The My Of It

August 17, 2009 | By | 15 Replies More

Listening to the harangue over the health care reform squabble, I can’t help thinking—even I saw a few episodes of West Wing, I who do not watch television, so of all the  Lefties out there who probably hung on every second of that show, why is it so hard to grasp how things don’t get accomplished in D.C. ?  Yeah, it was fiction, but it was, in my opinion, pretty accurate in terms of the culture.

But people complain and wonder why Obama doesn’t just “ram his reforms through.”

Well.  The man is a consensus builder.  We just got done with a president who wasn’t.  Obama has not yet been in office a year and already people are ready to jump ship because he’s not the second coming of FDR.

Image by Mark Coggins at Flickr (creative commons)

Image by Mark Coggins at Flickr (creative commons)

How thoughtless, ill-informed, and shallow supposedly intelligent people can be.  It should not be surprising, yet…

First off, instead of presenting his reform package, he handed it to Congress—which is where all the arguing was going to happen anyway.  Suppose he had presented a package.  What is happening now would have happened anyway, and then he would be directly blamed for having drafted a lame plan.  His plan would have been eviscerated and Congress wouold then proceed to draft something possibly worse than what it emerging now since Obama’s plan would have been discredited through failure.   As it is, the plan being touted is All Congress’s.  Anything wrong with it, it’s on them.   Obama has been arguing that regardless what happens, things have to change—which is frightening.  With the stimulus package, things were already broken.  With health care they are merely on the verge.

Secondly, he’s got lots of balls in the air just now.  A lot.  Most of them are disasters he inherited.

Now, the metaphor has been used before, but that doesn’t make it any less true—this country is a Big Ship and you don’t turn it around on a dime.  If you do that, you break more than you fix.  Maybe that’s what needs to happen, and sometimes we’ve had leaders who did that when there was but one maybe two major things that needed to be tended to.  But that’s not the case just now.

Everything is in a mess.

I’m not going to fault the man for failing to meet impossible expectations.   Let’s assume he did just start “ramming things through” and taking a dump all over Congress in the process, and things would inevitably get worse.  For the ideologues who are displeased with what they perceive as half-measures just now, he might be a hero.  Maybe, but quite certainly he would be a one-term hero.  The Republicans could make good book on a spectacular failure and be right back in power, at least in Congress, and then what?

So I think it a stupid thing to start bailing on him this soon into his term when he is possibly the most unifying, certainly the most intelligent and well educated president we’ve had since…hm.

Here’s what’s going to happen.  Congress will put together a lame package.  It will pass.  Then likely as not it will fail.  The system will collapse.  On its own.

Then the big fix will come in.  Congress will be discredited and Obama will be able to present a plan with legs and the  public will back it because they will already have seen what happens when the really necessary steps are not taken.

Right now, the reality is that health care costs too damn much.  The public option was designed to force the industry to charge less.  The way it’s set up, they can’t.  Too many people making too much buck are too dependent on it.  When that system breaks down, then you can fix it.  As long as it is seen to work by those who can afford to hire lobbyists, it will remain in place.

And it’s true, Obama doesn’t have a way to pay for it.  He’s playing a dangerous game right now.  He’s banking on you and me and the next door neighbor fomenting rebellion.  He’s hoping we unilaterally strike (as in labor strike, just so my meaning is clear) and tell the insurance industry that enough is enough.  That we’re not prepared to allow them to hike our premiums whenever we have medical needs or cancel us if we really get sick.  The fact is, the insurance industry is a business, it is designed to make profit, and if it can do that by taking care of people, it will—but if it can’t, then it won’t help anyone it can figure out how cut out.  The basic principles need to shift, but that won’t happen in a system built on conflicting benefits.

It’s ironic, you know, that people are terrified of a government bureaucrat dictating health benefits, but they don’t have the same reaction when a corporate bureaucrat does the same damn thing—-or have we all forgotten HMOs?

It’s not so hard to understand, though.  It’s a mindset and it is basic to the American psyche.

