I’ve been meaning to write this post for a number of days and either haven’t gotten around to it (like a lot of my posts lately -new houses simultaneous with new babies are not conducive to blogging, people) or otherwise just haven’t done it. Not that I haven’t tried or made a few false starts, but, like a lot of my posts, the idea for this post has bounced around in my head for a while and it’s just needed a catalyst to get going.

My catalyst here is the first 30 seconds of this vide0, where a woman waving an Obama “Stand Together for America” sign shouts out against all of the “selfish people” she apparently sees as being in between her and some free chemotherapy, or something. That video is the catalyst, because, to some degree, it ties together the different pieces of this post idea.

Now, a catalyst is not the same thing as inspiration, and the inspiration for this post started with a couple of similar, but slightly different posts I’ve seen on Facebook lately. I’ll keep the names anonymous, because this post isn’t about the people themselves, it’s just about the statements they’ve made.

Here is the first one (made while posting a link to a “the only way to fix healthcare is to turn it into the DMV and anyone who disagrees is doing so only for craven political reasons” op-ed in the Dallas Morning News):

It seems all I ever hear is ‘what’s in it for me?’ This disturbs me tremendously.

And here are the comments:

John M. Greene: Disturbs you how? That the author wants “free” healthcare or that other people disagree on its necessity?

July 23 at 10:30am

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ORIGINAL POSTER: I agree with the author, God-forbid any of us have to pay for something for the greater good, just because it might affect THEM in a negative way.

July 23 at 10:36am

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John M. Greene: Ahhh… I agree with you – people should be more charitable and take better care of the less fortunate among us. No argument here.

July 23 at 10:48am

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COMMENTER #2: I don’t know…most people are pretty darn charitable and just don’t bother talking about it in public.

July 23 at 4:06pm

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ORIGINAL POSTER (clearly exasperated): I’m not talking about charity, I’m talking about taxes, and their benefit to society at large.

July 23 at 4:14pm

Because taxes are for the greater common good and people who are opposed to taxes are selfish and just don’t want to help people. Got it.

Let’s try this from a different direction. Here is the other Facebook post, this one being a friend of a friend responding a question about her health. I didn’t respond to this, because I don’t know this person and, I dunno, it would have been rude to pick a fight on someone else’s wall:

I am tired of hearing all of these people in opposition to meaningful healthcare reform. I am also tired of paying almost $800 a month for barebones coverage when there are so many other things that I could be spending my money on, especially when the people who are opposed are people who could easily afford to have their taxes raised to help other people. We elected Barack Obama last November and need not be afraid of real hope and change in this country. This topic is just too important for us not to fix things.

So, I’ll ask again, just who is being selfish? Is it not selfish to covet someone else’s wealth – and endorse the government taking it and giving it to you – because you don’t want to spend your own money? Just whose responsibility is your own health? And if we have a duty to one another to take care of one another (and I think we do), then let’s do that, but let’s do it ourselves and literally take care of each other. It’s not compassionate to just sit back and endorse the government emptying your neighbor’s wallet because you think it’s horrible that prescriptions cost too much money and you really need a vacation. The government is not omnipotent, nor is it our proxy or are elections an excuse to pass the buck.

Look, it’s been few weeks since I made a meaningful blog post, but back in July I was writing almost every day about the healthcare reform topic and here we are 6 weeks later and nothing has changed. A vast majority of people in this county have insurance and are satisfied with it and only a very small percentage of those who don’t have it truly can’t afford it or be insured. And the thing is, we already have programs in place to help those people.

But- but- but- what about people with preexisting conditions? What about people who lose their jobs? What about the children?

Well, some of those problems could be fixed through some sort of policy change (especially the ludicrous employer-endorsed part), but generally, the answer to that one is to take care of yourself beforehand and don’t sit back and wait until there is a problem to complain that there is a problem. We’re not quite to the point yet where people are routinely denied coverage on congenital factors (yet), so all preexisting conditions were at one point new. Do you know what happens when someone has insurance and a new condition pops up? It gets fixed.

What’s so unreasonable about making existing insurance plans easier to obtain, harder to lose, and more responsive to people’s needs, and what part of any of that requires letting the federal government be in charge?

Similarly, you want to have kids? How about waiting until you can actually afford to have one and take care of him or her, including making sure that you can afford to pay to visit the doctor?

It’s not that hard, nor is it particularly selfish to point that out.

I don’t normally do this, but it’s crying out for a least a little attention. Hendrik Hertzberg, come on down!

This is about as loony and pretentious and detached from reality that “respectable” liberal journalism can get.

