What Ever To Do About Health Care?

Robert Pear reflects on the SCHIP standoff and, perhaps inadvertently, peers into the soul of why we will never, ever reform the health care system unless strategies change.

The debate now raging here over the children’s health insurance program offers a cautionary lesson to Democrats running for president. It shows how hard it will be to persuade many Republicans to sign on to their vision of universal coverage.

If Democrats and Republicans had so much difficulty agreeing on a plan to cover 10 million children, most of them from low-income families, how can they ever agree on legislation to guarantee insurance for 250 million or 300 million people?

The biggest strategic error in the 1994 health care debacle, in my opinion, was trying to get the other side to agree. President Clinton had majorities in both houses of Congress, and had to be smart enough to realize that Democrats’ keeping their majority required not flubbing around. But they didn’t keep their majority because they did flub around. You may recall that one Sen. Dole (R-KS) was in control of the health care inaction in the Senate. Bob Dole!

When it’s the biggest domestic policy initiative since the Great Society, it’s time to demand loyalty from your side, and remember what LBJ said about Macy’s window. Pear continues,

Many of the questions that provoked fierce argument in the battle over the child health bill would be even more divisive in a debate over universal coverage: Should the government subsidize insurance for middle-income people? How much government involvement is too much? How much should the government spend, and who should foot the bill?

When the next President takes office in 2009, there must be only one side to the issue. The winning side. I know, this is the Bush Doctrine in a nutshell, but it also is the LBJ Doctrine. The difference between W and LBJ is whom they served in office for. 

Now what LBJ did was get things done. Many of us more enlightened beings are prone to prefer dialogue to confrontation, win-win solutions to zero sum games. But if anything over the past six and a half years has taught us anything, it is this: a critical mass of people with a critical mass of resources spit on your silly dialogue.

Yet a critical mass of Democrats seem not to have learned.

Democrats…  see a consensus forming around the goal of universal coverage, meaning access to health insurance for all, with payment coming from public and private sources. Given presidential leadership, they said, the goal can be achieved.

Consensus is swell. There is one minor problem.  Consensus never happens until after the system changes!

For crying out loud, if we waited to build a consensus to recognize the civil rights of African Americans, city buses in the South today would need, as Dick Gregory cracked forty-five years ago, twenty-foot steering wheel columns for African American bus drivers. Consensus with whom? This guy?

Representative Jeb Hensarling, Republican of Texas, said the debate over coverage of children was “a proxy fight” between advocates for two competing visions.

“This is only the first battle in this Congress over who will control health care in America,” Mr. Hensarling said. “Will it be parents, families and doctors? Or will it be Washington bureaucrats? That’s what this debate is all about.”

This is such patent garbage that Mr. Hensarling should not be quoted as a serious spokesperson in America’s newspaper of record.

And those of us who want a just health care system want a just system, not a debate. We expect the people we elect to be advocates for a just system.  So are there any true advocates rising on the presidential horizon? Time will tell, because campaigns are one thing and governing is another. If W had even vaguely resembled his 2000 rap, we’d be living in an entirely different country now. However, so far, I’m not thrilled.

While the Democratic candidates for president deny wanting a single-payer system, they do say the government should play a larger role. Defining that role is perhaps the biggest domestic policy challenge facing the next president.

Please, do not defend health care reform by making a point of telling everyone how much your proposal is not a government run system because that is accepting the other side’s stupid framing and then you are wimping out big time!

And as to “defining government’s role?” Government’s role in a democracy is, for starters, to stop placating greed, and second, to restore fairness and sanity. Ask Franklin Roosevelt. Ask Teddy Roosevelt! Please ask soon.

Amid the partisan uproar, some lawmakers see the nucleus of a possible bipartisan coalition.

Senator Ron Wyden, an Oregon Democrat who has worked on health care for three decades, said: “What’s emerging is a sense, in both parties, that each side has been right on a key point. Democrats have been right about coverage; if you don’t cover everybody, the cost of caring for the uninsured is shifted to people with insurance. Republicans are right about the need for choices and private alternatives.”

This reminds me of the Martin Scorcese classic Goodfellas, in particular the subplot in which the embattled restaurant owner goes into partnership with Paul Cicero (Paul Sorvino), who proceeds to sell of the inventory out the back door and bankrupt the place.