Monday, September 14, 2009

Samuelson's False "Balance"

Although supposedly addressing a lack of candor in the healthcare debate, Robert Samuelson's latest is itself less than honest. The NonSequitur takes Samuelson to task for personifiying (what I would describe as) the Bush-era Republican brand of "conservatism" - if the program they support will run the deficit through the roof, "that budget consequences should occupy a minor spot in our debates"; otherwise they're whine, cry, rend their clothes and wring their hands, deploring that with even a dime of new spending we're destined to go bankrupt.

Samuelson argues that President Obama's not being sufficiently candid because he's arguing that we can have expanded health coverage, generally maintain the current system, and also reduce costs. The NonSequitur kicks that argument out from under him:
Baring the fictional–yes fictional–scenario where you get to chose your own doctor and your own care (your insurance company does so long as you "qualify," which means so long as you don't get sick), every other industrialized democracy in the world has solved this problem. They get more than we do for half of the cost. That's just true folks. As Obama has argued over and over, one problem we suffer from here in our capitalist paradise is a lack of competition in health insurance. There is simply no incentive to deliver it cheaper. So you can have all three indeed. We should have all three. If we can't get all three, we will suck.
Okay, it's more than half the cost, but certainly every other nation in the industrialized world had established that you can have universal or near-universal coverage, a system where people can choose their own healthcare provider and get the care they need, and where the cost per capita is substantially less than in the U.S. - all while achieving, on the whole, better outcomes. If the Republicans and Blue Dogs in Congress prevent that from happening here, that's their fault, not Obama's. After all, when Samuelson says,
Americans generally want three things from their health-care system. First, they think that everyone has a moral right to needed care; that suggests universal insurance. Second, they want choice; they want to select their doctors -- and want doctors to determine treatment. Finally, people want costs controlled; health care shouldn't consume all private compensation or taxes.
he's effectively conceding that in an honest debate Americans would prefer the Canadian system to our own.

But there's more to Samuelson's editorial that should be addressed. The first is the false equivalence between what he describes as "frighten[ing] Americans into believing that it will harm them in ways that it won't" - that is to say, engaging in fear tactics and lying about reforms - with not showing proper candor by accepting Samuelson's pessimistic opinion over what has been proved to work in every other industrialized nation. Perhaps Samuelson should be showing some candor, as it's the healthcare industry and political right who are intent on frustrating the most cost-limiting reforms. I doubt that Samuelson is truly confused as to why Obama gave an aspirational speech, rather than a pessimistic drone about political realities dictated by insurance companies, pharmaceutical companies and health insurance companies, and the Members of Congress they own.

Another aspect to Samuelson's artifice about the three things we "want" is that he's truly concerned that "we can have any two, but not all three." He lacks the candor to admit that the three things we want (universality, choice, and cost control) can be addressed independently of another, and lacks the honesty to directly admit that the only factor he cares about (this time around) is cost. When Samuelson says "We refuse to face unavoidable - and unpleasant - choices", after all, he's already conceded that the only choice we actually have to make is whether or not healthcare reform justifies increasing the deficit.

It's due in no small part to opinion leaders like Samuelson that it's necessary to try to address all of those concerns in a single package, rather than taking a good look at each on its own, evaluating the costs and public policy aspects independently. It would be better, and would likely lead to better policy, if the various concerns about the healthcare system could be addressed independently - for example, looking at the true cost of implementing universal insurance coverage and evaluating whether or not it's worth the investment - rather than forcing everything to be wrapped into an oversized, arguably revenue-neutral or budgetarily constrained behemoth.

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