Are You SURE You Meant To Say That?

Methinks George Will – the “sensible conservative” on the Sunday morning political talk shows – might have wanted to re-read his most-recent Washington Post column before passing it along to the editor. Because it seems pretty clear he didn’t think through the implications of a lot of his argument:

The puzzle is: Why does the president, who says that were America “starting from scratch” he would favor a “single-payer” — government-run — system, insist that health-care reform include a government insurance plan that competes with private insurers? The simplest answer is that such a plan will lead to a single-payer system…. The president characteristically denies that he is doing what he is doing…

Uh, George? He denies it because Republicans have – for decades – opposed health insurance of any sort, if it’s publicly-funded. They’ve opposed the creation of any new programs, they’ve opposed the expansion of existing ones, and they’ve tried to limit debate to only those options which do not include or even recognize the possibility or worth of a public option. Remember Reagan’s famous line about how “Freedom is never more than one generation away from extinction. We didn’t pass it on to our children in the bloodstream. It must be fought for, protected, and handed on for them to do the same, or one day we will spend our sunset years telling our children what it was once like in the United States when men were free?” Ol’ Dutch used that line a few times, but one of the most famous was in a 1961 speech to the Phoenix Chamber of Commerce, and it was about…Medicare. Yes, that’s right, that awful, socialist menace which will absolutely ruin America as we know it, and transform it forever from something wonderful into just another tawdry collectivist mess. Medicare, for heaven’s sake.

So it’s perhaps not surprising to hear Barack Obama in 2009, having learned the lessons of the most-recent health care defeat in Congress (Bill and Hillary Clinton’s doomed 1993 shot at it), going out of his way to avoid saying that the public option he’s pushing for is intended to lead to single-payer. Republicans, with the help of a largely supine media, have made that word – and anything else that smacks even vaguely of government involvement – so toxic that smart Democrats (and Obama is most certainly one of those) know almost instinctively to avoid mentioning things in those terms, and thus avoid metaphorically lobbing yet another meatball over the heart of the plate for Republicans to whack out of the park and send Democrats back to the drawing board yet again, muttering “we’ll get ’em next year!” Obama knows that utilizing arguments which failed last time will only allow the GOP to dust off their already-existing playbooks and simply run the old plays which have served them so well for so long.

The GOP has injected such fear and loathing of government into the American psyche that it results sometimes in a very strange sort of national split-personality disorder. On the one hand, you’ll get results like the recent spate of polls showing around 70% of the American public in favor of some kind of “public option” for health care reform. On the other hand (though I know of no recent poll which has asked these specific questions), polling over the years consistently reflects a cynicism about government’s ability to successfully run things. People cite the Post Office or Social Security, but seem to forget that government is also responsible for things like the Army. Why? Because Republicans have spent a lot of time and money framing the debate that way: government=bad. That was another of St. Reagan’s favorite themes. His first inaugural contained the classic line: “government is not the solution to our problems, government IS the problem.” So people wind up thinking – just as the spin doctors in the GOP, guys like Frank Luntz, intended them to think – not about the things government can and does do better than any other group, entity or mechanism, but about the areas in which government is perceived, rightly or wrongly, to have done poorly.

Such has been the state of health care reform in the United States for years, if not decades. Powerful interests – not just Republican politicians but also many Democrats who’ve drunk deep of health care lobbyists’ campaign contributions, as well as the actual lobbyists for the AMA and big pharma and especially the insurance lobby themselves – form a very formidable united front indeed, opposing any and all health care reform which would limit their power or reduce their profits. And yet the health care problem will not go away, and people are realizing it more and more lately. Nearly everyone has a horror story of denied coverage, bureaucratic nightmares of “Brazil” proportions, etc — or at least personally knows someone else who has one. And everyone’s increasingly aware that all those problems have come from the system of private insurance coverage which already exists in America. Even if the public’s collective psyche has been programmed in a near-Pavlovian fashion by very careful and dogged spin-doctoring to think that government = bad, people know that it’s not government that canceled the insurance coverage of their aging and ailing mother when she was unexpectedly diagnosed with breast cancer. So the moment is ripe for a change of perspective. And both Obama and Will appear to understand this.

