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THE HAITI OF THE DEVELOPED WORLD! Haiti suffers under vast burdens. Among the world’s developed nations, aren’t we a bit like that? // link // print // previous // next //

Last call: Our first-ever fund-raising drive ends today, with this last call. You’re right! Given the disaster unfolding in Haiti, this turned into a slightly awkward week for our first-ever drive.

That said: We hope you’ll sample Chapter 1 over at our new site. Chapter 2 will soon follow.

We suspect that our focus over here at this site will be changing a bit this year. Conditions have changed since we started this site, almost twelve years ago.

At that time, the mainstream press corps was misbehaving badly—was running wild—in ways it isn’t quite doing today. Then too, a liberal/progressive world has sprung up to challenge its ongoing failures, along with those of the conservative press. In 1998, there was little noise coming from left of center in our political/journalistic fights. Today, we have a vibrant, noisy liberal/progressive world—although our famous liberal journals still sometimes seem a bit tame.

Given the rise of a liberal world, how can we craft winning plays?

Will Brown beat Coakley in the Bay State? We have no idea. But the fact that the question is being asked helps us see how easily progressive impulses can be swatted aside. Yes, we’re in a profound economic mess; that has helped create a difficult political environment.

But in our view, the health care discussion of the past year has often displayed the weaknesses of the liberal/progressive world, as well as the weaknesses of the mainstream press. How can we craft a winning long-term strategy? Branching out from our original focus, we’ll likely discuss that this year.

In 1998, the MSM was the straw that was stirring the drink. The playing-field is more crowded now. Over at the other site, we’ll be discussing the history of the Clinton/Gore era. Over here, our discussion will probably widen out from the mainstream press.

If you think those discussions might be worthwhile, we’ll ask you to consider a contribution. Analysts want a new pair of shoes! After twelve years in their old Buster Browns, can we really blame them?

Last call on Game Change: We had planned to do another day on the silly chatter which dominated cable this week, before disaster struck in Haiti. Instead, we’ll recommend that you read Joan Walsh, who talks about “gossip” in much the way we spoke about “novels” this week (see THE DAILY HOWLER, 1/14/10).

In the last few decades, this kind of gossipy novelization has often taken the place of news, in ways which have been destructive. Way back in March 2000, E. R. Shipp, then the Washington Post’s ombudsman, used slightly different language to describe similar work in the Post: She said it was like the Post’s reporters were “typecasting” a “drama” as they picked-and-chose the facts they would print about the four major White House contenders (Bush, Gore, Bradley, McCain). In our view, liberals need to find the best language with which to warn the public about this childish form of pseudo-journalism. And we need to avoid a temptation—the temptation to adopt these same techniques as we critique the other side’s leaders.

In the long term, we don’t think that’s a winning play. But for today, we’ll suggest that you read Joan Walsh. This topic will come up again.

THE HAITI OF THE DEVELOPED WORLD [permalink]: What happened to health care reform in the past year? In this morning’s Washington Post, Charles Krauthammer offers an explanation which is accurate in some major ways, but is also full of ironies. In this passage, Krauthammer starts to explain why President Obama’s approval ratings have fallen:

KRAUTHAMMER (1/15/10): Then, the keystone: a health-care revolution in which the federal government will regulate in crushing detail one-sixth of the U.S. economy. By essentially abolishing medical underwriting (actuarially based risk assessment) and replacing it with government fiat, Obamacare turns the health insurance companies into utilities, their every significant move dictated by government regulators. The public option was a sideshow. As many on the right have long been arguing, and as the more astute on the left (such as The New Yorker's James Surowiecki) understand, Obamacare is government health care by proxy, single-payer through a facade of nominally "private" insurers.

At first, health-care reform was sustained politically by Obama's own popularity. But then gravity took hold, and Obamacare's profound unpopularity dragged him down with it. After 29 speeches and a fortune in squandered political capital, it still will not sell.

“Gravity took hold,” Krauthammer says—failing to note that gravity was helped by claims about “death panels” and the like. But we were struck by Krauthammer’s scolding claim in this passage—the claim that Obama’s proposed reform “turns the health insurance companies into utilities.” That strikes us as a remarkable stretch, but the irony comes when we consider a basic fact: In several other developed nations with health care systems more successful than ours, insurance companies actually are run like public utilities! These systems do work through insurance companies—but the companies are non-profit, and they’re heavily regulated. Perhaps as a result, these countries spend vastly less than we spend on health care, per person. But despite the vastly lower level of spending, everyone is insured in these countries—and these countries achieve health outcomes which are roughly the same as ours.

