Michael Gerson has a sensible take on current Democratic efforts to reform health care -- by which I mean, of course, that Gerson has written something that I largely agree with. President Obama's health care reform is not dying because of persistent nonsense regarding death panels. Death panels are a favorite bete noir of some Democratic supporters, but, in reality, they are little more than chat noir. They are a distraction. The folks who believe these kinds of rumors are not going to support any Democratic-led health care reform effort.
The reasons why more Americans oppose* the Democrats' reform proposals than support them is much more pragmatic -- and far more problematic to Obama and the House Democrats. It's that many folks, all things being equal, will take the devil they know** over the devil they don't. Or, as Gerson says in considerably more words:
Why is comprehensive health reform so difficult? Some structural challenges have complicated this issue since the days of Harry Truman. Because there are vastly more people inside the current health-care system than outside of it, the majority tends to be risk-averse and suspicious of efforts that might benefit the minority at their expense. ....
Obama's massive spending, intended to stabilize the economy, also drained the Treasury, making it more difficult to propose major new expenditures. Deficit estimates of $9 trillion over 10 years have raised the prospect, according to Warren Buffett, of an American "banana republic" -- endlessly printing money, weakened by inflation and abandoned by foreign bond investors. ...
Yet, the sales job in favor of health care reform has been largely a game of defense. Aside from claims that the House version health care reform would bend the cost curve -- a claim that turned out to be false -- there's been nary a positive case made for it. (Well, at least not a competent case -- more on that below.)
That's a massive problem when you're proposing a new government program: You've got to explain why the new purchase is necessary; why it's better than what we already have. You've got to sell the new program.
There hasn't been such a sales job. Saying that the "public option" won't kill public insurance because public insurance will be just like the Post Office is an argument against public insurance-- not in favor of it. And proposing that we expand coverage is not enough. You have to show that current coverage won't be diminished. Put another way, when people worry about rationing, it's not enough to say that we're rationing under the current system. Of course we are. You have to explain how rationing will be different under the new proposal. How will it affect the overwhelming majority of voters who already have health coverage? Notably, "trust us, you'll be OK" is not a compelling answer.***
Similarly, when people worry whether cuts will disproportionately fall on the elderly, it's not enough to complain about lies and death panel scare tactics. How does the new plan answer President Obama's "very difficult" question: "Whether, ... society making those decisions to give my grandmother,.... a hip replacement when [she's] terminally ill is a sustainable model"? That is a very difficult question, and one that should be asked. Pity that no one seems to want to provide an answer -- most of all the Democrats.
As I've written before, I support health care reform under the bipartisan Wyden-Benett plan. In part, that's because Wyden-Bennett has answers to many of these questions -- even if the answer is that the new system will have many of the same advantages and disadvantages as the current system. Until supporters of the House plan do something like what Sens. Wyden and Benett did -- i.e., do more than just play defense -- the opposition to any reform effort, and the House reform effort in particular, is going to continue to grow.
*See Question No. 7. Even worse for the Democrats is that the number of strong opposers greatly outnumbers the number of strong approvers, 47% to 27%.
**Question 9: about 85% of Americans have health insurance or coverage under the current system.
***Yes, this is a selfish concern: You expect voters to suddenly become altruists, and vote en mass against their self interest?