Writing in all capital letters is, I’m told, the online equivalent of shouting. In my previous professional incarnation, as a writer of opinions for daily newspapers, I shouted a fair amount–mostly at people who called or visited to shout at me. Since entering the academic world, I’ve tried to keep the bad behavior to a minimum.
Sometimes, however, you just have to let go.
THERE IS NO SUCH THING IN THE UNITED STATES AS A FREE MARKET IN HEALTH CARE.
There. I feel better. Stayed on-topic, too.
Unfortunately, the same cannot be said for the assorted characters who have descended on the “town meetings” held by Democratic congressmen to discuss the bewildering health-insurance debates in the Senate and House of Representatives. They actually seem, if its possible, to feel worse as they continue in their pre-programmed rants.
There is a pattern: Start with some shouted slogan about health care. (“We hate socialism.” “Medicare is broke.” “If you can’t run cars for clunkers, how can you run health care?” “No death panel is going to kill my Great Aunt Matilda.”)
So far, so bad. But it gets worse.
Sometimes, it simply gets pathetic–as in the case of the woman from Texas who broke down in gasping sobs because she had lost her country which, when last anyone looked, was right where it has always been: Canada in the north, Mexico to the south, Atlantic in the east, Pacific on the west, us snuggled in the middle.
We had the emaciated guy from Ohio who said, for no readily apparent reason, that we should be afraid of Obama.
A particular favorite was the woman in Pennsylvania who warned Arlen Specter about the sinister plot to take away our liberties. At first, I thought nobody told her that W stopped being president in January. It turns out that she’s not worried about people held without trial but about having a Kenyan in the White House–socialism AND birth certificate, the perfect paranoid bank shot.
One guy wasn’t funny, pathetic or incoherent at all–just frightening.
He stood by the side of the road leading to the president’s own town meeting in New Hampshire. His sign said, “Time to Water the Tree of Liberty.” Strapped to his thigh was a holster complete with pistol. Was it loaded? As he said on MSNBC, you’d have to be a crazy person to carry around a pistol that isn’t loaded.
Just to remove all doubt, the slogan about watering the tree of liberty originates with Thomas Jefferson who, in one of his more tanked-up moments, observed that liberty’s tree periodically “should be watered with the blood of the patriot.” I assume, since Scary Gun Guy didn’t seem particularly suicidal, that he meant that we should use someone else’s blood. Mostly, though, I wonder where the Secret Service is when you really need it.
I’m sure all of this is just fine with the folks who ginned up this hysteria: the conservative media elite, of course, but also the insurance-industry PACs that co-ordinated and financed the town-meeting assaults. The tactic is simple enough: Get the shouting loud enough, destroy any chance for reasoned discussion, and then watch as yet another threat to the health-care oligopoly bites the dust.
That’s the secret, of course: Health care in the United States IS controlled by a vast, interlocking bureaucracy that has accumulated increasing power since the 1970s. The bureaucracy has flourished beyond the reach of government. It is as unchecked today as it ever was. The alleged “regulatory commissions” for insurance in state govenrments are pretty much toothless. Washington does even less. Every time Congress acts like it might do more, the private bureaucracy beats it down–hard.
It happened in the 1970s when Washington tried to develop the first regulatory framework of health-systems agencies, regional planning councils and the like. That time, the interlocking directorate broke the plan without even breaking a sweat.
The same thing happened in the early years of the Clinton administration, and it’s happening now.
Critics of Clinton and Obama point to strategic errors in the presentation of health-care reform systems, and they can certainly find errors or omissions in any proposal that runs to 1,100 pages. That’s beside the point. If you’ve followed the debates of the past two generations, you know the truth:
If Jesus, Gandhi, the Blessed Virgin and Abraham Lincoln returned to Earth today and presented Nelson Mandela with a health-care plan straight from God’s own hand, the whole bunch would be accused of socialism by sundown.
The various elements of the oligopoly don’t always get along. Sometimes their fights can get nasty. Over the past decade, for example, a growing trickle of physicians in specific medical disciplines has abandoned practice because, they say, they cannot afford the cost of malpractice insurance. This has the apparent effect of pitting the doctors against the insurance companies and the trial lawyers. These groups indeed are bitterly divided–until it comes to any plan that threatens to produce anything like real change. Then, they stand grumpily but firmly united
The doctors who evoke health-care Armageddon over malpractice insurance are also members of the most powerful trade union in the United States–the American Medical Association. One way to control medical costs, and thus make insurance more affordable, is to break the doctors’ monopoly on medical information and authority. That would mean either letting more people into medical schools or allowing other trained non-physician professionals to perform more basic medical functions. I’ll bet a major malpractice claim that the AMA won’t allow that to happen.
The hospitals and their adminsitrators complain about the “hidden costs” of the insurance crisis. They are undeniably correct: Every uninsured person treated in an American hospital represents an expense that, one way or another, falls onto the system as a whole. Yet you’ll not find many hospital presidents out there fighting for the kind of changes that will get at the authority exercised by doctors or give someone other than the oligopoly a real voice in cost control.
Malpractice lawyers must know, on the most elemental level, that some type of malpractice reform, such as a cap on punitive awards, would be a powerful boost to the cause of affordable and readily available health insurance. This is so even though, as so much of the evidence suggests, malpractice claims really are not major factors in the cost crisis. In politics, symbolism matters. Trial lawyers for insurance reform would be powerfully symbolic. It won’t happen, for the obvious reasons, and I’ll bet another major malpractice claim on that one.
This leaves, of course, the insurance companies. A question for them, and for the folks who shout down everyone at the town meetings: How can you trust AIG to control insurance costs when it is still run by many of the same folks who drove it to bankruptcy and gave themselves million-dollar bonuses? (I’m fully aware that the question is unfair on just about every level. AIG is a vast and complicated operation, as are most insurance companies. Any kind of generalization about any corporate entity is bound to be deceptive. At this point, I really don’t care. If they’re going to force-feed the nation’s anxieties about government, the least we’re entitled to do is make them swallow a dose of their own medicine.)
In the end, we’ll get exactly what the feuding interlocking directorate really wants: No change at all. Our doctors and lawyers and hospitals and insurance companies will come up with nifty 10-point plans for reform. Meanwhile, somewhere in each of these entities, people and cash will be mobilized to turn out the scared, angry, and confused at town meetings where the real purpose is anything but to discuss health insurance.
Our uninsured population will continue to grow. The fewer and fewer of us fortunate enough to have health insurance will find ourselves paying more and more for the privilege. So it will remain until someone decides, once again, that the time has come to face up to our failure–in the face of all the noble rhetoric–to acknowledge that, in a civilized nation, affordable health care must be a right rather than a luxury.
Maybe next time, it will be different. But I won’t be betting a major malpractice claim on it.
