Why Democrats Are Losing on Health Care

What's dragging the Democrats down in the health-care debate isn't confusion about details. On this the president and his supporters have proven themselves the ablest of technocrats, easily identifying each plan's particulars and its shortcomings, laying everything out on nice flow charts.

It is the big questions that are tripping them up. Concerns about the size and role of government are what seem to leave reformers stammering and speechless in town-hall meetings. The right wants to have a debate over fundamental principles; elected Democrats seem incapable of giving it to them.

And in the silence, some lousy ideas have flourished. If universal health insurance goes down to defeat again this year, Democrats will have to live with the shame not only of having failed to enact their No. 1 priority, but also of having been beaten by arguments that a novice debater would have no trouble putting down.

Consider the assertion, repeated often in different forms, that health insurance is a form of property, a matter of pure personal responsibility. Those who have insurance, the argument goes, have it because they've played by the rules. Sure, insurance is expensive, but being prudent people, they recognized that they needed it, and so they worked hard, chose good employers, and got insurance privately, the way you're supposed to.

Those who don't have what they need, on the other hand, should have thought of that before they chose a toxic life of fast food and fast morals. Healthiness is, in this sense, how the market tests your compliance with its rules, and the idea of having to bail out those who failed the test--why, the suggestion itself is offensive. We have all heard some version of the concluding line, usually delivered in the key of fury: By what right do you ask me to pay for someone else's health care?

This image of sturdy loners carving their way through a tough world is an attractive one. But there is no aspect of life where it makes less sense than health care.

To begin with, we already pay for other people's health care; that's how insurance works, with customers guarding collectively against risks that none of them can afford to face individually. Our health-care dollars are well mingled already, with some of us paying in more than we consume while others use our money to secure medical services for themselves alone.

The only truly individualistic health-care choice--where you receive care that is unpolluted by anyone else's funds--is to forgo insurance altogether, paying out-of-pocket for health services as you need them. Of course, such a system would eventually become the opposite of the moral test imagined by our Calvinist friends, with the market slowly weeding its true believers out of the population.

The idea that merit determines healthiness is almost as risible. To be sure, we should all eat right, brush our teeth, and cut down on sweets, but that will hardly help us if we're born with a condition that requires expensive treatment. Or if we eat cookie dough that's tainted with E. coli. Or if our industry dies and our employer shuts down. Or if our insurance company, looking out for its own health, finds some pretext to rescind our policy.

The righteous individualists among us might also consider that our current health-insurance system, which delivers them the medicine they think they've earned, is in fact massively subsidized by government, with Uncle Sam using the tax code to encourage employers to buy health insurance. And were it not for government programs like Medicare and Medicaid taking over the most expensive populations, the political scientist Jacob Hacker pointed out to me recently, the system of private insurance would probably have destroyed itself long ago. That image we cherish of our ruggedly self-reliant selves, in other words, is only possible thanks to Lyndon Johnson and the statist views of our New Dealer ancestors.

One reason government got involved is that our ancestors understood something that escapes those who brag so loudly about their prudence at today's town-hall meetings: That health care is not an individual commodity to be bought and enjoyed like other products. That the health of each of us depends on the health of the rest of us, as epidemics from the Middle Ages to this year's flu have demonstrated. Health care is "a public good," says the Chicago labor lawyer Tom Geoghegan. "You can't capture health care just for yourself. You have to share it with others in order to protect your own health."

Yes, Democrats can prove that America pays more for health care than other countries; yes, they have won the dispute that private health insurance is needlessly expensive. But what they've lost is the argument that we are a society.

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Comments

[policyhack]

Is always easier to defeat something. Republicans have cynically distorted the debated. Sure the White House's execution has been inconsistent and flawed. The fact remains we have a failing health care system that threatens to bankrupt this country. It must be addressed. U.S. private health insurance represents a classic market failure.

http://axisofreason.com/2009/07/13/us-private-health-insurance-classic-market-failure/

[Cay]

We're all operating under the assumption that our democracy still works - it doesn't. It's been sold to interest groups with money. Our congress and president aren't going to solve anything until we buy them back.