Our hero opens with an Oscar Wilde quote, so as to prove his New Yorker bona fides, because everyone knows just how witty – and just, so refreshingly unoppressed amidst all that Victorian angst – he was. I’m going to skip it, because this article isn’t about Oscar Wilde, although I’ll grant that The Importance of being Ernest is one hell of a funny play.

But I digress.

Oscar Wilde was obviously fond of Lady Bracknell—he gave her some of his best lines. But his affectionate satire had a serious point: like many in the class for which she was a stand-in, the haughty dowager saw little difference between subversive radicalism and ameliorative reform. Observers of the current brawl over health care will have noticed that some leaders of today’s Republican Party labor under a similar confusion. But a certain resonance between “social legislation,” on the one hand, and all sorts of figurative outrage and explosions, on the other, is metaphorically apt—particularly in Washington.

Wow. Don’t bother slowing down and waiting for the rest of us.

Since I’m obviously not as enlightened or clearsighted as Mr. Hertzberg, I’ve got to think this one through. So give me a second to think.

Hmm, 16% of the GDP of the United States being assimilated by the federal government is “ameliorative reform” and legislative opposition – nay, leglistative appeals not to shove a bill through congress in less than a month – is akin to one-liners from a caricatured upper class meddling dowager aunt character in an Oscar Wilde play.

I must have missed this exchange on C-Span the other day:

Democrats: “We going to lower healthcare costs with trillions of dollars in deficit spending and a brand new government bureacracy that controls citizens from cradle to grave!”

Republicans: “…. a handbag?!?!?!”

Rick Hertzberg: “bwahahahaha! You crazy GOP nuts!”

So if any of this stuff individually – stuff like real time government access to your bank account, mandatory end-of-life counseling for elderly patients, and wage controls for doctors, among other things – isn’t “subversive radicalism” on its own, I’m still missing the connection how all of it combined is still just “ameliroative reform” and (justified) vehement opposition is akin to getting the vapors. Really.

Turn it around: In Mr. Hertzberg’s world, just what would be subversive radicalism if it’s not this? Making Daffy Duck the Bird Flu Czar? It doesn’t have to be absurd to be extraordinarily dangerous or disruptive.

Let’s move on.

In other free countries, legislation, social and otherwise, gets made in a fairly straightforward manner. There is an election, in which the voters, having paid attention to the issues for six weeks or so, choose a government. The governing party or coalition then enacts its program, and the voters get a chance to render a verdict on it the next time they go to the polls. Through one or another variation of this process, the people of every other wealthy democracy on earth have obtained for themselves some form of guaranteed health insurance or universal health care.

Well sure they have, just like they’ve voted themselves all kinds of welfare goodies at the expense of lower quality care, reduced personal freedom, ossified business environments,  a capable and functioning defense sector (instead they outsource their problems to the United States), and a “normal” unemployment rate that’s equal to the levels that are making most Americans (somewhat unreasonably) feel like kindred spirits with Tom Joad.

But they don’t have to pay to go to the doctor!

The way we do it is, shall we say, more exciting. For us, an election is only the opening broadside in a series of protracted political battles of heavy artillery and hand-to-hand fighting. A President may fancy that he has a mandate (and, morally, he may well have one), but the two separately elected, differently constituted, independent legislatures whose acquiescence he needs are under no compulsion to agree. Within those legislatures, a system of overlapping committees dominated by powerful chairmen creates a plethora of veto points where well-organized special interests can smother or distort a bill meant to benefit a large but amorphous public. In the smaller of the two legislatures—which is even more heavily weighted toward conservative rural interests than is the larger one, and where one member may represent as little as one-seventieth as many people as the member in the next seat—an arcane and patently unconstitutional rule, the filibuster, allows a minority of members to block almost any action. The process that results is less like the Roman Senate than like the Roman Games: a sanguinary legislative Colosseum where at any moment some two-bit emperor is apt to signal the thumbs-down.

And then sometimes you wish someone had paid attention in 8th grade civics instead of dreaming of journalism school. Our system works this way because it’s by design. Government at the federal level in the United States isn’t supposed to be involved in the day to day pieces of our lives, health care included. The individual states are. And accordingly, whenever the federal government gets away from the big common issues that all the states have in common and can’t do for themselves – military, taxation, foreign relations – the system is supposed to break down and not be smooth. And it’s worked out pretty well, I think.

If you want someone else to pay for you to go to the doctor, then go prevail on your state govenment  in Albany (or Trenton or Hartford or wherever you live, Mr Hetzberg) to put a plan in place for you. You’ll find those governments a lot more accessible and smoothly run, which is the way our system is supposed to work.

