Tuesday, August 25. 2009
George Lakoff: The PolicySpeak Disaster for Health Care. Useful and somewhat insightful critique of how Obama and most of those who more or less support him speak about the health care issues -- not that I'm not annoyed with the insinuation that it's all a matter of framing. The masses may only respond to political issues in emotional terms, but there's still something to be said for rationally figuring out the policy details. Of course, the left is at a disadvantage here, as in virtually all policy debates, both because we have some good faith in democracy and because we actually intend to accomplish something worthwhile. The right, with no interest in either, is free to kick our asses, but they've hardly been geniuses in this shouting match: they repeatedly come off as ignorant, hysterical, and mean, and in some ways we're best off just to let them destroy themselves. Lakoff has a knack for finding an important point then losing it on his first stab at reframing:
Morality isn't the right word here, but he's close. The basic fact is that if you can put a price on surviving an illness or injury vs. dying, that price would gladly be met by anyone able to meet it. It's easy enough to see that we value our own lives and most likely the lives of the people we love most more than money. Focus on cost runs against this instinct. (A curious turnaround, actually, since it is usually the moneygrubbing right that lectures us on how little we can afford to pay even for the most basic necessities of those most desperately in need.) That's why we should focus first on quality care and keep that from slipping regardless of cost, only secondarily looking at cost as an aid to being able to do more thing better. On the other hand, following Lakoff's suggestion and decrying insurance companies as deathmongers isn't even true -- at most you can say they are indifferent to deaths because their fiduciary responsibility is focused on profits.
So, sure, we can do a better job of talking in this campaign, but what would help more than better branding and wordsmithing would be a better solution to the problem. In fact, a good start would be to actually understand the problem, which quite simply derives from the commercialization of health care. That part is simple enough, but the industry is so huge and varied that no one realistically wants to try to wring out all of the commercialization. The single-payer advocates are only going after the insurance companies, which is a big and pernicious target and one that could most easily be dispensed with, but that leaves the actual providers, who have plenty of their own problems. Arnold S. Relman, in A Second Opinion, wants to go further and reorganize the providers into non-profit PGPs, which also makes sense, but is a much bigger task, is very likely to be disruptive, and still leaves the drug and tech companies free to scheme. I'd go after them too, and I got a few more things on my list too, like information architecture, training more professionals, and educating people to make smarter health decisions. But more than all that, you need to get people to recognize that professional virtues are more important than acquiring money. The essential reform of the system is to get to the point where your doctor values your health more than his own pocketbook. That's not impossible, but it's pretty hard to do in America these days.
Matt Yglesias: The Psychology of Health Reform. Back to reality, this quotes an article by James Suroweicki on the psychology of loss aversion, then adds a couple of points that are probably more important. I'll add that a key part of why the "public option" is so critical to those of us who think reform is not just a good idea but a dire necessity is that -- exactly contrary to so many folks on the other side of the divide -- we can't stand the idea of ever again being subject to a corporate bureaucracy where our health and welfare is treated as a zero-sum game. We at least know that even mediocre government bureaucracies in theory work for us. We can at least appeal to them, and it helps knowing that the coverage we need isn't coming out of their pockets -- it's actually coming out of our own, but cushioned by the fact that in a public insurance scenario everyone helps everyone out.
Ironically, the other side is equally convinced that it is the government that is arbitrary and capricious, attributes which they may or may not also recognize in the companies. (Some may hold to the fantasy that a free market forces companies to respond to the demands of customers, but there is no free market for health insurance -- nothing even remotely resembling one.) This is one reason why the real debate isn't over health care: it's over democracy. One side insists that the government can never be trusted with anything so important as health care. The other takes a similarly jaundiced view of companies, except insofar as they are regulated by laws enforced by government. Moreover, it sees government as the only agency that can represent the interests of the broad public in a society that is otherwise dominated by business. The Republicans have tied themselves to the mast of Ronald Reagan's dumb joke about the scariest words in the English language being "I'm from the government, and I'm here to help." The fact of the matter is that whenever anything goes seriously wrong -- a hurricane, an earthquake, a terrorist attack, a bunch of bankers swindling themselves into a drunken tizzy -- even Republicans descend on Washington looking for a bailout. There actually isn't anything wrong with that: many problems, especially really big ones, are by far best handled by government. Health care is one of those problems, but if the Republicans admit it they'll lose their whole shtick. So they stick to their guns and suffer, their only comfort being that others suffer worse.
Paul Krugman: Obama's Trust Problem: The news today (i.e., 5 days after this column appeared) is that Obama will renominate Ben Bernanke for a second term as Fed Reserve Chairman. Bernanke hasn't been as bad as a lot of Bush appointees, but part of that was circumstance -- he was nominated as a hawk against inflation, but he spent most of his term in a deflationary recession where his instincts were unneeded and could do little harm. On the other hand, past Fed chairmen have repeatedly been able to hold the economy in a death grip. If you're a president who is committed to trying to stimulate enough growth to actually improve the welfare of the people who voted for you, you'd think you'd want a Fed chairman who'd see eye-to-eye with you on that. Obama could in theory appoint anyone he wants, so why not come up with someone more in line with his programs and ambitions? I don't know what the thinking is here, but it sounds like Obama did this to reassure the banks and investors. That's what his team has done consistently ever since they took office, which is why we've had bailouts without any meaningful reform. Same thing has happened all across the board. Obama was elected as antiwar but he's presdided over business as usual in Iraq, an escalation in Afghanistan, and budget increases for the defense industry. The only other issue as important to his voters is a massive overhaul of the health care racket, and there he's made a series of inside deals with the AMA and PHARMA to cut back on any meaningful reform while the Republicans have had a field day with their unanswered hysterical nonsense. Obama's offer to drop the public option in favor of non-profit co-ops is one more example of his willingness to knuckle under. Krugman notes:
What's left of Obama's plan is a set of private insurance company regulations that would be better than the present situation but will almost instantly translate into significantly higher insurance prices, which will make universal care all that harder to achieve, and leave us in pretty much the same mess we've been entrapped in for several decades now. That may eventually turn into a make-work program for future Democrats, given that the Republicans have no ideas and no desire to actually address any real problems. But with 60 Senators and a big majority in the House you'd think now would be the time to do something. It's not happening, and a big part of the reason is that it doesn't look like Obama's fighting to make things happen or stand up for things he certainly knew before the election were right. Krugman again:
Time: Top 10 Health-Care-Reform Players: Just a list, but gives you a sense of the obstacle course.
Display comments as (Linear | Threaded)
The author does not allow comments to this entry