Here’s the mindset that has to be overcome.  “Keep the government out of my medicare.”  I heard that actually said.  Oxymoronic, yeah?  But it expresses a bone-deep sentiment that is fundamental to the American psyche and it is expressed by one word in that phrase—My.

Reality aside, people do not view government services as “theirs”.  They pay their taxes, in this view, to benefit Other People.  Not them.  Yes, yes, I know, it’s ludicrous, but tell me it isn’t true?  The public option would be seen as Not Ours.  If it goes through the government it passes out of private hands—my hands—and becomes something that no longer belongs to me.  Private insurance, private health care, bad as it may be, is Mine.  That’s the key word, that’s the core of the fear.
Tally the complaints we hear daily, often as a joke, about dealing with City Hall.  The Department of Motor Vehicles is a case in point.  Complaint after complaint.  Not all of it invalid, but far far more than is warranted.  Get someone, anyone, over fifty-five talking about vehicle inspections and the more recent emissions tests, and you can get a visceral reaction all to the negative.  People do not see the government as Theirs.  It is an institution with which they must deal, but it is a nuisance, a thing that gets in the way, a burden, an obstacle, not like the local retail store or the private contractor.
Further, though, that resounding My goes to the heart of another sensitive issue in American culture that is connected to merit.  Because when you support something through the government, when you pay taxes for it, people who don’t deserve it will get it.  You lose all control.  And then you get the same level of attention as “those people over there” who don’t work.

That most of us do not fall into anything like that category, and government programs are pathologically geared to preventing the so-called undeserving from getting anything they shouldn’t have matters not at all.  I will not argue the perversity of the mindset, but that’s where it lies.  Single payer, to take it further, means it is no longer Yours.  Your money goes out the door to the government and is diffused through a population of folks, many of whom you don’t want to pay for.  Never mind that improvement in general public health redounds to all our benefit.  Never mind that dealing with poverty-related disease protects us all.  Never mind that decent health care is fundamental to beginning the eradication of the cycle of poverty.  Never mind that so much would cost much less in the long run.  The question in the average mind it, “Why should I be made to pay for someone else’s health care?”

Now, it doesn’t matter that basically this is the way insurance works now.  We’re talking psychology here, not reason.  The fact is, you can cancel your insurance if you don’t like how it’s operating—stupid maybe, but it’s the illusion of control, the fiction of private property.

And just now, we are still living under the aegis of Reagan-speak, which cast the government as the Other, the Alien, the Tyrant.

It’s a form of classism.  Never mind that it might work better.  The sad fact is, it will work for people many of us may feel don’t deserve it.  And that is part of what America is all about.  Ownership, control of personal destiny, the ability to deny on the basis of merit.  It’s the dark side of the very system that has also provided a great deal of good to a great many people.  It’s a holdover from the age of self-reliance and is reinforced through our romantic connection to Manifest Destiny and the City on the Hill, the latter image most recently invoked by Reagan and referred to obliquely by George W. Bush.  Only the Elect may live there, and that doesn’t include those who can’t (or, in this characterization, won’t) support themselves.
The fact is, we haven’t found a way to effectively argue with this.  Two reasons—it is largely unstated, and it’s hard to debate something that is not even cogently recognized; and when it is challenged, the challenger sounds like a Socialist.
Remember.  It’s all about the My.

Share

Category: American Culture, Bigotry, Communication, Culture, Current Events, Economy, Education, Health, ignorance, Language, Noteworthy, Politics, Psychology Cognition, snake oil

About the Author ()

Mark is a writer and musician living in the St. Louis area. He hit puberty at the peak of the Sixties and came of age just as it was all coming to a close with the end of the Vietnam War. He was annoyed when bellbottoms went out of style, but he got over it.

