Thursday, August 6, 2009

Healthcare "Debates": Ugly, Non-Substantive

During the Democratic primaries and after the presidential election, many commentators argued that President Obama would do a much better job advancing healthcare reform than Hillary Clinton, whose efforts failed miserably in the early 1990s. Many political observers argued that Obama's graceful style and "unifying" approach would guarantee favorable results. Today, with all of the emotional divisions over this issue, that discussion seems very dated.

While Clinton certainly made missteps during her healthcare initiative, I have always believed that if Obama had an easier time, this would happen because nearly two decades after Clinton's failure, the political landscape has changed significantly. Healthcare costs have continued to rise sharply, which has created the incentive for change among businesses and voters. Also, even though Clinton "failed," government sponsored healthcare expanded, in the form of new programs like SCHIP and the expansion of Medicare. Furthermore, even John McCain included healthcare reform in his political platform. Accordingly, passage of some type of reform seemed inevitable.

Nevertheless, I have also doubted much of the hoopla surrounding the supposed "new left" movement in the United States -- purportedly demonstrated by the election of Obama. On many important social issues, the country remains solidly centrist or center-right. Apparently, voters are divided on healthcare. Although many voters want reform, they are have different ideas about how these changes should look.

In Search of Real Debate
The public desperately needs real debate over these issues. The mainstream media, adhering to its obsession with sensationalism -- has offered utterly weak coverage. For some time now, most of the media coverage has primarily monitored public opinion and discord, rather than discussing the implications of various proposals. As usual, theatrics supplant substance.

I believe (and it seems rather obvious) that many members of the corporate media do not want a public plan option (and certainly not a single-payer provision). Their inability to get beyond this disagreement and engage in actual reporting on this subject has been tremendously disappointing. During the Democratic primaries, members of the media bashed Clinton as a policy wonk -- someone with immense knowledge and intellect but who was boring and uninspiring. Being an academic, I actually find facts, knowledge and intelligence inspiring, but apparently, that makes me an oddball.

The healthcare debates could really use a generous dose of facts and analysis. Instead, the nation's leaders are playing games with each other, and many people are engaging in loud and theatrical protests. I certainly believe in freedom of expression, but passionately expressing an idea does not guarantee that the idea has merit or that it contributes to a debate. It is time for real discussion.


Anonymous said...

Dear Mr. Hutchinson: Good let's get started:

1. Is it no longer an article of faith among progressives that "dissent is the highest form of patriotism?"

2. Many think that national health care is an urgent priority (I don't, for the record.) Why should it be the top priority, compared to, say:

i) The conflicts in Iraq and Afghanistan
ii) The serious economic conditions worldwide, specifically un- and underemployment, and deficit spending.
iii) Gay rights, specifically "Don't ask, Don't Tell" and gay marriage.
iv) The consequences of climate change (I doubt that human caused climate change exists, again for the record)

All four of these issues have serious claims on the nation's attention. Why does health care outweigh them?

3. The President is on record as saying "You can keep your doctor and your health insurance if you like them." Yet his previous statements indicate that he's for a single payer i.e. national health, model. His praise of the current House bill also makes "keeping your own doctor and insurance" unlikely. Rightly so> If you believe that the present health care system is broken, how can you be in favor of letting everyone keep their own insurance and doctor?

3. Senator Tom Coburn has put in an amendment to the Senate version of the bill that would require Congress to give up its present plan and go with the public version Why shouldn't Congress swallow the medicine it is prescribing for the rest of us?

4. Insurance is accepting a comparatively small guaranteed loss (the cost of the premium) in exchange for not having the risk of a catastrophic loss. Once laws dictate guaranteed coverage for pre-existing conditions, it isn't insurance we're discussing, but welfare. How much welfare are we willing to pay for? The flood of people trying to sell their cars to the Feds under the idiotic "Cash for Clunkers" program is instructive---for those who will see.

