Tuesday, September 1, 2009

The Economics of Health Care: Bank Bailouts, Insurance Bailouts, and Health Care Reform

In an article written last night, Arianna Huffington made an interesting attempt to conflate the bank bailout with health care reform and advance the idea that President Obama's handling of the former has created opposition to the latter. I'm a fan of Arianna Huffington, and I enjoy her writing (when reads her facility with the English language in print one entirely forgets her 'deer in the headlight' traffic accident guest hosting the Rachel Maddow Show) very much. However, I am afraid that she is more comfortable criticizing than analyzing and more practiced in finding fault and making complaint than she is in serious political policy or theory. I tend to view her as an excellent political critic, but not always the best political analyst.

Here analysis in this piece strikes me as wanting. Her thesis is that President Obama's handling of the bank bailout is at least partly responsible for public opposition to health care reform. It is true that the bank bailout is deserving of criticism. Rather than bail-out small banks, the government bailed out the biggest banking concerns (in some cases mandating or bank-rolling mergers) and the result was that the banking cartel is smaller and more powerful than it was before the credit crunch. Ms. Huffington is correct to note this, but is not entirely correct to blame it on President Obama in its entirety. While many of the executions of policy went into action while he was President and he did argue for a bail out as a senator and presidential candidate (and thus is certainly not absolved entirely of responsibility for the bailout either), TARP was passed on President Bush's watch in response to the aggressive lobbying of President Bush's Secretary of the Treasury. TARP is a Bush administration bill and it can be argued that Senator Obama and other leading Democrats in both houses of Congress were responsible for inserting the few redeeming features the bill contains.

I should note, in the interest of full disclosure, that I am not philosophically or ideologically opposed to bank bailouts. Other socialists, such as Senator Bernie Sanders (I - Vermont), are. I have a very high regard for the senator and his knowledge and opinions, but I respectfully disagree with him on this issue. I am very much opposed to the ultimate form the bailout took, and to its effect of concentrating control of the financial market into an even smaller cartel of big banking concerns than had controlled it previously. I would have rather seen some of the worst offenders forcibly turned over to the control of their stockholders as credit unions, with the bank executives kicked to the curb, and then the bailout money given to the new credit unions (and to the remaining banks with significant strings attached.) Dwelling on my preferences overlong, however, is sort of useless. What is done is done.

I don't think any of this really has much to do with opposition to health care reform. Why not? Well, the very same people most opposed to the 'way President Obama handled the bank bailout' fall into two categories:

1.) Hardline paleoconservatives and libertarians who view any government intervention in economic and business matters as absolutely verboten.

2.) Equally hardline populists, New Dealers, radicals, and socialists (four widely disparate groups who do not always have anything else in common but a few basic areas of economic agreement) who view banks and corporations as 'the enemy' and thus believe government's job is to 'keep them in line' so they don't screw up rather than to bail them out when they do screw up.

The first category includes all the Republicans opposed to TARP when Bush was president (among others), and the latter category includes people like me as well as genuine lefty Democrats like Dennis Kucinich. However, regardless of whether these people fall into category 1 or 2, they will have ideological reactions to health care reform entirely unrelated to their opinions on the bank bailout. Indeed, their ideological reactions to health care reform are far too strong for the bailout to affect them either way.

The people in Category 1 (and some of the populists in Category 2) will be opposed to health care reform because it is health care reform. They will be against it on principle. There would be no way to make them support it, because they are opposed to the very idea on basic ideological principle. Blaming their reaction to health care reform on the bank bailout would be like blaming a hurricane on Microsoft. It's simply entirely ridiculous. Category 1 and those members of Category 2 who think like them on 'welfare' and 'entitlements' will simply always oppose health care reform. Period. They may say (as Roy Blount did) that they have no intention of offering any ideas at all, or the may say (as Judd Gregg and John McCain did) that they have an idea for 'reform' that merely makes the biggest problems with our current system worse. Either way, they will oppose real reform of the health care market designed to give access to health care to more Americans because doing so would raise their taxes. As it will.

The people in Category 2 (save some of the populists mentioned previously) are going to be four-square in favor of health care reform for the exact same reasons they are pissed off about the bank bailout. They are pissed off about the health insurance industry, as they have every reason and right to be. They want to see meaningful health care reform pass, and they want to see it pass fast. Some of them have wanted health care reform since the 1930s, some since the 1960s, and some since the 1970s or 1990s... but they have all wanted meaningful health care reform to pass for at least 15 years. They aren't going to oppose health care reform now because of the bank bailout.

Indeed, the people involved in the health care debate who may have been most influenced by the bank bailout are Democrats in both houses of Congress. While there is no discussion of direct handouts of easy cash to the health care industry yet, certain aspects of both HR 3200 and the bill the Senate Finance Committee is currently mangling (most notably the individual mandate that those not otherwise covered purchase private insurance) have the tone of an insurance industry bailout.

