As the healthcare debate plays out, we're all getting to see in real time the fundamental political contradictions that make it so hard to get anything done. The big lesson learned from the Clinton debacle of 1994 is that people who currently have insurance from their employer don't want it touched. Ditto for senior citizens covered by Medicare. So Democrats are making sure they aren't touched: in fact, they're repeating like a mantra that if you like the insurance you have now, you can keep it. No one's going to take it away. No one's going to so much as look at it crosseyed.
Fine. But two-thirds of the country already has health insurance through their employer and another big chunk are on Medicare. If these aren't going to be touched, then why should they care about healthcare reform? In particular why should they be willing to pay higher taxes for something that won't help them out in any way?
No reason, really. So instead Dems are promising to increase "access" and cut costs. The former is basically welfare and gets only anemic support. The latter is not only unproven, but doesn't do much to excite most people anyway. Sure, they'd like it if their copays went down, but mainly they just want healthcare and they don't care how much it costs. Mickey Kaus comments:
1) As is so often the case, overpolling seems to blame....I suspect [Obama aides] saw what they wanted — and they wanted to focus on costs. It's possible to take polls that show something very different; 2) Is "access" the right word to test-as opposed to "security"? "Access" makes it sound as if you are focusing on the problem of the uninsured — i.e. charity, to many middle class Americans — as opposed to security for everyone. If they polled "access," that may have stacked the deck from the start; 3) "Maybe" they "overcorrected from the Clinton model"? Maybe?
I sympathize with the Obama folks. How do you promise to leave most people alone and also convince them to support major change? It's a tough nut. And putting aside whether the Obama team overcorrected or not, it's still true that "security" didn't get the job done for Clinton. So what's the answer? In a nutshell, fearmongering. Like so:
Rather than overall cost....the selling point of national healthcare is freedom from the endlessly gnawing problems of our current jury rigged system. For example: HMOs that make it hard to see a specialist. High and rising copayments. Fear of losing coverage if you lose your job. Long waits for non-urgent care. New (and usually worse) healthcare coverage every time your HR department is told to find a cheaper plan.
And more: Small businesses that have a hard time attracting good employees because they can't afford to offer health coverage. Big business that are on the verge of bankruptcy because of skyrocketing health costs. Lack of choice in physicians because you're limited to whichever medical groups have signed contracts with your company's insurance carrier. Losing your longtime family doctor because your company switches insurance carriers and you can only see doctors on your new carrier's approved list.
And yet more: Fear that preexisting conditions won't be covered if you take a new job. The risk of financial ruin if someone in your family has a truly catastrophic illness. Crowded emergency rooms that have essentially become clinics of last resort for the poor. Being forced to go on strike year after year because your employer relentlessly tries to gut your healthcare benefits every time your union contract gets renegotiated. 43 million people who lack health coverage of any kind.
Reducing healthcare costs ought to be a goal of any national healthcare plan, and a truly national plan is probably the only way we'll ever accomplish that. But that's not the way to sell it. Freedom from fear, freedom from pain, and freedom of choice are the ways to sell it.
Fine. I'm cheating. That was me a couple of years ago. But I still think it's the right sales pitch. And even if it's not as highminded as Obama might like, it has the virtue of being true. For most people, healthcare reform isn't so much about insuring their health now as it is about insuring their health tomorrow. If they understood just how precarious that is, they'd be a lot more enthusiastic about healthcare reform today.