Thursday, November 12, 2009

Irrationality and health care reform

It is probably no secret to the very small number of people who read my blog that I support the Democratic health care reforms being bandied about. Yet I sometimes fear my desire to see the reform approved clouds me from some serious objections to the plan.

I realize that the major criticisms of the plan I'm aware of--1) a mandate is somewhat problematic and 2) the plan would not really address costs--have some validity. At the same time, I refuse to listen to these criticisms, or I brush them aside in my enthusiasm to see something done that would result in most people getting insurance.

One might not know it from the quality of my writings, but I am, I believe, a very rational, systematic thinker. Yet on this issue I have a hard time being rational.



Laura(southernxyl) said...

I think the ticket is to ask ourselves:

1 - Exactly what is it that we want? For instance, say that we want everyone to have insurance; well, why? Is that really it, or is it that we want people to go to the doctor when they're sick? These are not the same thing. Is it that we want no one to go without basic medical care? - in which case we have to define what "basic" medical care is. Do we want people not to have to pay anything out of pocket, or should there be a sliding scale? What should people expect to have to pay? Remembering that ultimately we'll pay one way or another. Can we tolerate a two- or more- tier system? Which leads to a discussion of the philosophy here - is it to see that the poor get medical care, or that nobody gets anything that everybody else can't have? And so forth.

2 - Exactly how should we go about the task of getting there?

2a - What assumptions are we making about what will work, and how can we test them?

2b - What are the pitfalls that we should avoid?

3 - How can we communicate with total transparency what we are trying to do, how we'll do it, the advantages and tradeoffs?

I don't think the nation has a consensus on the first point, and I don't see us progressing beyond it until we do. Especially I see a lot of resistance from people who've seen the efforts of individual states to provide more and more care, end up with wasteful bureaucratic nightmares and people still suffering.

theolderepublicke said...


Thanks for the thoughtful comment on my blog.

I agree that much of the problem is the difficulty in forming a consensus on #1 of what you wrote. (I have my own views on what I'd like to see, but the problem is, as you say, forming the consensus (or to put it as Plato might, "recollecting" the consensus that already exists).)

I suppose my post, in some respects was about #2 and my inability (or refusal) to consider the very real questions that are involved in getting whatever plan I'd like to see enacted. I'll admit that the one example I know anything about (because I've seen a couple of new reports) is Massachusetts, which certainly isn't encouraging for people like me.

#3 is a big issue, too. I do get the sense that the promoters of the Democratic plan(s) are not being honest, especially when they claim repeatedly that we have only things to gain and nothing to lose. As a tactical matter, I think it's sometimes necessary to lie and equivocate in order to get thins passed, but I still don't like it, and I believe it insults everyone's intelligence.

And in my view, the non-transparency of the Democrats feeds what I do believe are the disingenuous arguments of the opponents of the Democratic plan(s). I'm not saying all (or even most of) the objections are disingenuous, but in debates on legislative programs like this, I fear there is always going to be a race to sloganeering on both sides, and we have to hear about the specter of "death panels" from Republicans and the claim that "Republicans want people to die" from the Democrats.

Again, thanks for your thoughtful comments.