One man's ceiling is another man's floor . . .

And your taxes are my income. Massachusetts has typically weathered recessions a bit better than many states because we have a bigger than average health care sector, which has just kept on growing through hell and high water. Not so much this time.

On the one hand, I've been ranting and raving ever since I've been doing this blog thing (BTW this is my 2,007th post, I didn't even notice the 2,000th) that our medical industry is too large and much of it is waste. That's still true but that waste is also income for people -- medical underwriters need to eat. And those anesthesiologists making the 300K employ a lot of nannies and gardeners as well as keeping the Mercedes Benz dealer in business.

BUT, the contraction we're feeling right now isn't actually such good news, because it isn't accompanied by a rational re-allocation of resources. People who are avoiding appropriate medical services because they can't afford the co-pays, or can't find a physician who will accept Medicaid, aren't making us better off in the long run. Massachusetts has few people without insurance, thanks to Romneycare, and I doubt that whatever effect the recession is having on undocumented people has much of anything to do with the aches and pains of the health care industry. So yeah, there is probably a little bit of efficiency and beneficial belt tightening by the highly paid going on here. But without radical reorganization and reform of payment policies we aren't going to get a better, cheaper industry, we'll just get more injustice.

However, if we do ever achieve those radical reforms (not that I'm holding my breath) we will have a substantial workforce whose skills and experience are made obsolete, including many wealthy executives. This why it is so difficult to achieve meaningful social change in a democracy. All of us may have some interest in reform, but most of us are a) unlikely to understand our real interests and b) even if we do, reforming health care isn't going to be the most important thing in the world to us so long as we do have decent access.

But the people who would be out of work, and the rich people who might actually have to find honest work for the first time, care a lot - more than they care about anything. And they will donate to candidates, buy attack ads, and pay for massive disinformation campaigns if they must in order to protect their sinecures. That's political science.