Healthcare Reform Response

First, thanks for having me aboard. For those of you who don't know me, I went to UGA with James and Channing, studied philosophy and religion, taught English in China, and now I'm at Boston University School of Law.

Martha Coakley is a grad of BU Law. My school has a big health law and policy program. We're in Massachusetts, state healthcare capital of the country. In the wake of Coakley's defeat, my classmates were aghast. Clearly this program is in the interest of the American people, so why are they not getting behind it? Our system is broken. We pay the most for healthcare yet have terrible mortality rates. Millions of Americans can't even get healthcare.

I think all the factors Alex identified are the most important in the public's response to this legislation, but I'd like to add that the timing and order of taking on this part of the administration's agenda played a large part in its failure. Obama followed a huge deficit-spending programs in the stimulus, TARP, and cash-for-clunkers with something that could be labeled another big-government spending program. Had Obama devised a plan for balancing the budget in the medium-term, realigned the incentives that lead to systemic risk in the financial markets, and then addressed this pet project, things likely would have gone better.

The Obama supporters I talk to account for this decision making by arguing that he wanted to tackle this while he had the political capital. This was a big part of his platform for the left, healthcare needed to be addressed, and this was his best chance to do it. That may be true, but these arguments are based on political realities and ignore the realities outside of Washington and dissonance of such policies with the experience of Americans in the recession. In other words, [insert generic statement about how Washington is detached from Main St.].

First, the economy and financial reform are the far more pressing issues, both immediately and long-term. With the dotcom and subprime busts, Americans have been subjected to upheaval in their daily lives twice in the last decade for which they bear no personal responsibility. Surely there was the political will to regulate finance in a way that affords the benefits of finance without harming borrowers or economic stability. Now, I doubt the idea of strengthening or creating new regulatory bodies will have much appeal; it will just be another example of Democrats and big-government spending, taking away economic freedoms, and suffocating growth. Healthcare has been this way for while and could wait while we attached some meaningful conditions to the government guarantee of the financial system. I'm afraid that we will be left with an explicit guarantee and the same business models that do not contribute to substantive economic growth, reward high-risk profits made in the short term, lead to market volatility, and unscrupulously extract billions of dollars from consumers of financial products.

Second, Americans that are largely tightening their belts see this program as the exact opposite of what they are trying to do in light of the crisis. While people are trying to save and cut spending, the government is paying for a new healthcare system. Some people are making decisions on whether they really need to spend any money to see a doctor, so healthcare seems to be less of a necessity right now. The trade offs that individuals are making exposes the flawed premise in the Democrats' rhetoric, that healthcare is right and not a luxury.

The best argument that I've heard on healthcare not being a right is that healthcare is service and a good created with someone else's labor, and in a system of private property, no one has the right to someone's labor or property. I think its a pretty strong argument against positive rights in a capitalist system, but the core problem is that positive rights can't be a right in any universal sense when there is scarcity. Once you declare something a positive right, be it food, water, housing, clothing, or healthcare, the realization of that right comes at the expense of realizing another right. Maybe what is meant in calling healthcare a right is that things aren't so scarce that this need should never go unmet, but if that is the case, then the debate needs to be in these terms. The Democrats should do away with this rhetoric of rights and address the issue on purely economic/utilitarian terms. At heart, I don't think the two parties are far apart ideologically, and the Democrats could beat the Republicans on their rhetorical terms.

On a personal level, the process of healthcare reform reinforces my misgivings about the Obama administration. Despite the high-minded principles of his campaign, Obama has been a cripplingly pragmatic politician. The mammogram hoopla embodies these failures. The decision to raise the age of exams to 50 was a reasoned, utilitarian policy, but after getting pushed by the public and biotech manufacturers, that policy is gone in the final bill. The bill got through on back room deals with the healthcare industry. I'm disappointed in myself for drinking the Obama kool-aid and thinking he was above the political fray. The Republicans were right to condemn the Democrats for shutting them out of the debate and cutting deals (even though its how they make a living) because the political system needs to change its method of discourse and governing processes.

This bill is done. Scott Brown ran his campaign explicitly on voting against healthcare, and there is no way the moderate Democrats and those up for reelection stay on board. The administration will likely try to compromise and water the bill down to save face, but the chance for meaningful reform is over. I think this really was Obama's Waterloo.

Clark Howard has some interesting nuggets of thought on healthcare reform and the Massachusetts plan from a consumer prospective. http://clarkhoward.com/liveweb/shownotes/category/9/67/