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RJ Eskow

RJ Eskow

Posted: July 1, 2009 03:23 PM

On Health Reform, George F. Will Just Threw a Spitball


One could say of George Will what James Russell Lowell wrote of Emerson: "His eye for a fine, telling phrase that will carry true is like that of a backwoodsman for a rifle." Which is to say, the guy can write. But anyone who reads Will's latest screed on health reform with a critical eye might also be inclined to quote Lowell's observation about an Emerson lecture:

"It was as if, after vainly trying to get his paragraphs into sequence and order, he had at last tried the desperate expedient of shuffling them."

Indeed. Will's column is a mashup of disparate declamations. As is often his style, he offers quotes that are very enjoyable but only loosely related to the topic at hand. We also see the selective use of survey information and some standard-issue conservative lamentation that we have yet to unleash the power of the free market to fix health reform. (Will someone please provide some working examples of a "health care free market"?)

And baseball references, of course. If it's a George Will piece there has to be a baseball reference.

To the extent that the piece has a structure, it is built around a statement from Elizabeth (Betsy) McCaughey saying that the percentage of family income Americans spend on healthcare is essentially no greater now that it was in 1960. No supporting information or source material is offered for Ms. McCaughey's statement. Given her well-documented history of making false statements about health-related issues, it is sadly impossible to take this statement at face value. (See here for more information. Mickey Kaus, himself no liberal, wrote that "she completely distorted the debate on the biggest public policy issue of 1994.")

What's more, the point isn't all that relevant even if it's true. Medical conditions account for two-thirds of American bankruptcies today. Perhaps people died from lack of medical care at a greater rate in 1960, which limited their out-of-pocket expenditure. Or maybe people suffered just as much health-related bankruptcy back then as they do now.

Will goes on to say: "... (A)s societies become richer, they spend more on health care -- and symphonies, universities, museums, etc." This statement would be hard to substantiate, especially in the prosperous nations of Western Europe that spend far less on health care than we do. And Americans struggling to stay solvent while paying for needed care might rightfully take offense at the Marie Antoinette-ish undertone of the sentence. It's as if medical treatment were a whimsical indulgence of the prosperous, like attending the gala premiere of a new opera season.

"It is also because health care is increasingly competent," Will adds. But competent for whom? Isn't the ability to spend money on what works an essential aspect of competence? Yet conservatives continue to oppose studies that demonstrate what works and what doesn't. We spend far more on health care than other industrialized nations and yet have poorer results, as measured by public health statistics. That does not meet any commonly-held definition of "competence."

And why compare us to the US circa 1960, anyway? In those pre-Medicare days older Americans and their families often went broke trying to meet basic medical needs. That could certainly account for the relative lack of change in those cost percentages over the past 50 years. It would make more sense to compare us to those countries that have a rational health system today - but that's not a comparison Mr. Will appears ready to make.

Ms. McCaughey, for her part, is now hard at work trying to undermine health reform by playing what can be described as a "six degrees of policy separation" game. In this piece, for example, she takes the Kennedy bill's "medical home" provision and suggests that it vaguely resembles "the unpopular controls HMOs imposed two decades ago" penalizing doctors for providing or authorizing care that was not approved by the plan. That provision is not present in the Kennedy bill nor, upon careful reading, does she claim that it is. But it looks like something that looks like something that looks like that provision ... or so she says, leading to guilt-by-inferential-association.

I don't mind a good healthy challenge in the marketplace of ideas. It would be valuable and even enjoyable to engage in a pickup game with our conservative colleagues over the merits of health reform. But George Will is throwing spitballs, layering extraneous matter - effluvia, you might say - onto his anti-reform pitch. Betsy McCaughey spits on the beanbag and George Will throws it.

Will and McCaughey have been guilty of this unsportsmanlike conduct before. As James Fallows documented so thoroughly, this is a routine they perfected in 1994 (see excerpt below).

To his credit, Will acknowledges that conservatives should stop arguing that reform will lead to health care "rationing," since - as he correctly observes - all goods and services (he uses the word "product," but I don't think that's applicable to healthcare) are already rationed "by price or by politics." Well said. As always, when Will stops throwing spitballs and gets to his real point he's well worth reading. He prefers rationing that is based on price because, he says, "prices produce a rational allocation of scarce resources."

Will should stick with that point and elaborate on it, since it's the crux of his (and other conservatives') argument against health reform. I think that's precisely the wrong way to allocate health care resources, but that's a debate worth having. In fact, it's the debate we should be having.

Instead, Will is too easily tempted to adopt a conservative strategy that appears to come from an old playbook: Toss out false statements or distracting statistics and hope that, as in 1994, the press starts repeating them as if they were either true or relevant.

The astute reader will observe that I've adopted some of Will's literary mannerisms in the writing of this piece. Consider it an homage to a master essayist who, should he so choose, could be a much better advocate for his own political philosophy. Instead he offers us, to use Russell's words, "a chaos full of shooting stars."

The problem with spitballs, as any baseball lover knows, is that the pitcher has a hard time controlling them. Will does neither his readers nor himself a service by continuing to throw them.

_______________________

(From Fallows)

The article's working premise was that McCaughey, with no ax to grind and no preconceptions about health care, sat down for a careful reading of the whole Clinton bill. Appalled at the hidden provisions she found, she felt it her duty to warn people about what the bill might mean. The title of her article was "No Exit," and the message was that Bill and Hillary Clinton had proposed a system that would lock people in to government-run care. "The law will prevent you from going outside the system to buy basic health coverage you think is better," McCaughey wrote in the first paragraph. "The doctor can be paid only by the plan, not by you."

George Will immediately picked up this warning, writing in Newsweek that "it would be illegal for doctors to accept money directly from patients, and there would be 15-year jail terms for people driven to bribery for care they feel they need but the government does not deem 'necessary.'" The "doctors in jail" concept soon turned up on talk shows and was echoed for the rest of the year.

These claims, McCaughey's and Will's, were simply false. McCaughey's pose of impartiality was undermined by her campaign as the Republican nominee for lieutenant governor of New York soon after her article was published. I was less impressed with her scholarly precision after I compared her article with the text of the Clinton bill ... In claiming that the bill would make it impossible to go outside the health plan or pay doctors on one's own, she had apparently skipped past practically the first provision of the bill (Sec. 1003), which said,

"Nothing in this Act shall be construed as prohibiting the following: (1) An individual from purchasing any health care services."

RJ Eskow blogs when he can at:

A Night Light
The Sentinel Effect: Healthcare Blog

www.eskowandassociates.com

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