Tuesday, August 25, 2009

The Argument No One is Making

I am not a politico. My experience in political strategy consists mostly of having seen every episode of The West Wing twice. That said, I've been crafting arguments for most of my life, and it seems to me the argument that could win the health care debate is one that no one is making. I don't know if no one has thought of it or if it's deficient in some way I haven't yet realized. We can debate this in the comments. In the meantime, I can't get it off my mind, and this is pretty much my only public forum. Forgive me for abusing it.

The fundamental problem with health care reform is that people fear the unknown. Change means uncertainty, and one thing people don't want to feel less than certain about is their health. People prefer avoiding losses to acquiring gains, and they'll cling to even a flawed system when faced with the uncertainty of living without it.

It's extremely easy to feed this fear. Despite the patent absurdity of the idea that a system of forced Euthanasia could survive in a free democratic society, the Obama administration has been forced to spend a significant amount of time and resources defending against this idea of "death panels." Their strategy, so far, has been to refute the misinformation, but this will never work. If a lie so brazen and simple could dominate the debate for three weeks, the Right should have no trouble coming up with another once this has been dispelled. These lies work because people are confused and scared.

It's time President Obama and his team put forward an argument that acknowledges this fear. People need to hear that what they fear is not true, but that's only part of it. They also need a defense against all the other uncertainties that haven't yet occurred to them. They need a failsafe. Luckily, one is provided in the Constitution. It's time the Obama administration began to emphasize the one element of certainty in government-managed health care that is totally absent from the private system: democracy.

Let's start with Death Panels. Obviously, there are not going to be death panels. This is not obvious because I have read the bill; it is obvious because if there were government-run panels that began to kill old people against their wishes, every member of congress would lose his job. Problems that big simply cannot survive democracy. Obama should use this defense writ large:

"Look, I promise you that the finest minds in Washington have been over every detail of this plan, and we're convinced it's going to work much better than the current system. That said, I know you still have concerns. Some of them might even be legitimate. But I promise you, if there's something you hate about the public option, and enough people agree with you, it will go away. That's because you have the power to elect us every two, four, or six years, and that means we work for you. Insurance companies, on the other hand, do not. If they deny you coverage because you're too sick to afford, as happens to X number of Americans every year, you don't get to fire them. If they raise their rates to the point that the middle class can no longer afford to get sick, as they've done in 10-20% increments every year for the last five, you don't get to vote on how wrong you think that is.

Giving the government a role in health care means YOU have a role in health care. So how you feel about this issue really comes down to this: do you want to work for your health insurance, or do you want your health insurance to work for you?"

Can somebody get this to Josh Lyman?


Anonymous Anonymous said...

I don't believe your argument makes a real difference. Doesn't really address the fact that a lot of people in this country don't like things run by the government. It seems whenever the government gets involved to try to do something they are not able to do it very efficiently.

8/25/2009 1:10 PM  
Blogger L'Alex said...

Hi Dan, I liked this post. :) I'd say that you're right about general aversion to change - which is why I'm surprised the Obama administration didn't take a more multi-phased approach to health care reform. I mean, having a government-run health plan in direct competition with private insurance carriers is kindof extreme in the spectrum of possible solutions. Intermediate steps, like addressing the fact that the AMA is a cartel, or finding ways to bring down the exorbitant administrative costs employers incur to provide health care and COBRA coverage, could have really warmed up the American audience to more sweeping solutions in the future. Just my two cents.

8/25/2009 2:10 PM  
Anonymous Anonymous said...

Representation reinforcement does not stop a whole plethora of wrongs from occurring. Look at, for instance, extraordinary renditions; many of us thought by getting rid of the last guy and putting our new young lawyer in office, we would see that changed. We were wrong.

The practical reality is that government behavior is just far too diverse and broad to attempt to use an argument of democracy to quell our fears about a specific program.

Anyways, this is more a republic than a democracy.

8/25/2009 2:39 PM  
Blogger Dan said...

Thanks for the comment, 2:39. I think I acknowledge that this is a democratic republic in the post.

And I agree that institutional changes are sometimes hard to repeal or scale back. That's a perfectly reasonable counterargument that should be part of any responsible debate on this subject.

I do not claim that my argument answers all the questions about healthcare or that it is beyond dispute. I just think it's a very solid response to the sort of fear tactics being used by the opposition, and I can't believe no one is using it.