But Republican apologists for the status quo like George Will have a very difficult row to hoe right now in regard to health care, because they’ve got to try to convince – or trick – a large enough majority of the public (or at least the Senators) into believing that any government plan would be even worse than what they already have. In the past, they’ve done so successfully by pointing to the strawman of “choice” – telling voters that under a single-payer system, everyone’s health care would be obtained through the same huge government bureaucracy and no one would have any choice. It’s a bogus argument, of course, because the real choice in the health care debate is the choice of provider, not the choice of insurance company…and that’s not what the private system offers. GOP spin-doctors have in the past successfully conflated the choice of insurance company with genuine freedom of choice among medical providers. But the current private-insurance system often – usually, even – forces people into “in-provider” lists of “recommended physicians,” if they wish to have their insurance pay for their treatment, anyway. Some large HMOs even have their own buildings in which all the doctors and other medical staff work, and you can choose from any of them…but not anyone outside. This is “choice?” Of course not. And people – after decades of “managed care” (which was the last industry-concocted term for the previous supposed “fix” to the health care system – the one which gave us HMOs) – are realizing that things aren’t better in any measurable way at all, and that, if anything, their personal “choice” about health care decisions is even more restricted than it was thirty years ago. Many people are even afraid to “choose” to leave their job, for fear that they’ll lose their health coverage.

George Will is a smart conservative (and no, that’s not an oxymoron, though with some of the oxy(contin)morons **cough, Limbaugh, cough** the GOP seems content to use as spokespeople, you might be tempted to wonder acutely if there were such things as smart conservatives in existence any longer). And he knows that the old saw of “choice” is growing increasingly feeble as a scare tactic to keep people in fear of publicly-financed or managed health insurance (or at least keep them preferring, even if only slightly, the status quo). So he’s got to come up with something else as a reason for why the public option is bad, or the status quo is better. But what does Will come up with to argue that? Did you catch it? He says two things: first, that Obama is “cheating” by not telling the public that the “public option” plan is just a Trojan horse for the ultimate goal of single-payer. But secondly – and far more interestingly – Will actually flat-out states that a public option WOULD lead to single-payer!

I do not think Will intended to say that. At least, I don’t think he intended to so clearly and powerfully argue the strength of a public option in comparison to the private insurance system.

Oh, I don’t mean Will made a mistake…only that he’s essentially just conceded the argument in favor of single-payer. The Republicans and various health care lobbying groups have been arguing to inconsistent (frankly, more like incompatible) things in recent months: first, we’re told that a government-run system would be a bureaucratic nightmare would drown everything in its path in an ocean of callous indifference and red tape. That there’s no way it could do things as well as the famed “private sector.” Then, sometimes within only a sentence or two, we’re told by the very same people – as Will does here – that there’s no way the private sector could compete with a publicly-run health care option; that the minute such a public option was introduced, it would spell the beginning of the end for the private health insurers because they would be unable to compete with the advantages of any public system. Will actually sayd that the reason Obama is pushing for a public option (and not being truthful about his goals, Will implies) is “that such a plan will lead to a single-payer system.” Not “Obama thinks it will lead to a single-payer system,” but “it WILL lead to one. Interesting talk from a guy who’s obviously trying to tout the superiority and preferability of the status quo of private health insurance. Will goes on to list the specific advantages that a public option would have over the private, for-profit insurers which would allow it to slowly (but inevitably) drive them out of business. What advantages? I’ll let Will explain:

Assurances that the government plan would play by the rules that private insurers play by are implausible. Government is incapable of behaving like market-disciplined private insurers. Competition from the public option must be unfair because government does not need to make a profit and has enormous pricing and negotiating powers. Besides, unless the point of a government plan is to be cheaper, it is pointless: If the public option conforms to the imperatives that regulations and competition impose on private insurers, there is no reason for it.

So…let me see if I’ve got your argument straight: a public option, because it’s not seeking a profit for shareholders or its executives, and because it could negotiate lower prices with drug companies and providers (something private insurers aren’t really able to do, and don’t really want to do anyway because they operate on a cost-plus basis), would cost its subscribers LESS…and somehow, that’s UNFAIR?

Uh….OK, I guess. If that’s your argument, have at it. Unfair for WHOM, I’m tempted to ask: the poor insurance companies? Or for the American citizens who need health care? I dunno, George: I gotta say, if these are your arguments AGAINST a public option, then I think President Obama should recruit you tout-de-suite to get your ideas on good arguments FOR a public option!

Will’s argument here outright concedes that the federal government absolutely would – not just might – lower costs for their subscribers. Will is a free-marketeer. He believes that competition is healthy, and that the best (most innovative, cheapest, best-featured) product, service or company will always come out on top. His argument in this column isn’t that the federal government wouldn’t be able to compete, price-wise, with the private insurers, it’s that it would be able to compete too well (and, in Will’s mind, unfairly), that it’s very existence would inevitably lead to the end of the basic, non-supplemental private health insurance market in this country. He’s explicitly admitting, through his arguments, if not by actual declaration, that the federal government would provide better bang for the buck in health insurance. In other words, that it is better able to compete in this particular arena. You’d think he’d cheer the public option then: let the best (most competitive) entity win!

