Barring disaster: Barring some sort of technical disaster, we’ll be starting a second site next Tuesday. We’ll resolve to do better this year. And we’ll hit you up for cash, just like you’ve always wanted.

Special report: After reform!

Read each thrilling installment: After health care reform, we’ll need health care reform! Why not read each installment:

PART 1: After reform, we’ll need health care reform! How can we win the next time? See THE DAILY HOWLER, 1/5/10.

PART 2: If we want stronger reform the next time, we have to start telling the people. See THE DAILY HOWLER, 1/6/10.

PART 3: Next time around, progressives should push the other moral argument. See THE DAILY HOWLER, 1/7/10.

In today’s installment, we see why we’ll likely always have health care reform:

PART 4—A TALE OF TWO LETTERS: Gaak! If Bogey and Bergman will always have Paris, most likely we’ll always have health care reform. If Congress passes some form of the current bill, many more people will have insurance. But will our massive over-spending really be addressed by the bill? We’d have to guess that it will not—that future reform will be needed for that. And winning reform will be hard to achieve, unless we start to work for it now.

Winning reform will be hard to achieve. Consider the e-mail we received from a reader, just yesterday:

E-MAIL (1/7/10): In November, I moderated two focus groups for our local Democratic organization to learn more about how voters feel about various issues. Health care was top of mind with many of the participants. However, we didn't delve into cost comparisons vs. other countries (not part of the purview). But after our session was completed, I had a chance to talk to a few of the people. Of the four people I spoke with, not one knew that the U.S. spent 2x-3x as much as the rest of the western world. In fact, by their reactions and questions, it seemed like they thought I was making up the numbers:

"What do you mean 'per capita'? Is that everybody or just insured people? Those numbers don't sound right. Where do they come from?"
Over the holidays, I attended a number of parties. I took the opportunity to ask folks how much they thought we spent per capita compared to France or Japan. No one had a clue. And when I told them the numbers, they also indicated that they thought I was exaggerating.

However, at one party, a friend was talking about how his son had recently fallen and broken his arm. The bill was some ridiculous amount...Everyone was aghast. I sprung the $7200/US, $3600/France, $2800/Japan numbers and this time, not as much disbelief. It was more "that's outrageous." One guy did question where the numbers came from and what exactly did "per capita" mean.

We didn’t attend those focus groups or those parties. We can’t confirm the reactions the writer reports—nor did he speak to a scientific sample of American voters! But do voters know how much extra money we spend for health care, as compared to other developed nations? Do they know that those other nations get health results that are much like ours?

We’d be amazed if voters knew such things. In large part, this is due to the way two tribal groups have behaved in the past forty years.

One tribe has spread disinformation around, through familiar sound-bites. Voters have heard these bites again and again. After that, they’ve heard them some more:

• We have the best health career in the world!
• Socialized/national/European health care has failed everywhere it’s ever been tried!
• Big government never did anything right!
• Good God! Those waiting lines in Canada!

In response, our tribe has tended to say the following—and has tended to say little more:

• 47 million remain uninsured!

Our side tends to argue so poorly, Obama had to scale that number back this year, eliminating 16 million illegal residents from the total. (The other tribe scored some points with that fact.) So let’s be candid: Why would anyone at those parties know how much the French spend on health care? Why would they know about European health outcomes—or about waiting lines in Canada? Our tribe has never quite gotten around to addressing such tedious points. And the mainstream press corps broke its backs avoiding such discussions this year.

(Here at THE HOWLER, we’ve come to respect Ed Schultz’s basic approach to politics. But gaak! To recall his response to the “waiting lines” sound-bite, see THE DAILY HOWLER, 7/2/09. We’ve come to respect this man’s approach. But prepare to avert your gaze!)

