived to exist, and that's what needs to be fixed. The perception of social and economic fluidity is vanishing. In a properly working capitalist system, the Harvard prof would encourage the student's investing; he would not be resentful if he succeeded; he would still try to educate the kid the same way regardless of his position-- all because (if things worked correctly) he would believe that he CHOSE his position as Harvard prof with X salary, and is thus satisfied with it. But he feels he "chose" some other lifestyle that he didn't get-- that his value system isn't shared by society and din't reward him sufficiently. Hence, resentment.

To illustrate this, look at it the other way: do Harvard students have to hide who they are, their hopes and aspirations, from professors because they could be resented? If they do, then the entire educational system is completely broken.

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From Physicians For A Natio... (Below threshold)

July 31, 2008 2:54 PM | Posted by David Johnson: | Reply

From Physicians For A National Health Program you quote: "Only single payer would eliminate the high corporate overhead, profits, and enormous inefficiencies...." And then, quite magically from a logician's point of view you conclude: "The stated reasons include reducing corporate profits. That's not a byproduct, or a necessary result, it is a reason for doing it."

Let's move to another quote from the same organization:

The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 47 million without health coverage and millions more inadequately covered.

This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.

Is this too emotional for you? Because later on in your article, you declare:

That's why the social welfare angle is a red herring. It's not that they want better services for the underprivileged and hurting the rich is the byproduct; it's the opposite, hurting the rich is the emotional, primary motivator, and the rest is an intellectual posture that rationalizes this resentment. This is why it's dangerous. That's why you can't side with them even if you agree with their policies. Intention matters.

I'll disagree, calmly, of course. I wouldn't want to get too overheated, deny the feudalistic paradigm and be accused of hyperbole. For over 47 million people who are uninsured and for the legions who are underinsured, intentions may matter. But ultimately, in the real world? Results matter more.

I encourage people, dispassionately of course, to at least explore the Physicians For A National Health Care Program, at http://www.pnhp.org/. Contempt prior to investigation would be ... unduly emotional.

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I'm tired of this "oil comp... (Below threshold)

July 31, 2008 3:29 PM | Posted, in reply to Oliver M's comment, by Nick C: | Reply

I'm tired of this "oil companies making record profits" argument. Its complete BS and shows a slanted economic view. Oil companies are making almost the exact same % profit as they were 10 - 15 years ago. The only difference is that gas costs more. 15% of a dollar is 15 cents, 15% of 4 dollars is 60 cents. It quadruples their profit but not because they are "screwing us" but because the commodity is more costly.

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My argument was crudely sta... (Below threshold)

July 31, 2008 9:34 PM | Posted, in reply to Nick C's comment, by Oliver M: | Reply

My argument was crudely stated, so let me state it more clearly. There's nothing intrinsically wrong with profit, but since oil companies are making four times as much profit in absolute terms, they could lose 3/4 of that and be no worse off than before. Oil companies aren't going reduce profits on their own, but reducing consumption is a good way to convince them to lower prices. Therefore, it is possible to be both rational and to resist oil companies. If there's any economic bias in the above, I'd be grateful to know.

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Interesting piece. I think ... (Below threshold)

August 1, 2008 9:07 AM | Posted by Sally: | Reply

Interesting piece. I think people don't realize that the "insurance bureaucracy " is such a huge supplier of employment in the US that doing away with it would cause more harm than good. I take the health care debate in a different direction. No mandatory insurance, no mandatory health care. The expense of health care comes to a large extent from the beefing up of insurance premiums.

It’s simply shocking how many US folks think that mandatory health insurance is a good idea, who don't get the fact that what they want is health care not health insurance. Few people balked at John Edwards serious suggestion that citizens be legally compelled to have an annual physical which would essentially give doctor’s recommendations the force of law because if you’re legally compelled to have health insurance and the doctor says you have to lose weight to keep your policy, or take anti depressants or have the knee replacement or whatever, the insurer will be able to cancel you if you don’t do these things, but in a mandatory insurance state, it’s illegal to be canceled…and I bet a lot of folks can’t see the problem with this.

As for the bleeding patient analogy: “The patient is bleeding, your solution is to mop up the bloody floor so it doesn't look as bad. How long will this work? At what point do you become so deluded by the system that you think the "real" solution is better mops?”
Excellent way to make your valid point, but I’d add that psychiatry will take a patient bleeding from a gunshot wound, not suture the wound, give him a drug to slow bleeding but with the side effect of grand mal seizures, and claim that the drug is to stop him from exploding from the inside, completely denying the gunshot wound.

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The resentment--or anger--i... (Below threshold)

August 1, 2008 11:06 AM | Posted by Alex H.: | Reply

The resentment--or anger--is natural, if you believe that the rich have unjustly received a larger slice of the pie. While I don't particularly want to punish the rich (my income level probably puts me in that category, from the perspective of many Americans, even though my net worth remains less than zero), I entirely understand where that sort of thirst for justice comes from.