5. The present proposals are nominally going to provide care to the 47 million who aren't insured. This is going to raise costs. It may be that the new system of coverage will be more efficient than the present "emergency room" vehicle (but if so, this implicitly concedes that insurance isn't necessary, just go to the emergency ward), but the history of saving money by expanding programs is gloomy.

6. In a single payer system, what criteria are we going to use to develop new treatments? Such development is notoriously expensive, not least because so many attempts fail. In the present system, the cost of the failures is borne by the successes. Given that there will be great pressure to save money (see #5) how is the nation going to pay for development of new drugs & techniques.

I see the 4096 character limit on comments looming so better stop. This should get the debate rolling. As that great Prez Ronald Reagan said, "If not now, when? If not us, who?"

Bring on your arguments.

Sincerely yours,
Gregory Koster

Darren Lenard Hutchinson said...

I didn't say that healthcare was the most important issue. It is definitely important, and since we are having the debate, at least have a real debate.

I don't think most people value dissent, until they are in the dissent.

Obama didn't propose a single payer - either in the campaign or during his presidency. Instead, Change.Org and WhiteHouse.Gov have always advocated a public plan option.

As for the question of Congress - I would accept a proposal that allowed people to get more if they paid more. Medicare has shifted to this, in allowing people to use private insurance companies. Maybe that's what members of Congress should do. This is not a paralyzing question for me.

You ask a lot of other questions (some outside of the scope of this thread). They are great questions. I'd rather hear those debated rather than reading about phone tag games, death threats, and awful "us" v. "them" rhetoric.

Aspasia said...

Darren, I find facts, knowledge and intelligence inspiring as well, but then I'm also a university student. Rather sad that most people probably find American Idol more inspiring than those aforementioned attributes.

But speaking of health care, for me this is a number one priority. Even though I am in university, I do not have insurance. I am at a private Catholic school and as such they do not provide free health insurance. And I'm unemployed though even if I did have a job, that doesn't mean I'd have insurance or the ability to pay for it on my own. Furthermore, I would be too old to be covered by my parents, though they are both on MedicAid/MediCare or VA insurance anyhow. They were both laid off and then forced into retirement by health issues. I haven't been able to see a doctor in about seven years. When I was at college the first time (10 years ago), I tore four ligaments in my left ankle and went to the emergency room.

Though I was covered by my father's insurance, even 800 miles away because I was in college and 20 years old, the company refused to pay that expense. My parents had to pay out of pocket. That was the last time I saw a doctor. It's scary not having insurance and going so long not being under a doctor's care.

So, no Gregory, health care isn't as important as some of those issues you named. However, there are millions in my position. We can't have a nation full of sick people and since we always hear that people are but one accident away from a disability, this is a priority too. And why do critics of single-payer (which is NOT what Obama is endorsing) always ignore France, who has the best health care system in the world?

Inspector Clouseau said...

As a practical matter, this country lacks the ability to address healthcare (and for that matter ANY problem), in a focused, direct, and coordinated fashion. It is also incapable of really planning much of anything of real value, at least not at this point in time. That type of activity does not fit within our governance model.

What you see here is an example of what happens when ANY entity is run by committee. We've known that as a society for a long time.

Our governance model is a “herding cats” governance model, where we let people and the entities they form have the freedom to do most of what they consider to be in their best interests, and we hope that it will also be in society's best interests.

Sometimes that works for us, and other times it doesn't. It will never yield consistency in approach, effort, and results. For us to think so is delusional in nature.

We (as a nation) lack the ability to rally around anything, unless it is perceived as An imminent threat to virtually all of us, and that's not going to happen often. And so we become self-absorbed in thinking about our own personal, close to home minutiae.

There are some positive and negative ramifications associated with ANY alternate approach we might pursue, and the yelling and screaming will always loud and raucous.

As George Will often says, there is the "inertia" which is Washington. There is also the "inertia" which is the U.S. and its constituent parts.

Although this approach has served us well for most of the last 110 years, from a theoretical perspective, one has to wonder how long we can govern ourselves using the "herding cats” governance model, in light of our increase in size and complexity of our citizens.