Most likely, we’ll always have health care reform in this country—in part, because the “liberal” world tends to do such a poor job with the topic. Our poor performance continued in the past few years—even after Michael Moore’s movie—as the liberal world returned to life after some decades of dormancy. Alas! Those focus group people heard little from us about the way they get ripped in health spending. If “no one had a clue” at those holiday parties, it was in part thanks to us.

Those focus group people heard little from us about the way they get ripped in health spending. Instead, they often saw our tribe adopt the childish politics of the pseudo-right. This politics is devoted to calling the other tribe names—liars and hypocrites. This Monday night, Keith even adopted the pleasing term “traitor,” thus showing that we’re now prepared to screech just as loud as the rest.

It’s fun to spend your time calling the other tribe “hypocrites”—especially when our side is prepared to “improve” the various things they have said. (“Traitor” sends a thrill up the leg.) But this creates a politics of warring tribes—a politics of division and conquest. At present, both tribes are getting ripped off in their health spending. But our tribe has never shown much interest in explaining this fact to the other tribe. And when we build our re-emergence around loud screeching clatter, we help insure control by Big Interests.

The Big Interests will always be with us, hoping to undermine meaningful change. And so alas! If we remain two name-calling tribes, we’ll always have health care reform!

We thought these dark thoughts yesterday morning, as we read a pair of letters to the New York Times. These letters concerned a David Brooks column about the tea party movement. “Personally, I’m not a fan of this movement,” Brooks wrote. “But I can certainly see its potential to shape the coming decade.”

One letter came from within Our Tribe—from a letter-writer in Moose Lake, Minnesota. He knew all about the tea party folks. To our highly sensitive ear, he spoke the language of cable:

LETTER TO THE NEW YORK TIMES (1/7/10): I think that David Brooks allows the tea party too much consideration in his analysis of today’s political scene. The party is not organized around any single idea other than the thought that its members don’t like our president.

They get their inspiration and justification from the right-wing extremists who hang on the fringes of the Republican Party, and who continue to incite the groups but take no responsibility for the tea party activists’ actions.

Thus, when tea party members shout down members of Congress, or shout racist slogans, or hold racist signs, or openly carry firearms, or defend anarchy, Republican Party leaders opt to look the other way, or feign moral outrage.

The tea partiers are reactionary, and shrill out of fear. They are the bully on the playground. We just need to hold steady to show them up for what they are.

The Moose Lake man was ready to fight, in the way The Interests have always adored. (Divide and conquer!) As on cable, he quickly said “racist.” And right there in his opening paragraph, he explained that tea party folk have just one thing on their minds.

(Last summer, three or four tea party people “openly carried firearms.” Months later, they’re in his third paragraph.)

In our view, that letter represents a form of losing politics. At any rate, we were struck by this letter—because of the letter which appeared right above it. This letter came from a nascent tea party member—from a person in Tewksbury, Mass. For the record, this person is getting looted in his health spending, just like the guy in Moose Lake:

LETTER TO THE NEW YORK TIMES (1/7/10): I think that David Brooks is missing something here.

I am a 50-year-old husband and father of two. My wife and I vote and are not affiliated with any political party. We are not activists by any stretch of the imagination. Our idea of a good night is a good movie or a book and a comfortable chair.

We are both displeased with our government of late and are concerned about our nation’s future. Our Depression-era parents taught us to live within our means. And to keep our house in order. This is a lesson lost in Washington.

When the next tea party rally comes to our area, we plan on attending. If the tea party can get middle-aged people like us to brave the cold to make our voices heard, it is time for the Democrats and the Republicans to worry.

Are the Tewksbury Two just slobbering racists who hate Obama? We doubt it, though we don’t have the slightest idea. But those letters create an interesting contrast. And by the way: Has our tribe ever tried telling that Tewksbury man about our ludicrous health care spending? About where all that money is going? About health outcomes in the rest of the world?

About the looting which seems to afflict everyone, in both these tribes?