Sometimes better.

Some countries do treat insurance companies as public utilities! Judged by twin measures of outcome and cost, their systems are vastly better than ours. But do American voters know these things? How many Post readers will see the irony in Krauthammer’s claim, in which he seems to assume that it’s an obvious bad thing to treat insurers this way?

We’d guess that few readers will see that irony. You see, our country suffers along with a badly broken political infrastructure. Our big news orgs made little effort this year to describe the way other countries do health care—to describe their stunning low levels of spending; to describe their strong health outcomes; to explain where our vast spending goes. When the New York Times described the Swiss health system (right on page one), it stressed the fact that the Swiss system has no “public option.” But the Times failed to note another key fact: The Swiss heavily regulate their insurance companies—run them like public utilities. (See THE DAILY HOWLER, 10/2/09.)

This was one of the Times’ only attempts to describe the foreign experience—and the report might as well have been written by the insurance industry itself. Partial result? Three months later, Krauthammer is free to roll his eyes at the very idea of treating insurance companies like a public utility. Good lord! Who would ever do that, the gentleman seems to say.

“Obamacare turns the health insurance companies into utilities?” Well actually, no—not really. But Krauthammer feels free to assume that this would be a very bad thing. He’s free to argue that way because of our broken political infrastructure.

In the wake of the Haitian disaster, many observers have lamented the millstones around Haiti’s neck—its poverty, its limited physical infrastructure, its broken political culture. Suffering Haiti has long been the western hemisphere’s political/economic basket-case, many observers have said.

But in many ways, we’re the Haiti of the developed world when it comes to political culture. Our political culture is virtually defined by a long string of potent deceptions. (National health care has failed everywhere it’s been tried!) The Papa Docs of American culture have pimped these doctrines for the past fifty years. They leave us the political basket-case of the developed world, as this past year’s health care “discussion” has once again clearly shown.

(Go ahead. Go back and review that pitiful, isolated attempt by the Times to describe the foreign experience, through the Swiss example.)

When it comes to political culture, we are the developed world’s version of struggling Haiti. Consider Paul Krugman’s column today—a piece about the ongoing need for vibrant bank regulation.

In this passage, Krugman explains how our recent financial disaster occurred. This week, Haiti suffers through massive disaster. Krugman uses the same word here, describing a wealthier nation:

KRUGMAN (1/15/10): Consider what has happened so far: The U.S. economy is still grappling with the consequences of the worst financial crisis since the Great Depression; trillions of dollars of potential income have been lost; the lives of millions have been damaged, in some cases irreparably, by mass unemployment; millions more have seen their savings wiped out; hundreds of thousands, perhaps millions, will lose essential health care because of the combination of job losses and draconian cutbacks by cash-strapped state governments.

And this disaster was entirely self-inflicted. This isn’t like the stagflation of the 1970s, which had a lot to do with soaring oil prices, which were, in turn, the result of political instability in the Middle East. This time we’re in trouble entirely thanks to the dysfunctional nature of our own financial system. Everyone understands this—everyone, it seems, except the financiers themselves.

There were two moments in Wednesday’s hearing that stood out. One was when Jamie Dimon of JPMorgan Chase declared that a financial crisis is something that “happens every five to seven years. We shouldn’t be surprised.” In short, stuff happens, and that’s just part of life.

But the truth is that the United States managed to avoid major financial crises for half a century after the Pecora hearings were held [in the 1930s] and Congress enacted major banking reforms. It was only after we forgot those lessons, and dismantled effective regulation, that our financial system went back to being dangerously unstable.

We brought on our recent financial disaster when we “dismantled effective regulation,” Krugman explains. That said, we’ll disagree with one claim from this passage. “Everyone understands this,” Krugman says—“everyone, it seems, except the financiers themselves.”

We’d tend to disagree with that statement. We’d guess that many voters don’t quite “understand this.” Here again, we’d blame the problem on our broken political infrastructure, which is enabled by us.

How many voters could offer a coherent account of the run-up to our recent financial disaster? Very few, we would guess; we’d count ourselves among them. But here, as elsewhere, public instincts are strongly shaped by the potent string of talking-points churned from the right in the past fifty years. Many such talking-points stress the way the “free market” works its inviolable wonders. (And of course: Big government never did anything right!) But how good a job has our side done in the past fifty years, explaining the obvious need for sensible, sane regulation?

Has government never done anything right? Does regulation defeat the free market? The red lights for which you stopped today represent “regulation” by “big government;” would anyone really want to unplug them? That said, has our side ever developed the frameworks which might help the average citizen grasp the obvious need for sane regulation? Have we ever developed winning frameworks—familiar narratives which defeat the pathologies conjured by the other side?

