Public Policy and Governance – Page 341

Tod Gitlin Sums It Up

I was going to post about Obama’s speech this morning, but Tod Gitlin has already said it, and said it best.

He sounded like a winner. Like all great preachers, he started methodically and built to crescendos. The Republican responder, Charles Boustany of Louisiana, sounded like a whiner, crying, Deficit, deficit, and government-run, government-run, and built toward nothing. Obama charged the Republicans with specific lies. He made the obligatory gestures toward bipartisanship, including the unexpected shout-out to John McCain, who had campaigned in favor of mandatory catastrophic insurance–and I don’t want to be cynical about those gestures, even though I think he’s naive about the other party’s intentions–but that’s not where his stresses fell. He was reminding the majority who voted for him why they did that. He was reminding independents that the reason why no progress has been made toward universality, mandates, and affordabiity is Republicans–as with 1935’s Social Security and 1965’s Medicare laws. He was reminding them, as well as the few rational Republicans left, that the insurance companies are not the glories of American value.

He did not sound like a patsy. He offered specific programs but the peroration was clear: he stood for values and national character. If he went too easy on the insurance companies for my taste–his audience could have used the information that Americans pay insurance companies twice as much as they pay doctors–he took a proper jab at Republicans (they know who they are) who make up the party of fear. You can say that he’s still not willing to talk to Americans straight about the need to limit high-tech medicine for the very old and very frail. Presidents won’t do that.

But he bet on the strength of the American character. It was his finest public moment since the Inaugural. I’m betting national decency wins.

Over at Balkinization, Frank Pasquale has an interesting analysis of the philosophical roots of opposition to healthcare reform.http://balkin.blogspot.com/2009/09/risk-health-care-and-red-america.html It is worth reading in its entirety, but the last paragraph does sum up the situation as it appears right now:

The really appealing goal of reform–a strong public option that would be part of an exchange open to all–appears to be more of a bargaining chip than a firm commitment for the Obama Administration. Strategically, if your goal is to get “something” through Congress, this makes a great deal of sense: Republicans and some waivering Democrats think a public option smacks of socialism. But as a political matter, it is draining support for reform. People can understand a public option, and building support for it might have been as decisive to Democrats’ fortunes as FDR’s reformulation of the American social contract in the 1930s. Sadly, Obama’s technocrats appear more attracted to wonk-talk like “bending the cost curve” than the forceful moral case for collective responsibility for health. Only the President can correct that course. It takes an ideology to beat an ideology.

Hissy Fits

Conflict is a given in democratic systems. Citizens are expected—nay, encouraged–to bring their different value systems, ideas and political preferences into the public square, where we have not only the right but the duty to make our arguments as forcefully and persuasively as we can. Only after we’ve aired the relevant pros and cons in our lively but civil marketplace of ideas do we select the winners in a fair and square, open process. We elect the most persuasive candidate, or we pass (or defeat) the proposed legislation. Everyone gets a say, we have a fair fight, and everyone abides by the result.

Or so the theory goes.

Unfortunately, this system only works if everyone plays by the rules, broadly conceived. Another way to put that is the system only works if the participants are grown-ups.

I can remember when my sons were small. Telling a two-year-old who doesn’t want to share his toy that “time’s up, now it’s Johnny’s turn” would more often than not be met with a tantrum, and screams of “no! mine!” Some of the footage we’ve been seeing on the evening news has reminded me forcefully of those less-than-idyllic moments of motherhood. We see people showing up at Congressional “town halls” with guns, or signs accusing the administration of being “Nazis.” We’ve even seen people biting each other! (Talk about angry toddlers!)

Now, people are refusing to let their children hear President Obama tell them to study hard and stay in school. (It’s communist indoctrination!)

There’s no polite way to say this, folks. This is nuts.

Now, this is the place in the discussion when someone can be counted on to sputter that they “have a right” to say their piece. And they do. I absolutely agree. But just because you have a right to do something doesn’t mean that doing it is appropriate, or helpful, or smart. Name-calling—especially when it is abundantly clear that the person hurling the accusation has no clue what “socialist” or “Nazi” really means—is about as persuasive as a two-year-old’s shriek.

When people on the left called Bush a Nazi, they made it much more difficult for people with principled and very specific concerns to be heard. When people on the right throw hissy fits, they drown out more thoughtful and reasonable critics, making it easy—if unfair—to dismiss all opposition as unhinged. When we see television clips of people who have gone off the deep end because there is a black family in the White House, it makes it tempting to paint all opposition as racist.

Many of us were dismayed when Bush won in 2004, but he was elected, he was the President and we had to suck it up and live with it. We made our arguments, we registered our protests and we waited for the next election. It’s time for these rabid Obama haters to grow up and do the same.

You win some, you lose some. It’s called democracy.

