Pragmatist Hope for Health Care
Yesterday, David Brooks opined in the New York Times that President Obama's slide in the polls stemmed from his embrace of the left wing of his party, thus losing the support of the political center supposedly more concerned with federal budget deficits than with the plight of the uninsured. Brooks's point is that it would be "suicidal" for Obama to push through health care reform without appealing to the real American values of the political center: "You can't pass the most important domestic reform in a generation when the majority of voters think you are on the wrong path. To do so would be a sign of unmitigated arrogance."
As I held the morning paper in my hands, I realized that in the same space on the op-ed page about a week before Paul Krugman had made almost exactly the opposite argument. Krugman criticized the president for reaching out to a middle that wasn't there. In trying to achieve bi-partisan support, Krugman observed, Obama was losing the energy to achieve any substantial health care reform. On August 22 Krugman wrote:
"It's hard to avoid the sense that Mr. Obama has wasted months trying to appease people who can't be appeased, and who take every concession as a sign that he can be rolled."The columnist urged Obama to forget about pleasing Republicans intent on preserving the status quo.
Talk about getting it from all sides! Progressives (whom Brooks identifies as readers of the Huffington Post!) apparently are disillusioned with a president who looks weak because he continues to work with elected officials who seem intent on seeing him fail. Centrists apparently are disillusioned with a president who can't create a coalition of forces able to pass legislation that will initiate some reform, even if it doesn't pretend to solve all the problems we know are there. The president is accused of being weak and arrogant.
These charges amount to saying what we already know: President Obama is a pragmatist, and he is an heir to the great tradition of the reformist progressives in the United States. This tradition, at its best, has found ways to mitigate the inequalities created by our economic system without sacrificing individual freedoms and the virtues of decentralized power. Those who approach politics with a more theoretical or absolutist bent tell you that the progressive tradition has failed to fulfill its potential, or that it is naïve in believing in incremental reform. But Obama, professorial as he may be from time to time, is no theorist. He has long known that the best is the enemy of the good, and he has been focused on getting something done now that we can build on in the future. Pragmatists don't start with a belief in the "Truth" that they then try to realize with action in the world. Instead, we begin with hope that our country can move along a path to realize its dreams of being a more just and compassionate community through collaborative effort.
Spectators of politics have no difficulty mocking the reformist, pragmatist agenda. It's easy to wave your fundamentalist principles in the air and demand that the president fulfill what you know to be the Truth. Pragmatists, after all, always fall short of the targets established by absolutists on the Left or Right, because we don't believe those targets are anything more than motivators to help get something done in the short term. And through experience and the evaluation of our efforts, we pragmatists are willing to modify our hopes as we prepare for the next round. Our motivation comes from the stories of previous battles fought, and from wanting to add hopeful chapters to those narratives of progress.
I am confident that Obama will stay focused on the moral and historical aspiration of providing health insurance for all Americans while controlling costs and maintaining the quality of care. As part of the great pragmatist tradition in American politics, he will lead efforts to pass legislation that will move us closer to realizing what has already become a shared belief among most Americans: that no one should be denied health care because of an inability to pay. In doing so, I don't expect he will satisfy those who are absolutely certain the government shouldn't get any bigger, or those who have no doubt that only the government can adequately address this basic need. But he will have made progress, and so will we.
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I thought of two examples of that great pragmatist tradition you speak off. 1 Don't ask don't tell. 2 Defense of Marriage Act
US Health Care is too expensive. Why? Because the private health insurance market represents a classic market failure. We have the best trained physicians in the world. We have the most advanced technology and pharmaceuticals in the world. Yet our health insurance system pays for unnecessary procedures and denies coverage for unprofitable risk. The result is a classic market failure.
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I same to. Obama just make statement that what he is thinking
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I'm a little stumped as to why so many people demand that Obama embrace the public option. He already has - repeatedly. But if Democratic senators won't embrace it, it's a dead duck. All Republicans - with possibly one or two exceptions - are no votes, which means that every single Democratic senator has to vote at least for cloture (including Lieberman and whoever replaces Ted Kennedy). Guess what - that doesn't sound like it's going to happen. So, by demanding that Obama "embrace the public option", what people are demanding is that he leave the whole thing at status quo - and leave 47 million Americans without health care. Leave 47 million Americans in a position where they can pay for minor office visits, and if they get sick enough to be willing to be bankrupted they can go to the ER and get care, and have nothing in between. 47 million Americans who are living on borrowed time because they can't go to the doctor. Americans who have to tell their children they can't go to the doctor.
I guess if you're an ideologue and the political fight is the whole point, that's a sacrifice worth making - kind of like generals in World War 1 considered 10,000 dead soldiers an acceptable sacrifice to gain 100 yards of ground.
But you do not want to loose 10,000 soldiers and 100 yards of ground. See universal mandate and continuing insurance company profiteering.
If the House bill has a public option and the Senate bill does not, then the Senate can pass a public option as part of reconcilliation, especially since it will reduce the cost of the bill by billions of dollars. That only requires 50 Senators and VP Biden.
But by all means, suggest that 47 million people should be forced to pay for health insurance instead of making mortgage payments or buying food. It is great for the insurance companies, but some of the uninsured might not like it.
As a self-described Socialist, well left of the Democratic party and Liberalism, I never expected anything more than incrementalism from Obama. I haven't been disappointed yet. For all you cry babies who are pounding the drums claiming you'...ll never vote Democratic again, consider the alternative. What do you think McCain/Palin would have done? C'mon folks, be realistic.
You a learnt a lesson albeit the wrong one.
If Obama does not support a public option on Wednesday's speech, then do not donate any money to Obama's Organizing for America's group, donate money to other groups that will support and push for a public option.
