The big picture
Some reasons why health care reform is such a tough sell
The big picture
Dick Polman, Inquirer National Political Columnist
As we move ever closer toward the passage of health care reform, public support for reform continues to tick downward; as reported in the latest NBC-Wall Street Journal poll, only 41 percent of Americans currently believe that changing the health care delivery system is the right course of action, while 44 percent favor the status quo.
We could debate endlessly about why the support for reform is so dismal -for instance, conservatives and GOP-leaning independents are worried about higher deficits and government intrusion; many liberals think the current Senate reform bill is a sop to the private insurers, and thus not worthy of passage; many pundits say that President Obama has failed to take the lead and clarify what he wants - but most of those diagnoses are predictably partisan, or otherwise framed too narrowly.
At this point, I'd like to yield the balance of my time to Walter Russell Mead, a leading American scholar who normally specializes in international affairs, but who, in a written rumination this week, offered what I consider to be the best big-picture perspective on why health care reform has been such a difficult domestic political sell. Here's a lengthy excerpt:
"Health care is probably the single hardest and trickiest problem American society faces. Economically, it involves about one seventh of the economy and everybody in the United States has a dog in this fight. Hospitals are the biggest and fastest growing employers in many communities around the country. Health care jobs are some of the best paid we have.
"People's expectations for health care are deeply irrational. Everybody wants to live forever, nobody wants to cut any corners for their own health care, and nobody wants to pay through the nose for everyone else's. When my grandma is sick I want everything possible done for her; when it's your grandma with the problem, I want the death panel to meet. Oh - and I don't want any politicians telling me that my expectations are out of line, contradictory, and on a very deep level foolish and vain.
"This is why health care reform is such an attractive quagmire. Everybody loves the idea of health care reform in the abstract, and everybody understands how important it is. But the more concrete the proposal gets, the more people turn away. Concrete proposals create winners and losers; they also create uncertainty. Any attempt to change the American health care system is going to be complicated; most people will have no idea how it will work out in practice."
Concrete proposals create winners and losers; they also create uncertainty...Mead got that right. No wonder so few presidents have gotten any traction on health care reform over the past 60 years; no wonder congressmen and senators have generally been terrified to push for it. Politicians don't like to create losers, because losers (or those who fear they might become losers) are bound to lash out on election day. Politicians don't like to sow uncertainty, because it's easy for the opposition party to exploit that mood. And even if the Democrats manage to pass an historic law this winter, the Republicans will be able to play on that mood of uncertainty during the '10 election season - and for several years thereafter, until the reforms finally kick in.
Mead's advice? Democrats should scale back on their most contentious ambitions and pass a reform bill with all deliberate speed, something "smaller and more targeted," that Obama would feel comfortable signing. In Mead's words, Obama and the Democrats should basically "declare victory and get out," and then map "a long-term incremental strategy" to codify further reforms. Having already exhibited admirable (or foolhardy) political courage in taking on what Mead calls "the single hardest and trickiest problem in America," Obama has no choice but to persevere. There is no going back.
-------
I did an hour on Philadelphia NPR this morning, critiquing the political landscape with Rutgers political science professor Ross Baker. The show is archived online, here.
To add to the confusion, there's also David Brooks' column this morning. He gives reasons both to vote for and against the bill. If you care to peruse it, here's the link: http://www.nytimes.com/2009/12/18/opinion/18brooks.html?_r=1&hp— NigeltheMastiff- An every campaign hereafter will be a pathetic display of which candidate can deliver government services more efficiently. We cannot afford this. No way in he**ll is this deficit neutral. It still leaves 24 million uninsured so the liberals we be back in short order clamoring for more. Democrats will pay at the ballot box for this but the damage is done.
