Dana Blankenhorn

The Key to Health Reform

Think of this as Volume 14, Number 9 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.

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The key to any health reform is giving someone the authority to say no.

That's the difference between the American system (or any proposal from any party to change it) and the systems in place everywhere else in the world.

There are many ways to say “no,” and in America we do it with dollars. We say “no” when the money runs out.

If you're in the middle class, if you can't afford the health care premiums you're offered, the system says “no” to you in every respect. If you're poor, however, or old, or you work for the government, or you have a generous employer, or you're rich, or you're a kid, or you once served your country, however, we say “yes” to you on just about everything.

This is the system Republicans are defending. The middle class is squeezed and screwed, more people fall into this widening crack every year. We know the ultimate Republican goal, because they state it plainly. They want those other groups (save the rich) falling into the same hole. Health care is not a right, they say, but a privilege, something that you have to earn. No one should give it to you.

That's a consistent message but it's one that even Republican constituencies don't swallow in practice. The party's greatest gains in the last year, according to all opinion polls, are among those 65 and older. Medicare recipients. “Keep the government's hands off my Medicare,” these people shout.

It's sort of funny.

But the system Democrats are offering right now is little better. Everyone gets a pony. Savings will appear by magic. If everyone gets into the pool, we can afford to cover everyone. We'll just do some adjustments around the edges.

It's a lie.

Back during the 1990s we thought there was a way to say “no.” It was called managed care. HMO companies like Humana grabbed big hunks of market share by promising to control costs. They lost. Hospitals shifted costs onto other people, fought them at every turn, beat them in court, made it more worthwhile to give in than fight. Humana is now laying off tons of people and calling itself a “health insurer.”

Where will the authority to say no come from?

The best place for it to come from is science, from data. The health IT revolution now underway is designed to collect that data. Get everyone's health records online and we can do a database sort to see what treatments are most cost-effective. Not just which are effective, but which deliver the best bang for the buck -- in every case.

This is called “comparative effectiveness.” And it was the first thing tossed aside when the debate over health reform began. “You're gonna kill grandma,” cried the right, and liberals caved.

Here's the truth. Grandma is going to die some day. Get over it. So are you. So am I. Health care is not about immortality, it's about living as long as you can, as well as you can. It's about managing wellness, trying to cure sickness, giving you all the good days God may permit to you.

Short Attention Span Theater

One of the biggest lies told by modern journalism is this.

Viewers have short attention spans but journalists provide perspective

In fact the exact opposite is the case. Journalists -- both print and TV -- now work in an instant news cycle. We're not even talking of a 24 hour cycle any more -- we're talking about instant, right-now back-and-forth, in which what happened just moments ago and what might happen moments from now don't matter.

Most people, on the other hand, are busy living their lives. There are a few -- blog habitues and cable TV shut-ins -- who live like reporter-rodents, but these are a very small minority. Yet, because this small minority is the audience for which print and TV journalists feel they must compete, the focus is entirely upon them. 

It's like watching a dog chasing its tail.

The Enemy Within

Think of this as Volume 14, Number 8 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.

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We tend to think of politics in two dimensions -- left and right.

The Nixon Thesis of Conflict has accustomed us to this. Democrats accommodated themselves to it first through triangulation, the Clinton "Third Way," and later through confrontation, the Dean Netroots.

The President's Thesis is different. I have called it the Obama Thesis of Consensus. What I have learned recently is this thesis adds a third dimension to our politics, one that most have as much trouble seeing as all of us do the dimension of time.

Agreeability.

The right's Achilles Heel

Science.

Science is not a belief system. It is a process, a method. Just like democracy is a process, and markets are a process. (To the right, vaccine scientist Paul Offit.)

No one believes in what scientists say. Even scientists don't. They accept what scientists say, when it is experimentally valid, because it answers good questions, because it can be engineered into things of use.

Over the last decades the political right in this country has forged a dangerous alliance with idiots who reject science, who call it a "belief" system and thus subject to political process.

