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Psychology Matters in Health Care Reform

August 17th, 2009 . by economistmom

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The New York Times’ David Leonhardt had an interesting column in the Sunday magazine.  He thinks that in the health care reform debate, policymakers aren’t paying enough attention to the influence that policy could have (and perhaps should have) on human psychology.  David leads with the story of the Cleveland Clinic, which adopted a “hire no smokers” policy two years ago:

[I]t is so striking to talk to Delos M. Cosgrove, the heart surgeon who is the clinic’s chief executive, about the initiative. Cosgrove says that if it were up to him, if there weren’t legal issues, he would not only stop hiring smokers. He would also stop hiring obese people. When he mentioned this to me during a recent phone conversation, I told him that I thought many people might consider it unfair. He was unapologetic. “Why is it unfair?” he asked. “Has anyone ever shown the law of conservation of matter doesn’t apply?” People’s weight is a reflection of how much they eat and how active they are. The country has grown fat because it’s consuming more calories and burning fewer. Our national weight problem brings huge costs, both medical and economic. Yet our anti-obesity efforts have none of the urgency of our antismoking efforts. “We should declare obesity a disease and say we’re going to help you get over it,” Cosgrove said.

David then points out that the largest contributor to people’s health, more than “substandard medical care” or social and physical environments or even genetics, is “behavior.”  And today’s worst health problem is a big behavioral problem called obesity.

What does David think public policy could do about changing the bad behavior that leads to obesity, short of arresting or just not hiring obese people?  He thinks we could use prices to create an economic incentive to avoid obesity.  We need to charge a penalty for obesity because obesity imposes costs on society, not just on the private citizens who “choose” (selfishly) to be obese:

Today, the great American public-health problem is indeed obesity. The statistics have become rote, but consider that people in their 50s are about 20 pounds heavier on average than 50-somethings were in the late 1970s. As a convenient point of reference, a typical car tire weighs 20 pounds.

This extra weight has caused a sharp increase in chronic diseases, like diabetes, that are unusually costly. Other public-health scourges, like lung cancer, have tended to kill their victims quickly, which (in the most tragic possible way) holds down their long-term cost. Obesity is different. A recent article in Health Affairs estimated its annual cost to be $147 billion and growing. That translates into $1,250 per household, mostly in taxes and insurance premiums.

A natural response to this cost would be to say that the people imposing it on society should be required to pay it…

One idea is surely too controversial because it seems to attack obese people so personally (some of whom have more of a genetic predisposition than others):

Cosgrove mentioned to me an idea that some economists favor: charging higher health-insurance premiums to anyone with a certain body-mass index. Harsh? Yes. Fair? You can see the argument.

So David’s favored approach is via what economists call a “corrective tax”–one which taxes an activity that generates external costs (social costs in excess of market prices) in order to bring private incentives more in line with socially optimal choices:

The solutions to these problems are beyond the control of any individual. They involve a different sort of responsibility: civic — even political — responsibility. They depend on the kind of collective action that helped cut smoking rates nearly in half. Anyone who smoked in an elementary-school hallway today would be thrown out of the building. But if you served an obesity-inducing, federally financed meal to a kindergartner, you would fit right in. Taxes on tobacco, meanwhile, have skyrocketed. A modest tax on sodas — one of the few proposals in the various health-reform bills aimed at health, rather than health care — has struggled to get through Congress.

It’s true that tobacco taxes have increased dramatically of late, and that will help to decrease smoking further (as well as provide needed revenue to fund children’s health care), but as an ex-smoker myself, I can attest that the social stigma from signals (or “cues”) that an activity is “bad” can often be a far more effective way to change behavior than are (just) higher prices.  Many policies that are designed to affect private economic (purely pecuniary) incentives have a bonus effect of signaling what society scorns or values–and I mean even beyond the size of the tax or subsidy.  Sometimes the easiest (and cheapest) way to get humans to change their behavior is to suggest that their current behavior is “totally uncool.”

