There are two debates on healthcare reform: The first debate is on the merits of various proposals, and how they will impact people outside of the notorious Beltway. The second debate is about motivations of the individuals and organizations pushing for those various proposals, often spiked with questionable polling data. This is primarily a political battle generating more heat than light.
The first debate is confusing enough, with the House and Senate having cooked up three conflicting proposals before leaving town for a summer break of often hostile meetings with constituents. It is quite impossible to tell where they now stand on many of the issues, although many have made absolute statements for or against the public plan. Some have also drawn lines in the sand regarding cooperatives, even though very little is known about what the Senate Finance Committee has in mind, and some congressional leaders have displayed little knowledge of the concept.
The second debate has been outright baffling, even to people who live and breathe national politics. This debate seems to be primarily about what is politically possible, rather than what is most likely to have the best results.
Motivations and agendas are important, as they provide a filter through which we should run arguments. But that filter is not the point, and the importance of bias detection is not the whole story. We should not lose sight of the pros and cons in a thicket of shifting and hidden motivations. Just because someone promotes a solution for hidden or corrupt reasons, it does not follow that the solution is a bad one. And just because many people have the best of intentions and no conflict of interest, it does not mean that they have a good idea.
Similarly, popular ideas are not necessarily good ones (think of Prohibition, red scares, and pet rocks) even if we could figure out what is popular. The most recent poll (NBC Aug 15-17) shows that support for the public plan has slipped from 46% to 43%. This is hardly conclusive, but more useful than the previous poll (Fox Aug 11-12), which leads with a totally vague question: “Based on what you know about the health care reform legislation being considered right now, do you favor or oppose the plan?” There are several different contradictory proposals in play, any one of which might be in the mind of the respondent. No wonder 16% answered “unsure.”
Too much of Washington’s decision-making is based on counting votes. People can argue about what’s behind each others’ arguments or what “the people” want until the cows come home. But the real question is what will (hopefully) work best. We should be looking at the merits of the proposals.
Nobody knows how this will turn out. Some months from now, Congress will probably agree on something and President Obama will probably sign it, but anyone who says they can tell you what comes after that is making stuff up.
Government programs, cooperatives, and the private sector all have mixed records in dealing with health care, so the best we can do is look at the track record of each: how well have they addressed the problem in the past, and how well do they seem to learn from mistakes. We should work toward a solutions that are flexible, transparent, and responsive.
What worries me most about the public plan is that it will potentially never leave the political arena. The constant comings and goings of politicians and their various loyalties will mean that the whole thing could be in constant flux. De-funding will probably be a regular threat. Whenever Congress changes hands, there could be a shift in what services are available to whom. An effective plan could also simply be gutted by politicians who are mostly beholden to various medical industries; 1/6 of our economy is health-related, so presumably 1/6 of the campaign dollars available are also health-related.
There is no guarantee that co-ops would be immune from this, and the high degree of government involvement in their creation would be very dangerous. There have been cases where various profiteers have undermined or even killed co-ops despite their internal democratic processes; if the co-op plan is adopted, the members and their board(s) will have to be eternally vigilant.
However, we can at least hope that moving the long-term battle out of the Beltway will do some good for the long-term stability of reform. And taking the system out of politicians’ hands improves the chances that the plan will focus on what works, rather than what has the votes.