Sure, just take control of the 'Subjects" right?
No thanks!!
UK Death Panels, coming soon to a hospital near you?? http://www
Painkillers for people who need them, UK (soon to be USA?) style: http://www
Do not read science based articles if you have no sense of rational how research si conducted and expectations. Reading those two articles just shows resistance to changing one's attitude to new approaches and are examples of the tussles that go on everyday in medicine to determine best practice and in the end leads to improved care. There is always that inertia.
you want a pragmatic view of health care, you're never going to get it in DC. You're not even going to get it from the average joe public whose biggest concern is a sprained ankle he receives during weekend football and beers with the boys. You MIGHT get it with a woman who has complications during a pregnancy. But, if you really, truly want a pragmatic view of health care, ask someone who uses and has used the health care system for years and years. The Disabled. And, while of course there are going to be variations in experience, I'm willing to bet that the people who use their health care the most will tell you that the cost and availability of their insurance is small beans compared to facing a life long chronic disability such as MS, MD, CP, etc, or even short term criitical issue such as cancer that has the potential to lead to terminal illness
I just signed a petition demanding that the U.S. Congress allow a public option.
Click here to sign: http://bit
A "pragmatist" focuses on what can be done. The truth is that Obama CAN pass almost any health care plan he wants - he would just have to have the backbone to take a stand and make sure it happens. "Pragmatist" and "milk toast" are not synonymous.
I only wish that were true. Consider the blue dogs. Please, if you live in one of their districts, as I do, vote against them in the primaries. My Senator is Evan Bayh and my Congress critter is his pale shadow, Baron Hill. I don't vote for Evan because Republicans never bother to run against him for a reason, and I always vote for Baron Hill's primary challenger. But, believe you me, I'll never let a Republican take either of those seats. I call it political triage.
The great reformers of social policy were FDR driving home Social Security and LBJ doing the same for Medicare. A "great reformer" would not have begun with neutering his most valuable card in health policy reform: single-payer, then withdrawing his second most valuable card: public plan option which Obama is apparently poised to do. The "negotiating" is all on one side, those who won the last election. What we are about to witness I fear is Carter-Clinton-like weakness of spirit.
Obama the "pragmatist" disappeared the day single-payer was taken off the table.
37 Trillion Reasons to support Medicare for ALL WHO want it!
HEALTH CARE WILL COST AMERICA $37 TRILLION OVER TEN YEARS?
WE ARE WORRIED ABOUT LESS THAN 2% of THAT BLOCKING REFORM! GIVE ME a BREAK!
At Stake is $37 Trillion over ten years! INSURANCE and Health Care Industries want every DIME they can GET!
Calculations (see table below): ($5+$2.4)/
And we are worried about $600 Billion, less than 2% or 1.6%
PLUS Savings of $1.3 Trillion/10 years from uninsured NOT using Emergency Rooms!
If you want a Public Option then pass HR 676 Medicare for ALL
And ADD a clause that let people OPT OUT to buy Insurance!
100,000,000 people to 306,000,000 people in Medicare can negotiate "FAIR PRICING" for Health Care Services! Stops the FOR-PROFIT GOUGING!
It works in #1 France and it can work here!
Make MAY0 C1inic the N0RM instead of the Exception!
__________
HEALTH CARE COSTS = THE #1 THREAT TO OUR FUTURE!
$2.4Trilli
$3.1Trilli
$4.3Trilli
$5.0Trilli
Medicare is going bankrupt . . .
Your answer is to make it go bankrupt faster?
Medicare for all isn't logical until they can make it sustainable for the 40 million people on it now.
Don't forget to add: $2.4 trillion spent in 2008, 17% of OUR GDP, and only $912 billion returned in actual care.
American medicine is now structured like a 50 lb tapeworm eating us from the inside out. Currently medicine is 17% of the GDP while the Fed (including defense spending) is 18% The present system has no means of limiting costs. There is no leadership built into the system, so all players just ride along adding on their %5. Without change it will climb to 20-25%.
At present levels, it's an extreme drag on the economy. It's going to get worse.
"There is no leadership built into the system"
So turning 17% of our economy to these people in power now seems like a great alternative? Not in my mind, I don't trust them to do what is right any more then I trust the insurance companies.
How much are you getting from the insurance companies? do you have any control over the insurance companies? The politicians you can at least change by voting them out of power. You appear not to realize that the goals of the insurance company and the patient (aka insured) are diametrically opposite so the insurance company even though you pay them can never be on your side. So by being so gunho for them you are showing a big lack of insight into the realities of health insurance and the insured.
Obama's slide in the polls has to do with his not being clear about what he wants, being passionate about the moral imperative behind what he wants, explaining how getting what he wants will help us meet that imperative and getting out front and disciplining the ranks of the party to do the 'right' thing as it relates to benefiting the American people.
Up to now, Obama has looked 'wonky' and seems to be more passionate about 'bipartisanship' than peoples' health. Even if he wants to be pragmatic he still has to enlist people into a cause that goes beyond reducing costs, bending the curve, and offering choice. He needs to stake his claim to get affordable health care to all people so that they won't be abused, denied, or go broke when they need medical care.
"Obama's slide in the polls has to do with his not being clear about what he wants"
I would also add that he sounds like he doesn't know what he is talking about either, he hasn't addressed any questions with specifics . . .
When people here career politicians say "pay for itself" or "cost savings" without any specifics . . . the red flags go up.
It's worth noting that Obama's slide in the polls is almost identical to Reagan's slide in the polls right after he took office - and for the same reasons. Both of them took over a dripping sack of snot and are wrestling with it, and the American people are impatient. But when the economy turns around and there is some kind of health care reform that will allow for universal coverage and at least some trimming of Medicare costs, his polls will go back up.
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