Take the Cash for Clunkers program, for example.  It’s easy to complain that the program does not do the best job of encouraging fuel efficiency and resourcefulness; the mileage standards are pretty low, and to get the federal subsidy on the new car, you have to destroy (effectively waste) the old vehicle (which doesn’t necessarily have to be that old at all).  One doesn’t have to buy a hybrid or other highly-fuel-efficient vehicle to qualify–for example, one can do what my parents did and turn in their old Ford Explorer SUV for the smaller Ford Escape (even the non-hybrid version) which is nonetheless still an SUV.  Yet reports of the types of new vehicles purchased by Cash for Clunkers participants suggest that people haven’t been just “squeaking by” with the minimum mileage improvements; the most popular cars purchased have been the compact cars.  That observation is consistent with two explanations:  (i) a purely economic incentive in that the smallest cars tend to be the cheapest models, so the $4500 clunkers rebate is a larger percentage off the compact car’s price–plus there’s an “income effect” that should encourage more purchases of cheaper cars during a recession, even apart from the bigger markdown (price or “substitution” effect); OR (ii) a “social response” of consumers to “do the right thing” given that the government is rewarding them for their supposedly “common good behavior” (not just selfish gain) and that maybe they’re feeling a little guilty about destroying their old, less fuel efficient, but still useful vehicle.

OK.   Maybe my last theory sounded a little “touchy, feely” to you.  What kind of “economist” am I, saying that more than prices matter and talking about feelings driving people’s economic decisions?  Well, it turns out that I am, in Myers-Briggs speak, an “ENFP” economist–that’s an “Extroverted, iNtuitive, Feeling, Perceiving” economist.  Which sounds pretty crazy for an economist trained in neoclassical theory, doesn’t it?  It turns out the Myers-Briggs type of people that make the best economists are (at least according to this site) “INTJs” (Introverted, iNtuitive, Thinking, Judging)–the opposite of me in 3 out of 4 of the traits.  I’m currently trying to conduct a Facebook survey among my economist Facebook friends to see if most of them are indeed INTJs.  The problem is that those economist friends of mine who are also on Facebook are probably a biased sample of my economist friends; they’re probably the ones least likely to fall into the typical I, T, and J categories because they’re interested in being on Facebook, after all.  (They’re probably “weird” economists, like me.)  And I haven’t collected many data points because I think my economist friends on Facebook are actually the least likely to spend time on Facebook out of all my Facebook friends.  (This is sort of like being “the economist” on a Democratic congressional staff; take my experienced word for it–the economist always turns out to be the least liberal of the staffers.)

Which brings me to Part II of why “psychology matters in health care reform.”  I think the psychology of our political leaders matters in terms of how successful (or not) any health reform effort will be.  This past week while I’ve been so fascinated about my unusual-for-an-economist ENFP personality, I discovered that many people speculate that President Obama is also an ENFP.  From a Slate article written during the 2008 presidential campaign (by Emily Yoffe, emphasis added):

Barack Obama—no one will be surprised to learn—is an Idealist. His specific type is an ENFP, what [psychologist David] Keirsey calls “the Champion.” ENFPs, says Keirsey, are “filled with conviction that they can easily motivate those around them.” Champions work to “kindle, to rouse, to encourage, even to inspire those close to them with their enthusiasm.” Idealists “usually have a tongue of silver” and are “gifted in seeing the possibilities” of institutions and people. Here’s Obama on leadership: “[W]e need leaders to inspire us. Some are thinking about our constraints, and others are thinking about limitless possibility.”

This ability to move people through imagery and rhetoric carries a danger for the ENFP, says Keirsey—a belief in “word magic.” “Word magic refers to the ancient idea that words have the ability to make things happen—saying makes it so.”

