Over the past months, the healthcare debate has degenerated into a series of scare tactics designed to engender opposition to any Democratic effort to reform how we pay for medical care. The campaign to frighten Americans is succeeding. Public approval of President Obama’s plan has dropped below 50 percent, according to a September 24 CBS News/New York Times poll, even though healthcare reform could protect Americans from unjust treatment at the hands of insurance companies and increase competition among insurers.
This astonishing statistic raises the question: why doesn’t the majority of American people support a program that would be enormously economically beneficial to them? In his 2004 book What’s the Matter with Kansas, political scientist Thomas Frank tracks the ideological shift among conservatives up to and during the Bush years, a shift that forms the backbone of today’s campaign against healthcare reform: “While earlier forms of conservatism emphasized fiscal sobriety, the [right wing] backlash mobilizes voters with explosive social issues…which it then marries to pro-business economic policies. Cultural anger is marshaled to achieve economic ends.”The GOP of today is employing the same tactics. Top political operatives are capitalizing on a broad anti-government populist sentiment in service of a shoddy, confused, and often hypocritical agenda. Their endgame is not passing meaningful, effective healthcare reform, but politically weakening a Democratic President.
What's the matter with a free market?
The bipartisan consensus in Washington is that the current healthcare system is unsustainable. The system leaks money from every angle: it absorbs 16 percent of our GDP and grows each year. The health insurance industry has traditionally functioned under a flawed market model that breeds systematic inefficiency. While conservatives argue that any proposed change shouldn’t involve government intervention, this laissez faire approach only leads to waste because the current healthcare structure is rife with market failures. Healthcare cannot be a pure market for several reasons. Those who do have health insurance are insulated from paying the full cost of their healthcare, and are therefore more likely to abuse services. Also, providers can easily increase demand for their services by over prescribing tests and exams.
Most important though, most employed Americans do not have a choice of insurers—they can’t shop around for the best deal, unless they are willing to switch employers. This leads to insurance monopolies. The Justice Department defines a monopolistic or “highly concentrated” market as one in which a company has 42 percent of the market share. In Arkansas, Blue Cross Blue Shield has over threequarters of the market. Yet that state has only the ninth most concentrated health insurance market in the nation. We need government intervention to restore competition to the system.
What's the matter with the public option?
This is where the much-maligned public option comes in. The public option, an attempt to curb a monopolistic insurance industry, has paradoxically been portrayed as the villain in the debate. The House bill, as currently drafted, creates a health insurance exchange to provide coverage for those unable to obtain insurance through an employer—a type of insurance bazaar, with companies angling for new customers.
Lawmakers realize the exchange would not necessarily increase competition on its own. If the same insurance companies with most of the existing market share are the only participants in the exchange, there will be no cost savings. The public option would be a government-run health insurance company that would be required to follow the same regulatory rules as the other members of the exchange. Contrary to the right’s chief complaint, the public option would be funded by premiums, not with taxpayer dollars. Unlike other health insurance companies, the public plan would be not-for-profit. Forcing commercial insurance companies to compete with one that is not trying to generate profits for investors would drive down costs. The Congressional Budget Office has estimated that a public option will save anywhere from $85 to $110 billion (depending on how the plan is set up) in 10 years. At the same time, insurance companies would have an incentive to offer more attractive plans to win over the thousands of new customers in the exchange, increasing the quality of coverage offered to the public.
When the public option is detached from President Obama’s name, it enjoys overwhelming support, a telling indicator of how the debate has been bogged down in political gamesmanship. The September 24th CBS News/New York Times Poll found that 65 percent of respondents would support “a government-administered health insurance plan like Medicare that would compete with private health insurance plans.” If the public option would control costs, lead to better care, and has widespread support, why has it become a focal point of the rallying cry against reform? The answer is a lack of awareness—people don’t know what the buzzword “public option” means. In a poll conducted for the AARP, only a third of respondents correctly identified the public option from a list of three choices. The differences between Democrats and Republicans were relatively slim—a surprising 35 percent of Republicans thought a public option meant “creating a healthcare system like they have in Great Britain,” but so did 23 percent of Democrats.
