De-linking an American Myth

There are so many thinright-winggs wrong with the current conversation on Health Care Reform that it makes it difficult to catch a whiff of civility on the topic. Most of the problems come from good old fashioned ignorance. Why do we continue to see this debate more in mythic terms than fact-based? It’s enough to make this Cajun country economist round up a few alligators to go after her blue dog pols. This reform should save the country and businesses beaucoups bucks if done right. Every other industrialized/advanced nation has gone before us! There are examples we can learn from! Most of them include way more provider choice than we have now!

Still, all we get are canards of epic proportion. Moses did not come down from the Mount with employer based insurance programs inscribed on the tablets. We can do much better! The continuing screed from the right claiming that a single payer insurance option is complete nationalization of the delivery system that will lead to huge wait times and ice floe ends for the elderly is probably the most obvious example of making policy based on myth rather than common sense and data.

I continue to have to remind people that while that story about some one’s Aunt Sally that died in Canada while awaiting hip replacement surgery is touching, it is an anecdote. Anecdotes are just specific data points in a population that may or may not be representative of what goes on for the most part within that population. You need a database to get the complete picture. That explanation even gives the anecdote the benefit of being true since many are just those viral things passed around the internet as urban myths. One data point is not the proper reference for any kind of policy decision. Try, however, to tell that to the general population and some depressingly dim witted pol like the majority of mine from Louisiana.

There are so many myths surrounding the health care debate that Nancy Pelosi has sent fact sheets to Democratic Congress critters to help them fight off the disinformation. (Yeah, like people are going to take THAT source as the best messenger for the program. What’s her approval rating? Some where in vpResident Evil range?)

House speaker Nancy Pelosi returned home to San Francisco this weekend carrying a red, white and blue pocket card that will help guide her through the August recess. The card lists talking points she hopes will convince everyday Americans of the benefits they could receive under the health-care reform plan she hatched with other House Democrats last week.

Pelosi distributed the cards to all 256 of her caucus members, arming the unruly Democratic majority for battle in their disparate districts across the country. After laboring for weeks in Washington to reach a compromise between liberal and conservative factions of her caucus, Pelosi is taking the fight outside the Beltway, where polls show that her popularity is faltering. She plans to stump for health-care reform in San Francisco, Denver and other cities.

At stake is legislation that could define her legacy as speaker and shape President Obama’s political future. Pelosi called health-care reform with a public insurance option “the issue of an official lifetime.”

“August will be a month of inoculation against the negative message of the insurance industry,” Pelosi said in an interview, resting in a yellow armchair in her stately office, which has sweeping views of the Mall. “It will be a month of education in terms of what is in our bill. It will be a month of communication — listening, listening, listening to what constituents have to say.”

In this particular debate, I’m not sure we need to listen to everything constituents have to say because they’re getting their data from viral email anecdotes and TV infomercials from the insurance industry. I’d say it’s more about at looking at what the facts on the ground say and helping constituents make sense of what various options with health care reform would mean to the American people. We need to debunk the myth that we have this great functioning system now. We also need to de-link from the US pathology that makes our health care system unique, costly, and deadly.

The Financial Times had an op-ed piece today by Matt Miller that succinctly explained one of our main problems. Health care in this country is basically linked to employment. Here’s a taste of his thesis.

The bipartisan “gang of six” in the Senate wants to fine employers whose workers choose Medicaid, the US public healthcare system, rather than more costly insurance from their company. The House wants to impose an 8 per cent payroll tax on all but the tiniest companies that do not offer healthcare. These damaging proposals show that both political parties remain deeply confused about the roles of government and corporations in a modern economy. Their premise – that companies have a duty to provide health benefits – has such perverse consequences that it may doom reform efforts altogether.

America’s unique employer-based healthcare system may have made sense 50 years ago, when healthcare was cheap and business faced little global competition. But today’s circumstances are radically different. Soaring health costs strangle business and absorb cash that could otherwise go to wages. The link between healthcare and employment explains why millions of Americans have lost coverage during this recession. Budding entrepreneurs with ill spouses or children stay in jobs they loathe for fear of losing the insurance they need. Keeping employers at the core of the welfare state is bad for business, bad for the economy and bad for families.