Ideally, of course, we could improve the welfare of the least privileged while maintaining the welfare of the richest, but the fact is that while it may not be a zero sum game, there are trade-offs to be made. One of those trade-offs is the amount of profit the health care industry can support. The mix of money and medicine is already a moral morass--how much is human suffering worth?--but when children are dying from curable disease and health care companies are making record profits, a bit of anger, and yes, a desire to punish, is not unreasonable.

The extension to oil companies is a telling one. Anger over the increased profits of oil companies (and yes, those profits have increased substantially, even if the *margin* has not), is because those profits are subsidized by American taxpayers, and because they are provided inexpensive access to drill in areas that we control as a polity. They drink our milkshake! Yes, under those conditions, people have a thirst for justice.

Wanting social justice and equal opportunity to access food, shelter, and health care doesn't make you anti-capitalist. It demonstrates that you understand the limits of capitalism; that "externalities" are sometimes pretty core to who we are as humans.

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I thought this was a great ... (Below threshold)

August 2, 2008 1:14 AM | Posted by Chris: | Reply

I thought this was a great article. It points out how the current education system and parents are not fostering the right education in our children. This leads to many people feeling, "I'm stuck..." Whether their stuck with their careers, their families or their lives, they feel powerless to change things. This is, in fact, wrong. Everyone has the power to change their lives. Just this knowledge should increase their feeling of control and well being.

I was lucky enough to have two parents who gave me different, and complementary, messages. My father taught me that, barring the laws of physics, I could achieve anything I wanted to achieve. I could be anything I wanted to be. My mother's words were always, "You want that? Well, what's your plan to get it?"

Because of my father, I learned to paint, taught myself to drum, got an English degree because it was fun and participated in some pretty active sports, even with a heart condition. Because of my mother's advice, I planned my art classes to maximize my time, researched drumming to learn more, got a Technical Writing degree to help me get a better job, and studied my heart condition to determine the best ways to exercise. I planned and did personally satisfying things. I also hope to teach these same principles to my daughter so she can create a vision for her life and follow through with it.

Now, I don't blame "Big Oil" or "Big Pharma" or "Big Medicine" or even "Big Government" for me being middle class. I purposely chose this life. I looked at what it took to be really rich, to be a high priced lawyer or doctor, or a dazzlingly successful salesman. I determined that the sacrifice it takes to earn these goals was, for me, not worth it. And that's something I think our education system and parents are not teaching. Everything in life requires a sacrifice of something else.

If you want lots of money, it usually involves large chunks of your time and effort to get them. It may also require a monetary investment to achieve. You cannot expect something for nothing. You have to plant the seed now if you want to see the oak tree in 50 years. But it seems people forget this and expect things to just show up because they want them. How silly is that?

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To the gentleman who wrote ... (Below threshold)

August 2, 2008 10:34 AM | Posted by Kevin: | Reply

To the gentleman who wrote the following:

…psychiatry will take a patient bleeding from a gunshot wound, not suture the wound, give him a drug to slow bleeding but with the side effect of grand mal seizures, and claim that the drug is to stop him from exploding from the inside, completely denying the gunshot wound.

This is, regrettably, fair criticism of my profession. However, I must admit that I do get defensive with I hear such remarks. The accusation that we don’t “suture the wound” – I interpret this as a suggestion that we don’t treat the root causes of symptoms patients present to us with. Fair enough, but I would ask the person who posted these remarks: “What is the root cause of [insert psychiatric illness]?”

”…completely denying the gunshot wound.” ?

Not hardly. Even the mediocre psychiatrists I know would admit that we don’t know -- and thus can’t treat -- can’t treat the root cause of, say, Bipolar Disorder. What we’re doing is the best we can. Prescribing medications with admittedly dangerous side effects is done (ideally) after painstaking risk-benefit analysis. And if such medications are prescribed, it is done with careful and diligent monitoring. Now, psychiatry hasn’t learned the root cause of any illness since…I don’t know…neurosyphilis (?) When that cause was determined, physicians abandoned previous their previous treatments with haste. You see, when we can see the gunshot wound, we’ll treat it most hurriedly. Unfortunately, we can’t see most gunshot wounds. More than likely, when we do begin to see these, there will be more than one. Taking the analogy further, what we’ll probably see in, say, the “Bipolar” patient will be gunshot wounds, knife wounds, some fragmentation wounds…and all these wounds will be in various stages of healing – some fresh, others mere scars. In addition to these wounds inflicted from the environment, we’ll probably also see evidence of systemic illness, perhaps a rash.

So, the criticism is fair. However, what would be more helpful than arm-chair quarterbacking would be for the critics to enroll in grad school, don lab coats, and join the effort to gain further understanding of mental illness.

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It seems to me that you are... (Below threshold)

August 2, 2008 4:27 PM | Posted by Anonymous: | Reply

It seems to me that you are attacking the motivation of doing something (helping to create government sponsered health care).