Comments (15)

Trackback URL | Comments RSS Feed

  1. BJ says:

    So I want to make sure that I’m getting your position correctly. You believe that Obama has largely avoided making the case for specific health care reforms so that the Congress (with Democratic leadership in both houses) can make a giant mess out of it. Obama’s been arguing that now is the time to reform health care. The country is debating various parts of the plan that Congress has drawn up, which is known colloquially as “Obamacare”. Once this Obamacare plan is widely discredited as a failure (perhaps after a collapse of some sort?), Obama will swoop in and enact the real plan which will be widely acknowledged as viable, although it was somehow too much of a political risk to enact in the first place. He’s doing all this in the name of building a consensus, or bi-partisanship. So presumably, this plan which will bring us to edge of collapse in the health care system will be a compromise plan (in the name of consensus-building). Inexplicably nobody will associate the failure of that plan with Obama, leaving him free to push for the “real plan” which he’s had all along.

    I can’t believe that you consider that a more plausible scenario than the alternative: President Obama is not nearly as progressive as Candidate Obama. The moneyed interests have co-opted his presidency. More cynically, but I believe also more accurately, there is the shocking idea that Candidate Obama never intended to be that progressive to begin with. I mean, what politician would lie and tell the people what they wanted to hear just so they could win an election?? That would never happen in the good ole’ USA, right? Especially from a politician that campaign on the utterly vague slogans of “hope” and “change”. You may not get the reform you wanted (and were promised), but you can still hope for next time, right Mark? Maybe after the system collapses, then we can have the “change” that we wanted.

    None of this is to dispute that he’s got a lot of balls in the air. All presidents do. And, he’s got all of that extra stuff to do that he wasn’t counting on. Things like maintaining the Bush administration’s policies on the fatuous “war on terror”, expanding the war in Afghanistan, hiring lobbyists and insiders to run the executive branch, maintaining the Bush Administration’s pledge to make ensure Wall Street doesn’t suffer, etc…

    Thoughtless, ill-informed, shallow indeed.

  2. BJ,

    I'm suggesting that this is a tactic. Just look at what's happening. Congress is on the verge of making a hash out of it. And everyone keeps harping on that fillibuster proof majority—it's not, because not all the Democrats are in agreement.

    No, I just think people's expectations were and are way too high. Did Obama promise too much? You'd have to go back and parse everything he said, but I think people heard what they wanted. He said "We need change" and everyone heard "I will give you change." Well, the best he could do is try.

    And yeah, I think the health care system is so bollocks-up that the only way to effectively "fix" it is to break it first.

    But go ahead an be a cynic. That's the other favored American position.

  3. One more thing—my piece is about the most important part of the puzzle, which is the general public. If Obama were to ram shit through without paying any attention to the public, what does that make him? And the skepticism over health care reform—not whether we need it but what it's going to look like—is coming from the public.

    So who does Obama not listen to?

  4. BJ says:

    Mark,

    Ok, it's a tactic. I think it's a terrible tactic, and I think it's the wrong way to go about it. But, he's a young president and maybe he'll figure out how to do things after a couple of years.

    My point with the filibuster proof Congress is this: whenever policies which are widely popular are not implemented, one of the standard reasons given by the ruling elite is that the opposing party wrung too many concessions, or blocked reform in some other way due to their numerical makeup in the Congress. Now, the stage is set for almost nothing to happen (again) now that nobody is standing up for a public option, not to mention a full-blown single-payer plan, and they cannot hide behind the easy rationalization that the other party blocked reform. Obama had all the elements to be able to make a real push for true reform, or dare I say it, a radical revolution in the health care system in this country. Now it's obvious that we are not going to see the revolution in health care that is needed, we'll get a band-aid instead. And Obama will say that he tried his hardest, and they didn't get everything he wanted, but they got a pretty good bill. And the people (the ones who are paying attention anyway) will know that he's lying- they will know that he didn't try his hardest, and it's not a good reform bill at all.

    And I will go ahead and be a cynic. But let me remind you, there's ample reason for cynicism. Why do you think it's such a favored American position? I submit that it's because the people repeatedly get the short end of the stick, even as they see billions in concessions going to big business. Politicians have been lying to the people for years, how could one be anything other than cynical? In fact, I say we should avoid the negative connotation of "cynicism" and just call it "realism".

    But, I could be wrong. I'll check back with you in a couple years and see if you're happy with the level of change. As for me, I'm betting that we'll all be disappointed.

