Agreeing to Disagree on Health Care Reform

Rich Rodgers

Free market economists use models that assume that people are given complete information and make rational decisions.  How absurd. No one has complete information, most people have terribly unreliable information, and people make stupid decisions all the time.  Witness the election of George W. Bush in 2004.

But people usually are not alone in their beliefs.  If anything, people often seek the comfort of a group of like-minded people.  They find them in their neighborhoods and through their social and religious activities, and increasingly, they find them by virtue of the sources of information that they choose (Daily Show:Fox News::Oil:Water).  It's uncommon for people to survey the breadth of ideological offerings on a given political issue.  They go, and stay, where they are comfortable.

The insurance industry is massively funding the campaign against health care reform, especially reform that includes an option for publicly administered insurance.  They want to keep making a lot of money, so they prefer to keep things the way they are.  The industry is abetted by its mouthpieces on Fox News, talk radio, and in the op-ed pages of the Wall Street Journal.  Their teams of strategists are rolling out some rabid crusaders to try to stop the conversation, apparently encouraging them to use tactics as close to brute force as the law will allow (and then some).

This illogical outrage and outrageous behavior obviously didn't spring up overnight, it's been cultivated for years by political strategists and interest groups on the right.  The rabid dogs know what they're doing--they know their role, even if they can't control themselves.  If you sat these birthers and screamers and Glenn Beck fans down and asked them to explain how the universe is put together, the story you heard would be scary and wrong, but they would believe every word of it.

While it rests uneasily on an old foundation of philosophical principles, the right's current 'platform' on health care is a twisted-up mess of distortions and opportunity-driven sound bites.  It makes very little sense for an ordinary working person to adopt a stance against public health insurance--what exactly is so great about private health insurance?--but rational decision-making has nothing to do with this.  People are committed to being on a team, and they will fight for the team.

It will take a long time, if it ever happens, to shift perspectives in a way that will allow people to stop viewing politics as an intense and bitter rivalry between two teams.  This raises an important practical question:  can we introduce an element of choice to the health care discussion, reflecting the chasm between the two sides, that doesn't undermine the bargaining power of a public option? 

While every community has people of all persuasions, we all know of predictable differences in 'the sense of a community' spread across different geographies.  In general, urban centers are socially libertarian and supportive of spending on public services, while rural areas tend to be socially conservative and anti-tax.  The suburbs are the swing districts for the most part, in terms of D or R, but they have their own cohesiveness as well. 

The current debate in DC has focused on 1) a national public option for everyone or 2) state-by-state decisions on whether a public option is available.  Neither of these approaches successfully take into account the reality that people are bitterly divided on the issue, and will stay that way.  One answer to the dilemma might be to create a national public health insurance option, but give local communities the choice to opt in or out.  Union County can vote in or out.  Multnomah County, same choice.  Equity can be ensured via the tax code.

It's a foregone conclusion that the major urban areas will all opt in.  Both coasts will be in.  In parts of the country where the political divide is intense, communities will have their say; e.g. rural Georgia will probably be out, and Atlanta will opt in.  With most cities in, the population base will be plenty large enough to ensure maximum bargaining power.  And the conservative communities that are whipped into a frenzy can sit this one out. 

If we're right, in a few years they will be clamoring to be included.  If we're wrong, they can say they told us so.

  • (Show?)

    Because commenters on previous threads have raised an "originalist" description of what health insurance "should" cover, I'm repeating a comment I left as #106 on one of those threads.

    Many commenters describe insurance as it was 30 years ago. Before deregulation, insurers gathered premiums and paid claims. They invested conservatively, and earnings were used to increase resources available for claims. Those days are gone, and you can't get insurance like that in Mayberry. Now, the "health insurance" business is basically a front for an arm of the financial sector, an operation to maximize profits and stock prices. There is no competition because the market is dominated by so few insurers, all with the same game plan.

    If you really want to learn something about this, go here:

    and here: The Private Health Insurance Industry is Killing the U.S. Economy

    and here: The Health Care Industry vs. Health Reform

    and especially here: Bill Moyers Journal

  • (Show?)

    Rich, I like the spirit of your post: let's compromise, or let's make a deal. I think we're at that stage in the health care legislative process, and I could support the one you propose.

  • Dan (unverified)

    The difficulty, Rich, lies in that people have different priorities and different interpretations of the same information. You posit that people were stupid and made an incorrect decision when Bush was re-elected in 2004...and that a rational person with good information and education should not have made that choice. Therefore, people should not be allowed to make choices because it leads to a bad result if they aren't enlightened enough. Thus, single-payer healthcare is the way to go because it removes the randomness and poor results from the buggaboo of "choice." Liberals seem to be pro-choice when it comes to their bodies, but not their healthcare. Can anyone see the glaring contradiction in that statement, as if the two are not inextricably linked?