This also touches on something that really bothers me occasionally – the tendency of many people to to find fault with American and its institutions while ignoring that those very same institutions enabled our country to grow in just 200 years from a collection of small towns hugging the coastline of an empty wilderness into the richest and most powerful country in the world? Why, our country is just so great and can afford to do so much! Hell, let’s just break it and be more like Europe!

These perverse (if time-honored) institutional arrangements (and the above accounting only scratches the surface of their perversity) are the principal cause of America’s sad health-care exceptionalism. Americans, polling shows, have long been as receptive as Europeans to the principle of universal health care.

Sure they are, and I’m receptive to the principal of universal plasma televisions. It’s called wanting something for nothing. There’s nothing “exceptional” about that, except the time-honored liberal trope that America can also be “exceptional” in a bad way, too! Clever!

Six times since 1948, we have elected Presidents committed, at least on paper, to that principle. There have been gains, small (under Clinton, the State Children’s Health Insurance Program, or SCHIP) and not so small (under Johnson, Medicare, for the aged, and Medicaid, for the very poor).

You’ve answered your own question. In a sense, we already have universal health care. Services and insurance are already available to anyone with the money to pay for it and, as you’ve pointed out, we’ve got plenty of programs in place to help the people who can’t pay. So now I’m confused.

Yet forty-six million of us—a number roughly equal to the population of half the states of the Union—have no health insurance at all, and, as President Obama noted during his prime-time press conference last week, fourteen thousand more are losing theirs every day.

Where to begin?

That the 46 million number is contrived in an number of different ways?

That this sentence steals the proverbial base by conflating insurance with access to care?

That while on average 14,000 Americans do lose their insurance coverage every day as a result of layoffs, it only stands to reason that you would expect a statistic like that during a recession and they’ll get it back when they start a new job? Are people “gaining coverage” ever going to be used as a political talking point in a speech someday when the business cycle is back at the top? Why not just fix that problem directly by subsidizing COBRA payments and then making it easier and more tax advantaged for people to provide for their own insurance that isn’t tied to their employer?

I guess because this article isn’t really about “ameliorative reform”? It’s about… oh, I’m not sure yet.

Many millions of us have coverage that is inadequate, and almost all of us live with the well-founded fear that unemployment, a change of job, or striking out on one’s own to freelance or start a business couldcost us our coverage and leave us open to medical and financial catastrophe.

Again, the easiest way to fix this is to make it easier for people to pay for their own insurance, but even though there’s not a tax break for it now and the hoops are significant, private health insurance is still available and that doesn’t mean people aren’t able it buy it. It just means that they’ve decided to bear a certain amount of that risk of “financial catastrophe” as is their right (and opportunity) to do. But just because someone decides he’d rather pay for HBO and Showtime than for insurance against “financial catastophe,” that’s not an argument for government assimilation of the entire health care sector. It’s an argument for encouraging people to make better decisions and take care of themselves. (Heartless, I know)

Pretty much everybody who believes that health care should be a human right, not a commercial commodity, and who makes a serious study of the abstract substance of the matter, concludes that the best solution would be (to borrow Obama’s words at the press conference) “what’s called a single-payer system, in which everybody is automatically covered.”

Right. And pretty much anyone who thinks it’s a human right to eat strawberry jam for breakfast also comes out in favor of someone else paying for the jam, too. Now we’re talking on whole idea of “negative liberties” (as Obama likes to say) – they already belong to you and don’t require someone else to pay for them, so they can’t be taken away.

But, by the same token, pretty much everybody who believes the same thing, and who makes a serious study of the concrete politics of the matter, concludes that a change so sudden and so wrenching—and so threatening to so many powerful interests—is beyond the capacities of our ramshackle political mechanisms.

If only we didn’t have this archaic representative government structure getting in our way, we could just tear it down and start all over! Let’s get healthcare done so that we can start arguing over who, exactly, gets the 10th month renamed in their honor, the president or the talk show host? Compromise: Obama gets 32 days in either July or August, his choice.

The American health-care system is bloated, wasteful, and cruel.

I’ll agree on the first two, because that’s because government policy has encouraged the system we’ve got to become that way, but until a nurse makes me sing for my morphine, I’m not buying the cruel part. If you’re saying it’s cruel because people have to actually pay for services, then Best Buy is equally cruel for not handing out laptops for free.

Under the health-insurance-reform package now being bludgeoned into misshapen shape on Capitol Hill, it will still be bloated, wasteful, and cruel—but markedly less so.

Because nothing will get us out of the government-created hole except for more government digging. Duly noted. And snickered at.

The House bill, for example, would make basic coverage available to tens of millions who now have none.

I’m not going to repeat myself. Just go about 6-7 paragraphs up and reread the one that starts with, “You’ve already answered your question…”

It would curb the practice of denying insurance to persons with “preëxisting conditions.” (We’re all born with a preëxisting condition: mortality.)