  5. BJ writes:—"Ok, it’s a tactic. I think it’s a terrible tactic, and I think it’s the wrong way to go about it."

    I didn't say if it was good or bad. As it happens, I agree with you. I'm just saying that this is what it looks like to me, and the reasons I think he's going this way. It wouldn't be the first time he let the other guy hang himself with his own rope.

  6. BJ says:

    Mark- Fair enough on the tactic.

    As to the skepticism originating the public, it appears that is debatable. I'm sure you've heard the term "astroturf" applied to those that are organizing against reform. Also, apart from this weekend's town hall meetings, I really couldn't say that the president is doing much lobbying for something that is ostensibly a priority of his. I think he could be doing a lot more to debunk the obvious falsehoods that are circulating, but instead he abdicates debate on the issue and gets rid of the contentious portion.

    For example, consider the "death panels". Sarah Palin makes a characteristically vapid argument about death panels, the right predictably throws a hissy fit, and instead of fighting for something that even Newt Gingrich was in favor of, Obama rolls over and gets rid of that part of the legislation. Apparently, a similar thing happened over the weekend with the public option.

    Further, there has been a vocal contingent that wishes to at least debate the possibility of single-payer health care, which has been completely ignored by both Congress and the Administration. Everyone from Robert Reich to Ralph Nader (not to mention a large contingent of physicians) have been saying that's the way to go, yet there has been very little acknowledgement that this point of view exits. In fact, if you'll recall, Candidate Obama promised that the health care debate would be held in public, with all stakeholders having a seat at the table.

    "That's what I will do in bringing all parties together, not negotiating behind closed doors, but bringing all parties together, and broadcasting those negotiations on C-SPAN so that the American people can see what the choices are, because part of what we have to do is enlist the American people in this process," Obama said at a debate in Los Angeles on Jan. 31, 2008.

    The special interests and lobbyists, he said, "will resist anything that we try to do. … And the antidote to that is making sure that the American people understand what is at stake."

    Obviously, that's been abandoned, and I can't say that he's made a real effort to make "sure that the American people understand what is at stake."

    Therefore, it seems to me that there's quite a few problems with arguing that Obama's listening to the public, at least on this issue.

    To review then, we've got none of the promised transparency in the process, we've got no idea what the President actually is going to stand for on this issue, and the surviving changes that have been proposed for serious consideration apparently benefit <a href="http://www.alternet.org/healthwellness/141856/obama%27s_$80_billion_deal_with_pharma_is_a_very_bad_deal_for_us/&quot; rel="nofollow">Big Pharma and <a href="http://online.wsj.com/article/SB124891353497192109.html?mod=todays-us-page-one&quot; rel="nofollow">Big Insurance, at least as much as, or at the expense of the average American.

    • Erich Vieth says:

      BJ: I see the health care debate much the same way as you do. As I mentioned in a prior post, what has transpired sometimes even brings me to the point of despair. It seems as though Obama has given up the fight for the things he ostensibly believed in during during the campaign and he's now focused on expediency. He seems to want to pass some sort of bill that will have the title "Health Care Reform Act of 2009," even if it lacks major components of what Obama considered to be health care reform during the campaign.

      I find myself shaking my head when I see Obama failing to put up a any fight on single-payer or a strong public option. The American public is for these things. Doctors support single-payer. Public policy experts I respect (e.g., Marcia Angel) are for single-payer. Why is single-payer slipping down the drain? It could be front and center; when you're President, you can make it front and center simply by strongly taking that position.

      Why isn't Obama loudly advocating the precise kind of care to which everyone is entitled? Maybe we can't afford to give everyone heart or liver transplants, but isn't there a level of health care to which all citizens should be provided, regardless of income? Then we could allow individuals to supplement this basic level of coverage with their own private policies, if they so choose. Isn't THIS the proper way to compromise? Define a basic level of care to which every American is entitled and then push for it with all you've got?

      Actually, there are several ways to approach the problem, as set forth by Paul Krugman yesterday.