    Two people can and will arrive at two very different conclusions when given exactly the same information, because they are, in fact, different people. They have different needs, different wants, different priorities, and with this healthcare debate...vastly different viewpoints as to what is best for this nation. Liberals seem to love diversity, just so long as it isn't diversity of opinion.

  • Bill R. (unverified)

    Meld the Ron Wyden Individual Choice Amendment with the Exchange with Public Option and each individual gets to choose whether they want public or private insurance, not the employer, not the govt. Do the tea-baggers really want anyone to have a personal choice? I don't think so.

  • Misty (unverified)

    I predict that despite all the violent rhetoric surrounding this debate if a public option passes, these "Nay Sayers" will be first in line to sign up, and when you point out their hypocrisy they will just shrug their shoulders.

    Case in point, Bobby Jindal. He made a huge stink about refusing stimulus moneys for his state, drawing a line in the sand he wouldn't cross...when his State Senate vetoed him and accepted the funds Jindal appeared at a press conference with a over-sized prop check and bragged about how hard he fought to get the money for his state.

    Focus on what we know is right, ignore the noise, educate yourself and keep the pressure on our representatives to follow through on a public option.

  • Ted (unverified)

    If you are going to attack free market economists, please do so in an educated manner. Keynesian and Lassaiz-faire economics "assume" perfect information as a theoretical construct, the same way wave theory in physics assumes that there is no external force acting on the energy of the wave. "Perfect information" implies that all public information is valued into the price of a stock and homogenous expectations exist.

    Here is where the arm-chair critic of free market economics always blows it. No educated free market economist actually believes this state exists, any more than anybody believes you can strike a piano string and register a note if the string itself is not attached to something to give it tension. The "free market" ideology you claim to understand is nothing more than a neo-conservative propaganda device that is used to advocate monopoly and cartel capitalism under the rubric of traditional conservatism.

    Additionally, the US never has been under any administration a "free market" economy, except perhaps in the colonial days when tobacco leaves were currency or in the earliest days of the Old West. It is a mixed market economy with government regulation. Free market economics says that the hand of government should rest as lightly as necessary on the market place. In the beginning, this aphorism was maintained by Jefferson and Hamilton alike. The ultimate question for our democracy has always been, "How heavily should the hand of regulation weigh now?"

    No true advocate of "free markets" advocates no regulation, because that is the road to fascism, which is the concentration of power in the hands of a despot or oligarchy. No true advocate of a socialized system advocates complete government control, because that leads to Chinese or Stalinist style (not the utopian pipe dream) communism.

    I am a free market economist. I fully support a socialized model for health care in the way that Canada has it, or even our own Veterans Administration, because the current system has become a racket--a cartel--a pharmaceutic-industrial complex. That said, if you are going to adopt this government-managerialist approach to health-care in the way that early Trotskiests like Barnum and Strauss (neocons who who drooled over the Soviet model in the 30s), you have to be prepared to make decisions that subjugate the divine right of the individual to the state (assuming that the state is capable of making those decisions in the best interest of the general population and not the "elite" or nobility. So far, I'm not seeing much from Obama to suggest that his own administration will.

    But let's say they do... Does the grossly obese chain-smoker deserve unlimited access to health care at the expense of those who exercise personal responsibility and reasonable effort to remain physically fit? Should their individual efforts and economic ascension be taxed for the irresponsibility of others? Suddenly, that's not so progressive is it?

    Snake bites its tail.

  • (Show?)

    I'm in no way suggesting that stupid people be deprived of choice. I'm only saying that we don't have enough time to resolve the current 'you're stupid, no you're stupid' dynamic.

    So, I'm suggesting we acknowledge that people have the right to be stupid. If people of Yoknapatawpha County don't want a public option, if they want to be limited in the choices available to them, give them that choice to limit their choices.

    Let each local community decide for itself whether it will opt in to the public option.

  • one of those teabaggers (unverified)

    Bill R -

    I guess you could call me 'one of those teabaggers' and yes, I really do want personal choice.

    Get there by taxing employer provided health care. Then govt hands that money over directly to the employee to buy his/her own insurance.

    Also allow Americans to purchase personal health insurance across state lines, open it up so the competition is coast to coast.

    I'm an Oregon resident but choose Nebraska's 529 for my daughter's college savings plan. The returns have so far outweighed Oregon tax benefits (especially last year!).

    Apply the same concept to allowing individuals to buy their own health insurance. The plans that provide the best will win.

    A couple of simple reforms that will bring down costs...