The other side has developed high-quality dramas concerning “big government” regulation. In these dramas, such regulation is done by “federal bureaucrats” who intrude upon us, the people. In Krauthammer’s familiar language, they regulate “in crushing detail,” working “by government fiat.”

The dramas implied by this language are of course quite familiar. What dramas has our side ever produced—dramas designed to tilt the voter in a more sensible direction?

In our view, winning dramas would be built around the notion of flawed human nature. As a general tendency, Americans want to let the market proceed—but Americans also know about the failures of human nature. Absent sensible regulation, we the people may be inclined to overdo our quest for success. In our view, everyone really does know about this part of our nature. Everyone knows that our human nature calls for some brakes here and there.

In our history, “big government” once “regulated” children out of factory sweatshops. Except you wouldn’t call that “big government.” That’s something you’d want to occur.

We failed to regulate in the 1990s, as Krugman winningly says. Millions of lives have been harmed in the process. But has our side ever sought to tell that story in ways the average voter will grasp? The other side keeps churning its tropes, about government fiats, distant bureaucrats, free markets. What are the stories which our side has told? When will we think them up?

In political terms, we’re the Haiti of the developed world, a nation forced to fumble ahead despite a deeply unfortunate infrastructure. Our politics is built on familiar, bogus claims, the kinds of deception which lead to disaster. The health care discussion of the past year shows us as the world-class joke we actually are. Obama wants to treat insurance companies like public utilities! So Krauthammer has claimed today. He’s confident that our political culture is so broken that his readers won’t rise to say this:

But isn’t that what the Germans have done? And don’t they spend less than half what we spend? And don’t they get better health outcomes?

T. R. Reid discusses the German health system in The Healing of America (chapter 5). But have you seen the German health system discussed, even once, in the Washington Post or the New York Times? Our political culture runs on dumb, a point on which Krauthammer’s column depends.

Partly, that’s due to the Post and the Times. Partly, it’s due to us.

Reid does Dusseldorf: Reid devotes chapter 5 of his brushed-aside book to the German health system. An excerpt:

REID (page 67): In its home country today, the Bismarck health care system guarantees medical care to just about all 82 million Germans and to millions of “guest workers,” legal or not, who live in the country. The package of benefits is generous, covering doctors, dentists, chiropractors, physical therapists, psychiatrists, hospitals, opticians, all prescriptions, nursing homes, health club memberships, and even vacation trips to a spa (when suggested by a doctor). The quality of care is world-class; Germany stands at or near the top in all comparative health care studies. Because the supply of hospitals and doctors is ample, there’s no “queue” for treatment; on measures such as “waiting time for elective/non-emergency surgery,” Germans spend less time waiting for care than Americans do. Patients can choose any doctor or hospital, and insurance must pay the bill. And every German has a choice among some two hundred different private insurance plans, which compete vigorously even though the prices for insurance are fixed.

Please note: “Insurance must pay the bill” and “the prices for insurance are fixed” because the German system treats these companies as if they were public utilities. By the way, here’s the relevant per-person spending from 2007:

Total spending on health care, per person, 2007
United States: $7290
Germany: $3588

Astonishingly, the German health system was not discussed in the Post or the Times last year. Then again, did you see it discussed in our “liberal journals?”

Can you see why it’s easy for Charles to roll his eyes at the very idea of treating insurance companies like a bunch of public utilities?

We’ll close with a point we don’t understand. Here’s an excerpt from Ezra Klein’s blog at the Washington Post:

KLEIN (1/14/10): There are two things going on with health-care costs. The first is that we spend a lot right now. In 2008, we clocked in at $2.3 trillion. That's a lot of money. But the other problem is that that sum is growing by quite a bit every year. A normal year sees 8% or so growth.

We can afford $2.3 trillion. We can't afford $2.3 trillion after 20 years at 8% growth (which would be $10.7 trillion, if my calculations are correct).

To get costs under control, we have to change the 8%, not the 2.3 trillion.

“We can afford $2.3 trillion,” Ezra says. He goes on to say that we need to adjust the rate of growth in that spending. When it comes to that $2.3 trillion baseline? Pshaw! Nothing to look at! Move on!

Might we note an obvious fact? That $2.3 trillion represents a more-than-100 percent mark-up over the German rate of spending—a rate of spending which produces the health care system Reid describes in that passage.

We can afford that rate of spending? Why would progressives (or anyone) reason like that? Why do we tolerate same?