How to sell health care reform, according to liberals
I did a little reading yesterday about health care reform over at Matthew Yglesias blog. I was trying to learn the current liberal point of view on the subject.
Yglesias himself is frustrated at the American people, who don’t seem to understand (as he does) that what they really need is a fundamental change from a fee-for-service model for doctor reimbursement to one of salary-for-wellness. He cites seemingly contradictory data that says that Americans are satisfied with their own health care, and yet they feel that the system needs fundamental change and that rising medical costs are a threat to the economy.
Yglesias’s conclusion:
I just don’t really know what one is supposed to do in the face of public opinion data like that. Opting for the Barack Obama approach where you focus on reassuring people that the status quo won’t change too much seems like a smart play, even though the case for changing things a great deal is very strong.
I’m not sure whether Yglesias believes that Obamacare would in fact result in such a fundamental change and that, in order to sell it to the American people, Obama needs to dissemble; or whether Yglesias is chiding Obamacare for not going far enough to cause fundamental change, and therefore he believes Obama’s reassurances to be the truth.
At any rate, I don’t see anything in Yglesia’s piece (and only a single comment in the entire thread) that appears to understand the basic problem the American people have with Obamacare: they may want change in health care, but they want it to be for the better rather than for the worse. They want the freedom to make the important choices themselves, and they deeply distrust government’s ability to bring greater efficiency and cost-saving to the system (fearing that not only will the savings be illusory, but they will occur at the cost of Draconian and unwelcome rationing), as well as being mighty suspicious of the Democrats’ undue haste in trying to pass this enormous and life-changing bill so quickly. Those are the things that make the vast majority of Americans wary, not some sort of love of fee-for-service over salaries.
I haven’t done any other reading at Yglesia’s on the subject, so perhaps he does acknowledge these issues somewhere. But I found it remarkable that, in the thread I did read, issues of choice, liberty, distrust of government intrusion and government inefficiency, and distrust of the speed of the bill and its lack of transparency were difficult to find in either the post or the comments section (except for the inefficiency argument, which surfaces briefly in comment 6).
On the other hand, strongly present in both the article and in many of the comments was the idea of the American people’s stupidity and/or cluelessness, their ignorance about what’s best for themselves (something the blogger and most of the commenters profess to know). The entire thread reminded me of the way liberals often tend to talk about “the people” when amongst themselves—like Obama at the San Francisco fundraiser speaking of the bitter clingers.
The condescension is palpable:
The public at large doesn’t know the difference between fee-for-service and capitation, and probably wouldn’t care.
The trick is selling this change so it doesn’t frighten people. I would do it this way:
– tell people that you’re going to abolish co-pays and deductibles – “you’ll never have to pay anything but a premium.”
– tell them you’re going to pay doctors extra for improved outcomes – “we’re going to pay doctors more for making people better!”
Then turn round and trade the AMA non-profit Federal no-fault malpractice insurance in return for not causing a fuss.
See also this:
Americans don’t want insurance reform. they want premium control and protection from cancellation. They want the same amount or more stuff for less money.
That’s fine on an interim basis. I just hope that at some point, people figure out that true slash-and-burn reform is going to be needed, meaning that insurers get purged, doctors see their pay cut and patients be forced to use low-cost options (non-emergency clinics, pharmacists with expanded authority, etc.) for most issues before running off to their GP’s or high-cost specialists.
Several of the comments display what I regard as a deeply naive trust of the government (see this):
I think a government-run healthcare service ”“as competition to the private sector ”” is ESSENTIAL. Not just for the benefits of competition ”“but because it will also provide the government with deep insight into the inefficiencies and bottlenecks of the existing system. It will help the government determine how best to design an integrated medical information system , for example, that will detect overcharging, poor care, fraud and waste.
And then there’s the need to increase the grip of the nanny state over the lives of those who display insufficiently responsible health habits (see this):
Patients definitely need to become more responsible – the obesity rate in our country is huge concern and a huge drain on our medical resources.
