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Our Unhinged Debate on Health Care Reform

Or, Large Majorities of Americans Support the Specific Reforms Obama Is Proposing, But the Debate Going On Now Has Confused Them Into Opposing It

[digg-reddit-me]Andrew Sullivan provides a pretty good summary of the policy questions at stake in the health care debate – slightly modified by me to make it a list:

  1. Should we demand that insurance companies provide policies to anyone regardless of pre-existing conditions?
  2. Should we help the working poor buy that insurance with subsidies?
  3. Are competitive exchanges for health insurance a good or bad thing?
  4. Would a public option or a co-op help bring down healthcare costs?
  5. Does it make sense for the government to study the effectiveness of various treatments as a guide for doctors?

These are the basic questions Democrats are trying to answer. The only real presumption Democrats made in creating these policies is that the government can be effective. The proposals on the table now are modest – tinkering even – in which market mechanisms, government regulation, and a government plan together are designed with three goals:

  • to provide more security and choice to those Americans already covered by banning abusive insurance company practices and allowing individuals to buy insurance on a health care exchange;
  • to institute certain incentives that will hold down the growth of health care costs – using market mechanisms in the Health Insurance Exchange, spreading information with the Independent Medical Advisory Committee, and with the public option;
  • to cover the 47 million Americans without health insurance (whose use of health care, which we already provide as a matter of right, creates a de facto $1,100 tax on each individual).

The various bills under consideration are so long and complicated because they attempt to make slight adjustments to the system we have – and to remain true to Obama’s promise that if you like your health insurance you can keep it.  They prohibit certain practices by insurance companies, they set up a Health Insurance Exchange, they may or may not allow citizens to choose a publicly run health care plan, they subsidize individuals who currently cannot afford insurance, they set up committees to study best practices. What they certainly do not do is attempt radical change.

This isn’t about the free market versus communism, or radicalism versus moderation. The anger at Obama’s health care reforms has little to do with what he or other Democrats are proposing. There are those with reasoned objections. But the Republican Party has instead embraced and encouraged the inchoate rage of people frustrated with the direction our country is headed, with the various moral dilemmas George W. Bush left for his successors, with the massive failure of the markets that caused our current recession, with the failures of the visceral politics and policies of George W. Bush. On Slate’s Political Gabfest today, this exchange captured pretty well the essense of the hyperbolic debate going on now:

DAN GROSS: In college, we had the primal scream where at a point in time people would open their windows and just yell randomly. It was done to relieve stress but you weren’t yelling a set of statements about how your workload was too high. You were simply yelling. And it strikes me…that the things they are yelling are not the reasoned case for doing health care reform in a different way. They’re saying things like, “Let’s take our country back!” or “Lies, lies, and socialism, communism, fascism.”

JOHN DICKERSON: Yea – it is a sort of Tourette’s of the political…

I want to repeat that there are reasoned cases to make against the various policies Obama is proposing – but aside from an odd blog post by a libertarian economist every now and then, I don’t see them made. Instead, we get the approach Jon Stewart described: “You know, the individual mandate is going to hurt small businesses by…aw, fuck it: YOU’RE ALL GOING TO DIE!!!”

That’s what we’re dealing with: cynical manipulation of an inchoate public anger by entrenched interests and the primal screams of a minority of people frustrated with the direction of the country – both of whom are trying to scare the majority into indecision and intimidate the Democrats into submission. Then there are the many – some of whom are wary of action on health care right now; some of whom are concerned about government spending;  some of whom support reform, but aren’t clear on the issues; some of whom are frustrated with Obama’s moderation. Very little of the public debate has to do with the issues addressed above. Instead, we have anonymous lies spread by email, we have right-wing organizations claiming that “Obamacare=Gov’t Funded Abortion and Euthanasia,” we have Sarah Palin claiming Obama would make her son go before an evil “death panel,” we have Senator Jim DeMinto comparing America under Obama to Germany under Hitler, we have people on the streets and in town halls  and on the radio claiming that Obama is instituting Nazi policies, we have protestors deliberately trying to shut down debate (pdf) and silence those in favor of reform. And I’m not cherry-picking the most egregious examples here – these are the tactics used by mainstream opponents of health care reform.

The response and the debate going on now is unfortunately unhinged from reality and has very little to do with any bill being considered. Americans started out in favor of Obama’s health care proposals – expressing support for both him and the policies he had campaigned on. Polling shows they still support the policies: 72% of Americans are in favor of the public option; 74% of Americans believe that health insurance companies should not be allowed to exclude those with pre-existing conditions; 71% of Americans believe that the fact that 47 million Americans are uninsured is a “very serious” problem, with 49% willing to accept higher taxes to cover these individuals. When Obama’s plan was described in neutral terms, 56% of Americans still supported it today (with 38% opposed). But as Obama and Republicans and Blue Dog Democrats all raised concerns about deficit spending and soaring health care costs, many in the public became wary of increased spending. And as Republicans and entrenched interests began to spread rumors of the health care reforms being proposed, Obama’s support dropped.

But now this debate has broken out into the open – and amid  all the accusations of Nazi policies and “death panels” and rationing and socialism! and “killing Granny” the American public can see what is really going on. Republicans will soon learn the truth of Abraham Lincoln’s aphorism:

You can fool all of the people some of the time, and some of the people all of the time, but you can’t fool all of the people all of the time.