While we watch the excitement of a political drama unfolding, behind the scenes the ending is already known. In this particular story, the health care insurance industry and big pharma wrote the script.

I hope I am wrong, but it looks like Obama and congress will not push for a meaningful overhaul to our health care "system" (nor regulation that will prevent the next economic bubble, nor substantial changes to energy policy.)

change-congress.com go take a look at it.

[treetracker]

But the problem is, Mr. Frank, they don't want to be a part of society. They want their individualism, they care nothing for others, they have no empathy. It's all about them and theirs and under no circumstances do they want to give up anything for the benefit of society as a whole.

This began with Reagan and his "welfare queens" nonsense. And it has continued with Grover Norquist's desire to "make government small enough to drown in a bathtub." They want the benefits of society; the roads, the parks, the air traffic control, safe food, safe cars, police, fire, ambulance, schools (maybe), a good job (subsidized by all), and insurance (also subsidized by all), but they don't want to contribute to their costs.

They decry "free markets" when, in fact, there is no such thing - it's a pipe dream pushed by the ideologues to sucker their believers. There is not a single corporation in this country that is not subsidized in some way by the government providing them a tax break, a tax loophole or a direct subsidy. Even the insurance companies & PhRMA are getting subsidies for advertising to us no less! 75% of all corporations paid NO tax in 2007.

[treetracker]

We labor to make the corporation's profits and their defenders and them aren't satisfied with what they already get. They want it all. They take our jobs away at will so they can make yet more profits and leave behind a decimated economy for we peons to try to salvage something from.

Our society is sick, it's not just our health care system. And it will take more than universal health care to heal us. We are approaching the death of our democratic republic in the very near future. We will be a wholly owned subsidy of the corporations.

[dino213aa]

Or.. let's just say that if Dem's lose the health care debate, it's because American's as a whole are too stupid and undeserving of universal coverage. Any country that would be snowed over by the types of asinine opposition being peddled by (mostly) the Republican party deserve what they get. It's amazing how quickly people will vote against their self interest to preserve the rights of the Top 1% of society.

[Stringer32]

Well said! These tactics being used by the right are so rediculous that to be fooled by them suggests that you would be fooled by anything. But the media also plays a critic role in the disinformation by treating these tactics as credible.

[drbobo]

FRank is right the Dems are losing the rhetoric war even though facts are on thier side.

The health care debate has become a battle of fear laden memes.
Why do the Dems have no word that cancels the meme of Socialism?
I have a suggestion
Why dont the Democrats spit back Monopolism?
The health insurance market is Monopolized already.
when you have no choice in service providers you pay Monopoly prices, or you get no service at all.
Even right wingers know this is true.

Obama should not be afraid of using the overt Monopoly word, considering all the words used overtly and subversively against him already.
Since the subtext of the attacks on Obama are that he is a Communist/ anti Capitalist, he needs in particular to take all the C words back and use them against the smears.

Obama could focus on Competition, when Competition is suppressed by market giants, there is no free market and there is no Capitalism, when you restore Competition by providing options its not socialism, its restoring free market Capitalism.

When you talk this way there's all sorts of points to be made and stories to be told.
Health Care used to Cost one percent of GDP, now its five percent, and the Monopoly plan is to make it ten.

If Obama and his gang ever say all the C and M words they might win the rhetoric war. If they do nothing the Socialism meme stands alone and wins.

[mehurst]

Excellent point. But I don't know how Democrats are supposed to "argue" it. Since the Reagan era, we have steadfastly shifted to a thoroughly individualistic society, without any sense of community. This cowboy culture is pervasive in all aspects of our lives, from our clinging to gas guzzlers in spite of the clear evidence of the damage done to the human race, to clinging to our "right" to carry and display deadly weapons, despite the clear evidence of the danger, to our refusal to pay enough taxes to cover even the most basic of public needs. We are killing ourselves as a country, as a people, all in order to say that we can do it without government interference.

Profits made by the health care industry would be perfectly acceptable, if what was being provided to make the profit was good health. But the current system is based on "sickness profiteering" -- set up so that profit is made by treating, and overtreating, symptoms of illness, and the incentives are actually skewed toward keeping people sick. Drug companies and providers make more profit the sicker people are. Insurance companies make profit by sloughing off sicker clients, accepting only the healthiest, and limiting services whenever they can get away with it. If we want to truly reform health care, by which I mean improving the health of Americans, we must either remove profits from the equation, or change the incentives that produce profits.

