Why the Party of No Has Got it Wrong on Healthcare

I recently had someone post some critical responses to a post I made on my Facebook page regarding an interaction between a Congressman and a heckler with a defaced Obama poster in which the president was made to look like Hitler. I answered her criticisms one by one the best I could. If the Republicans (Hell no! Status quo! Hell no! Status quo!) think our healthcare system is doing such a heckuva job then why are they manufacturing arguments and answering questions no one has asked?

Q: Why can't we try [healthcare reform] at the state level - name a single state that has succeeded in providing universal healthcare?

Some problems are so large and diffuse that a regional or local solution will be quite difficult. Each of the cantons in Switzerland, however, which are most analogous to states in the United States, has come up with its own variation on a theme with excellent results. The federal government provides a leadership role, however, as indeed it must. I do not understand this insistence on finding a local solution before providing healthcare for all our children. Cancers and trauma and diabetes and schizophrenia do not respect man-made borders; why should we throw them up as an excuse for continuing to deprive tens of millions of our citizens with healthcare? How about this: why not name a state that has successfully won a war or put a man on the moon or developed a polio vaccine? If the Party of No had been in charge during the space race, we would have never launched a rocket until West Virginia could convince us that its rocket program was independently as good as Alabama's.

There is no state in the union that does not already receive much of its healthcare funding from the federal government, either through Medicare or its federal employee retirement programs, or CHAMPUS or Tricare for military members and their families. Therefore, it would be impossible to answer your question unless those programs, all of which are wildly popular and much more efficient than their for-profit counterparts, are abolished.

I don't think all of this applies to the United States.

Why not? Is there some genomic variation that occurs when people cross the Atlantic or Pacific to reside here? Is our government that much stupider than that of France or Germany? Do you really think Americans would rush out and get breast cancer if the treatment for it was suddenly affordable?

This argument is often advanced by those who advocate doing nothing about the uninsured or underinsured in this country. Even if there were some unique qualities to American society, surely SOMETHING must be done for the least among us. Simply because those drowning in the water might not all fit perfectly into a French or Swiss lifeboat, does that mean we should give up on trying to save them?

At any rate, there is no evidence that the distribution of illnesses is that much different for American populations than for those in European countries. Obesity rates are much higher in the United States but smoking rates are lower. What is clear is that if you get an illness in the United States, particularly a chronic illness, and you do not have health insurance, your morbidity and mortality are much higher. Our abortion rate is also much higher than in any Western European country, and those who are concerned about this might be interested to know that lack of access to healthcare is an independent risk factor for abortion (as is poverty, but adjusted for income, you are more likely to seek and obtain an abortion if you are uninsured). If you are Pro Life as it has become so narrowly defined in our country, you should be for universal healthcare.

France's plan is a failure from what I have heard because it causes too much tax and the country has a history of high unemployment as a result.

You should tell this to the French; they would be quite surprised to hear it. This is also why it is so important to get the facts, not just listen to something you might have heard.

You should also tell this to the World Health Organization (my wife's employer, by the way), which recently rated France's healthcare system #1 in the world! (The United States, by comparison, was #37.) If France is failing, let's try to replicate their "failure."

At any rate, this whole "failure" business should be properly defined. A truly failing healthcare system is one in which there is some measurable difference at the population level in some measurable health outcome that can't be explained by other variables. The healthcare systems of the Soviet Union, for example, despite theoretical universal access, would have been a failure in this regard, as would the healthcare systems of many impoverished countries that simply can't afford access or the infrastructure to deliver it. If a system is truly horrible, you should see a difference in life expectancy at birth. The French enjoy a life expectancy of 80 years, greater than ours, so clearly they must be doing something right.

If failure is simply measured in cold, hard dollars and cents (or Euros and centiemes) then this also is measurable. The implication you make is that France is bankrupting itself through its healthcare expenditures. You further speculate that these higher expenditures cause higher taxes and higher unemployment than in the United States.