Even if we ignore the coercive aspects of how this might be accomplished—good luck with that one, since doctors have no idea how to make people lose weight, short of gastric bypasses for the select few.
When Yglesias wonders why “Obama has forgotten” to sell the idea of a “comprehensive healthcare system that would never cost them a cent beyond their (likely lower than at present) premiums,” my answer would be that maybe it’s because “the people” are actually smarter than that. Perhaps those folks who so bitterly cling to their current health insurance realize that they would be paying through the nose for the new system—and not just in premiums, but in skyrocketing taxes (as do “the people” of Europe, big time). And in liberty—but hey, who cares about that?
Yglesias is yet another Harvard guy with the usual, apparently, Harvard attitude towards the little people and how they need to be managed for their own good.
The other Obama argument for healtchare that’s not flying well is how it is so necessary right now to fix our broken economy. I don’t think the little people are getting that either.
Apparently you need to go to Harvard to understand these things. Perhaps Mitsu will drop by and explain it all for us.
Thx Neo for the update on liberal ‘thought’. I couldn’t bear to read the full content of the comments of such people. Their sneering condescension is blistering and offensive. From what you describe, THEY don’t understand what Obama care really means. We seem to have the firm grasp of where he’s trying to take this country.
“Their sneering condescension is blistering and offensive. From what you describe, THEY don’t understand what Obama care really means. We seem to have the firm grasp of where he’s trying to take this country.”
They’re not different, they’re just wrong.
I wish these folks would keep in mind that Hippocratic Oath.
Do no harm.
Salary-for-wellness would work great for those areas of wellness that can be assured.
Most health issues, however, don’t apply. People get sick, they catch stuff, they have accidents, they have hereditary issues or even just bad luck.
My childhood best friend has a severely disabled child due to a pre-birth injury… cord around his neck causing brain damage… she said that one of the hardest parts of dealing with that when he was born was that SHE HAD DONE EVERYTHING RIGHT. She didn’t gain too much weight, she ate right, took her vitamins, didn’t drink or smoke, not even caffine. She did everything right. And she knew mothers who hadn’t, who drank and smoked and even who did drugs who’s children were born healthy. And that was hard.
Salary for wellness isn’t a BAD idea if it is applied to those areas of wellness that can be assured, even if not guaranteed, but generally subject to controllable things… our teeth, perhaps, or immunizations or well-baby care and pregnancy…
But it doesn’t work the moment a spanner gets thrown into the works.
For that we still need to be able to go to people who are not there to keep us well, but to fix us after we break.
there are two things your seeing clearly…
the inability to reason is one…
with self confidence this means that they dont want to be discovered that they are faking it and dont understand it.
the second is as you say the condescention is palpable.
in this way, they can choose to be on mount olympus, and no one can tell they are faking it among all the others…
it doesnt take long to get the feeling that you are lucky to be on the right side of those who are plotting and setting out to act on the others wihtout their knowlege.
if you want to leave your only other choice are the ignorant masses, or the manipulative few who plot.
since you think the masses are stupid… and you dont understand these points, but do know the right catch phrases, you can pretend to be on the right side of issues and get a pat on the head and a yummy for doing so.
the other side doesnt even offer awareness let alone protection, understanding, and a valid other side of the argument… their lumpen proletariat
It’s such a NAIVE argument by Matthew.
It’s like saying we are changing the auto industry so that everybody is delivered better transportation..
and who wouldn’t want that???
Unfortunately when you APPLY common sense you know that giving everybody transportation from the government will result in higher costs for everybody (unless the so-called rich are taxed very heavily).
Matthew (if you dare come read),
If you taxed the top 1% at the tax rate of 100% you will only bring in about 400 BILLION into the government that year. What about following years??
It’s a matter of understanding that we should ALL be required to pay for services whether it’s housing, health, transportation, etc.