Keirsey says Idealist leaders should be called catalysts because “[t]he individual who encounters such a leader is likely to be motivated, animated, even inspired to do his or her very best work.” The New Yorker’s Packer writes, “Obama offers himself as a catalyst by which disenchanted Americans can overcome two decades of vicious partisanship. …”

Idealists are deeply introspective. According to Keirsey, their “self-confidence rests on their authenticity,” which makes them “highly aware of themselves as objects of moral scrutiny.” Idealists, such as Thomas Paine, Mohandas Gandhi, and Martin Luther King Jr., tend to be leaders of movements, not office-holders. If Obama is elected, not only would he be the first black president, but according to Keirsey, he’d be the first Idealist president.  [According to this site though, Bill Clinton is a "verified" ENFP.] (Kroeger speculates that Lincoln may have been an Idealist.) Idealists are rare in any executive position…ENFPs themselves are rare—Keirsey estimates only about 2 percent of people are ENFPs. Kroeger says the ENFP can be an effective boss. “At their best they bring a refreshing alternative style to top management and decision making.”

Keirsey says that the Idealist is the unusual leader who is “comfortable working in a climate where everyone has a vote.” In a Vanity Fair profile, Todd Purdum quotes a Harvard Law School classmate of Obama’s describing his collaborative style as editor of the Law Review…In a speech, Obama described this ability: “If you start off with an agreeable manner, you might be able to … recruit some independents into the fold, recruit even some Republicans into the fold.”

As leaders, Keirsey says, the Idealists possess a “diplomatic intelligence.” They “seek common ground,” want to “forge unity,” arrive at “universal truths,” and are “trusting.” Given these qualities, it should be no surprise that Obama says that as president, he would quickly sit down with our enemies…

The ENFP can have a problem with “restlessness,” says Kroeger. “As a task or responsibility drags on and its mantle becomes increasingly routine, the ENFP can become more pensive, moody, and even rigid.” Obama himself referred in a debate to his disorganization and dislike of paperwork—and his self-knowledge that “I need to have good people in place who can make sure that systems run.” But as Purdum writes, it is Obama’s “restlessness” that prompted him “to take a chance, to aim higher—when others told him to wait his turn.”

Now that might not sound all that wonderful for Obama’s ability to get the health care reform job done quickly and efficiently.  But contrast that description of Obama’s ENFP personality with the same article’s explanation of how Hillary Clinton’s ESTJ personality may have doomed the Clinton Administration’s (ok, Hillary’s) health care reform effort:

ESTJs are most comfortable in the world of the specific. Keirsey says they will listen politely to “theoretical or fanciful” conversation—what an ESTJ surely thinks of as a certain other candidate’s gasbaggery—then “shift to more concrete things to talk about, more solid and sensible topics” using their ability to call up at will “an enormous fund of facts.” (Ever heard a Hillary speech?)

It is this ESTJ-ness that may explain the failure of Hillary’s health-care initiative as first lady. ESTJs like nothing better than digging deep into the specifics of a system and batting out proposals with trusted staff, then presenting the perfect fait accompli to a grateful public. As [consultant Otto] Kroeger points out, ESTJs can be stunned when the plans fail: “Having packaged the argument so neatly and precisely, how could anyone possibly disagree?” Keirsey says this blindness comes from the concrete-thinking ESTJ’s pronounced weakness at the abstract arts of strategy and diplomacy. Hillary neither foresaw the attacks by competing interests nor had the people skills to win over her opponents.

So those are a couple ways in which “psychology matters” in health care reform: (1) if we’re going to “bend the cost curve” in a cost-effective manner, we ought to devote some of our creative thinking toward clever ways to affect human psychology to get people to start losing weight; and (2) we better get our ENFP president to inspire not just the American public, but also those nasty partisans on both sides of the aisle in Congress, to come on board.

13 Responses to “Psychology Matters in Health Care Reform”

  1. comment number 1 by: Brooks

    Regarding the overall impact on our long-term fiscal imbalance of smoking and obesity, The Congressional Research Service has concluded that “Governments save on the costs of old-age medical care, social security, and nursing home care due to the earlier death of smokers…Smoking has apparently brought financial gain to both the federal and state governments, especially when tobacco taxes are taken into account. In general,smokers do not appear to currently impose net financial costs on the rest of society.” http://www.law.umaryland.edu/marshall/crsreports/crsdocuments/97-1053_E.pdf See also http://www.nber.org/papers/w4891 And similar conclusions have been reached regarding obesity.

  2. comment number 2 by: Anandakos

    Madame,

    I agree that obesity is a disease and the nation should make reducing it a priority, both for the national exchequer and the well-being of its citizens.