But no. That sort of consistency is simply not in Will’s – nor most conservatives’ – makeup. Instead, Will spends 1,000 words prattling about how “unfair” this would be, as if government has a fifteen-yard head start in a 100 yard dash, or something. But – as all consumers of health care understand in their bones – this isn’t some abstract, theoretical race between principles or ideologies. If government can provide more (or at least as much) for less, then that’s the best real-world solution, obviously. Unless you’re like Will, who is arguing his point not from a position of utility, but one of theory and ideology. What ideology? Why, that government is simply BAD, no matter what, and that “the free market” is always good. And if government can be shown in a particular aspect to be demonstrably better than the private sector at accomplishing something for the citizens, then obviously, government must have cheated, or it wasn’t a fair test, or you caught the free market on one of its bad days, it had a limp, it wants a rematch, it’s NOT FAIR, Daddy!!

We have a name for this: it’s called “poutrage;” when an ideologue is so wedded to his pet theory or worldview that conclusive evidence of flaws in his chosen ideology causes the proponent to experience cognitive dissonance – an uncontrollable urge to think or even say “that can’t POSSIBLY be the case” – followed by petulant whines that the test wasn’t fair, the evidence was rigged, the other guy cheated.

To be a bit more charitable to Will, there’s a possible second side to this equation. It’s quite clear that even Will is conceding the point that the federal government would beat the free market on a purely cost basis of delivering health care. But I mentioned “delivering MORE for LESS,” and it’s worth examining whether Will believes that perhaps the problem stems not from the fact that a public option would be cheaper, but that it would provide markedly worse quality of care to patients. So…is that Will’s argument? Is that what he thinks? No – you’d be hard-pressed to find any such arguments of any substance in his column. Instead, Will brings up (and tries without success – again! – to refute) another of the arguments in favor of the public option: that if the idea is that greater choice is good and maximum competition will ensure the most innovation and lowest prices, then why would any free-marketeer or conservative be opposed to MORE competition and choice. He attempts to dismiss this argument by talking about Medicare Part D and how competition has led to lower prices (great! What’s wrong with MORE competition, then, George?), but it doesn’t sound like his heart – or perhaps his mind – is really in it. He sounds like a man trying more to convince himself than he is trying to convince his readers. Will goes on to note that many of America’s 45 million uninsured are only temporarily uninsured, as they pass from one employer-provided health plan to the next (as they change jobs). But Will surely knows that, as the nation’s Bush-engendered recession deepens to Great Depression-like proportions and the number of the nation’s uninsured edges upwards towards 10%, that more than just a few of his fellow citizens are no longer merely “switching jobs” these days, but remaining unemployed for longer and longer periods of time. And that regardless of how quickly the roles of the uninsured turn over, 45 million uninsured at any moment is still 45 million people who could be stricken by a severe illness – or a bus – and have no coverage at all to pay for it (and good luck trying to find a private insurer who will take new customers who have pre-existing conditions which will likely or certainly cost a lot of money in treatment).

Will ends by desperately dragging in the illegal immigration issue as a stand-in strawman, noting that 39% of the uninsured come from five states that are well-known entry-points for illegals (Texas, California, Florida, New Mexico and Arizona), apparently assuming that people will respond to the argument that people should be left to die or remain ill if they don’t have a green card – and obviously forgetting that public hospitals with emergency rooms have a responsibility to treat anyone who needs treatment in the ER, which results in higher costs for all of us who DO pay for insurance, because the doctors and hospitals pass along to the insurers, as a surcharge in every normal bill, the costs of treating those who can’t pay.

But there is nothing – literally nothing, in the entire rest of Will’s column – about how the federal government will provide WORSE care…only complaints that it would be a big meanie in the cost department to the private insurers. Well, duh, George – that’s sort of the point: to lower costs and/or improve care for the CITIZENS, not preserve the right of the insurance companies and their shareholders to make a profit by acting as the financing mechanism for providing people health care. If you’re going to oppose a public option for health insurance while at the same time admitting that it would save people money, then you ought to make your argument be no more and no less than that you’re simply morally – or ideologically – opposed to saving people money on health insurance in this way. That would be the honest argument.

Of course, it’s also a dead-solid loser of an argument, and one which George Will holds himself in too high regard to be honest enough to make with a straight face. Nor would (nor should ) anyone believe him if he did. to make.

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