“To each according to his needs” is a sure fire way to bring more misery and poverty to this nation. Because when the people are given all of their needs their drive to produce and pull more of their weight diminishes.
Capitalism = the people choosing who gets what resources.
Socialism = the government choosing who gets what resources.
Let me make this clear Matthew. YES, the non-able bodied and elderly should be provided for as we are a caring and generous nation.
But those of us who are part of the 90% (the people who should be pulling the wagon) need to realize PERSONAL RESPONSIBILITY.
There are reasons why the health care in this country is too expensive Matthew. And it’s because of you liberals and lawyers.
let’s tackle the problem of cost that has been created by you people. Vote out ∅bama and the Democrat controlled congress and let’s get a free market solution implemented.
Most likely, Yglesias means that he does not think Obama and his minions are lying well enough. See, for instance, Yglesias’ advice just about two years ago:
“If I might throw in my two cents, I would further strongly urge Democrats who don’t believe marriage is between a man and a woman but who feel they ought to pretend to believe this in order to win elections (a plausible position) need to do a better job of pretending.”
http://tpmcafe.talkingpointsmemo.com/2006/07/12/at_least_pretend/
Oops. Sorry. That was just about three years ago. Tempus fugit.
Houses for everybody….
What happens to those of us (large percentage of the population) that work hard, apply themselves, SACRIFICE and strive for that bigger house.
That better care…
That better car…
That better college…
That better retirement…
Name the issue Matthew? You propose something that:
1) Isn’t in ∅bama/Congress’s bill
2) Isn’t what the American people want anyways
We have the best delivery of heatlh in the world.
Yes there are problems.
Here is a good solution:
1) Buy your own catastrophic health insurance
a) if you can’t afford it – it may be because you are an illegal immigrant working for less than minimum wage
b) it may be because you are unemployed – for which there can be options
Costs for health, college, etc have gone through the roof not due to market forces but the removal of market forces and the need for tort reform.
There seems to be some low-hanging fruit in terms of personal responsibility: diet, exercise, not smoking. I wonder what would happen if that list were expanded to include unprotected sex with changing partners, risky sports, and not learning how to read a warning label. Who monitors it all? Who determines which sins are gravest?
There is just no way to have it all for free. If we want to protect people from cancellation if they loose their job / income or prevent insurance companies from being able to deny coverage for pre existing conditions (and then have the public buy the insurance for the poor) both (even with this free market path) will cause premiums to go up. It’s obvious. Adding single payer or a government run insurance company will not help. They’ll just shift costs to the tax payer when they run red and/or those with private insurance will pay more to make up government insurance underpayment for services (again, raising private insurance rates).
Thomass: I didn’t put this in the body of the post (it was getting too long), but one of the reasons many Democrats think it’s okay to skip the tax consequences and just talk about premiums is that, for many of their low-income constituents, the tax consequences will be nonexistent or minimal.
Sure, but you can’t then argue that your measure is an actual cost saver… well, unless your Obama.
Americans do not want change for the worse when it comes to their healthcare, and this is a huge risk once you read portions of the bill. Based on what I’ve seen, Congress needs to do a much better job than this.
Basically Matthew (and his ilk) are saying, “I don’t understand you Kansans. How do you not get that it’s in your best interest to become slaves? How dumb are you?”
When the potential slaves say, in essence, “We don’t want to be slaves.” there is a fundamental failure of understanding between the two sides.
It’s sad, though, when people like Matthew are forced to just twiddle their thumbs waiting to take on the role of being the slave masters. After all, they have the education, the background, the connections, and most of all the good intentions to make everything an unadulterated success. Utopia, here we come. Can’t people see that? Can’t they?
How to sell health care reform?
What reform.
All I see is a pea and three walnut shell halves on a green felt covered table top.
Somebody is going to lose the milk money.
Actually we’re about to lose our country. And it’s not an accident or over reach or unintended consequence.
Morons of the Left, rejoice: Your Dreams Are All About To Be Realized!
