The following piece is part of an ongoing series of OffTheBus reports by citizen policy experts critiquing different aspects of Campaign 08.
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The Kaiser Family Foundation this week launched a series of thoughty, chewy interviews with presidential candidates on our dysfunctional medical system, and John Edwards, who has been trying to get out front on the issue, was first up. But from the tone of the discussion so far, the candidates must think that to perform major surgery on this moribund patient, first we have to anaesthetize the voters.
The format, borrowed from the sedate, PBS-News Hour style where reporters and guests aren't allowed to thwack each other with rubber mallets, is supposed to elevate the debate but instead threatens to launch it into the ionosphere of Platonic Forms. It comes off nice, pat and perfectly incredible, in the original sense of 'not meriting belief.'
The interminable policy chatter about health in this presidential campaign makes me fantasize about how far a proposal to guarantee health care as a 'human right' as Brazil's constitution does would fly here. Not very, of course, but it's the sort of gut-wrenching, polemic-stirring underlying fairness issue that deserves a better hearing than the ultimately disingenuous blueprints for reform that are going to be trotted out from now until, well, your death.
Edwards has some good ideas about health system reform, but you also need a ripping political strategy to give any of these worthy schemes a snowball's chance. The collapse of Hillary C's plan a decade ago illustrated the smug selfishness of our social discourse dating back at least to the Reagan years and how easily the entrenched industrial interests will turn any threat into soundbite mincemeat. Edwards and the rest of the candidates seem unwilling to turn up the rhetorical heat to anywhere near the requisite levels to reverse this momentum.
A good example is his wimp-out on malpractice reform where he repeats the Hillary error from the 1990s. He proposes a prior review process for potential malpractice cases and a 'three-strikes-you're-out' punitive faculty to weed out lawyers bringing frivolous suits, a bland position that will convince no one and expose him, as a former trial lawyer, to a howitzer blast from doctors and insurance industry.
Our current malpractice procedures need to be dug up root and branch, not timidly tweaked. They're ostensibly designed to reduce error and compensate those harmed but do neither while terrifying practitioners and absorbing millions. The Swedish no-fault malpractice system, to cite one example, arguably does better on both counts for a fraction of the cost, and different states have led the way on innovating their malpractice laws in that direction. Edwards' proposal is the sort of fiddling around with a mess that he more astutely criticizes elsewhere.
He finesses the 'choice' issue that helped bury the reform attempts in the 1990s by proposing to allow people to keep their current policies while insisting that everyone have something. He was also right when he answered the inevitable whiner about 'our taxes' going up by saying that tinkering with a junker isn't the answer, junking it is. That way, you spend here and save there, but in the end you're better off.
So he's right as far as he goes, just as when all the Democratic candidates tut-tut Bush's threat to veto the expansion of SCHIP medical coverage for poor children, which alone should be giving the opposition a field day. But where's the moral outrage? Where's the challenge to individual self-interest (including those of the sainted 'middle class'), the call for the solidarity implicit in all insurance schemes--that people contribute when they don't need care to guarantee protection for those, including themselves, who eventually do?
If they don't stir up that hornet's nest, a lot of people, encouraged by the howling wolves of the industrial propaganda machine, will continue to react to the reform proposals by saying, I'm fine--it'll cost me money--I'm agin' it. Instead of pandering to this attitude, someone, somewhere, should be confronting it.
Edwards does call our current system immoral although he doesn't say people have a 'right' to be cared for when sick. But the current discussion is too politically disemboweled to build the momentum for actually achieving the profound change Edwards says we need. The soothing sounds coming from him and his competitors so far only show at best a Clintonian aptitude for obtaining power, not for actually changing the course of events once they get it.
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