We must have missed that discussion this year—or in the past fifteen. In our view, our tribe has made very little attempt to create a real progressive politics around the issue of health care. And as a liberal movement has re-emerged in recent years, our leaders have often adopted the pleasing politics of tribal name-calling.

We’ll only say that real reform is hard to achieve in the midst of such politics. The Interests will always have powerful thumbs on the scales. If the public is split into two warring tribes, The Interests will have a leg up.

Our reaction? If we could wave a magic wand, we’d make the fellow from Moose Lake spend some time with the Tewksbury man—and we’d ask our e-mailer to join them. Because by the way: In all the clatter on last year’s cable, did either one of these voters ever encounter the sorts of things T. R. Reid wrote about French health care? About the remarkable state of that health care?

REID (pages 51-52): As a general rule, the French don’t have to wait in line to see a general practitioner or a specialist; waiting times are usually about the same as those for people with insurance in the United States. A key exception here is pediatricians, who are in short supply in France. That shortage disturbed a friend of mine, in the north Paris suburb of Bondy, who had to wait until her son was six weeks old before she could get an appointment with his pediatrician. As is standard in France, a post-natal nurse came to visit mother and child at home several times in the first weeks after the birth, for free. “And that was good,” the new mom told me, “but I wanted Samuel to meet his doctor!”

There’s almost no limitation on a patient’s choice in France. There’s no such thing as the “in-network” and “out-of-network” lists developed by U.S. insurance companies; under French law, every health facility is “in-network.” Any patient can go to any doctor, any specialist, any surgeon, and any hospital or clinic in the whole country, and the insurance system must pay the bill. If you feel sick, you can call an ambulance to take you to the doctor or hospital of your choice—for free. The French don’t have the “gatekeeper” system, common in the United States and several other countries, in which you have to get a referral form from a general practitioner before you can go to a specialist. The French tried to establish the gatekeeper process in 1997—it tends to save money for the system as a whole, because GP’s can filter out some problems that don’t need an expensive specialist’s care—but the public rebelled against this limitation on free choice. With the streets of Paris blocked by furious demonstrations of patients and doctors, the government caved, reaffirming the right of any French patient to see any specialist, anytime.

And France achieves all that at a reasonable cost. Of course, the French don’t consider their system cheap; their planners and politicians see only that nearby countries like Britain, Sweden, Italy, Spain and the Netherlands all spend less on health care than France does. This has spawned repeated campaigns for health care reform over the years. Compared to the amount of money the U.S. health system burns through each year, though, France’s system looks like a bargain. France spends about $3,165 per capita each year for a health insurance system that covers everybody; the United States spends more than $7,000 per capita and leaves tens of millions without coverage.

In a rational world, that’s an astonishing passage. (Those spending figures seem to come from the year 2005.) For the record, Reid’s book appeared last August. It got ten minutes of pseudo-attention from the mainstream press—and almost nothing from our own tribe. Searching Nexis, we find no sign that Reid ever appeared on any MSNBC program!

Gaak! Searching on the name of Reid’s book, we find exactly one hit in the past six months from this news channel. (In November, Senator Conrad mentioned the book during a day-time interview.) According to Nexis, Reid was interviewed on NPR, CNN, CBS, PBS—but not on our tribe’s fiery channel. Reid wrote a fascinating book—a book we very much recommend. But you didn’t hear about it one cable—at least on the channel that’s aimed at our tribe.

Gaak! Bogey and Bergman will always have Paris. Most likely, we’ll always have health care reform. We’ll always have that gigantic level of health care spending, floating around without explanation. Most likely, we’ll always have two screaming tribes—and focus groups in which voters know little or nothing about where their money has gone.

Most likely, we’ll always have the familiar sound-bites about that comically failed French system. A guess: We’ll never see our own tribe respond to these bites in an organized way.

We have a profoundly childish politics—a politics in which we even changed the name of french fries in a recent year. But is our tribe inventing a stronger politics? Check back with us in fifteen years, the next time we have health care reform.