On the Profoundly Ironic Illogic of Screaming “Keep Your Government Hands Off My Healthcare!”

When a system has been in place throughout your entire nation since well before you were born, it’s easy to make the conclusion--unwarranted, given a lack of exploration of the evidence--that it's normal and that it makes sense. So it is, it seems, with the opinion of many Americans about our employer-based healthcare system, which is anything but normal among the major economies of the Western world.

It is a natural human phenomenon, one of the faults in our cognitive wiring. Thinking that “the way it’s always been” is normal and sensible is no different than a child who is just beginning to become aware of foreign languages refer to his or her own native tongue as “normal talk.”

To those who, at town hall meetings, are screaming “KEEP YOUR GOVERNMENT HANDS OFF MY HEALTHCARE,” or brandishing signs with similar messages of indignant protest, I would ask you to take a close, critical look at one very fundamental but largely ignored question.

To indulge, for the sake of argument, in some phraseology that might among some readers get my non-party-affiliated, more-or-less centrist self branded as a lot more Lefty than I in fact really am, I would like to ask: why in the WORLD, out of all the scenarios one could possibly envision, would you want your EMPLOYER’S bottom-line-driven hands on your healthcare?

If you are concerned about a government healthcare plan infringing upon your privacy and your constitutional rights to life, liberty, and the pursuit of happiness, I would suggest taking a closer look at whether you might be much more vulnerable to abuses in those areas from your employer.

The right to privacy is all but non-existent in a workplace setting. Once you cross the threshold of your office building, you waive, by implied contract, many of the rights and protections you enjoy when you are out in public. Your employer can archive your e-mails and read them if they wish. Your employer can monitor your activities with hidden cameras, without your knowledge. Your telephone calls "may be recorded for training and quality assurance purposes." And your employer, of course, is involved much more intimately in your daily life than the government could ever be, unless, perhaps, you work for the government.

The potential for abuse may be greatest in small-to-midsize companies, in which the administrative infrastructure for ensuring the protection of employee rights to privacy and non-discrimination may be non-existent, as may the checks and balances to prevent personal and private information from getting into the wrong hands and being misused.

Here is just one of many scenarios. Imagine you work for a small firm of about 25 people, in which, as is often the case in small offices, there is virtually no privacy, and everyone pretty much knows everyone else’s business.

Let's suppose, further, that you or a dependent covered under your plan have had a serious, chronic illness that will require very expensive treatment for some time to come. And everyone in the office knows it, from the owner of the company right down to the guy who comes in to empty the trash at night.

And suppose, for the two years running during which this illness has been an issue, your company's health insurance provider has hit your company with a hefty increase in premiums. In a small office, it wouldn't be hard for the owner, or the operations or HR manager, or whoever else might be responsible for benefits, to put two and two together and figure out just what might be playing an important role in the increasing costs.

And finally, imagine that, after years of glowing performance evaluations, the boss suddenly becomes concerned about some previously undiscussed flaws in your performance, and dismisses you for cause -- or, even more stealthily, promotes you to be head of a new department and then, not long afterward, decides that the new department no longer fits the corporate strategy, eliminates the department and, by extension, the need for your job.

Illegal? Yes. But also difficult, if not virtually impossible, to prove. And even if you could prove it, doing something about it would be very costly--both monetarily and, quite possibly, professionally. Most employees, particularly in small communities, or in smaller industries in which managers in competing companies tend to know one another, would likely rather move on than risk the possible stigma that can follow someone who has sued a prior employer.

Do you think this scenario is unlikely? I don't. I'm sure it plays out in various permutations and combinations all the time, all over the U.S., with its wonderful, employer-based healthcare system. The best healthcare system in the world, say those who are fighting the current reform effort and screaming at the town hall meetings.

Unfortunately, many of us seem to be stuck in a cognitive loop when it comes to seeing the flaws in the most basic attribute of our current system, and to envisioning alternatives. Sphere: Related Content

So Now the Public Option Seems to be Off the Table -- And That's a Crying Shame

President Obama, in the spirit of his reputation as The Great Compromiser--which I do in fact applaud as one of his stronger political attributes that enables him, like Bill Clinton, to at least get SOME things accomplished in the face of stiff opposition from within his party and without--has now backed down entirely on the much and very unfairly maligned "Public Option" for healthcare reform.

The fringe contingents of tea-baggers and town-hall-meeting disrupters, spurred on by their deceitful talk-radio gurus, like mustacheoed villains in an old melodrama, appear to be winning the battle.