It is this fact, combined with poor media parsing of presidential comments on the subject, that have contributed to the large degree of ambivalence toward health care reform among the general population that widely favored it before the debate began and the increasing hostility toward the particular ideas being advanced by those most strongly supportive of reform in principle. The addition of virulently divisive Republican propaganda does not help, but I believe the majority of the individuals cooling on health care are doing so less because of Republican propaganda (which is primarily believed by those receptive to it, which is to say those opposed to health care reform) than because of the haphazard and mismanaged way in which Democrats are handling the reform ball and the media coverage of same. To be fair, however, the media also deserves a great deal of criticism for the manner in which they are handling the current Republican propaganda barrage. Can you imagine how history would have gone if the media had covered Republican opposition to Medicare in the same kind of irresponsibly serious manner in which they are handling the Republican claims about the extremely moderate bills Democrats are tossing around now? Not to refute such lies whenever mentioning them is to give those lies credence in order to maintain an appearance of neutrality in politics. That is an egregious violation of journalistic ethics.

'Opposition' to health care as it stands now is currently lumped into three groups:

A.) Those members of Category 1 in our previous breakdown, plus some populists with similar views on 'entitlements', who are ideologically opposed to serious health care reform. Period.

B.) The members of Category 2 in our previous breakdown who are having difficulty accepting the reform ideas on the table as 'serious', question the White House commitment to serious reform, or both.

C.) Those people who (because of the ineffective salesmanship of liberal Democrats, the ridiculous shilly-shallying of moderate Democrats, the propaganda of Republican opponents of reform, and the incompetent coverage of the debate by the mainstrea media) do not have a genuine grasp of the issue. Some of these people are truly 'opposed' to health care reform because of misconceptions they have drawn from the smoke and mirrors surrounding the debate. Most, however, have gone from strongly supporting health care to being deeply ambivalent about health care because not enough of a concerted effort has been made by anyone (either the reformers or the media) to educate them about the factual details therein. A few others have misconception of the entire issue for a variety of reasons.

Group A and Group C include some people who likely cannot be won over at all. This is most all of Group A, though there are some populists who could possibly be won over with a strong and honest indictment of the health insurance industry. Most of Group C should be amenable to direct, honest, forceful, passionate arguments on behalf of health care reform by advocates who believe strongly in it. The exceptions are fools with such a desperate miscomprehension of our health care system that they believe making insurance companies pay for doctors educating Americans to eat bran flakes will lower health care costs so much that insurance premiums will fall and universal coverage will just happen. Even they, however, might be reached if someone could actually educate them on the realities of our health care system.

Group B might be harder to win over with the bills currently on the table, but a strong commitment to meaningful reform and a serious ear turned to their concerns... and a little bit of input into the legislative process for them would not hurt... and I believe the White House would see a lot of positive response. The biggest complaint from the single payer and national health service advocates on the left is not that they are not getting their way, but they have been left out of the equation entirely and their views unsolicited. Even if Congress ultimately decides upon an individual mandate, the single-payer and nation health service advocates have a great deal of valuable input about the economic facts of health care which need to be considered in serious reform proposals. The right dismisses proven economic practice in favor of economic theory that is best described as a religious cult and the center is dangerously close to wading into that same water on the issue of health care. The real economics on this issue are on the left and the real economics are necessary to the debate even if the solutions of the left are not adopted at this point in time.

Of course, the same sincere expression of serious commitment that could close the sale with Group B would also succeed in educating many in Group C. The putative excuse for excluding Group B, winning over at least some part of Group A, is useless. To win this fight, all the advocates of serious health reform must be brought on board and then they should work together to inform the uninformed and educate the uneducated. Most people who don't know what's going on or what it is all about want to know. Badly. Their lack of knowledge is the reason for their ambivalence.


Unknown said...

I follow your discussion but I think that you left out or didn't address the people who oppose health care reform because they choose to ignore the facts. These are the people who after being presented with factual information, turn right around and demand to know why the elderly are going to be forced to choose death under helath care reform. Last evening at a town hall meeting in my hometown,Raleigh,the capital city of North Carolina, after a clear and detailed presentation of all the elements of health care reform that have been continually misrepresented to the public, a woman asked, "How are we as taxpayers going to pay for free health care for everyone?" She recieved some applause for this question. The panel once again explained that there was no proposal for universal free health care. Her response was, "But why should I pay for health care for illegal aliens?" Either she truly has a brain the size of a pea or she is choosing to willfully believe lies and damned lies about health care reform.

I don't find her to be alone in this. Much of the anti-health care reform movement is characterized by accusations that it will provide free health care to the those deemed undeserving--the poor, illegal aliens, and those on public assistance. Classism is the accelerant poured onto the fires of racism. I don't know that there are any arguments that can reach such people.

The Eclectic Geek said...

People such as this fall into the category (at least in my opinion) of people who are simply against the idea of health care reform, period. They believe the propaganda because they want to believe the propaganda and disbelieve the truth because they don't want to believe it. They may claim otherwise, but most of them are active opponents of health care for the selfish, ideological reasons as most of the others I described.

These are the people that the White House wants to win over for 'bi-partisan' reform who will just never agree to be one over because they don't want reform.