The word perverse is correct. A perverse disincentive is why good paying automobile assembly jobs go to Canada and out of Michigan. Canada has unions. Canada has higher taxes. Canada, for all intents and purposes, should have no comparative advantage over the United States for Automobile Manufacturing but it does. The one big cost that every business faces here if it wants to attract workers is their health insurance liability. The price of that liability continues to spiral out of control. Businesses simply cannot compete with other industrialized nations if they offer health insurance to their employees. It increases the cost of their product by an ever increasing amount. If you were truly interested in American business, why would you saddle the majority of them with costs that simply provide profits to a bunch of inept third party paper shufflers and naysayers? Wouldn’t you be more concerned with the majority of businesses than the profit seeking tentacles of the insurance industry?

How can we move beyond the meme that a program that is non-employer provided is socialism? The move to something else is about creating a cost effective structure that can take advantage of risk pooling and uniform paperwork to provide every one cheap health insurance, regardless of employment status. People don’t seem to get that it doesn’t even have to be the Federal Government providing the single payer insurance. Is your utility company or your cable company Fidel Castro’s wet dream?

In this day where 1 out of 10 of us are unemployed, and many of us work for small businesses with no ability to provide coverage, you would think this would dawn on a few folks. For some reason, the blue dogs, the Republicans, and some hold out U.S. citizens that scream “I have mine!!” just don’t get it. That’s not even the majority of us, however, so why do their voices count more than ours? It appears that it’s not their voices. It’s the campaign contributions.

You would think that all of those folks would like the extra money in their pockets and not in the pockets of the bonus class. Unfortunately, some of that profit-making off the ill in this country winds up in the pockets of the very folks who are voting on reform. Here’s some information from the Milwaukee Journal Sentinel on that very issue. If you are from Wisconsin, it details the entire list of who bought your representatives on the issue this year from the health care industry. We need a list like that for every state.

In the first six months of 2009 alone, the health care sector has given $11.4 million in campaign contributions to members of Congress, according to the Center for Responsive Politics, a nonpartisan group that tracks money in politics. Campaign contributors – from insurance companies to hospitals to doctors – are showering Wisconsin members of Congress with donations.

“There’s tons of money coming in,” said Mike Klein, of the Sunlight Foundation, who argues that the health care sector has significantly boosted its campaign donations to Congress in an attempt to get “a seat at the table” as the debate over health reform takes shape.

Back to the rational from the FT article and the argument that needs to be made.

The most depressing examples of this thinking are the proposed rules to keep people in job-based care. Strict limits, for example, would govern who could use new insurance “exchanges” that would give access to competing plans, including a public insurance option. Those who already have coverage from an employer would be barred from seeking coverage there. But this is exactly the opposite of what sound policy should be doing. Worse, this lockdown obviously does not lower national health costs at all – it just keeps the amount on the public ledger below some threshold deemed politically acceptable.

The better solution would be a “grand bargain”, through which business shifts health costs off its payrolls and on to government, in exchange for business supporting the broader revenue needed for government to accommodate this shift. Contrary to conservative claims, it is perfectly possible to do so in market-friendly ways. As health systems in Switzerland and Holland show, the US could have universal coverage without taking the road of single-payer care.

Democratic Senator Ron Wyden has been the lonely voice arguing that America must move beyond job-based healthcare to boost business competitiveness while assuring family health security. Mr Wyden mustered a small bipartisan coalition around such a plan, but the weight of dead ideas in Washington has stifled the proposal.

Why can’t we get a discussion going on salient information like this? Why are we bombarded with 30 second junkomercials instead of real information that we could use? Well, of course, it’s the money and it’s the profits of one industry lording itself over the benefits of the society and even the business community. How can we get a real conversation going under these circumstances? There should be a lot more on the table than what we see now. We should be able to expect more from the Democratic party and its POTUS and its huge majority. We need to demand more than facts from little red, white and blue index cards and TOTUS. We need some kind of Health Care Reform Marshall Plan.