What's the matter with Teabaggers?
Elements of the campaign against healthcare reform can be found in the anti-Obama zealotry that has grown more potent since the election. Right-wingers are incensed by any position Obama takes. Their outrageous claims are a nasty smear on public discourse (Obama was born in Kenya! He is a socialist/communist/fascist! He hates white people!). The undisputed royalty of this dubious tribe are Glenn Beck, the radio and television host, and Sarah Palin, the former vice-presidential candidate. The nebulous, baseless anger of the mob has flitted from topic to topic in search of an outlet. It was the perfect medium for backlash against healthcare reform.
Nasty rumors about the bill began to spread through email, on cable television, and at town hall meetings. These scare tactics, initiated by individuals and groups who were already filled with anti-Obama sentiment, played to a fear in the American people that was sown during earlier attempts at reform. These critics fail to recall the detractors of Medicare who, in 1965, warned that government funding for seniors’ healthcare would jeopardize our freedom, a claim that never materialized. The current healthcare legislation, which would increase market competition and end questionable insurance practices, looks nothing like socialized medicine either.
What's the matter with the GOP?
Where ideologically is the GOP during this free-for-all? As the party of limited government, the Republicans could have distanced themselves from the Palinites and led a strong, rational fight for fiscal responsibility. Instead, they behaved exactly like “the party of no” that has emerged since President Obama’s election. Their response was reactionary—any bill the Democrats proposed would have been the wrong bill. Bipartisanship was discarded as the Republicans cherry-picked the topics that would be safest politically.
This led to the ideologically nonsensical position the Republicans hold today: they are unequivocally opposed to a government-run plan but are staunch defenders of Medicare, a government-run plan. In a convoluted August 27th interview with Steve Inskeep of NPR, RNC Chairman Michael Steele tried to defend his party’s contradictory position. He decries the Obama administration’s attempts to rework Medicare while simultaneously pointing to it as an example of government waste. After dancing around the logic of the RNC’s position, Steele declares, “I’m being very clear. I want to have an open debate.” The GOP is playing a cynical political game calibrated to weaken the President.
South Carolina Republican James DeMint revealed the Republican strategy when he announced that President Obama’s loss on healthcare would be the “Waterloo” that doomed his entire political agenda. The GOP has not offered a comprehensive alternative to the Democrats’ bill, nor has it distanced itself from the lies of ultraconservative ideologues. The combination of fear-mongering by fringe groups and the reactionary negativity of the Republican base has bogged down real reform and effectively protected the status quo.
Healthcare reform would help the average American. It would provide coverage to those who need it and prevent those who have coverage from losing it. Competition would increase between insurance companies through an insurance exchange including a public option, ensuring that people get the best plan possible. Although Democratic lawmakers have made some effort to discuss the substance of healthcare legislation (see Obama’s fact-checking website and Barney Frank’s town
hall outburst), 55 percent of respondents to the September 24th CBS News/New York Times Poll thought that Obama has not done a good job explaining his plans for heathcare, and 59 percent reported that they do not understand the reforms.
The 24-hour news cycle gravitates towards the unusual, exciting, and controversial. Sober explanations of legislation and policy have no place on CNN’s ticker. Obama’s address to the Joint Congress on national television was a good first step in spreading truth, but the media focused on Joe Wilson’s scandalous outburst, not the President’s pragmatic explanations. The President should host a primetime special, as he did during his campaign, to outline how reform would impact daily life. Lawmakers should continue to reach out to their constituents, but instead of holding town halls, they should host question-and-answer sessions to clarify the proposed legislation.
On September 29th, the Senate Finance Committee defeated two public option proposals. Legislation from the House bill and from other key Senate committees, however, include public options, foreshadowing a fierce struggle to come. It is not too late for reform, but both politicians and the media need to spread awareness to prevent it from being derailed by those who have purely political motives.
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