Why Getting Health Care Passed Is Insanely Difficult

Picture our health care system as a spider web at the top of a tall redwood tree.

Both the public and the special interests know they can't stay in the web forever, lest they be eaten. But at the same time, no one wants to be the first one to cut up their own part of the web for fear of falling to their deaths.

And herein lies the problem with current reform efforts: While our health care system threatens to bankrupt us all, it remains enormously profitable for insurance companies, pharmaceutical companies and hospital chains. Such key special interests have banded together to kill national health insurance plans time and time again, from the progressives' proposals during the Wilson era to Truman's health care plan in the 1940s to Clinton's failed reform effort in the 1990s.

At the start of his presidency, Barack Obama thought he could succeed in reforming our health care system by essentially bribing the different factions opposed to reform by promising to keep intact the inefficient portions of the system most beneficial to them. This is why we're not going to tax employee health benefits to start weaning people off the bloated and inefficient employer-based system, why we're not looking seriously at changing incentives for how doctors get paid and even why it's increasingly unlikely that we'll end up with a publicly funded health care plan to compete with private insurers.

Even with these concessions, the special interests are working behind the scenes to make sure that Congress doesn't snip out their goodies.

The New York Times reported earlier this month that the pharmaceutical industry is fighting a provision that would fund studies to compare the effectiveness of their products for different treatments. Again, consider the implications of this: The drug companies want us to continue paying them top dollar for drugs that might not even work as well as advertised.

The hospital lobby, meanwhile, is trying to kill a proposed Medicare-oversight board that would be charged with, you guessed it, trying to weed out inefficiencies in the system. Even though everyone acknowledges that our health care system is on a fiscally ruinous course, nobody wants to make the real sacrifices that would put it on a marginally more sustainable path.

All that said, it is somewhat understandable why the Obama administration has gone down the path it has taken so far.

If the current version of health care legislation passes, it will indeed provide coverage for tens of millions of uninsured Americans, and it will cap out-of-pocket expenses to ensure that far fewer people go bankrupt trying to pay for treatment. It will also bar insurers from discriminating against people with pre-existing conditions and will stop insurance companies from rescinding coverage.

These are very important policy goals for progressives, and it can be argued that Obama's strategy of bribing the special interests, despite being unsustainable in the long run, has gotten us closer to attaining them than the strategy of any prior administration. As sad as it might be to admit, it could really be the best we can do for the time being.

Of course, that doesn't mean that anyone should become complacent if reform passes, since it's unlikely to do much to contain health care costs. Bringing about significant change to our health care system -- whether it comes in the form of a single-payer system or a system of tightly regulated private nonprofit insurers -- is going to require a long-term siege war against the status quo. And this means we need to have a liberal messaging machine that tells Americans in no uncertain terms that our current system is ripping them off and that better alternatives exist.

Why is this necessary, you ask? Because the health care industry has done a remarkable job of pumping decades' worth of propaganda into our public discourse, thus making anything remotely resembling universal health care unthinkable in American society.

As sociologist Paul Starr has documented, efforts to implement universal health care have been attacked as sinister plots hatched by foreign powers since the early 20th century.

When progressives were pushing for a compulsory health insurance plan during World War I, for instance, right-wing lobbying groups accused them of trying to undermine the American way of life by introducing a subversive foreign concept onto our shores. Indeed, one pamphlet at the time described universal health care as "a dangerous device, invented in Germany, announced by the German emperor from the throne the same year he started plotting and preparing to conquer the world."

And once the Soviet Union became America's No. 1 foe after World War II, of course, reformers were tarred as communist sympathizers, or worse. One particularly famous example came in the late 1940s, when Ohio Sen. Robert Taft described President Harry Truman's universal health care plan as "the most socialistic measure this Congress has ever had before it" and even suggested that it had come straight out of the Soviet constitution.

Seen in this light, the only surprising thing about our current health care debate is that reform opponents have yet to claim that universal health care is a backdoor policy for converting America to Islam.

Nearly a century of relentless propaganda has convinced Americans that our health care system is actually the best system in the world (it isn't) and that all national health care systems are bankrupting their countries (they pay less for health care than we do). Part of this is also embedded into our cultural DNA: Americans wrongly believe that we have the world's best health care system because we like thinking of ourselves as the best at everything.

And to be fair, we Americans have a lot to be proud of: in addition to prevailing in two world wars and the Cold War, America has brought the world the cotton gin, the electric telegraph, the electric light bulb, the airplane, the moon landing, the Internet, jazz, rock 'n' roll, hip hop and all the world's biggest blockbuster films.

But our health care system is not Miles Davis, Raiders of the Lost Ark or the Chevy Corvette C3. Our health care system is Kevin Federline, Waterworld and the AMC Gremlin. Our ability to spend 16 percent of our gross domestic product on health care and still leave tens of millions of people uncovered is not something the rest of the world looks upon with a mix of envy and awe. Rather, it's something that makes them crinkle their eyebrows and say, "Dude. For real?"

But if reformers ever hope to change our basket-case health care system, they will have to repeat these simple truths over and over again to our fellow Americans until they realize that they're getting ripped off.

For, unless we collectively realize the breadth and depth of our current health care disaster, we will never be able to fundamentally change it for the better. It's going to be a long haul.


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