THE BLOG

Politics, From the Greek Politikos, Meaning Hypocrisy

03/18/2010 05:12 am ET | Updated May 25, 2011

If you should happen to think that the provision of health care to the people of this country should not necessarily be a political matter--in the pejorative way that "politics" is often employed--I would be rather inclined to agree with you. If, on the other hand, you sincerely believe that health care reform is, should be, or even can be an apolitical issue, might I suggest that you come ever so gently to grips with the fact that you are sorely mistaken.

Now, I trust that this is glaringly obvious to many of you, but I've had my share of conversations over the last couple of weeks that have convinced me that a great many Americans think that it should be possible to have a debate over health care reform that adheres to nothing other than facts. I love this concept, but find it laughable. The reason why is simply this: Members of the general public have little to no idea about how their health care system actually works, what is wrong with it, or what--good research suggests--might begin to fix it. There are people who know these things, and they are working behind the scenes on the health care issue in hopes of making improvements to the system and "getting it right," but most people aren't dialed in to those people and their information. So, people rely on other people for their information, and the game of telephone begins.

Very few people who purport to have strong feelings about health reform have actually read the bills that are currently moving through Congress. What's more, even if people had read the bills, few would really understand them and what they would and would not do, because--as I've already said--very few people understand all of the elements of the American health care system. So how do you begin to address this? Well, I thought a blog would be a good way to try and make a dent in it, but the problem with that is that the learning curve is still too steep for most people. Actually learning about the health care system, then reading the bills and understanding them, evaluating the pros and cons, determining the evaluative criteria, and anticipating the consequences of enacting new health care policy is a complex task. In fact, it's so complex that it takes a great many people with a wide variety of highly specialized skill sets to begin to accomplish it. Health reform is being shaped by the ideas of economists, clinicians, social scientists, insurance companies, hospital executives, and other industry lobbies, along with consumer advocate groups, lawyers, and others.

Most people don't understand this stuff, not because they can't, but because they really don't want to. It would take far too long to really get a handle on it. It's much easier to simply draw a conclusion on the basis of a few grossly oversimplified pieces of information--which may or may not actually be accurate--that have been provided by trusted sources. Whether or not such sources ought to be trusted is an entirely different matter. Consequently, there are people who are against health care reform because they envision a scenario wherein the government will tell them what care they can or cannot get, while they ignore entirely the fact that their health insurers can do the very same thing right now. There are people who are against health care reform because they think that they are going to have to foot the bill for the uninsured to get coverage or for "illegals" to get care, when the reality is that we all already pay a hidden surcharge in our monthly premiums to offset the cost of providing care to the uninsured and the health care legislation in Congress specifically excludes coverage for illegal immigrants.

It basically comes down to an ironic duality: Everyone trusts someone. If you distrust government, then you are trusting that private corporations have your best interests in mind. If you distrust the corporations, then you are trusting that government intervention will keep them straight. But you're not trusting your fellow man (perhaps for good reason) and you're not trusting change of any kind. Fear of the unknown is the great equalizer here. The solution to that problem is to begin to know more, and since most Americans aren't going to become health policy experts, the first step is to cut through the dense fog of politics that envelops the debate. Only then will you be in a position to begin to draw some truly sensible conclusions about health care reform. In fact, it's as close to apolitical reform that you're ever going to get.

To make my case, I'd like to refer to an article by Jacob Weisberg in the December 21, 2009 issue of Newsweek. In his article, Weisberg draws sharp parallels between the current Democratic reform proposals and the earlier Republican effort known as Medicare Part D (providing prescription drug coverage for seniors). Weisberg's point is that the Republicans did the very same things in 2003 that they are now chastising the Democrats for in 2009. They orchestrated all sorts of "shenanigans" to get the bill through Congress, and what they produced was an expansion of an entitlement program (If you thought Republicans traditionally opposed entitlement programs you'd be right) that was very complicated in its design and quite expensive. In fact, as Weisberg points out, Part D still hasn't been paid for, and its 10-year cost is estimated at $1.2 trillion, which is considerably more than the Senate's current $848 billion legislation, even though it only applies to pharmaceuticals for persons age 65 and over. It's well-known, too, that Part D was a sweetheart of a deal for PhARMA.

Looking at it, the Republicans seemed to put their values on hold to push through legislation that they would typically not believe in at all. Why did they do it? Because they wanted to solidify the senior vote. As Weisberg says, conservatives don't object to expanding government. "What they object to is expanding government in a way that doesn't help them get reelected." It was politics through and through. But was it entirely bad? Not at all. Giving Medicare beneficiaries drug coverage was long overdue, and Part D was at least a start. Since it was enacted, changes have been made to improve the program, and I'm sure that there are more to come. The same can be said of the current reform proposals. They are less than ideal from a liberal point of view, but they would do a lot of much needed things, and the legislation can still be improved upon later. It isn't the end-all be-all bill.

Well, I fear I've rambled on so long now that you may have lost my point, which is simply this: Both sides are playing politics--always have and always will--but that doesn't mean that some good things aren't happening in the process. The sooner you can accept that, the sooner you'll be able to see past the political posturing to the substantive policy beneath.

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