    However, it’s not so easy when the entire food distribution system is dedicated to the dissemination of empty calories and toxic fats. Yes, manufacturers ARE trying to be better about the fats, but at the same time they’re substituting high fructose corn sweetener for sugar at every turn because its cheaper. HFCS visits havoc on the body’s sugar regulation system, exacerbating today’s epidemic of adult onset diabetes (Type II).

    It’s not going to be easy to incentivize people to stay thin when a million years of evolution says “eat everything you can shove in your mouth that doesn’t kill you! It might not be there tomorrow!”

  3. comment number 3 by: Brooks

    Anandakos,

    Although I don’t have all the dots connected, my sense is that our current campaign finance system* plays a role in the increased use of high fructose corn syrup. Huge corn-focused agribusinesses like Archer Daniels Midland are probably using their influence from campaign contributions to get government to distort the market in ways (subsidies, favorable regs and other policies) conducive to sales of corn-based products, and probably also to obstruct measures that would mitigate or reverse this trend (I’m glad to see, by the way, positive changes at the state and local levels, such as improvements in cafeteria and vending machine food and beverages in schools).

    So my sense is that mitigating this trend would be among the many other benefits of shifting to a mostly publicly funded system of campaign finance (voluntary, based on small contributions and very high matching multiple and flexible cap to compete against a candidate who opts out, making opting out unattractive).

    * The disproportionate power of farm states (due to higher per capita representation in the Senate) probably contributes to the distortions in the market that contribute to this problem as well, but unfortunately that’s in the Constitution.

  4. comment number 4 by: Anandakos

    P.S.

    Cosgrove and Leonhardt’s proposal to tax based on BMI would be extremely regressive. The poorest people in America are the most obese, from several factors.

    Poor people tend to be in the South where the diet for both black and white people has more pork and pork fat (lard) than anywhere else in the US. Pork is renowned for causing “gout”, which is the old term for obesity. They also drink sodas by the bucketful because it’s hot and most water outside the Appalachian belt tastes like piss down there.

    Poor people everywhere — in the rural South and in the urban ghettoes — have little access to healthful foods that they do not grow themselves. In both environments the primary food sources are convenience stores; they’re affiliated with gas stations in the rural parts of the country and are sited at every significant bus stop in poor urban areas.

    If you want to fight obesity in this population the government will have to do things like make food stamps more valuable for produce and bulk foods and less so for CocoaPuffs. It will have to subsidize food outlets in the inner city that carry the more healthful items so that people can purchase them at all. It will have to spend some serious bucks educating people at all stages of their lives about good nutrition — and PRACTICE what it preaches in school lunches. And since it makes no economic sense to replicate the fast food stores in rural areas they will have to be subsidized to carry healthful items and produce.

  5. comment number 5 by: Anandakos

    Brooks,

    You are a very good and smart guy, but I fear way too much of an idealist. Your specific ideas for campaign finance reform are spot on, but the parties have different but equally powerful reasons for rejecting them. I think you know what they are.

    The Supremes have made it clear that they consider political contributions “protected speech”, so we can’t limit contributions. The only hope is countervailing subsidies for non-incumbents as you propose, and have you noticed that most Congresscritters have a serious desire to remain incumbent? So, we have and will continue to have “The Best Congress Money Can Buy”®.

    Since we don’t have the Initiative at the Federal level we can’t ram such reasonable limitations down their throats, and they have their hands firmly on the Amendment control panel.

    The best we can hope for is an epidemic of extremely virulent Escherichia coli in the congressional lunchrooms.

  6. comment number 6 by: Brooks

    Anandakos,

    Thanks for the compliments. And it’s unusual for someone to think I’m “too much of an idealist” (I’m actually quite the skeptic, generally cynical about politicians, and oriented toward exploration of trade-offs and toward pragmatic solutions), but that’s nice in its own way, too. I’m not saying that achieving the kind of campaign finance change that I advocate would be easy or even likely (at least for now); it would indeed be an uphill battle, because, as you indicate, because the foxes are watching the hen house.

