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

Friday, November 6, 2009

Thriving Fear and Sick Hyperbole

They Represent Republicans’ Two Weapons Against Healthcare Reform Legislation

Yesterday, conservatives gathered in the thousands on the steps of the U.S. Capitol for a Tea Party-style protest against the healthcare reform bill currently moving through the House of Representatives. “This bill is the greatest threat to freedom that I have seen,” House Republican leader John Boehner of Ohio warned the crowd. Boehner then collapsed and was rushed to a local DC hospital, where he received treatment for what doctors there described as one of the worst cases of hyperbole they had ever seen.

Okay, I made that last part up.

As Boehner exhorted on the protestors, New York Times columnist Nicholas Kristoff took on a criticism of healthcare reform posited by many conservative activists. Namely, that reform is completely unnecessary because healthcare in the U.S., in its current state, is just fine. Proponents often take their assertions a notch higher. Not only is U.S. healthcare better than that in foreign nations featuring socialized medicine, it is paramount.

Republican Senator Richard Shelby of Alabama, sneezing out a strain of calumny nearly as virulent as that of Boehner’s, has said that Obamacare amounts to “the first step in destroying the best healthcare system the world has ever known.”

However, Kristoff demonstrates that U.S. health statistics do not stack up so well against those of other industrialized nations, including the ones with socialized medicine. The only U.S. demographic group consistently getting healthcare equal to or better than their international peers are those over sixty-five years of age – the ones on Medicare, a government-run universal coverage healthcare program.

It is true, Kristoff concedes, that the wait to see some specialists or have certain operations performed is shorter in the U.S. than some foreign countries. Then again, one valid reason for this may be that foreign doctors do not face pressure from private insurance companies to push patients out of hospitals as quickly as possible. Is it better to get the fastest cure possible or the best cure possible? The answer, of course, is that getting both is best. The point remains that what we have today is, at best, a tradeoff and not a triumph over the rest of the planet.

I am not trying to make an argument here that U.S. healthcare system is horrible. In fact, it is effective on many levels. On the other hand, its clear superiority to the rest of the world, much as jingoistic national pride might wish to believe in such, simply does not exist. Even if what we have is good, better is demonstrably possible.

The reason this particular falsehood maintains so much traction, beyond our patriotic bias, must surely derive from poll after poll finding a majority of Americans with health insurance declare themselves satisfied with it and the level/quality of care they receive. Even so, at some level, we realize the need for improvement because the same polls also find a strong if seemingly contradictory desire by Americans for reform.

Why, then, do so many of us insist we are happy with what we already have and regard so skeptically any legislation currently being proposed? A recent Rasmussen survey found that fifty-five percent believe passage of healthcare reform legislation would increase the cost of healthcare and fifty-two percent believe it will reduce quality of care.

I believe the answer lies in the finding that a whopping seventy-two percent of those polled believe it likely companies will drop insurance coverage for employees in reform’s wake.

For many years, American workers in all but the smallest companies received health insurance coverage at their employers’ expense. It was a “benefit” for being a productive citizen of the most powerful nation on Earth at a time of economic largesse. The insurance provided was probably imperfect but with medical costs generally within the means of most middle class families, protection against catastrophic loss from a severe long-term illness was the only worry and this was, or at least appeared, covered.

The only people who did not have health insurance were those who were unemployed or held the lowest-skilled jobs and our culture often viewed either condition as an indictment against the effected individuals for being uneducated and/or unmotivated.

Then, as medical costs began to rise, companies began playing hardball with employee, including those in unions, over healthcare benefits. Either employees must begin contributing part of the expense for their coverage or the company would cut jobs. Loss of a job was a potential threat because few affordable alternatives to employer-based health insurance were rare. However, despite rising healthcare costs, the economy was growing at an unprecedented clip and unemployment was low, thereby allowing a kind of uneasy equilibrium to prevail.

In recent years, as the economy soured and jobs began vanishing overseas as a result of globalization and other factors, the threat of job loss became long-term and the loss of health insurance with it. Simultaneously, medical costs continued growing to the point that even relatively routine care became ruinous for middle class and even some affluent families.

Employer-based health insurance was more imperfect than ever yet Americans felt pressured to stick with it more than ever because the alternative was almost certain devastation and poverty. Workers also became resistant to any insurance changes, fearing switches by employers to new insurance providers to get better deals. A new provider could mean switching doctors or hospitals and/or introduced the possibility of denials for “pre-existing conditions.”

Even worse, as unemployment soared and the cost of health insurance made it prohibitive in any form to more families, nothing changed in our underlying beliefs regarding them. Being unemployed and uninsured is still something more to be ashamed than outraged over, more a reflection on individual inadequacies than problems or unfairness in the system. In such a situation, it does not take much stoking by those opposed to reform, for various reasons of their own, to generate fear and panic among Americans about potential changes.

If genuine satisfaction on the part of most with the insurance they have today truly were the primary driver behind opposition to healthcare reform legislation, then I would have to agree that President Obama and Democratic Congressional leaders are suffering from mixed-up priorities or worse. However, I believe many Americans are inclined to rate their current coverage as “satisfactory” based not on its merits but due to vague but potent fears regarding its loss.

Part of the reasoning behind universal coverage and a public option is to reduce some of the shortcomings of the current employer-based system. Yet terror of the traditional “no man’s land” that has existed beyond employer coverage for health insurance may well be a major driver behind public opposition to this solution. Boehner can talk all he wants about “threats to freedom” but the current system, intentionally or otherwise, has been all about limiting choices for years.

In light of this, Congressional Democrats more than ever need to place doing the right thing over doing what is popular. Fortunately, for Republicans, fear of losing popularity is a potent weapon against politicians facing re-election bids in 2010. It is certainly more potent than what is apparently their only other weapon in this fight – hyperbole.

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