      Why can't Obama be clear as to what he demands as non-negotiable components in his vision of health care reform and then stick to his guns? I don't expect Obama to be a miracle worker, but I want him to stand up and advocate for what he believes. He's a lawyer, but its seeming more and more that he's the kind of lawyer that teaches in a law school classroom. I'd like him to stand up tall and push his points harder, like a courtroom advocate. Compromise is not a position in and of itself, but more and more it's seeming like it's Obama's endgame.

  7. Tony Coyle says:

    Mark & BJ:

    I have to both agree and disagree (I think).

    If this is a tactic, then I think it is excruciatingly wrong headed (but that's probably just the progressive, european socialist in me). I'd understand if this was the only iron in the fire…. but it's not, and it's too damned important to leave to the vagaries of congress, and it's too damned expensive to allow for any significant failure.

    If this is not a tactic, then I am reserving my right to be extremely dissapointed in a progressive candidate who has, in his presidential role, transformed into a corporate shill more conservative (small c) than progressive.

    I understand the need to make small steps. But his mandate was (relatively) huge. He had the mandate to drive change (with a big C).

    If heathcare reform fails, it will be the defining failure of Obama's presidency. I do not think he would, politically, survive failure of healthcare (on top of everything else). That would not, automatically, mean an opportunity for the Republicans – they are further in the mire than Obama is (or is likely to be). But it would sound a death-knell for his hopes for 2012.

  8. grumpypilgrim says:

    I'll echo Erich on this one. Obama has shown a distinct tendency to give up principle in order to get legislation passed, even if the legislation isn't what he campaigned on or, apparently, what he believes in. A good description comes from liberal talk show host Ed Schultz, who observes that Obama is acting like a senator, not like a president.

  9. BJ says:

    Erich, grumpypilgrim-

    I couldn't agree more. I'm all in favor of compromise in order to get some of what is needed. I just think that compromise does not entail one party giving up all of their priorities. It seems to me that he would have had a much stronger negotiating position if he had started with a well-articulated case for single-payer, and let the debate proceed from there.

  10. Niklaus Pfirsig says:

    The job of the president is to preside, not to dictate. The Bush administration failed to acknowledge the difference, but in a democracy, the power of the president lies not in proclamation of policy, but in choosing among the policies presented to him by the legislature.

    We are barely past eight years of an administration driven by an idea that any thing which benefits a select few is automatically good for the entire population, and that this select few knows what is best for the nation without knowing the needs of the nation.

    The Bush administration was guided by a father knows best mentality, applying persuasion when necessary, but often ignoring the letter and intent of the law whenever the law became an inconvenient obstacle to their agenda. They didn't evaporate when they lost the election. They are working really hard to make Obama fail, to discredit the democratic process and to promote a one party government.

    There are many questions I would like to have answered by the opponents of heath care reform, but they don't want to answer these questions.

    For example

    How many people would be willing to trade in a 10 to 20 percent payroll deduction for insurance in favor of 3 to 5 percent tax increase?

    or

    How many employers would be willing to trade the insurance premium they pay on their employees for a much smaller amount for the public option?

    And then there is the medical repricing issue. Under the current system, insurers negotiate with hospitals and clinics for lower payouts. This forces the cost of health care up, partly because the hospitals and clinics have to increase prices to cover facility costs. This has created a "Back door" subsidy for the insurance companies as the money eventually comes from government programs such as Medicaid.

    But what I would really like to see is an accounting, an audit if you will, of the insurance companies showing total premiums, total payouts and how much is going to offshore numbered accounts, or financing lavish lifestyles by denying benefits to sick people

  11. Erich Vieth says:

    Jon Stewart has advice for Obama:

    Stewart suggested that the health care debate is getting to the president and that he should learn from the Bush administration who got us into a war no one wanted by staying strictly on message.

    http://www.huffingtonpost.com/2009/08/18/jon-stew

  12. BJ says:

    Robert Reich (Secretary of Labor under Clinton and now a professor at UC Berkeley) spoke to exactly these issues today. Erich, it seems that he's echoing a lot of your points.

    The President's centeredness, calm, and dignity inspire trust but also suggest a certain lack of combativeness, a reluctance to express indignation, and an unwillingness to identify enemies — resulting in a tendency toward compromise even at the early stages of controversy.

