Tuesday, July 21, 2009

"Health care is a losing issue for whichever party is in charge"

"Health care is a losing issue for whichever party is in charge"--those words were spoken to me by a shrewd and unsentimental former Member of Congress, still a close observer of the DC scene. His point was that the party in charge, the party that feels obligated to "do something" on health care, is likely to find itself on the wrong side of public opinion--the choices to be made are simply too unpopular. It doesn't have to be that way. We could be both healthier and richer, but it will take new thinking to get us out of this rut. In the meantime, that wise old legislator has it exactly right: Whoever wishes to "lead" on health care will have few followers.

One might think that after a while the parties would get smarter about strategy, but apparently not. Instead they simply repeat the same policy process, over and over, like the combatants in World War One, culminating in the British disaster at the Battle of the Somme in 1916, pictured above. Such unimaginative and maladaptive policy-battle plans don't work, of course, but they do seem satisfying nonetheless. Why? Because they meet the injunction of, "Don't just stand there--do something!" So when the whistle blows, it's once more over the top, boys. And if we are mowed down in No Man's Land? Well, at least we tried.

As John Maynard Keynes, who served in the British government during the bloody follies of the Great War, observed, for most people, most of the time, it's better to fail in a familiar way than it is to succeed in an unfamiliar way.

That's what is happening to the Democrats today. They are failing in a familiar way. Sample headline from The Washington Post: "GOP Focuses Effort to Kill Health Bills/ Republicans Seek to Link Issue With Obama's Handling of the Economy."

As Joe Biden says, Barack Obama has mishandled the economy, but even if the administration hadn't bailed out the wrong people, the Democrats would still be pushing health care plans that, for all their variety, are unpopular for two obvious reasons and one not-so-obvious reason. And what are those?

First, they will raise taxes on Americans who won't get better coverage.

Second, they will make health care worse for most Americans. As Newt Gingrich says, "There will be a bureaucrat between you and your doctor."

And third, more subtly--because you can't see an unseen, as Frederic Bastiat said way before Don Rumsfeld--every moment spent haggling over "access" and "equality" is a moment that could have been spent advancing Serious Medicine. That is, use Serious Medicine to make real deliverables for real people. That's a vote-getter.

What if the Democrats could say, "Vote for us and we'll cure Alzheimer's"? Would that be popular? Sure it would. Or, if not Alzheimer's pick another disease or illness and announce a plan to reach a cure, in the way that JFK said we would go to the moon in 1962, seven years before Apollo 11 touched down on Tranquility 1.

During the New Deal, Franklin Roosevelt chose not to push national health care, but starting in 1938, he did push The March of Dimes,to fight polio. That was popular to the point of being uncontroversial; it was simply a winner for FDR, because the tangible beats the intangible. Hey American people! Which should we focus on, advancing a policy abstraction, or helping crippled children?

What's needed, to tangibilize the intangible, to make medicine more helpful to folks, is the application of additional technology. (That's what the British did after the disaster of the Somme; after having failed more than enough--Herbert Asquith's government fell after the battle, and Asquith lost a son, too, in the fighting--prodded by Winston Churchill, got to thinking seriously about the tank as the solution to the stalemate of trench warfare. Which, indeed, it was.)

There's no technology, at least no medical technology, in what the Democrats are pushing--no blood, no guts, no life. So of course most people are detached and disaffected!

So Republicans are in pretty good shape, right? Well, yes, at least for now. Until they find themselves in the position of having to carry out their own version of "do something!" And while the GOP is at least 18 months away of being in charge of the Congress, and at least 36 months of being in charge of the White House, already, one can see distant early warnings of the trouble Republicans will have explaining their health care plan.

Speaking to the National Press Club in DC yesterday, Republican National Committee chairman Michael Steele was pounded in the press for not being able to answer a question about an "individual mandate" for health care. As he said, he is a politics guy, not a policy guy, but the truth is that the Republican Party as a whole could not answer that policy question--there is no GOP position. And maybe there shouldn't be.

But if so, don't expect the Republicans to do any better than the Democrats at putting forward on a health care plan a few years from now, when the GOP is back in power. Indeed, at the rate things are going, intellectually, the GOP has a political Somme of its own in the future.

In the meantime, Democrats, realizing that they are exposed and overextended, having outrun their supply line of support, are hoping that the Republicans will rush up to join them on the political equivalent of Gallipoli, to borrow another grim WW 1 analogy. Here's some more from that front page Post article cited above:

"Instead of doing nothing and using insurance industry talking points to defend the broken health-care system we currently have, Republicans should work with us or at least put forward some new ideas," said Doug Thornell, a spokesman for Rep. Chris Van Hollen (Md.), a Democratic leader in the House.

Sure. Of course. The Democrats had better hope that they can talk Republicans into joining them in the health care killzone. And if Dems can talk Republicans into joining them inside the Kesselschlacht, then Doug Thornell, for example, quoted above, will have earned a promotion.

But neither party, even if they work together in good bipartisan fashion, will get very far without new inputs that are qualitatively different, not just quantitatively greater. Whoever wants to break out of this policy stalemate will need the medical equivalent of the tank.

That is, the history-changing firepower of Serious Medicine.


  1. Sadly, what you have written is true. Here is my version of medical coverage of the uninsured that maybe both parties can agree on.
    When I run this past Doctors, they like it.
    Let the uninsured go to doctors/hospitals (Uninsured Names & Patient SS#s).
    Let the doctors/hospitals send (Uninsured Names & Patient SS#s) - these unpaid bills, to the IRS.
    Let the IRS give the doctors/hospitals, say, a 30% tax credit as payment in full for their services.
    Any excess tax credits can be used to buy medical/office/computer equipment or carried over to next year or sold to another medical provider.

    Non-Profits can do the same.

    IRS then CHECKs UNINSURED PATIENTs' 1099s & Tax Filings to assure they TRULY CAN'T AFFORD TO PAY FOR THEIR OWN MEDICAL INSURANCE. If they can, the IRS debits them.

    Government stays at arms length out of Health Care! The Uninsured are covered.

  2. I've seen things you people wouldn't believe. Billionaires getting genetic repair treatment off the shoulder of Orion. I watched millions o get free liver transplants with iPods in the dark near the Tannhauser gate.

    All these serious medicine moments will be lost in time, like tears in rain thanks to fear of change. Time to tear up my census form. . .