Monday, October 19, 2009

Editorial: Have We All Flip-Flopped on the Healthcare Debate?

Last week, I wrote the following op-ed piece for my newspaper:

In one of last year's presidential debates, then-Senator Barack Obama was asked if health care was a privilege, a right, or a responsibility. He promptly answered "a right." As a liberal, I was glad to see him take that position. My conservative father sitting next to me was disgusted.

One year later, the nation is in the midst of a contentious health-care debate. It hasn't just been an intellectual discussion on how to manage the country's health-care resources, but rather the typical back-and-forth of political rhetoric. I should know, I frequently work on the sort of message development that we've seen in the current health-care debate. Yet, once we scratch the surface of this debate, it appears that both liberals and conservatives have flip-flopped in their principles.

There's no better place to start than with the classic Republican message: "A Washington bureaucrat should not get between you and your doctor." That message implies two things.

First, it suggests that patients would not have a choice of their doctors if a public option were introduced. That's nonsense. I have never heard of a health-care system in which public bureaucrats decide which doctors you can see - including the single-payer system in Canada and the National Health Service - true socialized medicine - in the United Kingdom.

The other implication of the message - which I intend to focus on - is that a bureaucrat can deny a certain health-care procedure or medicine that you and your doctor have decided is right for you. This is especially important because "deny" and "denial" are huge buzzwords in the GOP's rhetoric. The reason is simple enough: Those words scare people.

The idea that you can be denied certain procedures now has the right screaming "rationing!" The left has quickly argued back, saying, "health insurance companies already ration care" so why would a public option be any different?

In fact, rationing only makes economic sense. All resources are limited - including those in health care - and whether you have private or public insurance, it simply cannot cover everything. This may be a hyperbolic example, but even if you're terminally ill, you cannot expect America to spend its entire GDP in order to save your life.

But wait - then aren't we liberals justifying the actions of the dreaded health insurance industry? Are we actually saying we will model a public option the same way? Aren't we putting a price on human life? The answer appears to be "yes." Meanwhile, conservatives - who evidently oppose rationing in general - appear to be arguing that, regardless of costs, health care is a right! Both sides have swapped principles.

All this being said, I believe it is possible for progressive principles to be reconciled with pragmatism. Principles are impossible to implement without pragmatism, but they are still critical when it comes to improving public policy.

In order to achieve health-care reform, we Democrats need to get our principles back on track by reaffirming our basic beliefs and then by adding conditional reasoning.

The principle can be, "You have a right to coverage for basic health services" including doctor visits, pharmaceuticals and certain procedures. The cost-benefit analysis used in all economic decision-making will still be done by patients, doctors and bureaucrats - now both private and public.

How can Republicans reconcile with pragmatism and get their principles back on track? That I don't know - you'll have to ask my father.


Keif said...

There are many flaws with your thinking, but because you sound reasonable, I will respond:

1. Health care cannot be a right because resources are not unlimited. There aren't enough drugs, machines, doctors for everyone to get free unlimited healthcare. Check out this Robert Reich article for more info:

2. If it weren't for the free market, the government wouldn't have any drugs and high tech equipment to provide. The government could very easily kill the goose that is laying the golden eggs.

3. The issue isn't whether a bureaucrat will get between you and your doctor, but that the government will tell him what he can do. There are many examples. I heard that women in Britain over 63 don't get mammograms because it is considered a waste of resources.

Here is another story:
I had an elderly British visitor this month who's had a recurring problem with her left hand. At one point it swelled up alarmingly, and so we took her to Emergency. They did a CT scan, X-rays, blood samples, the works. In two hours at a small, rural, undistinguished, no-frills hospital in northern New Hampshire, this lady got more tests than she's had in the past decade in Britain – even though she goes to see her doctor once a month. He listens sympathetically, tells her old age often involves adjusting to the loss of mobility, and then advises her to take the British version of Tylenol and rest up. Anything else would use up those valuable "resources." So, in two hours in New Hampshire, she got tested and diagnosed (with gout) and prescribed something to deal with it. It's the difference between health "care" (i.e., going to the doctor's every month to no purpose) and health treatment – and on the latter America is the best in the world.

4. Yes, health insurance companies do ration care, but the difference is something decided within the free market. Whereas with a government program, you have no recourse. In addition, when healthcare becomes a line item in the budget, the people can't spend any more if they want to: it is all controlled by the gov't. Look at gasoline: if it were free, it would have to be rationed. But no one says it is rationed today because the price is set by the free market.

5. The healthcare bill is the wrong approach. We have Medicaid and Medicare. What we need to do is to lower the costs of healthcare, by making it more of a free market. Read this article:

I realize I have several URLs in here, but I hope you realize this is not spam.

Keif said...

BTW, here is an proposal with a bunch of good ideas on how to improve healthcare, NONE of which are in the current bills.

Also, Medicare is 10s of Trillions of dollars in debt. It would be responsible for the gov't to fix the current system before extending it to create a Medicare for all. The current proposals are extremely irresponsible.