I think that this is a crying shame, for the following key reasons:

• Proposed as the "alternative" to a public option is a seemingly vaguely defined notion of "nonprofit cooperatives," a model that some commentators have argued is virtually untested and has a shaky track record in areas of the U.S. where it has been tested.
  
  
• I have a sinking feeling that, without a public option, whatever plan ultimately passes will result only in a very limited change to the status quo. The non-profit cooperatives may not impose sufficient checks-and-balances on the for-profit insurers, with all their clout and public relations, marketing, and lobbying muscle.
  
  
• Non-profit organizations that DO become successful usually do so by acting a lot like for-profit organizations. I know that from the experience of having worked for a successful non-profit. And just look at Blue Cross/Blue Shield as a key example from the healthcare industry itself. So the differences between the private insurers and the non-profit "options" may end up being very superficial.
  
  
• As I have argued previously, I believe that the biggest flaw in our current system is also its most basic attribute: it is employer-based. Calling any new initiative a "reform" without substantively addressing this basic flaw is, in my opinion, highly suspect.
  
  
• The President's backing down on this issue in spite of a strong majority in both the House and Senate--and, for goodness sake, a filibuster-proof majority in the Senate--is a testament to just how powerful are the special interests who support the status quo. For example, as I have discussed in a previous post, there is evidence that the one senator who arguably has the most influence on the process may be vulnerable to heavy pressure from the healthcare industry.

Oh, well. At least we'll hopefully get some baby steps toward a better system. I guess meaningful reform may have been too much to hope for. Maybe after another 30 years of Waiting for Godot. Sphere: Related Content

No Revisit, This Time, On Employer-Based Health Insurance

In the earliest stages of his administration's engagement with the healthcare reform issue, President Obama made it clear that a "Canadian-type" model won't work for us, at least not now, since we are not starting from scratch.

This makes complete sense from a pragmatic perspective. If we were to try to start from scratch, the likely result would be the same 30-plus years of inaction we have already endured, with the status quo becoming worse and worse.

But, speaking from the North American summit today, President Obama made another remark that made his point on "the Canadian question" a bit clearer. He said that the reason a Canadian model won't work is that "we have an employer based system here," suggesting that he is resigned to the idea that a revisit of the employer-based insurance model is something that simply can't happen now.

This is a shame. Again, from a pragmatic perspective, he is probably correct. Any short-term effort to dismantle the system of employer-based coverage would almost surely be doomed to fail. Not the least among the reasons for this is the level of influence that industries vested in the status quo appear to have on our legislators.

But I hope the administration and its supporters do not lose sight of a revisit of employer-based coverage as a longer-term issue, because I believe that the employer-based model is the single biggest flaw in our current system.

Within the rest of the industrialized world, the employer-based system is truly an oddity. It is a remnant of the so-called "Gilded Age" in the United States, which on one hand is famous for the prosperity achieved by the few but on the other for the abuses of workers that were permitted by a hands-off government.

The fundamental flaw of employer-based healthcare is this: everything can be hunky-dory for your regular checkups, treatment of mild chronic illness, and so on, until you either get very sick, change jobs, or lose your job. When you don't need your health plan all that much, everything is fine. But when you get sick enough to REALLY need your health plan, chances are you will lose it, because you may also be too sick to work and, as a result, will lose your job.

This flaw in the model is so basic and obvious that it goes beyond illogic and into the territory of absurdity and insanity. I challenge anyone to persuade me otherwise with a cogent argument for why this model makes sense.

But until then, I can only conclude that there will be no meaningful healthcare reform until the employer-based model is either replaced entirely or supplemented with a viable, robust system of backup coverage for those who lose their employer-based coverage due to illness, economics, or other reasons. Sphere: Related Content

The Undismal Weekly Wrapup -- June 21-27, 2009

Analytical Summaries of Key Stories of the Week on Economics and Public Policy

A Funding Roadblock Ahead for Clean Energy (New York Times)
Kate Galbraith of the New York Times explores the question of what will happen to efforts to finance green energy projects “once the stimulus funding runs out.”

Analysis: Obama Scores Major, Much-Needed Victory (Associated Press)
News analysis piece by AP’s Liz Sidoti on the House of Representatives passing “the first energy legislation ever designed to curb global warming.” Also explores the implications of this legislative success for President Obama’s healthcare efforts.