- "44 percent favor the status quo?" Who are these people, and have they been to the hospital lately? Last time I did, I came away from the experience with a raging urge to emigrate to Canada. Or become a Christian Scientist. Or do SOMETHING so I wouldn't have to deal with my insurer again. I swear, sometimes it seems like the only thing worse than being uninsured in the USA is being insured in the USA. @Swedesboromike: "every campaign hereafter will be a pathetic display of which candidate can deliver government services more efficiently." Why is that bad? A liberal like myself and a conservative like yourself might disagree on which services government should provide, but surely we can agree that whatever services it does provide, it should provide efficiently.— Billy Ray Winthorpe
- I guess I am one of the lucky ones that after having six children, several trips to AI DuPont Hospital emergency rooms (for everything from a broken collar bone to a snake bite), my own medical problems that required a hospital stay of several days, and a parent with alzheimer's I have NEVER had a bad experience with my health insurance or medical provider. I wonder if the excerpt that states "People's expectations for health care are deeply irrational" hits the nail right on the head. Maybe some of people's bad experiences is because their expectations are so high they cannot be satisfied, where any incovenience is enlarged into a major defect. Who knows?— tom - wilmington, de
- @Nigel: Thanks for that link. I just finished reading Brooks's view and Krugman's as well and I found the contrast instructive. Krugman is saying that the Congressional liberals need to find a way to be content with half a loaf, as he put it, while Brooks in effect is asking if that half a loaf is poisoned. I absolutely agree with Brooks's point that something needs to be done about the perverse incentives and opacity of pricing; last time I looked at one of my wife's medical bills I thought the billers must be pulling prices for the various items directly out of their @rses. Brooks could be right: adding more people to that system without root-and-branch reform to control costs could do more harm than good. Of course, we could have just got the profit motive out of it altogether by going for single-payer, but nooooo...— Billy Ray Winthorpe
- Billy Ray- It is bad because we cannot afford any of this. Furthermore we have reached critical mass where the few are paying for the government services of the many. Of course you want this. You probably pay no federal income tax but it isn't so great when you get wacked every which way under the sun with taxes. We have reached a point where the majority of the voters are dependent on the government but get things pay for by others. So of course you will keep electing people who promise to buy you things. YOUR NOT PAYING FOR IT! SOMEONE ELSE IS!
- Sen. Ben Nelson (D-Neb.) will vote against cloture on the Senate health bill, effectively allowing a filibuster of the bill, unless there are substantial changes made to the legislation, Nelson said in an interview with a Nebraska radio station Thursday. Hopefully this can be stopped and we can end this nonsense once and for all. I think now the electorate is regretting putting so many irresponsible liberals in the Senate. If we truly want to improve the cost, accesibilty, and portability in healthcare insurance we need to get government out and de-regulate. Government involvment in madates and prevention of selling insurance accross state lines is why it is so effed up in the 1st place. What we have here is the class liberal two step. Get government partially involved, F it up, and then ask government to contol all of it. You misguided liberals are looking for the solution from the very entitiy that messed this up in the 1st place.
- You make a fair point, Tom, but in my defense my main issue on the particular occasion was that I wasn't notified of the cost of treatment before I had a chance to make a decision about the treatment. Given that the treatment was the removal of stitches from my finger and the cost was $75, I would have liked to have been given the chance to just remove them myself for free. The application of skill and time involved wouldn't have seemed to warrant the monetary cost. That's a big part of my beef with the status quo - the pricing of services seems rather psychotic. But maybe you're right and I'm expecting too much. After all, my insurer did take care of the entire cost beyond that $75, which was just the co-pay. I'd hate to see what the cost would have been if I hadn't been insured, or if, heaven forbid, the insurer denied the claim.— Billy Ray Winthorpe
- Good article by Brooks, as mentioned by Nigel. The thing is how unpopular this healthcare bill is becoming. Even the ABC/WaPo polls shows support at 44% and oppose at 51%. More striking is that of the 51% opposed, 40% strongly oppose the bill. Harry Reid still has no legislative text of his 2,000 page managers amendment, which in effect is the new bill, to be voted on come Christmas Eve. Is he expecting people to just vote on it without it being read, like the stimulus and climate change bills?— tom - wilmington, de
