In the opening comment of the hot-off-the-pixels new issue of the New Yorker, Hendrik Hertzberg uses the current push-me-pull-you over health care to make a point that we ought to make regularly: The United States government is set up, in ways that are bizarre by the standards of the world’s democratic systems, to favor inaction over action, even when the whole country agrees that action is needed.
Here’s the relevant portion:
“In other free countries, legislation, social and otherwise, gets made in a fairly straightforward manner. There is an election, in which the voters, having paid attention to the issues for six weeks or so, choose a government. The governing party or coalition then enacts its program, and the voters get a chance to render a verdict on it the next time they go to the polls. Through one or another variation of this process, the people of every other wealthy democracy on earth have obtained for themselves some form of guaranteed health insurance or universal health care.
The way we do it is, shall we say, more exciting. For us, an election is only the opening broadside in a series of protracted political battles of heavy artillery and hand-to-hand fighting. A President may fancy that he has a mandate (and, morally, he may well have one), but the two separately elected, differently constituted, independent legislatures whose acquiescence he needs are under no compulsion to agree. Within those legislatures, a system of overlapping committees dominated by powerful chairmen creates a plethora of veto points where well-organized special interests can smother or distort a bill meant to benefit a large but amorphous public. In the smaller of the two legislatures—which is even more heavily weighted toward conservative rural interests than is the larger one, and where one member may represent as little as one-seventieth as many people as the member in the next seat—an arcane and patently unconstitutional rule, the filibuster, allows a minority of members to block almost any action. The process that results is less like the Roman Senate than like the Roman Games: a sanguinary legislative Colosseum where at any moment some two-bit emperor is apt to signal the thumbs-down.
These perverse (if time-honored) institutional arrangements (and the above accounting only scratches the surface of their perversity) are the principal cause of America’s sad health-care exceptionalism. Americans, polling shows, have long been as receptive as Europeans to the principle of universal health care. Six times since 1948, we have elected Presidents committed, at least on paper, to that principle. There have been gains, small (under Clinton, the State Children’s Health Insurance Program, or SCHIP) and not so small (under Johnson, Medicare, for the aged, and Medicaid, for the very poor). Yet forty-six million of us—a number roughly equal to the population of half the states of the Union—have no health insurance at all, and, as President Obama noted during his prime-time press conference last week, fourteen thousand more are losing theirs every day. Many millions of us have coverage that is inadequate, and almost all of us live with the well-founded fear that unemployment, a change of job, or striking out on one’s own to freelance or start a business could cost us our coverage and leave us open to medical and financial catastrophe.
Pretty much everybody who believes that health care should be a human right, not a commercial commodity, and who makes a serious study of the abstract substance of the matter, concludes that the best solution would be (to borrow Obama’s words at the press conference) “what’s called a single-payer system, in which everybody is automatically covered.” But, by the same token, pretty much everybody who believes the same thing, and who makes a serious study of the concrete politics of the matter, concludes that a change so sudden and so wrenching—and so threatening to so many powerful interests—is beyond the capacities of our ramshackle political mechanisms. The American health-care system is bloated, wasteful, and cruel. Under the health-insurance-reform package now being bludgeoned into misshapen shape on Capitol Hill, it will still be bloated, wasteful, and cruel—but markedly less so. The House bill, for example, would make basic coverage available to tens of millions who now have none. It would curb the practice of denying insurance to persons with “preëxisting conditions.” (We’re all born with a preëxisting condition: mortality.) It would make insurance coverage portable, which would be a boon for both individual careers and the wider economy. Even one of these things would be a colossal improvement on the status quo.”
We favor government inaction because we’re smart. Our elected officials are more likely to screw something up than make something better. There’s a reason that the stock market performs better when congress is out of session.
To the point at hand, any health care reform that does not include people paying out of pocket for some of their own health care (those who can afford it) will do nothing to control costs.
Great Article. My brother and I also say a lot of money goes to South Dakota per capita. We used to drive the new 4 lane highway to nowhere (well okay aberdeen pop. 30k) and only see the occasional truck or car. Where as most highways in our near the metro are constantly full.
Let’s hope, even with this system that supports the status quo, that health care reform does pass this fall. There are some meaningful reforms that can be inacted: developing a system that promotes prevention and wellness over treatment of illness and medical problems, one that covers everyone regardless of pre-exisitng conditions and one that standardizes and simplifies a set of benefits, and reimbursement for care. One quick example:
we have a system that rarely reimburses for diabetes prevention and rarely pays for continuing support and education of diabetes management (nutitional conunseling, fitness and exercise programs, home nursing visits, etc.). The same system pays over and over again for the treatment of all the complication of diabetes that is not controlled (numerous hospitalizations, amputations and physical rehabilitation, vision problems, cardiac disease, treatment of renal fialure including dialysis, and many, many stays in an icu with various combinations of the above mentioned complications.
Let’s hope this will overcome the inertia in our system.
(full disclosure: I have worked in healthcare in NYC for 30 years. I am Eric Black’s cousin).
One problem is that Americans ignore politics unless there’s a presidential election coming. Only about half vote in presidential elections, and even fewer in Congressional elections. A lot of potential voters on both the right and left think that voting is useless because all politicians are crooks.
