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?