  • LT (unverified)

    OK, one of, but I have some questions:

    Should there be restrictions on whether insurance companies can deny insurance due to pre-existing conditions? If an insurer denies payment for a procedure, is there no other recourse for the patient than dumping that insurance company for another insurance company?

    Perhaps you have never had an insurance company say "we're pretty sure we will cover that".

    Say what you will about the VA being underfunded--which means long waits sometimes for appointments, Medicaid needing reform (how many states have as well run a program as Oregon?) and Medicare being less than perfect and running into problems of the cost of health care, I don't think any of those programs give vague answers or cut people off because they get sick.

    I'm tired of hearing that it is OK for an insurance bureaucrat to get between patient and doctor, but "having the government involved is scary".

    And is "fee for service " the best delivery method? Should prevention (tests, well baby visits, annual physicals) have the same rate of co-pay as things like cosmetic surgery? Are dental and vision as important as medical care?

    I don't believe that "the free market" solves everything. And what is the consumer protection with buying from another state?

  • LT (unverified)

    Thank you Ted for your remarks.

    "No true advocate of "free markets" advocates no regulation, because that is the road to fascism, which is the concentration of power in the hands of a despot or oligarchy."

    Some of the commentary on this and other issues from people who are afraid of the government sound like people who believe the last great president was McKinley --because T. Roosevelt put in regulations and did not allow unfettered capitalism.

  • Bill McDonald (unverified)

    Rich, You write, "...people make stupid decisions all the time. Witness the election of George W. Bush in 2004."

      I get your point but I can't let that pass. When you portray the election of 2004 as a stupid decision by the voters it is very frustrating for me, and should be for anyone paying attention. You are reenforcing a story that I don't believe is true.
      I believe Ohio was rigged and Karl Rove's IT guy, Mike Connell, was about to testify on the subject when his small plane pulled a Wellstone. Look into it. Google Mike Connell. Every American should.
       You might also want to revisit Florida in 2000. That one was stolen by a purge of the voter rolls by a firm hired by Jeb Bush and Katherine Harris.
      This is not off topic in the sense that we will never really have the power to change healthcare or anything else if we lose the ability to vote.
       It all flows from that. I believe with fair and clean elections the Bush administration, Iraq, and a whole bunch of hideous stuff would never have occurred. In a sense it is reassuring. America is in terrible shape but it took a crime to make it happen.
      If you want to  fix healthcare county by county, great, but swing by the election offices and check out those electronic voting machines while you're at it.
      Voting in this country needs some critical care too. As easy and condescending as it is to talk about how dumb the voters are, I'd still rather they have the final say.
  • (Show?)

    Right, Bill, because people who think that Obama is a non-citizen Muslim antichrist bent on destroying America deserve a fair hearing before we pronounce them stupid. Or is it that I'm being mean?

    It sounds like the public option is in trouble. Maybe it's more important to you to focus on 2004. I'm just offering a suggestion to try to get the public option implemented in a meaningful way. I think it will work so well that everyone will want it, so it's not a big risk to only roll it out in the cities to start.

    Trust me, I don't use the word stupid lightly. I think it's actually pretty mild in light of what we're witnessing.

  • Bill McDonald (unverified)

    Public Option. Got it. County by county decision. Got it.

    Did you see the article about Matthew Dowd in Huffington Post? It says an internal GOP poll shows 70% believe healthcare is "badly in need of reform." Why isn't this a no-brainer?

    If you think it's the birthers-Obama-antichrist crowd who have a vise-like grip on Congress, then you're no brighter than they are.

    I believe this unrest at the meetings is acting as a smokescreen - an excuse for members of Congress to take care of their corporate clients like they wanted to all along anyway. In that sense, it's a loud, ugly diversion.

    Some people shouting at a meeting shouldn't be enough to destroy the public option. Having a progressive Democrat like Senator Durbin go wobbly on it - now there's a problem.

    The White House's 80-billion dollar reduction limit for Big Pharma that prevents negotiating for cheaper drugs from Canada, etc? That's a huge problem. The fact that we have to try to win concessions from the drug industry says it all about their influence in this mess.

    Rich, I'm as frustrated as you are at how this is unfolding. You have an original idea that could work in theory so more power to you. I just think your idea - with the various counties deciding - is naive.

    If it were only that easy to get past the special interests and let the People decide on a good healthcare reform plan for them, this thing would have been here yesterday.

    Of course, you could be well aware of how your plan avoids the real problem, and you're merely using it as a device to say how stupid certain people are. In that case, have at it.

    Venting can be good for your health.

