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.
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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.
I wonder how many people who think the healthcare bill is a "mess" have actually read it? This includes not only laymen or whatever, but journalists and pundits as well. I've never seen so much disinformation on any topic for as long as I can remember..— liberal- p, don't worry conservatism isn't contagious (i don't think:) I wonder how many corporate loopholes and sell outs are in Harry Reid's bill. No one has seen it yet, it isn't scored by the CBO, it was negotiated behind closed doors in the senate leaders office by the lib'dem leadership in congress, the white house and corporate lobbyists for big pharma and insurance companies. It does nothing to lower the cost of healthcare premiums in the future, they turned away Byron Dorgan's amendment to import cheaper drugs, no tort reform, no insurance competition across state lines, raises taxes into a recession, cuts Medicare by $400 Bil over 10 years & is opposed by approx. 55% of the american people. Time to start over, start smaller and find some common ground:)— NEPhilly
- Liberal- The Senators don't even read the whole thing. And for that matter the bill isn't available to be read to my knowledge. If you know where it is posted please do tell. Didn't Obama say all this stuff would be posted on the white house website for 72 hours before it is voted on?
- liberal, the bill that is online is the original text of what the senate began debating weeks ago. It is not what Harry Reid wants to have a vote on before Christmas. Even Dick Durbin admitted he did not know what was in the bill during a debate with McCain on the senate floor. So don't say the bill has been available for weeks. The managers amendment Reid is going to bring to the floor will be the bill, and only those special invitees into his office have even the slightest clue what it contains. I recall Obama promising all the debates and negotiations for the healthcare bill would be televised on C-Span. Has anybody seen Harry Reid on C-Span lately? How about Rahm?— tom - wilmington, de
- still_independent, every time you agree with me (which is happening with increasing frequency, btw), I get four more grey hairs. At this rate, I will be needing "Just For Men" by the New Year. But it is good that we can agree. It shows there is hope for one of us yet.— tom - wilmington, de
- still_independent, the deregulation of the trucking industry was a success. It lowered transportation costs, reduced inventory costs, reduced "less than full" loads, and increased competition. It was not 100% de-regulated, but the government really loosened the strings and it seems to have worked well.— tom - wilmington, de
- Success in Copenhagen, Obama saved the day. An agreement was reached between the US, China, India, South Africa and Brazil to reduce greenhouse gases, list the ways they will make these reductions, list by how much each greenhouse will be cut, and provides a method to verify these reductions. Of course, the agreement is not a legal contract, it is not binding on any of the countries, set no target emissions reductions for the rich countries, and was not even signed by anybody. But what the heck, Obama turned out to be the hero. Also, it was agreed that any increase in the global temperature will be capped at 2 degrees Celsius. Now how are they going to do that?— tom - wilmington, de
- NEP, I have to take issue with airline deregulation. The shakeout for the first several years was awful. Service suffered and safety suffered due to the cost cutting reduction of maintenance. It took a while and was a major PITA before the dust settled . A lot of pain took place.— JimR
- Smike, a suggestion to deal with spelling. Do you have Word on your PC? Use the shortcut keys CTRL A, CTRL C, CTRL V, to copy the post you want to respond to, compose the response in Word and use the CTRL keys to move it back to the comment block. I too wrestle with spelling and syntax. Word picks up the spelling and likely grammer problems (or use the all saving F7 key) I use it when I am working on a long (too often) response. Having the original post in sight keeps me focused also. I usually keep that running in the background for quick reference.— JimR
- Smike, one of the biggest problems with the need for insurance is the difference in price. You know what the oil change will cost - not so with medical care. The strange part of care is that the less you have (insurance) the higher the charges (no pre-negotiated fees). From what I read, a lot of medically driven bankruptcies are the result of people who have little or no insurance getting involved in situations where the provider is permitted to charge full MSRP when the same treatment can be billed less than half that if the insurance carrier is paying. There's simply no balance to that.— JimR
Comment removed.
This is going to happen, if for no other reason, than to equalize how we structure our economy to globally align with the rest of the world. The additional cost to big business per unit of production now must count, before taxes, the cost of health insurance. That cost is not a part of the operation costs of business any where else in the world. The auto industry has known this for years and Iaacoca knew that we needed to shift from an employer provider system to one that would make us more competitive. I guess on the tombstone of Detroit it will read, I told you I wasn't feeling good about health care. The growth rate of premiums and costs over all is more of a problem that even the republicans acknowledge, that it is 1/6th of the economy. It used to be just 1/10th in 1978. It is too bad that the republicans do not know how to govern, analyse or solve problems, they only know how to cut taxes and go to war.- Add Ben Nelson and Blanche Lincoln to the list of Democrat senators that will not be re-elected come November as both caved on health care. I guess they don't care about the wishes of their constituents.— tom - wilmington, de
- From the Washington Post today "Instead of a public option, the final product would allow private firms for the first time to offer national insurance policies to all Americans, outside the jurisdiction of state regulations. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress." Correct me if I am wrong, but isn't that the same thing as allowing insurers to sell plans across state lines and avoid state mandates?— tom - wilmington, de
- From the same Post story "And all insurance companies would be required to spend at least 80 cents of every dollary they collect in premiums on delivering care to their customers." Now, how is that going to be measured? How do they define care?— tom - wilmington, de
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.
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