Unfortunately, once the bus drives by the nationalized banks, Government Motors, the polling places and census records staffed by ACORN operatives, the endless rows of government housing filled with the newly amnestied Democrat voters, and by the closed hospitals, it will keep on going right off the cliff that is always the end of the road for statists.
You are useful fools. You won’t be there for the arugula. Somebody had to tell you.
Your welcome.
We know the enemy; they make it very plain, even when they publicly advocate lying, like Iglesias.
So let us stop playing nice, like good ol’ Lindsey Graham (R-SC). Let’s stop making deals with them, like good ol’ maverick McCain. Don’t even mention Specter.
They are vermin, and those that choose to run with them become vermin too. Let’s just face it and get on with it.
I wonder why I still keep abreast of the whole wretched business. In part, I miss FredHjr.
“I think a government-run healthcare service —as competition to the private sector – is ESSENTIAL. Not just for the benefits of competition —but because it will also provide the government with deep insight into the inefficiencies and bottlenecks of the existing system. It will help the government determine how best to design an integrated medical information system , for example, that will detect overcharging, poor care, fraud and waste.”
Doesn’t Iglesias realize that the government already has several such programs? They are Medicare, Medicaid, and the VA. It is my desire to see the government eliminate the inefficiencies, waste, and fraud from these programs before they take on the private healthcare system. Physician heal thyself first!
The electronic records idea may make the system more efficient, but it is not guaranteed and some studies have shown this.
I happened to find a proposal for healthcare reform from a doctor that I found interesting. This doctor finished his MD when he was 17. (The real Doogie Houser?) He’s certainly got plenty of intellectual firepower to use on this problem. While I don’t agree with everything he proposes, it passes the common sense test, which Obama’s ideas don’t. His ideas are here:
http://daylightsmark.blogspot.com/2009/07/health-care-those-who-are-not-liberal.html
The Dr’s. first argument is for malpractice tort reform. That is also the first reform called for by the Senate Republicans proposal authored by Jim DeMint. The only way that will ever get any traction is if enough people call and write their Congress Critters and flat out demand it. Congress is, unfortunately, a branch of the ABA. It would be a major victory if we could get them to do tort reform.
I wonder if Yglesias has heard of the “complete lives system”
Read about it from Sandy Szwarcz
http://junkfoodscience.blogspot.com/2009/07/prioritized-lives.html
The system is described around half way through the article and was devised by one Ezekiel Emmanuel who is the bioethics advisor of the President.
Beware of medical ethicists.
After retiring from practice, I thought of training to become certified in medical ethics by the ethicists. I discovered that would be entering a leftist cadre that tolerates no dissent. Lies, patent lies, are ethically OK with the ethicists as long as these lies serve their greater good. Ezekiel Emanuel lied blatantly, without hesitation, to me in 1994 when he served on the Ethics panel of Hillary’s HealthCare Reform Task Force. Oh, yeah–Rahm’s brother, Harvard-educated.
It is another tactic of the Gramscians, to seize and hold the high ground of (self-defined) ethics as a castigation platform to squelch disagreement.
One of the consistent differences between right and left blogs is that left blogs focus more on political methods and tactics, with much of the ideology taken for granted. I noticed this a couple of years ago trying to find left-wing opinions on the dailykos blog. It was, at the time, all about how and not about why. Compare that to something like Pajamas or Neo.
Neo’s comment on better vs worse is spot on. People want more understanding. Will my health care vary depending who is President? Will the system work if the President is another Gerald Ford or Jimmy Carter?
Bush 41, while campaigning for a second term, made mention of lawyers being a huge problem in this country. I don’t think he ever got the words “tort reform” out of his mouth before he was so low in the pols you couldn’t dig him out with a shovel.
One of my big problems with nationalized health care, besides nationalized health care itself, is the probability of the money collected from us all being funneled into the general fund and disappearing into a deep, dark hole in the process, as does every other dollar they get.