Monday, August 24, 2009

The great disconnect

John Goodman writes:

All across the country, Members of Congress are facing very angry constituents over the issue of health care. So ferocious has been the response that an estimated two-thirds of the Members are not even going to hold town hall meetings. Reportedly, our elected representatives are shocked.

I don't know why. … Where, you wonder, were the politicians as this anger was boiling over? Don't they have staffers who answer their telephones and open their mail?

How did this happen? I think there are three causes.
  1. Politicians who don't know anything about health care.
  2. Policy wonks who do not understand the voters.
  3. A very deceptive presidential campaign … that made these promises: Universal coverage, … Paid for by taxes on the rich…; and If you like the health plan you're in (which 87% of Americans do) you can keep it

Now comes the surprise from Capitol Hill: Forget everything we said during the election. We really didn't mean it after all. In particular:
  1. Whereas the campaign mantra was universal coverage ("we're the only developed country that doesn't insure all its citizens"), that term is almost never heard any more. The clear goal now is to nationalize the health care system ("we're the only country in the world that doesn't have a national system").
  2. Far from being left alone if you like the plan you are in:
    1. You and your employer are going to be heavily taxed if your insurance doesn't conform to the plan the federal government is designing.
    2. You, along with millions of other Americans, may lose the plan you like and be pushed into a health insurance exchange where the premiums are likely to be higher than what you now pay and health plans have perverse incentives to underprovide to the seriously ill.
    3. Costs cannot be controlled unless we all get less — fewer tests, fewer exams, fewer services — with Barack Obama's grandmother's hip replacement being Exhibit A.
  3. Far from escaping the financial burden of reform, it now appears that everyone will be burdened — from the elderly to the casual consumers of soda pops.
To lighten up the harsh and specific criticisms, the blog posting also included a funny reference to the oldie-but-goody “Shout”.

I might disagree with the “deceptive” part. My reading is that there are many on the left who are economically ignorant (perhaps willfully so) and made promises without adding up all the numbers — math, accounting and economics not being strong suits for most lawyers and politicians (left or right). So when Sen. Obama attacked Sen. McCain's proposal to tax expensive healthcare plans (which may end up part of ObamaCare), the political operatives making the decision (and perhaps the senator) didn’t realize the corner they were boxing themselves into.

Goodman — who has claim to be the “Father of Health Savings Accounts” — edits the Health Policy Blog where the article appeared. (He is not to be confused with the movie actor or Marine general). As his blog demonstrates, Goodman is clearly a healthcare policy wonk, but one from a free market perspective.

In a column on Saturday night, Goodman added additional thought on the public frustration:
For the past two months the National Center for Policy Analysis (the think tank I run) and Salem Communications (which employees such talk-show hosts as Mike Gallagher, Bill Bennett and Michael Medved) have been sponsoring an online petition at for those who wish to express their opposition to nationalized health care. In the process we've collected more than 1.1 million signatures and we're in email communication with many on a weekly basis.

These are a very diverse group of people. … For the most part, these individuals are not funded or organized by anybody. They really are grass roots. Sure, there may be a few top-down "astroturf" groups and some special-interest groups that are secretly gleeful. But there is no way the kind of spontaneous outpouring we've witnessed could be bought or organized by anyone.

Why are they so angry? The reasons are manifold, but the single biggest reason is the arrogance of our elected officials in Washington. Think about it. For the past seven months a small group of politicians has been meeting behind-closed-doors with powerful special interests to decide whether you will be able to keep your current insurance, where you will be directed to get new insurance and at what price, what fines you and your employer will have to pay if you don't conform, and how they're going to get your doctor to change the way he or she practices medicine. In the process, they never asked you what you thought about anything. If you are not mad about this, odds are you don't understand the situation.
A leading healthcare economist, Goodman not only sees the problems that ObamaCare is trying to solve, but also the new ones that it will cause.

As I see it, that’s the chronic problem with this (and several other) administration efforts to ram through solutions while they have the votes. The real world is messier than the idealized view used to justify the legislation, and the proposals to expand government have not seriously considered the serious side effects they cause (most noticeably adding trillions to the national debt.) Frankly, most economists are being ignored in favor of inside-the-Beltway political operatives who favor command-and-control solutions, achieved in a once-in-a-lifetime crisis opportunity that won’t be allowed to go to waste.

In his WSJ piece, Goodman concluded:
In an off-the-cuff answer to a question on ABC's nationally televised White House infomercial, the president said we're only talking about people giving up care that is "unnecessary." Yet no patient, no doctor, not even the most liberal person in the country thinks the government can pull that off without a glitch.

In truth, there is a deadly serious issue here: How do you get rid of waste and inefficiency without denying people care they really need? The answer is not easy. No other country has found it. And if the president wants to tackle this challenge he, not his opponents, bears the burden of proof to show how that will work.

Yet far from accepting this responsibility, the White House is ducking the issue. …

The new tactics it is employing show the White House is completely out of touch with the American people. Those who attend town-hall meetings know they are not being organized or funded by anyone. And when the administration attacks their character and their motives and intentionally distorts the truth, it only adds to the anger people already feel.

Continuing blogging cost reductions through outsourced economic criticism

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