  • MAS (unverified)

    Who's calling the kettle black here. You typical liberal sterotypes think you have the corner on critical independent thought. I 'd admit that I do find comfort in hearing that the current mouth pieces of the conservative movement resonates with the personal feelings I may have. But to criticize us for not thinking rationaly gives you a platform of being intellectualy honest is simply not true. Every word of the left's liberal diatribe is a conceived and contrived thought process smelling of the union thugs that permeate your secular progressive movement. I have no fault of the unions and what they seek to establish under this or any other current political climate. It is a struggle between idologies and we are here to defend what we hold to be true. But don't lay this intelectual dishonestry of the left as being somehow more righteous. The Glen Beck's have only awaken the sleepy conservatives to the text book antics of the left and now you guys don't like how it feels.

  • Joshua Welch (unverified)

    This seems like a reasonable "deal" which wouldn't undermine the public option.

    Besides making sure we have the public option,there are two areas we should focus on in this debate.

    1. What is not covered. (instead of just who isn't covered) Most people who think they have good insurance don't

    2. We need actual healthcare and not disease-care, which is what we currently have.

    Here's a link to an article discussing these two points.

    Republicans: Would you support de-socializing the army, navy, marines, air force, police, FBI, CIA, Firefighters?

  • Scott in Damascus (unverified)


    When you mention "critical independent thought", "thinking rationaly" and "Glen Beck" all in the same paragraph - you have already lost your argument.



  • Jake Leander (unverified)

    MAS wrote;

    You typical liberal sterotypes [sic] think you have the corner on critical independent thought.

    Not every progressive is a fully informed genius. That should not shock anyone. But if you cannot detect the difference in the intellectual level of communication between "conservative" commentators like Limbaugh, Hannity, Beck, and O'Reilly and "liberal" commentators like Olbermann, Maddow, Schultz, and Hartmann; then you just may be a teabagger.

  • Wrench Monkey (unverified)

    Re: "It will take a long time, if it ever happens, to shift perspectives in a way that will allow people to stop viewing politics as an intense and bitter rivalry between two teams."

    Politics in the U.S. is an intense and bitter rivalry between two squads of the same team. The "debate" on health care has been once again moved far to the right, so the "public option" "reform" (most definitely not the Left's side of the argument) and "free market pay or die" are the two sides that are "focused on" by the corporatists and their political lackies.

  • Danny Schecter (unverified)

    Insiders hate conflict and loud voices. They prefer managing change from above and manipulating messages with language that blurs the truth. In this respect, The Dems and the GOP are more alike than different.

  • genop (unverified)

    Perhaps the "public option" could be compromised by limiting availability to those earning less than x (pick a number). The wealthier among us would then be subject to a free market system. The rest of us could opt for public or private insurance.

  • (Show?)

    "Every word of the left's liberal diatribe is a conceived and contrived thought process smelling of the union thugs that permeate your secular progressive movement."

    SEIU represents people like janitors and housekeepers at hotels. They represent the food service workers at the Portland Public Schools. I remember distinctly talking to SEIU about the problems some of their members were having.

    The district was limiting the hours of many of the people working in the kitchen to 20 per week, which meant they didn't get health care. Demographically, this group contained a lot of women aged 30-50, some single, some not. Some with kids, some not. Making in the neighborhood of $10-$15 an hour.

    Thugs? SEIU represents the people who do the hard work for low wages so that the basic operations get done. Someone with a full time job at $8-$15 an hour ought to have health care, and a lot of times they just don't right now. And there's no reason why that health care needs to be provided through a private insurance company.

    Maybe a public option prevails. That wouldn't be single payer, but it would at least provide a way to take the profit motive out of the equation in the insurance market. But if it doesn't have the votes, and you think the public option is important, you have two options: try to kill reform now until you have the votes, or try to make a deal.

    The combination of pressure from the base, and delivering the ability for rural communities to opt out, could get you a vote or two.

  • rural resident (unverified)

    one of those teabaggers ...

    If you're going to advocate for purchasing insurance across state lines (not necessarily a bad idea), then one must also assume that you are OK with the establishment of a national regulatory scheme for the insurance industry, replacing the meager and ineffective state by state regulation we have now. State regulation is incompatible with a national market.

  • one of those teabaggers (unverified)

    LT and rural resident - yes, I'd support a degree of national government regulations similiar to SEC type body when opening up insurance purchase across state lines.

    I'm also open to some level of govt mandatated coverage for those with pre-existing conditions.

    But start the system out where the individual is given the tax voucher his/her employer is recieving today to spend on the plan he/she sees fit.

    Government can provide basic oversight but otherwise stay out of the business of providing any more health care.

  • rw (unverified)

    NPR had a pretty funny bit tonight. About how stupid, lazy and hypocritical we appear to the rest of the world viz our knowledge of and caring about health care. :)

  • Gene (unverified)
    <h2>That is the thing. We can find things that we can agree on and run with that and the other tings do what we have always been best at doing: Compromising.</h2>

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