It is my personal belief that, doing something nice and then feeling good about it uses little brain power, making sure what you've done is good is not enjoyable. Thinking that you've put forth effort and not done what feel you've done is a horrible thing. Imagine working hard to give someone a present only to have them look you over and give an impaitent and resentful sigh. Would you want to give them another present? Where as if you are competing against someone "evil" to give away more presents, you really won't care about the present getter's reaction because you are concentrating on hurting/winning against your opposition. And well, if you really do end up doing good, isn't that the main thing?

Now help me define good ...

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The rich aren't always evil... (Below threshold)

August 2, 2008 11:46 PM | Posted by Stan Stammerson: | Reply

The rich aren't always evil, though I would naturally suspect, if they manage to make that much money, chances are they are performing some evil. Tricking people to buy products they don't need, to get rich, is effectively evil, and the companies at fault owe the public for damages.

The issue being, our lifetimes aren't necessarily long enough to assess the exact source of the damages, with so many sources out there getting rich by killing us (via any undiscovered cancerous preservative agent, FDA approved after ~10 years hormonal treatment, or addictive dependency creating product (even taurine)). They are successful because they can always blame something else. The "you can't prove it was us alone" factor doesn't prove innocence yet its accepted as such... and so they all get away with it.

There is no rich entity worth trusting in the world (generally). There should be active forces that dismantle and destroy big powerful unstoppable companies, and they don't really exist. There is probably more money destroying them, but chances are, anyone influenced by money, will do the wrong thing, and get bought out.

Powerful companies can buy out the best of the poor's intentions, and not even feel it in their pockets. The big companies can always crush the little guy, when yearly income is upwards of 100x larger. There is no active cooperation, agreement on who has to go or what is worth saving, and big corporations thrive on public confusion, disharmony, disorganization.

Saying everything big has to go is crazy (they would say), but pretty much anything big that isn't digital can't be trusted, and even digital companies will sell you nothing for something.

The advertising alone is sickening, how stupid they must think we are to fall for this nonsense, yet we may find ourselves buying it anyway. Getting a good deal doesn't mean you have to say good things about it, unless the company is worth saving, yet casually we slip, mention a name, and the branding ensues.

They aren't paying you to advertise, and you say the name, or so much as think it, you are working for them. Is there anyone who isn't owned? To say this country operates in a state of psychological stability is an understatement. We are in a state of psychological manipulation and control. To watch commercials, is equivalent with being attacked, invaded, marginalized, and packaged with a product, of dubious value.

The rich are simply too good at it, and it's Convenience alone, (psychological or physical, whether healthy or not), that serves as the Achilles heel of the poor who are working all the time (and consequently, may not have time left to think for themselves). I don't think its unjustifiable to hate the excessively huge that lack social consciousnesses of their own, or regard for who they hurt, if all it takes a is another buck to get past their concern.

Whether its healthy to Hate or not, is questionable, but i don't think its healthy to love the ones that are out to get you, and if you can't love them, and you can't ignore them (because they will get you), then hate is all that's left. There is no peace until they are gone, but then only to get replaced by someone else, and so the cycle of corporate destruction must continue. If you think about it hard enough, the differences between a big company and a government are relatively non substantial. Are not all companies subsidiaries of the govt?

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Without attention to basic ... (Below threshold)

August 3, 2008 11:26 AM | Posted by Diane Abus: | Reply

Without attention to basic social justice the "west" loses its moral authority .Surely respect for polity and public health care for all would be sensible equalizers in America.I appreciate the point.

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Thanks for sharing those st... (Below threshold)

August 4, 2008 11:50 PM | Posted by Chui: | Reply

Thanks for sharing those stories. I believe this sense of hatred comes from the American dream itself. A dream that promises any one who tried hard enough that they would be able to progress above the stations one is born in. Failure to achieve the heady goals seen on the media leads to one of two conclusions: that one is a failure, or the rich had cheated.

The proper treatment for this delusion is to remind people not everyone is born with good looks, good connections, or good parents. Opportunity is unequal. There will always a primeaval urge to take the rich down a rung-or-two, but it is not always helpful to one's cause.

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No. I am not saying the... (Below threshold)

August 5, 2008 1:41 AM | Posted, in reply to David Johnson's comment, by Alone: | Reply

No. I am not saying there aren't good reasons to have, for example, universal healthcare. And high overhead, huge numbers of the uninsured are all good reasons. What I am observing is that one of the explicitly stated motivations for doing these things is reduction of corporate profits as an end in itself. Why is that legitimate?

Now, a fair retort is that in politics reasons don't matter, what matters are outcomes. Ok, I grant it. But it is still a fact that she wants corporate profits reduced-- again, not as a byproduct, not in the service of something else, but explicitly for its own sake. What I want to know is why she feels that way.

Finally, the the commenters who observed that the poor have legitimate reasons to resent the rich, matters of social justice, etc, you are correct. But Angell is not poor, she is rich. That's the key. She can want, say, income redistribution, she can be an all out communist, but for her to _resent_-- to feel it deep inside her-- that speaks to something else.

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People only think they want... (Below threshold)