Betraying the Planet (New York Times)
Renowned economist Paul Krugman scolds the 212 House of Representatives members who voted against the Waxman-Markey climate change bill, characterizing them as climate-change deniers who are committing what is tantamount to “treason against the planet.”

Can Governments Till the Fields of Innovation? (New York Times)
The dicey question of whether governments can play an effective role in driving the private sector toward creating new industries in such areas as energy and healthcare to revitalize the economy and create jobs is explored in this report from Steve Lohr of the New York Times.

Confidence in Stimulus Plan Ebbs, Poll Finds (Washington Post)
A new Washington Post-ABC News Poll finds that barely half of Americans remain confident that the stimulus package will be effective in turning the economy around, according to this report by Washington Post staff writers Dan Balz and John Cohen.

Inflation – The Real Threat To Sustained Recovery (Financial Times / Tehran Times)
Former Fed Chairman Alan Greenspan cautions that failure to pare back the U.S. federal budget deficits and pubic sector debt after the economy turns around could set the stage for inflation and stifle the effectiveness of private market forces in efficiently allocating resources, in this Financial Times column reprinted in the Tehran Times.

The Debt Tsunami (Washington Post)
A Washington Post editorial characterizes the latest long-term U.S. federal budget deficit projections from the Congressional Budget Office (CBO) as “scarier than ever.” Sphere: Related Content

Insisting on a Better Way

It is surely no coincidence that, during the past several weeks, when the healthcare reform effort has been reaching a critical point, the voices of opposition against the Obama administration's economic policies have grown increasingly shrill.

On the other hand, it is a pleasant coincidence that, as we near Father's Day, some of my primary illustrations of the theme of this post come from a couple of stories my father told me long ago.

The first story was about how my grandfather reacted when the first motion pictures with sound ever came out. People called them "Talkies," at least in the small New Hampshire town where Dad was born and raised, to distinguish them from the silent movies of the day. My grandfather, according to Dad, characterized Talkies as a fad that would never last.

Far be it from me to poke fun at my late grandfather for this. He was a man of his times. And a man of his environment.

That environment is illustrated vividly by the second of my father's stories that came to mind as I formulated this post. The town that was home to my father and grandfather was the same place where, at a town hall meeting, when the topic of improving the literacy of local students was being discussed, an elderly citizen stood up and said "I don't believe in readin'. Readin' rots the mind." This is of course a very narrow view by a more contemporary and cosmopolitan standard, but it was a view that represented a pattern of thinking that has not been uncommon in certain places and times.

Let's be grateful that there have always been people who, even if they're usually in the minority, have been more open and imaginative in their thinking -- people, in other words, who insisted that there must be a better way. What would cinema be today if everyone had shared my grandfather's opinion of Talkies? And what would our entire society, let alone our educational system, look like if everyone shared the opinion of the elderly gentleman at the town hall meeting?

How does this relate to the healthcare reform debate? Well, it hit home for me during the first hour of All Things Considered on NPR today. I heard a teaser on a story that, as I write, may not yet have even aired. It featured interviews with physicians from Howard County, Maryland, on the subject of healthcare costs.

In a brief sound bite, one of the docs was talking in plaintive tones about the countless hours that are wasted on such bureaucratic processes as filling out forms, verifying insurance coverage, and so on, implying that costs could be reduced drastically if only we could make better use of all the modern technologies and resources at our disposal to make the process of managing healthcare more efficient.

So far, our wonderful, privately managed, competitive healthcare system hasn't accomplished that efficiency.

The real question, when you cut through all the partisan rhetoric, and through the squeals of interest groups who feel that the government is about to take away the fat slice chocolate cake they've grown used to having after every meal, is "how can we find away to do this better?"

If we engage in "readin' rots the mind" or "Talkies are a fad" thinking, we get to the kind of rhetoric we're hearing now -- "ObamaCare will bankrupt the country and destroy the best healthcare system in the world"; or "the system is so hopelessly broken that there's no fixing it"; or "government is incapable of making anything better and more efficient"; or "we'll end up with the nightmare scenarios of endless waiting lists for surgeries, rationing, and denials of treatment that you see in Canada and the UK."

Behind all that rhetoric, basically, is the kind of "it can't be done" thinking that hinders progress. It's like saying, before television, that "it's impossible to send pictures through the air." And it also reminds me of something that was said by an old-school mainframe programmer who worked for an organization where I used to work. His opinion in the early stages of an effort to migrate our content management system from mainframes to PCs was that "it can't be done."