To make this argument, it would seem necessary to prove that France spends more than the United States on healthcare, a lot more. As it turns out, France spends LESS, a lot less. As David Gewirtz recently put it, "In fact, we spend more on health here in the U.S. than the entire GDP of the United Kingdom, France, and Canada — and just below the entire GDP of Germany. Our health care cost is bigger than England’s entire economy! Interestingly, in a country where we’re arguing the issue of a national health care system, the U.S. spends more than twice (as a percentage of gross domestic product) than either the U.K. or Canada, who have national health programs. The U.S. spends 16.6 percent of its GDP on health care, while Germany, France, and Switzerland spend 10.1 percent to 13.0 percent — and India and China spend less than 5 percent." - http://ac360.blogs.cnn.com/2009/08/19/the-healthcare-hostage-crisis-how-much-does-this-all-cost/

So if the premise of the argument is false, one need not address the conclusions; if taxes and unemployment are higher in France than in the United States, the explanation cannot be healthcare because their healthcare costs are lower! Unless of course you are trying to make the point that France would be better off if it put its unemployed to work in a massive for-profit system such as ours, perhaps as claims processors (something France does not need) for all the different insurance companies.

Switzerland's employment rate has been far lower than that of the United States yet they have managed to cover all their citizens. Unemployment statistics are deeply misleading also in the case of the United States, where someone could work 3 minimum wage jobs and not have any health insurance or retirement benefits. That person would not be considered unemployed, but are they really better off than the worker in the McDonalds in Berlin who earns over $21 an hour and has healthcare, social security, and publicly financed college education to boot? When someone is employed in Europe, they are really employed, not just getting by without benefits or any hope of a better life. As a result, there are virtually no slums, massive poverty, or United States levels of crime (which are highly correlated with poor dispersion of income).

People still have to pay if they want good care and shorter waits. I do agree that any of these plans could be tried in a state of the United States but we (as you know) are a completely different country than Europe.

No, I do not know this. Our government is a logical outgrowth of the Anglo-Saxon constitutional parliamentary system. We do not have a monarchy, but do have a much more powerful, independently elected Executive. This American exceptionalism is largely a figment of our own imagination, with a little help from Donald "Old Europe" Rumsfeld and Dick "Freedom Fries" Cheney. Otherwise, our systems are quite similar. Our governments already spend far more on healthcare and social security programs than they do on any other government activity; the difference is that for some reason the word "socialist" is a bad word on your side of the Atlantic. (In fact, I heard someone quip that our government is essentially a social security benefits administrator with a lively arms business on the side.) Because of our anathema to anything that even smacks of central planning, we tend to do it badly and in fits and starts. FDR managed to establish Social Security in 1935; Republicans have been trying to kill it since its birth, but it remains one of the most popular programs. (I even read an article in Barrons about 2 years ago that FDIC was a quaint New Deal program that should be killed because despite its trivial cost bank failures just weren't a problem anymore… thank God that advice wasn't taken!) LBJ got Medicare done, another wildly popular program covering all over 65 and the disabled and doing so with less than 2% overhead, something for-profit companies could only dream about. Nixon and Clinton both attempted to advance universal healthcare initiatives, but both were shot down by extremely well-funded misinformation campaigns by those who profited from doing nothing.

Now we are at a similar crossroads but the stakes are higher, the number of uninsured or underinsured has skyrocketed, and the costs of our managed care for profit experiment seems to be rising with no end in sight. Republicans say we can't afford to join the ranks of every other industrialized country in the world and insure our children but the evidence seems to suggest that we can't afford not to.

What proof do you have the protestors are packed in by anyone.

