The right eloquence needs no bell to call the people together and no constable to keep them. ~ Emerson

Wednesday, March 4, 2009

Schrödinger's Stoned Cat

The two things Acea Schomaker, a twenty-year-old resident of Omaha Nebraska, loved most in life were smoking marijuana and his cat Shadow. One day, Shadow became “hyper,” to use Schomaker’s term for it, and none of his efforts could calm her down. Therefore, he did what any pothead worth his salt would do in such a situation and built a bong.

But not just any bong. This bong consisted of a piece of garden hose attached to a small plastic box. Then Schomaker stuffed Shadow into the box and began smoking.

The stuffing-the-cat-into-the-box part of the operation raised enough of a ruckus for neighbors to alert the sheriff’s office. When deputies arrived, they released Shadow and arrested Schomaker, charging him with misdemeanor animal cruelty and releasing him after he paid a $400 fine. Schomaker still faces possible drug charges.

To Schomaker’s credit, his device did ultimately calm down the marijuana-infused Shadow. “This cat was just dazed,” a deputy reported. “She was on the front seat of the cop car, wrapped in a blanket, and never moved all the way to the humane society.”

It struck me that if any person might find a metaphor in this bizarre little saga for their own situation, it would be Governor Kathleen Sebelius of Kansas, whom President Obama just tapped as his backup pick for Secretary of Health and Human Services. Obama introduced Sebelius, along with Nancy-Ann DeParle, who will head the White House Office for Health Reform, in advance of a White House summit on healthcare, involving lawmakers from both Parties, the health insurance industry, and consumer groups.

Everybody is generally favorable about the twin goals of keeping down healthcare costs and expanding coverage. It is likely the kitty litter will hit the fan when it comes down to specifics over how to do it.

Republicans in Congress have made their position clear. They want to avoid increasing deficits and expanding government bureaucracies like Medicaid. They see tax reform, malpractice litigation reform, tax-free private health savings accounts, and increased private sector choices as preferred methods for “leveling the playing field” to make healthcare more affordable.

Obama and the Democrats take a far more ambitious path, aimed at universal coverage. As with other items in his budget, Obama is willing to spend and spend big on healthcare reform. He has already announced he will release $155 million in the $787 billion economic stimulus measure to support over one hundred new health centers, giving people more access to primary and preventive healthcare services. The President further proposes $634 billion over ten years as a down payment on a total package that could ultimately cost $1 trillion or more.

To help pay for all this, Obama proposes, among other things, raising taxes for those earning over $250,000 per year while cutting taxes or at least remaining neutral as regards middle class and poorer Americans. This idea of wealth redistribution raised cries of “socialist!” toward Obama during the campaign and critics have used “socialized medicine” as a boogeyman against healthcare reform for decades.

In Monday’s Washington Post, E.J. Dionne takes the progressive position and argues it all comes down to a question of basic equality. “Do [politicians] believe that a fairer distribution of capitalism's bounty is essential to repairing a sick economy? Everything else is a subsidiary issue.”

David Brooks lays out the case for moderates and conservatives in Tuesday’s New York Times. He describes a vision “in which burdens are shared broadly, rather than simply inflicted upon a small minority . . . that does not try to build prosperity on a foundation of debt . . . that puts competitiveness and growth first, not redistribution.”

Much as I generally admire moderation, I have to go with the progressives on the solution to this problem and much of the problems facing our nation today. The sheer scope of the current healthcare crisis demands it.

Health costs consume sixteen percent of the economy and threaten to reach twenty percent by 2017 at their current rate of growth. In spite of this, an estimated forty-eight million people are uninsured and this number continues growing as well. Compounding the problem, falling tax revenues, thanks to massive tax cuts, are pushing Medicare into insolvency by 2016, a mere five years after the first Baby Boomers qualify for its services.

The healthcare system we have today is rather like a giant bong we have constructed or, more accurately, cobbled together in our collective attempt to satisfy all of our varied and sometimes conflicting self-interests. It does not really solve the problem but a hit on it now and then it makes us feel good about ourselves for a little while.

Those of us with good jobs that provide (partially) subsidized healthcare and enough income to afford co-payments and many other non-covered expenses, are analogous to Mr. Schomaker from Nebraska. Life is good. The noisy, nervous cat is quiet and we are feeling mellow. Everybody else is stuck in the role of Shadow the cat, squeezed into a box not quite big enough to accommodate us.

Rather like another cat in a box – an imaginary one belonging to Austrian physicist Erwin Schrödinger – there is a probabilistic chance we are actually receiving necessary healthcare services as needed and when we do it too often is just opiate for the masses that really does not make us better or our condition tolerable. Anyone who has trouble grasping the concept of verschränkung (“entanglement”) need only deal with an insurance claims office to realize the paradox of having coverage and simultaneously not being covered.

This is the problem with the conservative approaches. Even if we finally figured out the right way to do them, they will be insufficient for the task. It is not enough merely to think outside the box anymore – we need to tear down the box/bong, let the cat out, and start building something genuinely useful in its place. The rebuilding process need not necessarily be expensive, although this seems likely, but it must be far-reaching in scope. Obama seems to understand this.

“There's no easy formula for fixing our health care system,” he conceded when announcing Sebelius’s appointment. “[But] I didn't come to Washington to take the easy route . . . I came here to work for the American people. I came here to deliver the sweeping change that they demanded when they went to the polls in November.”

Obama and the rest of Washington had better prepare themselves because they will face growing discontent as more and more Americans find themselves relocating from the position of Schomaker to that of the cat in the bong/box. Never mind the uninsured or welfare recipients, we are talking about formerly insured workers and retirees who have seen benefits reduced or lost altogether. This group regards healthcare as an earned right, not a granted entitlement, even if not all of them have yet reconciled themselves to paying for it through their taxes rather than their tax cuts.

As Washington Post columnist Richard Cohen observes, “[Americans today] are soft, coddled. We actually thought we could have [it all ways] and that it would all somehow work out. This keeps being called the American dream. It was actually the American delusion . . . Obama will either figure out how to channel [the rage that follows] as FDR did or he will be flattened by it as Lyndon Johnson was.”

What is more, the people who, above all others, must hope the new healthcare system is not only better but also bigger than the current one are the affluent. If current trends continue unchecked, even they will eventually cease smoking the bong and find themselves in the role of Schrödinger’s stoned cat. As everyone knows, the hardest cat to stuff into a small box is a fat cat.

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