If the US were run like a business, then every single day, its management team would assess whether its goals are being attained, bust their butts to achieve those goals, ensure that it was getting the maximum value and productivity out of those working for it, and make on the dime changes to most effectively and efficiently reach those goals. In other words, be nimble.

This country is not nimble, and can not be.

I’m not advocating a particular change, either left or right; just the recognition that EVERY governance model has its limitations, and this one is no different. However, for us to think that we can continue to use it and not have negative periods and poor, inappropriate responses to problems, is not reasonable. A country needs to know its limitations.

Aeneas said...

Well said!

Especially, we first need to have facts and truth about what's in that bill. Only that can we truly say 'this item is what I want; this item I do not like or want; this I understand why is needed; etc.' I consider myself one of the more involved and interested in the public (ahem, one of Boxer's well dressed great unwashed masses) out there. Therefore, I listen. But when the President says that he doesn't know details, and the Senators have no idea, Sibelius says that she doesn't know because she's not writing it, then I shut down and I don't even listen. At that point I have made up my mind, and the credibility gap has grown to wide to cross.

As for Mr. O's grace and cool--grace has become glibness and cool a strange sense of being incurious.

Decidere said...

Well as Bob Somerby keeps pointing out, we pay twice as much for health care as other similar industrial countries. Much/most of our health care is subsidized by direct socialized medicine and tax exemptions for corporate-paid healthcare. We should be able to make the costs go down on this nonsense even while increasing enrollment, but for a nation that gave George Bush 90% approval at one point, I'm not holding breath.

For GK, 6) our current drug development program doesn't favor breakthrough drugs, it favors copy cats and moderate improvements, 5) if you have non-emergency room care, you're less likely to abuse emergency room care, which is usually a pain and lengthy and inconclusive, 4) life is a pre-existing condition. To misquote Dylan, we're all busy dying. One big reason to change the system is that it's not providing insurance, it's providing bait-and-switch, you pay for what you think is a guarantee and hope that the coverage you get in time of need is somewhat close, and not a boot in the ass out onto the street, 3) whatever Congress does is fairly irrelevant, like debating Gore's plane use rather than the merits of his arguments, 2) if Bush hadn't taken his eye off the security and financial balls in 2001 and deliberately run us off the rails, well, these wouldn't even be arguments, and rewarding the jackass politically for deliberate unsound financial actions is just not part of my good will nor good public policy, 1) dissent is good, but serious patriotic assessment of problems and their solutions rather than the unpatriotic dismantling of our systems of the last years is I think a good part of the equation.

Roy Lofquist said...


This comment is certainly not directed at you but is an observation of people. As an intellectual you value logic and reason, as do I. But most people distrust silver tongued devils. They have all been scammed, or thought they were, any number of times. The car salesman, the three card monte dealer, the grocer with his thumb on the scale. One of the themes, promoted by the Democrats since the 1920s, is to question the motives of the plutocrats and the monied. People have a deep grained distrust of grand schemes promising a chicken in every pot if you just "trust me". Ain't gonna sell.

The founders purposely designed the system to frustrate the transient will of an aroused majority. They were well acquainted with Edmond Burke who said "The individual is foolish, but the species is wise".

Radical reforms, as the people perceive them, are not going to happen. A gradual reform, to mind prudent, is what the people want.

As always, best regards


Reaganite Republican said...

These shameful episodes of the DNC dismissing Obamacare opponents as paid shills -even running disengenuous TV ads to slander them- while SanFranNan is halucinating and seeing imaginary Swastikas- should make clear to anyone just what these far-left elitists think of your opinion.

Note that whenever Obama, Emanuel, or Gibbs are asked about why polls show SO many people oppose their misguided Cap-n-Trade and Obamacare proposals, they ALWAYS segue-right-into “we need to educate the public…”.

LOL- save your breath- Constitutionally-aware patriots don’t take lectures from Marxists.

Riva said...

This is interesting. My question is, are CATS covered under family health care plan?

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