- Representative Phil Gingrey from Georgia advocated on national television that protestors – almost all white and Republican - bring guns to town hall meetings. (http://rawstory.com/08/news/2009/08/18/rep-gingrey-encourages-guns-at-town-hall-meetings/)

- Americans for Prosperity, the front organization created by billionaire David H. Koch who also tried to organize "tea parties" in April (remember those?) to create the illusion that real people, not just a tiny elite, would lose if the tax cuts for the richest Americans were ever rolled back to Ronal Reagan levels - has bought millions of dollars of television ads and has even sent a bus across America to mobilize opposition to healthcare reform. On its website, it lists town hall meetings to encourage activists to attend.

- Conservatives for Patients’ Rights, led by Rick Scott, former Columbia/HCA CEO, a healthcare company that paid $1.7 billion in fines for stealing from the taxpayers to profit themselves (overcharging government programs in the 1990s) - is working with another PR group responsible for the Swift Boat ads that defamed a decorated wounded Vietnam veteran (but did so effectively enough to tilt a tight election in favor of a draft-dodger who had not completed his service with the National Guard).

- FreedomWorks is a group, led by Dick Armey, a former Republican House majority leader that has been fomenting hysterical levels of opposition.

The protestors are grossly misinformed. Indeed, if they were informed, they would put away their Hitler mustaches and assault rifles and act like adults. Yes, it will be difficult making the transition to a system that covers all of our citizens, but let's disagree about means, not ends. The misinformation is coming from the top. When someone like Sarah Palin comes out with a statement as she did on her Facebook page in which she refers to the idea of insuring our children as a "nationalized healthcare plan" and "disturbing" and "downright evil" and says "we’re saying not just no, but hell no!" this language only incites the type of violent rhetoric and creates the mindset of a lynch mob (and with the ugly addition of automatic weapons seen by the predominantly white Republican protestors against the healthcare initiative of our first African American President, that metaphor is far from accidental).

Palin makes the ridiculous assertion that healthcare rationing will begin with the current reform (implying that such rationing is not occurring either de facto (those without insurance get no treatment) or de jure (apparently Ms. Palin has not heard of prior authorizations, restricted formularies, pre-existing illness exclusions, or lifetime medical caps, all of which represent forms of rationing brought to you by the for-profit healthcare industry).)

She goes on to claim that the "sick, the elderly, and the disabled" will be hurt most even though no one is proposing major changes to Medicare (which currently covers the last two categories) and it is hard to see how giving healthcare insurance to someone who doesn't have it is going to hurt them.

"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care." Yes, she really said this. Death panels. Read it and weep: http://www.facebook.com/notes.php?id=24718773587&start=10&hash=34d9414b0365b1e460511f13215ccb7d

Now I know most intelligent people have long ago stopped listening to Sarah "in what respect, Charlie?" Palin but some still do and many who are less educated or less informed will wonder why someone who is so well-connected to have been tapped to be a heartbeat from the presidency would talk about death panels if they didn't exist. Those people, showing up armed with their guns and their defaced Obama portraits made to look like Hitler (Hitler!) didn't just get there accidentally. If such panels existed, I would be mad too, and I might not be interested in debate or listening to what the other side had to say. Or even reading the actual bill. Sarah said it and I believe her. End of argument. (Remember, these are the same people that believe that reason and compassion are tools used by the devil to trick you out of your pre-destined front seat to the Rapture during the End of Times (which Sarah Palin believes will start in Alaska, boosting tourism (I wish I were making this up)).)

The latest polls show that over half the US is against government run health care and are very upset by the prospect.

If this argument is offered as an excuse for those who believe insuring children is the moral equivalent of mass murder, two things must be true: 1. most Americans oppose government run health care and 2. (more importantly) that the bill in question advocates it.

Unfortunately for the Party of No, reality once again remains a tenacious foe.

I am against a government-run health care system. So is President Obama. Thank God the bill that Palin condemns as "downright evil" does not propose a government-run healthcare system so we don't have to waste time arguing about a non-issue. Or do we?