Because no one should have to pay for insurance unless they’re already sick. Got it.

It would make insurance coverage portable, which would be a boon for both individual careers and the wider economy.

In the sense that the government is ominpresent in both individual careers and the wider economy, then I guess that’s one way of doing it, but I’d rather find my own way and let the government worry about other things besides my health.

Even one of these things would be a colossal improvement on the status quo.

It would be a colossal something on the status quo, but “improvement” isn’t what I was thinking of. Kind of rhymes with the second syllable, though.

The most consequential opposition to the reforms now under consideration is coming from a small group of Blue Dog Democrats, who protest that the plan does too little to control costs.

Why the hell are these guys worried about reelection? It’s just a ramshackle government structure anyway! Why do you even want to come back? Just do your job already and go home to Hicktown! Obama’s legacy is resting on your shoulders, Gomer and you’re ruining it.

To the extent that their concern is genuine, and not just a reflexive deference to wealth (they vociferously oppose a modest surtax on the top one per cent, whose effective tax rates have dropped by fifteen per cent since 1979, while their after-tax incomes have more than tripled), they have a point. But it’s a minor point.

Oy. My head hurts, because all fiscally conservative democrats care about is kissing up to rich people and being Republicans someday. I really am speechless at that line. Not to mention that trillion of dollars of additional government spending was brushed aside as a minor point. I might not make it to the end if this keeps up.

The prospective reform has more cost-containment provisions than past attempts, and, thanks in part to those same Blue Dogs, it is acquiring more such elements by the day—for example, the proposal for an independent commission able to set Medicare payment rates, which Obama has also embraced.

My bad. I forgot that Obama has embraced other things, too, like transparency, and it’s been a hallmark of his administration. I mean, we’re going to have an independent commission that Obama is  embracing. Why wouldn’t we expect costs to be low?

But the Blue Dogs are playing a dangerous game of chicken. Even if they’re right that reform would do too little about costs, the alternative—which, as the President has repeatedly pointed out, is the status quo—would do nothing.

Hey! That’s Obama’s game too! Say that the alternative is to do nothing and then refuse to look at the real alternatives. Well played, Rick m’boy!

Ultimately, real cost control will require a strong push away from fee-for-service medicine.

Oh boy. Talk  about “flattening the cost curve.” Now we’re back to economic ignorance again, and I just don’t have time to start lecturing about prices and value.

And besides… that push would be towards…what exactly? Slave doctors? Barter? Self medicine? Where are we going to get the doctors in that case?

In Massachusetts, which three years ago enacted its own version of near-universal health insurance, the cost of expanded coverage has created pressure for just such a push. That state’s experience suggests that the cost problem, too, will be easier to solve under a reformed system, with all its other benefits, than under the one we have now.

And yet. And yet. We don’t even get to talk about the real lesson learned in Massachusetts, that insurance really isn’t the problem. How in the hell can anyone in his right mind look at Massachusetts and say that it’s not really a fault of the Massachusetts system,  it’s the fault of the rest of us  not being in similar programs. Good Lord.

As for the Republican opposition to reform, most of it has been, in a word, nihilistic.

OK, I’ll say it again. Good Lord.

Nihilistic… how? That Republicans just don’t care about poor people and are interested in other goals instead?

Well, yeah:

William Kristol, the editor of the Weekly Standard, last week offered the same advice he did sixteen years ago, when he masterminded the death of the Clinton reform effort: “Go for the kill.” Senator Jim DeMint, of South Carolina, elaborated on the theme. “If we’re able to stop Obama on this, it will be his Waterloo,” DeMint said. “It will break him.”

Because Democrats and the liberal press, NEVER say things in bad faith just to play politics. Never. Especially the press.

Obama’s Presidency would survive the murder of health-care reform. But he would be greatly weakened, with dire consequences for his ability to meet many other urgent challenges.

Murder? That’s an interesting choice of words.

As for consequences being dire, they’re only dire if you agree that the challenges are urgent. Many people don’t. In fact, Obama already had his chance at the one current issue that people do agree is urgent, and he whiffed.

Whoever needs to be punished for morbidity, it’s not him.

Oh no. He’s just a servant trying to do the right thing.

And not the rest of us, either.

I guess that just depends on how you define punishment, huh?

You know, I’ve always wondered – and still wonder – how in the world John Lindh wasn’t court martialed (or militarily tried or whatever the proper term would be)  and summarily executed. Because if what he did wasn’t treason, what is?

Interesting comparison made in the first link, too, about the various media biases floating around relative to taking up arms against U.S. soliders and expressing a sincere religious belief in today’s popular culture. Excellent point.