    But there is a possibility that it can be achieved at some point, given the scale of sacrifices — and choices among them by politicians — that will eventually be necessary to adequately reduce our long-term fiscal imbalance. When Congress and the president are deciding how to distribute real pain across the population, and when people start feeling that pain, the public may start demanding that at least those decisions should not be heavily influenced by big money campaign contributions from special interests, not to mention that politicians shouldn’t require even greater sacrifices from the public in order to provide payback to those special interests.

    Additionally, in that new political competitive environment in which Congressmen’s/candidates’ hands are tied — no longer able to offer goodies through new/higher spending or tax cuts — they will be looking for ways to score political points that don’t require more federal spending, and “clean government” could very well present such an opportunity (watch out for hype of “values” issues, too, for the same reason — no budget constraint on moral posturing and related legislation).

    And yes, the best approach — one that can clear First Amendment hurdles AND be effective — is one that focuses on providing an even playing field by subsidizing the candidate who would otherwise be at a big money disadvantage rather than on trying to limit spending by or in support (explicit or not) of a candidate.

    A couple of links below related to the general idea:
    http://www.campaignmoney.org/campaigns/main/fair-elections
    http://www.commoncause.org/site/pp.asp?c=dkLNK1MQIwG&b=4773857

  7. comment number 7 by: Anandakos

    Brooks,

    I sincerely hope you’re right, because I agree with your fundamental assertion that our current campaign finance system is the root and branch cause of gridlock. It’s exacerbated by Gerrymandering, of course, and that has to be solved state by state.

    But even in extreme right or left districts public financing as you describe would give new ideas an airing. Lordy, lordy, do we need some new ideas!

  8. comment number 8 by: Brooks

    Anandakos,

    Yes, gerrymandering is bad for the country, too. As I think you are alluding to, it produces entrenched incumbents whose primary threat is…well, a primary threat (rather than general election), and who then seek to win and maintain favor with the extremes of their parties (including indulging their ideology-based myths) at the expense of political pragmatism (i.e., getting things done legislatively) and practical solutions (i.e., producing legislation that actually achieve the desired objectives).

    And gerrymandering is another tough nut to crack, also with the foxes watching the hen house.

    My biggest beef with our campaign finance system is not gridlock but all the ways in which the public loses so that big campaign contributors can get a good ROI on their rent-seeking investment. The public ends up paying, one way or another, for special-interest subsidies, special tax breaks, import quotas, favorable regs, etc. I also think the extent to which large contributors influence a candidate’s viability and chances of winning make a mockery of the principle of one-person, one-vote.

  9. comment number 9 by: Anandakos

    Paragraph 3: superb!

    I have wondered how the Supremes can be so “all about” one person, one vote and then allow people from outside the district (or state for a Senator) to give. Seems obviously inconsistent to me.

    I just got back from a town hall with Brian Baird. Wow, people are seriously afraid of this health care legislation. Maybe they’re right to be; who knows who will be running things in fifteen years and what will change about the legislation in the mean time.

    But the fears they expressed are completely unrelated to the legislation at hand. Baird said at least 20 times that the current legislation allows people to keep their current plan for five years. After that to get “credit” for having insurance, if the plan one is in doesn’t meet the minimum standards, one has to change.

    One would have thought that two or three repetitions would have gotten the point across, but person after person said in effect “you’re not going to force me into that government plan”.

    I suppose that if the government were nefarious enough it could define the “acceptable” plans in such a way that only a public option met the criteria, but I expect that whichever party did that would be voted out of office at the next election.

  10. comment number 10 by: Anandakos

    P.S. There were even people who want to do away with Medicare. WHAT insurance company is going to insure a senior citizen? (Quick answer: none on this planet).

    That’s why it was implemented in the first place. I think they made a mistake — understandable for the time, certainly — when they made the deduction only 3%. They had no way of knowing that medical technology would advance so rapidly, become so costly, and keep people alive so effectively, all of which add to the cost of senior care. People live a LOT longer and consume a LOT more health care than they did in 1964.