It is true that disinformation campaigns work. We know that just as Goebbels knew it. A lie repeated often enough will be believed, so it's no surprise that the percentage of Americans supporting the current healthcare reform has slipped from over 50% to about 42% of American voters (according to a Rasmussen poll). And with all this talk of death panels for the elderly, what do you know? 56% of those over 65 oppose the plan whereas those under 30 support it by a 2:1 margin.

However, although the Swift Boat campaign in progress may have slowed down the current bill's momentum, it is not true that Americans do not support the idea of government-run healthcare in general. In fact a recent New York Times/ CBS poll showed a whopping 72% of Americans supported a government-run program. Only 20% were opposed, about the same as the percentage of people in other polls (18%) who believe the Sun revolves around the earth. Half of Republicans would support such a proposal, as would 9 of 10 Democrats and 3 out of 4 independents. Other findings:

- 85% of Americans believe that the healthcare system needs radical reform.

- only 18% of respondents trusted the Republicans to improve healthcare

- 57% trusted the Democrats more. (even 1 out of 4 Republicans trusted Democrats more);

- 6 in 10 Americans are willing to pay more in taxes to support universal healthcare. 87% of Americans believe the inability of people to pay for needed tests and treatments was a serious problem. 1 in 4 said someone in their household had skimped on medications because of costs and 1 in 5 had skipped a recommended test or treatment. Only 75% of respondents feel that insuring everyone is more important than controlling costs (although the experience of every other country is that you can do both). - source

So there are some good, intelligent arguments, most based on a brutal Darwinian view of the world, for continuing to deny healthcare to our children while for-profit healthcare companies thrive. None are moral arguments, unless you really believe that human life is less worthy of protection than lower tax rates, or unless you have a Timothy McVeigh view of the federal government as always-evil-all-the-time (with the exception perhaps of those federal employees in uniform who are covered by the world's largest socialist healthcare system).

But the arguments the Republicans are fighting are ones no one is making ("death panels!" "government-run healthcare!" "mandated abortions!"). It makes me think that they know how weak and selfish their position is. They seal the argument when they use brownshirt tactics that shut down debate and guarantee failure and maintenance of the status quo.

Quiz someone who is all worked up about this bill for 5" about what is actually in the bill, or how many people really drop dead in waiting lines for medicine in Canada or the UK, and you will get either a blank look or an anecdote about a friend of a neighbor's brother-in-law's cousin who once knew someone in Canada who didn't like their doctor. Good thing that never happens here.

If you really think that spending 16% of GDP, more than any country on the planet, on a bloated for-profit system that leaves nearly 50 million Americans behind, 90% from working families, half children, then go for it. Get out your Hitler mustache and Obama poster. Hell, bring along your AR-15 (your congressman says there's nothing wrong with that). Make yourself and your country the laughing stock of the world. Guarantee this effort will fail also. But you're still left with the same high premiums, out of control deductibles, and will still be a paycheck away from financial disaster.

You will have your talking points though and maybe even a signed Sarah Palin poster and that's worth something, I guess.

But there are people out there for whom this is not a theoretical debate and I have worked with many of them and it appalls me.

I have plenty of anecdotes also, like that of the paramedic broadsided by an ambulance but then told by her private insurer that the physical therapist she found and liked was not part of her plan, so she would have to drive across town to see a stranger who offered substandard care.

Or the man who mortgaged his home to finance his chemotherapy only to be told he needed another round and unless he could find $100,000 in cash, he would die (he had private insurance, by the way, but blew through his million dollar lifetime cap so they dropped him midway through his cancer treatment… perfectly legal in America).

Or the countless numbers of patients who ended up in jail or worse because they had no mental health benefits or after 72 hours in the hospital for psychosis or depression or mania the for-profit managed care "coordinator" determined (without meeting the patient) that they had reached the maximum benefit of inpatient treatment for which they would pay anyway.

I think I have a different definition of evil than Sarah Palin. It's similar to Martin Luther King's, when he said that our generation must atone not just for the vitriolic words of the bad people but for the appalling silence of the good people.