Comment removed.- @swedesboromike: Don't tell me about taxes; I've been paying them for years. But you are right about one thing: I am in favor of the people who've received the most benefit from our great American system paying a larger share of its upkeep. And I do believe that part of that upkeep is in making sure that ordinary working folks - you know, the folks whose labor creates the profits that drive up your stock values - have access to health care that doesn't literally cost an arm and a leg. Heck, maybe if people's healthcare expenditures were part of their taxes and could therefore be accurately predicted ahead of time, we'd see more people take the plunge into creating their own businesses. Has anyone looked into this?— Billy Ray Winthorpe
- Swedesboro, there are two points in your other post I'd also like to address. First is your idea that deregulation is the answer. If we deregulate health care, who's going to ensure that the insurers actually pay their obligations? Who's going to keep the Blue Crosses from taking over 90 percent of their markets instead of the 50 percent or so they have now? Second is your specific prescription about selling across state lines. Leaving aside the probability that such a plan would probably favor even more consolidation among insurers, what do you think is preventing them from selling across state lines in the first place? It's because each state has a totally different regulatory regime than every other one. You literally cannot sell the same insurance product in Pennsylvania as you can in New Jersey. So if you want to harmonize the regulations among states, who do you think is going to have to step in and make that reform? You guessed it...— Billy Ray Winthorpe
- Billy Ray, the whole point about deregulation is not stopping insurance from being regulated, but about ending state mandates. Personally, I would love to see the Feds take over regulation and stop all the mandates from the states, many of which are not even used or needed by the majority of people but raise everyone's premiums. Some mandates make sense, but they have gotten out of control. The point about selling across state lines would allow someone living in New Jersey to purchase a policy from a company in Delaware that would exclude all the New Jersey mandates, thereby lowering the person's costs. Bottom line is let people pay for the coverage they desire. Set a minimum allowable coverage, like they do for auto insurance, but if people want better coverage, they should pay for it themselves, like they do for auto insurance.— tom - wilmington, de
- Tom - I'll buy the idea that a national-level discussion about state-level mandates should be part of the overall discussion about cost control, though I think the solution you're proposing is going to have some serious constitutional issues. I'd also be for a minimum allowable coverage, although my liberal conscience tells me that there ought to be some subsidies for low-income working people. You can get by without a car, at least in a city like Philly when the bus drivers aren't striking, but getting by without healthcare is a lot tougher. I think any real solution that controls costs (as fiscal conservatives would like) and expands coverage (as liberals are trying to do) is going to include some element of the rich paying for the poor. But that happens even at present, so the question, as ever, is: How much redistribution is actually fair and useful?— Billy Ray Winthorpe
- Billy Ray, thanks for your posts. You are knowledgeable, have good ideas and sound very reasonable. Sometimes the angry ideological rants on this site drive me elsewhere for a refreshing break. I also appreciate you, Tom, as you seem to have the same "policy wonk" knowledge that Hillary is famous for. I'm much more willing to listen and learn from reason than rant.— NigeltheMastiff
Cited by the Columbia Journalism Review as one of the nation's top political reporters, and lauded by the ABC News political website as "one of the finest political journalists of his generation," Dick Polman is a national political columnist at the Philadelphia Inquirer. He is on the full-time faculty at the University of Pennsylvania, as "writer in residence." Dick has been a frequent guest on C-Span, MSNBC, CNN, NPR and the BBC. He covered the 1992, 1996, 2000, and 2004 presidential campaigns.
ARCHIVES
All commentaries posted before April 18, 2008, can be accessed at www.dickpolman.blogspot.com.
- American Spectator
- David Limbaugh
- Free Republic
- Glenn Reynolds
- Hugh Hewitt
- Human Events
- John Hawkins
- Matt Lewis
- Michelle Malkin
- National Review
- Opinion Journal
- Power Line
- Red State
- The Brody File
- The Daily Caller
- Town Hall
- Weekly Standard
- Center for American Progress
- Crooks and Liars
- Daily Kos
- David Corn
- Huffington Post
- Media Matters
- Mojoblog (Mother Jones)
- Open Left
- Political Animal
- Salon's War Room
- Talking Points Memo
- Tapped
- The Democratic Strategist
- The Grey Matter
- Unclaimed Territory
- Andrew Sullivan
- Attytood
- Chi Tribune's The Swamp
- CJR's Campaign Desk
- CNN's Political Ticker
- CQ Politics
- FactCheck.org
- Gail Collins
- Howard Kurtz
- Mickey Kaus
- NBC's First Read
- Obit
- Political Wire
- Politico
- Politics Daily
- Pollster.com
- Real Clear Politics
- The Atlantic Wire
- The Fix
- The Moderate Voice
- The Plank
- USA Today On Politics
- Wonkette