People are clearly afraid of government, fairly or not. So far the response has been attempting to quell those fears by challenging them directly. But I think a broad defense of the things government does well is the next logical extension. And the fact is, simple or not, people have more control over their government than they do the private health industry.

8/25/2009 2:44 PM  
Blogger Beetle Aurora Drake said...

This argument would seem odd. It's essentially telling people to stop demanding things from their representatives because they can demand things from their representatives.

It's not really clear that people have more control over their government than their insurance company. To fire your government, you have to convince a huge number of people to agree with you. Firing an insurance company could (in concept) be a personal decision that you can make without getting approval from a bunch of other people. The details of why that isn't necessarily so all the time are not going to change the conceptual understanding.

The problem with your Death Panel argument is that Congressfolk get fired only if they can be blamed for it. While I'm sure folks will come up with a better name for it than "death panels," someone has to make decisions about what procedures can and can't be done. If you're focused on the ridiculous rhetoric, you're missing the point. It would be like responding to the anti-war movement with a point-by-point explanation of how Bush isn't actually Hitler.

8/25/2009 10:02 PM  
Blogger Dan said...

I take your point, Beetle, and the counterargument had occurred to me. I guess I should have clarified that this rhetoric is not necessarily meant to persuade the caliber of people who read this blog, but rather quell the irrational fears of those who claim the reform policies could conceivably have the kind of horrific provisions outlined by prominent Alaskans.

I understand that the flip side of what I'm saying is that people should feel equally entitled to speak up now, and they should (and are). But I feel like there is a general sense that once this happens, it's done, and people will lose all control over the system. On the contrary, I think they will exercise far more control over a government plan than private industry.

You are right that to some extent, unsatisfied customers can simply "take their business elsewhere" under the current system. A number of factors conspire, however, to make this extremely difficult for most. First, people generally purchase their plans before they get sick. Thus their dissatisfaction will likely not become evident until it is too late. Second, people are generally provided healthcare through their employer, which further limits their coverage options. Finally, the health care industry has shown it is at least partially immune from traditional economic rules. Much like in the legal industry, wealthy people and big businesses will overpay a top-notch service. Thus, heath care companies can make more by securing a few of these clients than they can by chasing down a lot of average joes. That's how they've been able to raise coverage rates far in excess of inflation for the last five years.

It's true that the democratic process is cumbersome and cannot be used as a scalpel. But at least congresspeople have someone standing by to take your call. Even that small measure of public control seems absent from the current system.

8/25/2009 10:39 PM  
Anonymous Anonymous said...

Another big issue is cost. Although I agree in principle that something needs to be done to make health care more accesible, I don't think we can afford it. The deficit is projected to rise to 10 trillion in the next 10 years. With the aging of the baby boomers I guarantee this number will grow. Social Security and Medi-Care/Medi-Cal is going to continue to mushroom out of control. Honestly, how can we talk about adding another entitlement program when we can't afford what we have.

8/25/2009 11:57 PM  
Blogger Beetle Aurora Drake said...

Dan, I think the visibility of the ridiculous is causing you to underestimate Joe Average. There's a reason why people buy "Death Panels," and it's not that they trust Sarah Palin. People have heard advocates claim that this government intervention in health care will reduce costs, expand coverage, and ensure that no one loses any access to options, and they don't see how that adds up.

How will the availability of coverage be decided? Can the government declare that everyone can get every treatment under the sun no matter what? If not, won't they have to draw lines? Won't those lines affect health? The term "Death Panel" is inflammatory, but that's not what the discussion is really about, except among the sensationalist class. People deciding health care options have to exist in any health care system ("Fears of 'death panels' are way overblown. Fears of 'Are second knee replacements worth it?' panels are not."), and the government's ham-fisted interventions to support political goals in other fields means that people do not trust the government more than they trust their private insurance company. Even if they think they're being gouged by their insurance company, they can work with known parameters, rather than subjecting their health care decisions to majority rule in a country where the electorate can be quite spiteful when determining what other people "deserve."

8/26/2009 1:10 AM  
Anonymous Anonymous said...

Maybe voters believe that increasing the politics in health care will do for health care what politics did for Freddie and Fannie.

8/26/2009 7:31 AM  
Blogger Dan said...

Beetle, I agree with most of what you're saying. But that kind of responsible debate about the realities of reform is really not what's been playing out at the town halls or in the media coverage.

8/26/2009 3:17 PM  

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