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Long Odds

President Obama wants to reform our dysfunctional health system.

America doesn’t have a socialized system, like England, where doctors work for the government. We don’t have a single-payer system, like several European countries where medical care isn’t socialized, but health insurance is. And for better or worse, neither Congress nor the President proposes emulating either approach. Instead, Obama wants to control costs, crack down on insurance company abuses, and create a public insurance option to compete with insurance companies—much as Medicare competes with private coverage for older Americans.

Seems like a no-brainer. Thirty percent of Americans get their health insurance from government now, and government at all levels currently pays over 60% of all American medical costs. Curbing waste and instituting efficiencies would give taxpayers more for that money.

So why does reform face long odds?

My son-in-law said it best the other night: there is too much money and power being deployed by those who are richly rewarded by the current system.

A couple of weeks ago, the Star ran an important investigative report about our own Senator Bayh, whose wife Susan raked in over two million dollars in two years for her “service” on the boards of several healthcare companies. The Senator seemed shocked—shocked!—that anyone might think this bonanza constituted a conflict of interest. (For those who believe it isn’t a conflict, or that this is an isolated case, I have some underwater land in Florida I’ll sell you…)

Public interest watchdogs report that insurance and pharmaceutical companies are spending huge sums to spread fear and disinformation about reform proposals. Since public understanding of these issues is thin, they’re making progress; the New York Times recently told of a man who screamed at a public meeting “the government better keep its hands off my Medicare!” Others evidently believe that reforms will include “death panels” to expedite killing off old folks. (Which does raise a couple of questions: if reform means killing us off, why is AARP supporting it? Why is the AMA? And haven’t the people who believe this nonsense ever heard of factcheck.org?)

Meanwhile, ironically, insurers profess concern that “bureaucrats” will get between you and your doctor. Those are the same companies that list the doctors you can see, specialists you can consult and for what symptoms, and tests your doctors can or cannot perform for a given set of symptoms.

The lobbyists’ most recent tactic is sending angry mobs to shut down discussion at public forums. This is faux populism, sometimes called “Astroturf” because it’s meant to look like a genuine grass-roots movement. Leaked memos confirm that the intent is not to argue the merits of particular provisions, which would be both useful and legitimate, but to drown out discourse and intimidate lawmakers.

It would be immensely productive to have an honest debate about how the actual reform proposals would work, and how they would affect our economy. Unfortunately, special interests are determined to hijack that debate.

If they succeed, we all lose.

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It Depends

It’s an interesting time to teach public policy.

As I tell my students, I am much less concerned about their eventual policy preferences than I am with the analytical processes through which they form those preferences. I figure I’ve done my job if they use two phrases more frequently than they did before taking my class: “It depends” and “It’s more complicated than that.”

Two current policy debates provide great examples of what I mean. The first is the huge mess that is Governor Daniels’ effort to contract out Indiana’s welfare intake system. The second is reform of American health care. The claims and counterclaims about both initiatives mostly involve labels—“privatization” and “socialization” being the most prominent ones. Those labels, in turn, trigger ideological reactions, left and right, that are generally—to be kind—unexamined.

The most basic question to be asked about any proposed public policy is a deceptively simple one: what, if anything, should government do? In other words, is the problem we are addressing one that can or should be left to the private sector? Or should it be “socialized,” i.e., provided communally by government or by for-profit or nonprofit organizations? Despite those on the left who want government to take responsibility for more aspects of our society and those on the right who believe private enterprise is always superior, the answer to that question will usually depend upon the nature of the task at hand.

Most Americans agree that police and fire protection, for example, should be socialized through the government. Ditto national defense, for obvious reasons. Most Americans also agree that income shouldn’t be socialized; we want to provide a safety net to those who cannot care for themselves, but we have ample evidence that socialized income systems—whether through idealistic communes or socialist governments—stifle important freedoms and don’t provide sufficient incentives for productivity and innovation.

When government is given responsibility for providing a service, contracting with profit-driven companies may or may not make sense. It depends. Filling potholes isn’t as complicated as deciding whether a single mom qualifies for welfare. Private contractors’ primary incentives are about cost control, not service to the indigent, and the human consequences of ineptitude and wrongful denials of benefits can be tragic.

It would also be nice if our policy debates centered upon the actual role that government is proposing to fill. I’ve seen several TV ads warning against “government-controlled healthcare.” But no one is proposing a system where our medical providers work for government. The argument is whether government should have a larger role in providing health insurance. Opponents of “socialized” medicine may not have noticed, but we have already socialized medicine, through the insurance companies that currently decide our care. The question before us is whether a new government entity should compete with those insurers. Would a “public option” keep private insurers honest? (Since Medicare’s overhead runs around 3% while private insurers average 24%, it’s worth considering.)

When should we privatize? When socialize? It depends.