Sunday, July 26, 2009

Why is health insurance reform so hard?

Perhaps the most important change that the Obama administration needs to accomplish, and is in the process of accomplishing, is to change people's attitude toward government. Ronald Reagan led a revolution thirty years ago that managed to convince most of the American people that government is always bad, and that the private sector can do anything more efficiently than government. While people still understand at some level that we need the government to build roads, collect garbage, run schools, organize the military, inspect food and drugs, operate courts and prisons, and perform numerous other functions; at another level people are still deeply mistrustful of the government doing anything. I believe this deeply ingrained attitude, one that many politicians both respond to and often encourage, is the main reason why it is so hard to pass health insurance reform.

Because of the power of an ideology that says private industry does everything better, many people simply refuse to accept the evidence that other advanced countries spend much less and get much better results than our inefficient, hodge-podge of an insurance system. They hear the horror stories of families filing bankruptcy to avoid their medical bills, or of being unable to change jobs because of health insurance, or of being denied insurance because of a pre-existing condition. They know that the tens of millions of uninsured are driving up costs for the rest of us. Yet with all its flaws, people will still believe that what we have must be better than any solution the government can devise, simply because the current system is mainly privately-run, and any reform must come from the government. Many people cannot be convinced otherwise.

It may be tempting to some to believe that the opposition to health insurance reform proceeds from evil or corrupt motives (see for example this post on Daily Kos), but I prefer to think of it as simply blinded by ideology. Certainly there are some Republicans who see the health care debate purely as a political struggle. Senator De Mint's comment that defeating health care reform was a means of defeating Obama seemed to be an example of that. There are people who put political victories ahead of crafting legislation that benefits people and reflects their needs and wants. But there are other forces at work in the opposition too: a sincere belief that the cure must be worse than the diseased system that we have, a fear of changing a system that does work for a lot of people.

How else to combat this attitude other than the patient, consensus-building approach that the President's team has been using to get us so close to passing a major reform bill? Some would rather force a solution down the American public's throats. I think it is better to continue to work to change people's entrenched attitude that government can't do anything right.


  1. Administrative costs for the health system the U.S. government does run is about 60% higher than with private companies. And that excellent healthcare system you read about in other countries leaves out how long people wait to see the doctor or the drugs that they are not allowed to use.

    As far as government doing things worse than private industry I think we only need look at the wasted taxpayer monies that went into the stimulus and how this is buying ham for twice as much as it costs in the store, for example.

    Amtrak, another government funded creation, loses money every year and is forced to run routes that lose money and carry few passengers. The government also wastes money to pay for airline companies to serve small airports where in some cases it is faster to drive. Obama requested, and got, a 40% increase for this government waste project.

    Government might fight wars better and collect taxes better but everything else, well, no.

  2. Thank you, Harrison, for helping me make another point, which is that sometimes people in this health care debate seem to be talking past each other. If I trot out the parade of horribles about our current health care mess, you respond with a parade of horribles about how people supposedly have to wait longer for a doctor in France, and how Amtrak requires a taxpayer subsidy. What we should really be talking about is how to fix the current system.

  3. My response was in reply to this point of yours:

    "and that the private sector can do anything more efficiently than government."

    The government cannot run what it already has much less some new system.

  4. I have analyzed this from an economic perspective. Imagine you are a health insurer....