    It's also because Obama hasn't yet taken full responsibility for detailed policies, such as the public option, or, on environmental legislation, whether cap-and-trade pollution permits should go to polluting industries free of charge. Keeping distance from the specifics has been a wise tactic — both Bill Clinton and Jimmy Carter got too far into specifics and paid a high price on health care when Congress wrested back ownership. And it helps Obama to separate his own approval ratings from public worries about legislation. But it has also made his policies more vulnerable to scare tactics and caused the Sallies in the Democratic base to worry about Obama's willingness to fight. Obama may be temperamentally incapable of being more combative and identifying enemies. But surely he can state less equivocally what he does and does not want — and, with regard to key matters such as the public option, what he'll sign and what he won't.

    The widening gap between admiration for Obama and cynicism about his policies also reinforces passivity in Obama's base, which makes it even harder to advance a specific agenda. His presidential campaign strengthened the nation's political grass roots and spawned hope for a new era of public engagement, but Obama's reluctance to fight for any specifics is causing the base to lose interest. Neither the Freds who trust him nor the Sallies who have become cynical are motivated to do much of anything.

    But their activism is crucial. If it comes to a choice between trust and cynicism, America will never achieve lasting change.

    Niklaus-

    You're right of course, that the president's job is not dictatorial (or at least, it shouldn't be). But you're not quite right when you say that "the power of the president lies not in proclamation of policy, but in choosing among the policies presented to him by the legislature." The real power of the presidency is in setting priorities and using the bully pulpit to argue for those priorities. It is precisely in this area that Obama has been lacking.

    As to the earnings of the big insurers, for the companies that are publicly traded it's fairly easy to see how profitable they have been. UnitedHealth Group, the umbrella corporation for the various subsidiaries reported after-tax net income last year of $2.977 billion dollars, on revenues of $81.186 billion dollars. That makes for a 3.67% net profit. Coventry Health Care, Inc., reported net income of $381.89 million dollars on revenue of $11.913 billion dollars which is a similar net percentage of 3.21%. Blue Cross is privately held, and therefore is not required to be as transparent with their numbers. To be sure, when we are talking about billions of dollars here, even a small percentage adds up to a massive pile of money.

    A couple of things to remember about these numbers:

    1- These are net profit numbers. It's after paying claims, handling all the administrative costs, paying for lobbyists, everything. The insurers could opt to do a number of things with that profit, including to distribute it to shareholders.

    2- A large portion of the funds of these insurers are intimately tied up with the fate of Wall Street. For example, UnitedHealth Group reported a loss from investing activities of $490 million for the six months ending 6/30/09. So they can afford to lose almost half a billion dollars here, and still show a massive profit.

  13. BJ says:

    Mark-

    It appears that Peggy Noonan with the Wall Street Journal saw the tactic in much the same terms as you did.

    Looking back, this must have been the White House health-care strategy: Health care as a subject is extraordinarily sticky, messy and confusing. It's inherently complicated, and it's personal. There are land mines all over the place. Don't make the mistake the Clintons made and create a plan that gets picked apart, shot down, and injures the standing of the president. Instead, push it off on Congress. Let them come up with a dozen plans. It will keep them busy. It will convince them yet again of their importance and autonomy. It will allow them to vent, and perhaps even exhaust, their animal spirits. Various items and elements within each bill will get picked off by the public. Fine, that's to be expected. The bills may in fact yield a target-rich environment. Fine again. Maybe health care's foes will get lost in the din and run out of ammo. Maybe they'll exhaust their animal spirits, too. Summer will pass, the fight confined to the public versus Congress. And at the end, in the fall, the beauty part: The president swoops in and saves the day, forcing together an ultimate and more moderate plan that doesn't contain the more controversial elements but does constitute a successful first step toward universal health care. That's not what happened. It all got hotter, quicker than the White House expected. The many plans of Congress congealed in the public mind into one plan, and the one plan became a poison pool. The president is now immersed in it.

Leave a Reply