  11. comment number 11 by: Jim Glass

    I just got back from a town hall with Brian Baird. Wow, people are seriously afraid of this health care legislation. Maybe they’re right to be; who knows who will be running things in fifteen years…

    Or less.

    But the fears they expressed are completely unrelated to the legislation at hand. Baird said at least 20 times that the current legislation allows people to keep their current plan for five years. After that …

    “Average” people (excluding us, of course) are always ignorant about the details of legislation, but they aren’t stupid about the basics of the process, and that’s what’s worrying them here — and they have good grounds to be wary.

    Take Social Security. FDR’s original Act of 1935 was very simple, a funded-plan model with benefits based on contributions as anybody could understand. FDR’s people could write the entire tax-benefit formula in simple English in a small phamplet or even on a post card, and did by the millions. “People” understood it and supported it.

    Then in 1939, the very firstCongress after SS actually began operating started radically re-writing it. FDR vetoed the changes in 1941 but they over-rode him.

    The entire program he had carefully explained to the public disappeared. Everything changed: taxes, benefits, who was eligible for benefits, when they were eligible — it became an entirely different program in four years. After his veto was over-riden FDR walked away from Social Security to fight WWII and never had anything significant to do with it again.

    Now one can argue whether the changes were good or bad. They were good for the retirees of the day who got hugely increased benefits, and for the taxpayers of the day who got lowered SS taxes — which means (bigger benefits! lower taxes!) it was good for the politiicans of the day.

    It’s also meant SS went broke in 1983, basically as FDR’s people predicted in defending his veto — resulting in bigger taxes and lowered benefits for later workers, making SS a much less-good deal, in fact a money-losing deal for today’s workers.

    But maybe that was worth it to give bigger benefits to the much poorer Late Depression/World War II generations. That’s a judgment call.

    The point is, FDR’s own Social Security Act of 1935, that he personally headed the design of and sold to the American people in great detail, was totally gone and a thing of history in just about 5 years after it went into effect. The promises made in selling it to the public meant nothing.

    Once Congress starts to act in a field there is no way to stop it from doing whatever it wants. It is in no way bound by its own promises. It can do anything. And it does break its own promises all the time. People know this and they worry when it gets into something close to them.

    Now consider the details of today’s situation:

    Obama could have put himself in an FDR-like postion if he’d had a clear objective and gone right to it. Such as:

    “We are going to insure the uninsured, this is what it will cost, this is how we will pay for it, it is a matter of social justice, end.” Clear, explainable, easy to frame, with his 60 votes in the Senate it’s hard to imagine how he could lose. Who would vote to keep people uninsured, if that was the issue?

    BUT THEN Obama went on to: “And we are going to stop your insurance premiums from rising, AND let you keep all the policies you have now, only better, at lower cost! … AND we are going to save the country from bankruptcy by cutting medical costs, by spending $100 billion *more* each year … To save the country we will slash Medicare spending! Because it is spending 30% too much! Which must stop!!! But no, no, no, it won’t cost retirees any Medicare benefits, because we’ll do it with a new commission that will “bend the cost curve” long after I am out of office. (You’ll believe that!) And when the commission cuts costs, it won’t do it by rationing, no! never! …

    “You ask: If Medicare is spending 30% too much now, since it’s a gov’t single-payer program, why don’t we just cut the waste ourselves now, to save the country from bankruptcy? But no, we can’t do that because AARP and thus Congress won’t go along with any cuts unless we give them more benefits now, so they’ll agree to cuts later. [Orszag to Postrel] You trust them about later, right?… etc.”

    And when average people go: “Huh? Uh, look, just tell usn where in your plan all these things are spelled out. You promised you were going to put all proposed legislation on the Interenet so we voters could review it…”

    He says: “Can’t do that! Because there is no plan! I mean, it’s all spread out among differrent House committees, they’ll have to compromise, then the Senate is going to make a lot of changes. I can’t know what the result will look like, I’m not writing it, I gave that job to all the committees (not making Hillary’s mistake!) … Besides, you heard Harry Reid say it doesn’t really matter that you can’t read it, you need a PhD to understand a lot of its provisions, so most people in Congress don’t understand them either.