The destructiveness of this kind of thinking is self-evident. And perhaps, unfortunately, there may even be a trace of it in the approach of compromise that Congress and the administration feel they have had to adopt in conceding that single-payer is off the table. The administration, in other words, should perhaps be doing a better job at articulating the message of "there must be a better way" to deliver healthcare to U.S. citizens, and the message that, even though our current, flawed system may indeed be the best in the world, at least in terms of creating innovative treatments, it doesn't mean that it can't be made better.

There must be a better way. That's the message that President Kennedy so successfully conveyed to the people in rallying support for the effort to land a man on the moon. And perhaps that's the message that President Obama should be articulating on healthcare reform. What if there's a way to still allow doctors, health insurers, and other healthcare professionals to be reasonably compensated, and to insure all Americans and give them fair and equal access to the best available treatments, without the need to put the private healthcare industry out of business?

The simplistic rhetoric we're hearing is all of the "either, or" variety -- public OR private; capitalist OR socialist; free market OR government-run. But those who are squealing loudest are likely to be those who have the most to lose. It's the same pattern that occurs in the "not in my backyard" reaction to certain public service projects, or the "don't cut my pork-barrel project" reaction to government budget cuts.

But the real issues aren't about any of that. It's all about finding a better way, about insisting that there is a better way. We need "we're going to put a man on the moon in 10 years" thinking here, not "reading rots the mind" or "Talkies are a fad" thinking.

Are Congress and the administration compromising too much, or not thinking boldly enough? Perhaps at this stage the best we can hope for in the near term is a baby step of progress. But if that's the case, let's not take our eyes off the long-term aspiration for a better way.

I'm glad that my father, in spite of a tendency in his home town to look at things from a rather narrow perspective, was someone who realized that there must be a better way to live, and got himself an education and allowed his life to take on broader horizons, both geographically and intellectually, enabling me to have a life much richer in possibilities.

Let's take a lesson from that model and from everyone else who understands the value of insisting on a better way, and apply it to our thinking and decision making on healthcare reform, and to the feedback and criticism we provide to the elected officials who are currently engaging in the debate.

And Happy Father's Day, Dad. Sphere: Related Content

The Undismal Weekly Wrap-Up -- June 7-13, 2009

Analytical Summaries of Key Stories of the Week on Economics and Public Policy

National Summit Arrives Amid Economic Trouble (Associated Press)
AP’s Jeff Karoub reports on a National Economic Summit being held under markedly different circumstances than those at the time it was originally planned, describing the climate as scaled back but no less determined to lead to tangible action.

G8 Finance Mins Start to Plan for End of Crisis (Wall Street Journal)
Luca Di Leo and Paul Hannon report from the G8 meeting in Lecce, Italy, on discussions focused on how to ramp down the pace of stimulus funding that member nations have infused into their economies in hopes of accelerating recovery.

Obama’s Spending Plans May Pose Political Risks (Washington Post)
Polling data and concerns among administration insiders indicate that President Obama may risk losing political capital if efforts toward reducing the pace of spending increases are not demonstrated soon, according to a story by Scott Wilson of the Washington Post.

2010 Vote Shift Could Bring Fed Policy Showdown (Reuters)
A standard rotation procedure scheduled for January will lead to changes in which members of the Fed’s Open Market committee will have voting authority, possibly leading to shifts based on such issues as differing viewpoints on the risk of inflation under the current policies.

Following the Money in the Healthcare Debate (New York Times)
Some $2.5 trillion and daunting issues about how it will be reduced and divided among numerous interest groups are at stake in the healthcare reform debate. Reed Abelson of the New York Times explores the complexities in an in-depth report.

Geithner Says 'Too Soon' for G-8 to Pull Back on Economic Aid (Bloomberg)
The U.S. Treasury Secretary cautions that G8 member nations need to stay the course on current stimulus efforts, focusing for now on restoring growth rather than reducing deficits, as reported by Bloomberg’s Rebecca Christie.

Lawrence Summers Defends Obama Policy (United Press International)
UPI reports on a speech to the Council on Foreign Relations by Nobel Laureate and top Obama economic guru Larry Summers, attempting to allay perceptions that the administration may have taken excessive measures to involve government in managing major segments of the financial, medical, and industrial sectors.

The Politics of Jump-Starting (Huffington Post)
Charles D. Ellison poses the question of just how well the tireless optimism and energetic initiatives of the Obama administration, such as the new 100-day effort to accelerate the pace of recovery, are actually resonating with the American public. Sphere: Related Content