It's not. Science has nothing to do with politics. Sure, scientists engage in little political games with one another. Good science is held down by authority figures all the time. Good scientists have their work questioned constantly. But in the end, science goes with what works.

Journalists have gone in for this game, because it's an easy "he said, she said" story. This is an incredibly dangerous stance to take.

The 1898 Game

Think of this as Volume 14, Number 7 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.

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The cycles of American history are important because they can show us where we are, and let us know that our reactions to events are not as unique as they appear.

Our history has been marked, so far, by six generational crises from which we managed to escape, and which defined all who went through them:

1. The 1800 Crisis, about the limits of our democracy and adherence to those limits.
2. The 1828 Crisis, a new balance between sections and the myth of "the people."
3. The 1860 Crisis, about Union, slavery, and the nature of our economy.
4. The 1896 Crisis, about balancing power between business and government.
5. The 1932 Crisis, about rescuing the economy and unity.
6. The 1968 Crisis, about culture, global war, and values.

The 2008 Crisis has much in common with the 1896 and 1932 crises, in that our problems are primarily economic. But it also has much in common with 1860 and 1968, in that our people seem culturally divided. (History is viewed like a picture on Google Earth -- everything below appears compressed and one-dimensional.)

There should no longer be doubt that 2008 was important, in the same way that our other crisis years were important. The assumptions of the past era had collapsed, our problems seemed ready to bury us, and we were ready to hear a new story about ourselves.

But we are now two years past that crisis. We have reached its center, its core. We are in the middle of cultural, economic and literal war, a time that tries mens' souls and has people wondering aloud whether this path is, indeed the right one.

Now is the time for heroes.

The Harvard Problem

One unspoken fact about this Administration is that it is largely based on Harvard.

Harvard people fill the top ranks of the Obama Administration. There were 20 Harvard people on his transition team.  His top finance guy, Larry Summers, was the President of the place. Summers' opponent within the Administration is a Harvard professor. Most of Obama's health reform ideas came from Harvard, and a Harvard guy is in charge of his health IT, too. 

Sure, George W. Bush was a Harvard MBA, but the political era of which he was a part explicitly rejected Harvard. Harvard represented the elite intellectualism Nixon campaigned against all his life (never mind that Henry Kissinger came from Harvard) and, while the elites were sprinkled throughout every Administration of the last 40 years, they came in despite their school.

Harvard has a reputation, best seen in the late David Halberstam's masterwork, The Best and the Brightest. Harvard people are taught that intellectual rigor, breaking complex systems down like mechanics do a car, then rebuilding them, is the way forward. And, as Halberstam notes, that approach is what got us into Vietnam.

Thus the politics of the last 40 years has been dominated by anti-intellectualism. Conservatives already consider Harvard ties Obama's Achilles Heel. 

I agree it could be. That's because politics is not just a game of intellect. Being right is not always good enough. There comes a time for banging heads and "Harvard boy" Obama has not yet shown a willingness to do that.

But there is also something incredibly dangerous about this anti-intellectualism.

The Rule of Optimism

Think of this as Volume 14, Number 6 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.

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Democrats are well-positioned to win the next election, and several after that.

This violates what Washington considers Conventional Wisdom. Conventional Wisdom is a lagging indicator.

What gives me confidence? Partly it's a belief the economy will keep growing, and start adding jobs. Much of the stimulus remains unspent, and there are enormous investment opportunities in front of us.

Mainly it's because Democrats have managed to capture the key issue that wins elections, and always has.

Optimism. 

Americans are by nature an optimistic people. We believe things can get better, that they will get better. We don't go in for the doom-and-gloom.

And that's all Republicans are selling.

Note to the media. Central Valley and East Side Baptist Church in Idaho are Southern Baptist Churches, members of the Southern Baptist Convention. American Baptists are a different crowd -- Roger Williams baptist vs. John C. Calhoun baptist. American Baptists were formerly known as Northern Baptist.