    “But we should have passed this already, reworking 16% of the economy, by August! We’re losing valuable time and momentum. You have to support whatever the plan will be NOW!”

    Now, many average people (including me): “Huh?”

    Hey, would you buy a car from a salesman who said:

    “You have to agree to buy this car now!! It’ll be the greatest car you ever own! It will solve forever all those problems you have with the ever-rising car costs: gas, maintenance, repairs, insurance, everything! Buy this car! Commit right now!

    “No, I can’t tell you what kind of car it will be, a bunch of committees are still designing it and will have to compromise that out. No, I can’t say how much we’ll charge for it, or how we’ll collect what we’ll charge. Do I really bindingly promise it will help you with your gas, maintenance, repairs, insurance, everything? So you can hold be accountable if it doesn’t? No, of course not! Who knows the future? You’ll get the car we give you, it will do what it will do, and if it turns out to be more than we can afford to give you we are perfectly free to take it back and give you a Yugo in a few years… But commit to buy this car now!”

    I don’t think anyone in the entire country would commit to buy a car on those terms.

    So I’m really impressed by how many people want to buy a rework of 16% of the entire economy on them — and that really so few feel so queasy about it.

  12. comment number 12 by: Brooks

    Jim,

    I agree that, notwithstanding all the myths, misconceptions, and wild exaggerations out there (and there are a lot), Obama and other advocates of “reform” are not talking straight and are trying to position reform as “all gain, no pain”, and are thus creating a fertile environment for suspicion, some of it justified — meaning that something indeed will have to give, since we cannot expand federal coverage to 47 million more people and lower projected federal spending on healthcare (and overal spending on healthcare) while avoiding any adverse impact on anyone’s healthcare quality and outcomes. Eugene Robinson deserves credit for talking straight to his “side” on this matter http://www.washingtonpost.com/wp-dyn/content/article/2009/08/10/AR2009081002455.html

    Also, in response to wild exaggerations from the other side, Obama has also gone too far by persistently, deceptively saying things like: “I keep on saying this but somehow folks aren’t listening: If you like your health-care plan, you keep your health-care plan. Nobody is going to force you to leave your health-care plan”, even though millions of people who would otherwise be able to keep their current coverage would lose it under his “reform”. http://www.prospect.org/csnc/blogs/beat_the_press_archive?month=08&year=2009&base_name=the_post_uncovers_the_truth_pr#comment-6286454

  13. comment number 13 by: Anandakos

    Mr. Glass,

    I don’t think Obama is saying “you should support whatever comes out of Congress”. That’s too simplistic. He’s saying “we need to make changes to the system, and here are eight things I believe need to be included”.

    When Mrs. Clinton proposed a highly-detailed, wrapped-up-in-a-bow package plan it was shot down as being high-handed and excluding Congress. Obama has gone the other way and is now being vilified for not taking more control of the process.

    Your party had 14 years to deal with the obvious problems in the current system: arbitrary rescission in some cases long after enrollment, pre-existing condition exclusions, advertisements for prescription drugs, and providers who over-provide in order to maximize their revenue and avoid lawsuits.

    When the critical players in your party say essentially “I don’t care what they come up with, I’m voting against it in order to give Obama a defeat” it’s little wonder that the Democrats are increasingly fed up and no longer listening to a bunch of dining room tables. Who in the Republican party has proposed anything except “tort reform”. Meaning what? That a person who has had a clamp left in her abdomen and suffered serious pain for a year while being jeered at by doctors for “psychosomatic” issues should not have the right to sue them? I will say that she got the wrong lawyer, because the bastard included the radiologist who saw the clamp and blew the whistle as a defendant in the suit. How very, very craven.

    How about this for a grand compromise? You folks get some sort of limitation on non-economic damages and we get a provision that the CEO, CFO, and COO of any health care provider who rescinds coverage held in good stead for at least a year on a patient who thereafter dies from lack of needed care can be prosecuted for negligent homicide? Sounds like a compromise that would cut out a bunch of greedy lawyers and put the necks of a bunch of greedy tycoons in the noose.

    I think we’d have a much better health care system.