Universal Health Care, or Socialized Medicine
Kevin Drum has been on target on this issue, and argues in the past couple of days that the liberal blogosphere is pretty well unanimous too. He wonders why it hasn't been a bigger issue, and asks for a reason why democratic pols shy away from it:
Kevin is right, of course. There's no visible reason for this. SO let's look for an invisible one. Let's call it power.
But wait, is it really all that invisible? Health care costs in the US account for about 15% of the economy, and almost all of that runs through privately owned and controlled insurance companies. One of every six dollars spent in the US economy comes from or goes to an insurance company. When the serious policy discussions take place, and when the candidates and elected officials decide to take a position on health care issues, then, there is always a lot of money in the room. Now even if candidates and elected officials were convinced that voters would favor universal health care, the wonks are there to convince them otherwise, or to convince them that legislation just isn't doable, and of course politics is the art of the doable.
So there is that kind of simple direct influence--all the money and power leaning on the women and men in the political system.
But then there is all the indirect influence too. The entire system of public intelligence, with professional journalism and policy think tanks at its heart, works to convince the phantom public that health care reform is a bad idea. The one memory of the 1993 fiasco that remains fresh is the "Harry and Louise" ad campaign, for which the health insurance industry paid $30 million, a very affordable price for 15% of the economy, I'd say. The ad campaign worked not so much because it convinced people that reform was a bad idea--though it seemed effective that way--but because it convinced public officials that people COULD be convinced that it was a bad idea, and that's all it took, because of all the direct influence in the way.
One reason why Harry and Louise worked was that professional journalism had already done its task. Reporters had gone to Canada and looked for stories. In their usual way, they went to the most dysfunctional places--the poorest hospitals in the biggest cities--and found shortages and delays, and even when they noted that similar US hospitals were also dysfunctional, they nevertheless consistently sent the message that reform was a fool's dream. They backed up this anecdotal negative reporting with the usual even-handed expert opinions--choosing one from think-tank A to say that reform would be good and one from think tank NOT A to say that it would be a disaster. Then it left it to readers to decide.
Now many US voters, but not most, know something about the Canadian system, so I thought it would be a nice natural test of the system of public intelligence to see how this worked out. It was possible for any resident of Florida, for instance, to track down a Canadian at Dunkin Donuts and ask if they'd prefer the US system. When they all said No, wouldn't that overpower the media impression? Clearly not. I have the good fortune of knowing many Canadians, and have taken the opportunity to ask just about all of them whether they'd prefer the US system, and only one said yes, and he was just posturing because he was a market fundamentalist. If you also point out that health care overall costs the Canadian economy a little over half what it costs the US, you'd expect that common sense would congeal in a dramatic fashion. If, that is, there's a working system of public intelligence.
There is not, apparently, at least on an issue like this. Instead, public opinion is systematically distorted and politics becomes a marketplace.
The one thing that Kevin Drum doesn't face up to in his thinking on this is that reform necessarily means downsizing. At first blush, this should make it a happy issue for Democrats, who really have been trying to sound "new" about policy--more business-like. Doesn't downsizing mean a kind of rationing? Now try to convince the great public that rationing is ok when it's NOT done by the market.
Now if we want to get really wild, can someone tell me why we shouldn't nationalize the entire insurance industry? It's all about shared risk, it's all run on careful mathematical formulas, and it really is one of those areas where centalization would lead to greater efficiency. So is there any reason other than an irrational fear of bureaucracy and the sheer power of private wealth that no one ever thinks of making this a political issue?
Kevin Drum has been on target on this issue, and argues in the past couple of days that the liberal blogosphere is pretty well unanimous too. He wonders why it hasn't been a bigger issue, and asks for a reason why democratic pols shy away from it:
I can't think of one. And while I'm not naive about the recent history of national healthcare plans, it still strikes me as a bit mysterious that virtually no major Democratic politician supports full-on, unapologetic universal healthcare. If there's any single big progressive policy that I think the blogosphere is a genuine bellwether for, this is probably it.
Bottom line: Surely it's time for someone to step up to the plate and stake their reputation on a simple, comprehensive, common sense plan to implement national healthcare? And if financing is the problem, just take a page out of the Bush playbook and ignore it: "If I'm elected president, I'll work with Congress to devise a fair and sensible revenue plan." How hard is that?
Kevin is right, of course. There's no visible reason for this. SO let's look for an invisible one. Let's call it power.
But wait, is it really all that invisible? Health care costs in the US account for about 15% of the economy, and almost all of that runs through privately owned and controlled insurance companies. One of every six dollars spent in the US economy comes from or goes to an insurance company. When the serious policy discussions take place, and when the candidates and elected officials decide to take a position on health care issues, then, there is always a lot of money in the room. Now even if candidates and elected officials were convinced that voters would favor universal health care, the wonks are there to convince them otherwise, or to convince them that legislation just isn't doable, and of course politics is the art of the doable.
So there is that kind of simple direct influence--all the money and power leaning on the women and men in the political system.
But then there is all the indirect influence too. The entire system of public intelligence, with professional journalism and policy think tanks at its heart, works to convince the phantom public that health care reform is a bad idea. The one memory of the 1993 fiasco that remains fresh is the "Harry and Louise" ad campaign, for which the health insurance industry paid $30 million, a very affordable price for 15% of the economy, I'd say. The ad campaign worked not so much because it convinced people that reform was a bad idea--though it seemed effective that way--but because it convinced public officials that people COULD be convinced that it was a bad idea, and that's all it took, because of all the direct influence in the way.
One reason why Harry and Louise worked was that professional journalism had already done its task. Reporters had gone to Canada and looked for stories. In their usual way, they went to the most dysfunctional places--the poorest hospitals in the biggest cities--and found shortages and delays, and even when they noted that similar US hospitals were also dysfunctional, they nevertheless consistently sent the message that reform was a fool's dream. They backed up this anecdotal negative reporting with the usual even-handed expert opinions--choosing one from think-tank A to say that reform would be good and one from think tank NOT A to say that it would be a disaster. Then it left it to readers to decide.
Now many US voters, but not most, know something about the Canadian system, so I thought it would be a nice natural test of the system of public intelligence to see how this worked out. It was possible for any resident of Florida, for instance, to track down a Canadian at Dunkin Donuts and ask if they'd prefer the US system. When they all said No, wouldn't that overpower the media impression? Clearly not. I have the good fortune of knowing many Canadians, and have taken the opportunity to ask just about all of them whether they'd prefer the US system, and only one said yes, and he was just posturing because he was a market fundamentalist. If you also point out that health care overall costs the Canadian economy a little over half what it costs the US, you'd expect that common sense would congeal in a dramatic fashion. If, that is, there's a working system of public intelligence.
There is not, apparently, at least on an issue like this. Instead, public opinion is systematically distorted and politics becomes a marketplace.
The one thing that Kevin Drum doesn't face up to in his thinking on this is that reform necessarily means downsizing. At first blush, this should make it a happy issue for Democrats, who really have been trying to sound "new" about policy--more business-like. Doesn't downsizing mean a kind of rationing? Now try to convince the great public that rationing is ok when it's NOT done by the market.
Now if we want to get really wild, can someone tell me why we shouldn't nationalize the entire insurance industry? It's all about shared risk, it's all run on careful mathematical formulas, and it really is one of those areas where centalization would lead to greater efficiency. So is there any reason other than an irrational fear of bureaucracy and the sheer power of private wealth that no one ever thinks of making this a political issue?
posted by jnerone at 9:00 AM
0 Comments:
Post a Comment
<< Home