When Americans do notice that there’s a presidential election coming up, the media do them a disservice by treating the nomination process as if it were American Idol, not a decision about the future direction of the country.
Note that as early as 2007, mainstream media were acting as if Barack Obama and Hillary Clinton were the only two people running for the Democratic nomination. Never mind that there were about four other people in the race. It as all Barack and Hillary all the time.
Since there was little difference between the policies of the two candidates, the news coverage was all in terms of, “Would you rather have the first woman president or the first black president?”
No mainstream media came out and said, “You know, these two candidates have virtually identical platforms. Let’s look at some of the other candidates and see what they have to see.”
John Edwards received far more media attention when his adultery was discovered than he did when he was an active candidate. Edwards came in second in the Iowa caucuses, but you’d never have known it from the news coverage, which was all about Clinton and Obama.
Nope, it was all about personalities. Coverage of presidential candidates has been about personalities for a good thirty years, perhaps longer. As a result, Americans don’t vote on the basis of issues but on the basis of how much they “like” a candidate, based on impressions given by the media. The media have taught them to do so.
It’s great for the rich and powerful. All they have to do is find a front person who presents a genial image to crowds, and they can do what they want. (The idea that either Barack Obama or Hillary Clinton is a socialist would be laughable if so many people didn’t believe it.)
Was the author promoting socialized health care, or the Parliamentary system?
If the president would actually SUPPORT single payer instead of the the corporate interests that contribute so mightily to their friends in Congress — those powerful committee chairs and members — it might have a chance.
None of the current plans being considered will save money (they are all modeled on the Massachusetts Plan that runs hundreds of millions of dollars over budget, has just kicked 30,000 legal immigrants out to save money, and is being sued by a major hospital for paying it so little its care programs for the poor may not survive).
The president until now has said he wants a public option to “keep the insurance companies honest.” Good luck with that. The national media announced today that Senator Baucus, in secret meetings for the last couple of weeks, is releasing a “bi-partisan” plan that will include neither a public option nor employer-furnished health insurance. I would guess his version of “bi-partisan” would be actually tri-partisan –Dems, Republicans, and corporations.
It’s called corporatism, the false belief and form of economic fascism that equates the interests of government with those of corporations. We’re seeing it at work in Washington, and many of those who have always been in favor of what the people want — single-payer universal health care that would save $400 billion per year instead of including ever more taxpayer dollars for corporations — seem to be supporting the Mass-Plan clone out of loyalty to the president when they should be rising up in outrage. (The exception being the Democratic Progressive Caucus, which has a hard time getting major media coverage.)
Perhaps the president’s basic mistake is that he did not choose public financing of all federal level offices as his first priority. It seems to be the only way we could, at last, end the undue influence corporations have upon the Congress.
Other nations which adopt universal care do, indeed, usually have a parliamentary system, and that says a lot about the potential for democratic systems to achieve important social goals–as well as our own institutional shortcomings. But another major factor is omitted from this discussion: you can bet that countries which make health care a basic right also have historically powerful labor parties, whether they are called laborites or social democrats. America’s Democrats cannot qualify in this regard, its labor contingent being comparably far less influential than in sister parties abroad.
“Pretty much everybody who believes that health care should be a human right,”
Sorry, but I do not agree. A right is something I have, such as life, liberty, and the pursuit of happiness. It is NOT something I have a right to have someone else do for me.
I have a right to hold property I have purchased or made. I do not have a right to have someone give me property.
I have a right to take the necessary steps to preserve or restore my health. I do not have a right to demand health services from others for free.
What we are in fact discussing in the health care debate is whether as a society we want to provide free or subsidized health care to those who cannot or will not pay for it.
And we are discussing the best means of providing that care, which is another matter entirely.
Politicians, aware of the current broken system of health care delivery and payment, promise a utopia where all will share rosy health, and someone else will pay for it — whether it be the insurance companies, the medical providers, or the “wealthy.”
If history teaches, none of this will happen.
What will happen, whether “something” is done or not, is:
>access to health care will decrease, as will costs to everyone;
>disgruntled health care providers will leave the profession;
>people will continue to live life as they have and if that lifestyle is unhealthy for them will pay the price in sickness and death.
But at least the Social Security Administration will benefit from not paying benefits to those who have passed.
And Big Brother, if national health care is passed, will control who lives or dies as they never have before.
My wish would be, since politicians are never ones to miss a chance to buy a few votes, that they would simply set up a tax supported major medicat plan, where the government would reimburse insurers for any costs for a single subscriber in excess of $20,000.00 per year.
The insurers would do the screening and discounting, and send a consolidated monthly bill to the feds, who would not need a humongous bureaucracy to issue a thousand checks a month.
Standardized basic policies could be mandated, and all citizens required to buy one.
Insurers could compete for this business by price competition.
Employers could afford to provide insurance at the new lower rates. And hospitals and medical professionals would soon adapt their billing practices to fit the new standardized plans.
And the politicians could go home proclaiming that they had “solved” the problems of health care without destroying a whole segment of the economy.
Why then do we move more quickly on foreign policy issues? Is it more tied to the administration? Fewer checks and balances? I was talking the other day to a retired oversees officer and he says other countries Japan, and some in the mideast can spend years and decades before going ahead with some changes.