[DrPaulProteus]

Mr Frank -- what makes you so sure that Democrats don't agree with their Republican brethren on the larger issue of role of government and "society"? From the evidence of the past 30 to 40 years I have to say the difference is slight. Republicans go whole hog for the Reaganite free-market individualism, Democrats pretty much agree in their actions but talk like they oppose so people vote for them. A tidy little unchangeable system.

[henryberry]

The first principle in discussing health care with the aim of reducing costs and making it available at acceptable costs to all is to note that the only sure way to reduce costs (and not incidentally to live a more enjoyable life) is to reduce the consumption of health-care services (or as some have been calling it, disease, sickness, and injury management care). This means healthier individuals. Relevant and productive disussion and debate move on from this first principle. Frank can caricature and scorn as self-righteous or insensitive individuals (such as me) who stress this first principle. But those of us who do are being realistic. Whether Frank wants to recognize it or not, individuals do have some degree of control over their own health. And why in this article he would take up so much space to push this reality out of the picture is beyond me. Frank ends his article noting society's obligation to the individual. I'm surprised he seems to want to ignore or ridicule theother side of this--namely, the individual's obligation to society. As I've said in other comments, there's no reason the habits and goals of good health shouldn't be regarded as a civic virtue along the lines of obeying the law.

[DrPaulProteus]

Did you even read the piece?

"To be sure, we should all eat right, brush our teeth, and cut down on sweets, but that will hardly help us if we're born with a condition that requires expensive treatment. Or if we eat cookie dough that's tainted with E. coli. Or if our industry dies and our employer shuts down. Or if our insurance company, looking out for its own health, finds some pretext to rescind our policy."

[henryberry]

In one place in this piece, Frank seems to have some problem with prudence; and also in another part of his piece, a problem with the cautionary advice against eating too much greasy food.

On the other hand, I prefer not to leave my health care entirely in the hands of insurance companies and politicians--but to do all that I can to maintain good health. This does not dismiss nor obscure the fact that my health may not be in my hands at all times. Yet obstinately and strangely to Frank and you, I continue to try to do what I can to conduce to better health.

One way of looking at health care is like looking at teen pregnancy. Teens, particularly young women, are advised not to have thoughtless sex. If this advice was followed (as it is by some), there would be no teen pregnancies. Such advice is widely ignored. Yet to the extent that it is observed, so many sorrows and tragedies are precluded. To say once again, to express a supercilious view or scorn for prudence, to me, denies control (limited though it may be) individuals have in their own lives and turns oneself over to bureaucrats, corporate drones, and politicians who will make decisions for one. This is an alarming prospect for me--one alarming enough to motivate me to try to eat right and get enough exercise, and brush my teeth and control my sweets too.

[miles120]

I like to invoke the beliefs of my hero Benjamin Franklin whenever my conservative friends talk about being self-made, and therefore not deserving to be burdened by taxes and such. Even Franklin, who began his adult life with nothing more than a hard roll in his pocket (as the story goes), eventually becoming one of the wealthiest men in the world, realized that many of his accomplishments were predicated on the economic and societal structures built by his predecessors. Regardless of his abilities and industry, he realized that his success was enabled by those around him. Upon his death, the bulk of his fortune was placed in trust to provide that same assistance to those who followed.

It seems to me that we either want to live in an advanced society or we don't. Maybe that's a question that the Democrats should be asking.

[JohnFromCensornati]

"Yes, Democrats can prove that America pays more for health care than other countries; yes, they have won the dispute that private health insurance is needlessly expensive. But what they've lost is the argument that we are a society."

After 30+ years of Republican, "free-market", you're-on-your-own propaganda, the Dems are waging an uphill battle on that front. This does not apply only to health care. How about the minimum wage or taxing the wealthiest amongst us? People do not get wealthy in a vacuum. They build their wealth on the backs of low income people and couldn't do it w/o them. We are all in this society (and economy) together.

Maybe you could remind your employer about that.