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24 replies on “Our Unhinged Debate on Health Care Reform”

I think this piece makes a solid point, although I’d argue that the equivalent frustration, for those republicans following the debate in the media and ‘shouting’ “you’re all gonna die!”, is:

For every “lets take our country back! no socialism!” moment portrayed in the media, there’s a corresponding, and equally-annoying “If you like the coverage you have… you can keep it.” (But what about the possible tendency of the underpriced public option to erode the private market for health insurance?) …”If you like the coverage you have… you can keep it.” (But won’t the pressure of higher taxes force my employer to dump me into the public option?) “If you like the coverage you have… you can keep it.” (But are these lawmakers, who aren’t reading the bill, going to sign up for public health care?) “If you like the coverage you have… you can keep it.” (Are you even LISTENING to me??) “If you like the covergage you have …you can keep it.”

You’re right that this statement – “If you like the coverage you have… you can keep it” – is a bit misleading. Part of the problem with our current health care system – and its rapidly increasing costs – is that almost no one will be able to keep the coverage they have now. Costs are rising too quickly. Obama and other Dems have made this point as well – but have focused on the fact that the plan as it is will not force anyone to change their health insurance despite the various claims to the contrary.

“The possible tendency of [an] underpriced public option to erode the private market” might be an issue. But if that the major concern, then it can be dealt with in the legislation.

What higher taxes are going to force your employer to dump you into the public option? There are various requirements in the bill that would prevent this – or would allow this only if employers provided a subsidy equal to what they were currently paying for health insurance.

As to members of Congress participating in the government plan…they certainly should sign onto the amendment for public relations reasons…but the amendment itself is clearly only designed as a public relations move. It doesn’t require members to participate in the Health Insurance Exchange – as Americans will be able to, which is similar to the plan open to the gov’t employees now – but in the public option which is only one of the choices on that exchange. And it would only require those members who voted for reform to do so. At the same time, they wouldn’t normally be eligible to participate in the exchange initially as members of the a large organization which already offers health insurance.

American’s people support is very important for Obama’s health care and in my opinion only forty five percents people are agree…now what is your next step…

The criticism that somehow a public option would put private insurance out of business is
NONESENSE
We live in a country where public and private options have coexisted side by side for years…giving Americans more options.
Has the Post office put Fed Ex and UPS out of business? OF COURSE NOT
Do you see anyone out there picketing their local post office with placards reading “Down with this Socialist Institution”. OF COURSE NOT
All of us…conservatives and liberals have used the public post office…and Fed Ex.
It just gives all Americans another choice of how we want to send our packages.
That’s good for everyone.
Also remember We have:
public education and private schools
public universities and private universities
public roads and toll roads
public transportation and private transportation
public property and private property
public libraries and private book stores.
pubic hospitals and private hospitals
medicare and private insurance
In every case the public option exists right alongside the private option
Rather than drive private options out of business, the public option
gives all Americans another choice

Time for a public option in health care insurance to give us ONE MORE CHOICE.

Joe,

Re: requirements in the bill preventing employers from dumping ‘ees into the public option: You can fiddle with ‘subsidies’ and the like in the legislation, but none of it prevents the tried-and-true private sector solution when you trap employers between higher taxes and something like a health care ‘subsidy’:

it’s called layoffs.

And re: the changes in the private market for health insurance. It’s not that there won’t BE a private market. There will always be ‘cadillac’ health plans for those who can afford them (just as you can pay $46.50 to get that package to Connecticut by tomorrow via UPS). But if you don’t have $46.50 to spend, you can get in line at the post office, which runs a $7 billion deficit this year, and your package will be there in six to ten business days. That is if your local branch hasn’t closed yet.

What supporters (and maybe Obama himself) don’t get is that it’s not the promised scenario that people are objecting to. It’s the utterly predictable abject failure that will be the execution of this plan in terms of fiscal solvency and accountability. We simply can’t trust a government that can’t run a solvent post office to run a solvent health care option. There are only so many wasteful programs we can support, and here we aren’t talking about letters and packages, we’re talking about lives and costly procedures.

To my mind, this leaves cost-cutting regulations such as competition across state lines and price controls on common procedures as examples of the only meaningful means of reform.

@O’Neil –
I think we agree that this is the core of the disagreement:

…it’s not the promised scenario that people are objecting to. It’s the utterly predictable abject failure that will be the execution of this plan…

I realized this – and tried to acknowledge it, writing:

The only real presumption Democrats made in creating these policies is that the government can be effective.

The ideology that assumes government cannot work is a big part of the problem. The other part of the problem is that many of these same people rely on the government to provide various services (many of which the government does well) – and do not want these services cut.

The government already runs the most popular and most effective medical service in America – the Veterans Health Administration. And the second most – Medicare. And each of these provides much cheaper care than private insurers. Over the 20th century, government has proven to be extremely effective at providing some services; less so at others. And while there are costly boondoggles – it is not as if the private sector is without them. I don’t think the government is inherently superior to private companies. I think it often is less efficient, less responsive, etc. But it is good and effective sometimes at doing some things. On this, most Americans agree.

But isn’t one of the big reasons that medical bills are rising that heath care providers are being underpaid by our current governmental health care payers (Medicare and Medicaid), and have to shift the cost to private insurers — who then raise premiums to cover increased costs? In other words, isn’t a public option going to make this dynamic even worse — shifting more and more cost to private insurers? The results seem ominous. Either premiums for private insurance skyrocket, or private insurance companies join the bandwagon of paying health care providers under cost.

The idea that the post office is not an effect instrument of government is preposterous.The post office is failing because of private companies and the internet !!!! We pay our bills on line ,contact friends and relatives on- line ,receive bank statements online;complain to companies online. We the people are forcing the post office into financial ruin.it’s called progress.We order goods and services and pay for them online. Campaign online , etc.

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