IGNORING THE LADIES: The ladies Dormady seem to know what the talk about rationing means.
The ladies sat with CNNs John King as part of Sundays State of the Union. (They seem to be sisters. King didnt explain. See THE DAILY HOWLER, 6/17/09.) At Juniors Diner, over oatmeal with raisins, they kicked around their views on health care reform.
No, the ladies Dormady arent experts. But it wasnt long before both ladies explained what decades of rationing rhetoric have been designed to convey:
KING (6/14/09): We went to Junior's Diner. It's in Orlando, Florida. We sat down. Everyone at the table agreed on the urgencythe urgencyof doing something about health care. But getting them to agree on just what, that is a whole other matter.
KING: with the way we do health care in this country now, if anything?
BLANCHE DORMADY: I think that depends on the person. I, I haveI don't like the insurance. The insurances decide what you're going to have and what you're not going to have. And I certainly don't want thethe government to have that ability. And I like it to be private.
KING: Well, are you , are you Are you worried, though, that they will make it worse, the politicians will make it worse?
BLANCHE DORMADY: It will make it worse! But I'm not a worrier.
MARGARET DORMADY: I'm against healthnational health care. I personally don't have health insurance, because it is too expensive. But I want to get for myself what I need. I I don't want to be told what I can have and when I can have it.
The ladies Dormady arent health care experts. But it wasnt long before they expressed the fears that have been driven by decades of talk about health care rationing. To wit:
When it comes to health care treatments, Blanche Dormady doesnt want the government decid[ing] what youre going to have and what youre not going to have. Similarly, Margaret Dormady wants to get the health care treatments she needs for herself. She says the following, sounding like her apparent sister: I don't want to be told what I can have and when I can have it.
The ladies Dormady dont want to be told what health care they can have. More specifically, they dont want to be told by the federal government.
Essentially, these are the fears that get stirred, fairly or otherwise, by talk about health care rationing. The federal government will parcel out health care. Even if you can afford to pay for a treatment yourself, you will have to stand in a line, waiting for your chance. And of course, the politicians make everything worse. Blanche says this wont be different.
These are the images and the fears that get conjured by talk about rationing. In 1993, the Clinton proposal was met by claims that care would be rationedthat you wouldnt be able to buy the treatment you needed even if you could afford it. This talk about rationing has never died; like rust, conservative spin never sleeps. The fears it produces are still alive. On Sunday, the ladies expressed them.
The ladies Dormady arent health care expertsbut they do know what talk about rationing means. By way of contrast, David Leonhardt is major cheese at the New York Times. And, to judge from Wednesdays column, he has no earthly idea.
As we noted yesterday, Leonhardt started his piece like gang-busters, swearing hed get to the heart of the problem (see THE DAILY HOWLER, 6/18/09). Spirits soared in our warren of study carrels as Leonhardt said he was going to lick every bit of spin in the house:
LEONHARDT (6/17/09): Rationing.
More to the point: Rationing!
As in: Wait, are you talking about rationing medical care? Access to medical care is a fundamental right. And rationing sounds like something out of the Soviet Union. Or at least Canada.
The r-word has become a rejoinder to anyone who says that this country must reduce its runaway health spending, especially anyone who favors cutting back on treatments that dont have scientific evidence behind them. You can expect to hear a lot more about rationing as health care becomes the dominant issue in Washington this summer.
Today, I want to try to explain why the case against rationing isnt really a substantive argument. Its a clever set of buzzwords that tries to hide the fact that societies must make choices.
At first, Leonhardt seemed to know whereof he spoke. Rationing sounds like something out of the Soviet Union, he saidseeming to know what was in the minds of the ladies Dormady. His reference conjured an uncaring bureaucrat, unfeelingly doling out access to care. And then, he said that he would try to explain why the case against rationing isnt really a substantive argument. Its a clever set of buzzwords!
Our analysts sat erect at their desks, eager to see what Leonhardt would say. But alas! Leonhardt wandered all over the countryside. It was all downhill from there.
The ladies Dormady seem to know what those rationing buzzwords mean. As usual, it seems the Times doesnt.
Leonhardts ramble: Perhaps someone should have rationed Leonhardts word-count He was given more than 1200 wordsquite a few by hard-copy standards. As a result, he rambled all over the countryside, speaking to this, that and more. But did the gentleman ever go where the rubber meets the road? The ladies Dormady had voiced the fears involved in decades of talk about rationing. Leonhardt rambled all over the world. But he ever get back to the fears expressed at Juniors? To the big plates of unformed mush King politely described as oatmeal?
Frankly, we cant really find the place where Leonhardt addressed the ladies concerns. (Go ahead. Search for yourselves.) That said, we can suggest a few ideas about how not to tangle with buzzwords.
First, if you going to tangle with decades of buzz, its best not to get highly theoretical. Its probably best to avoid getting metaphoric. And its best not to argue ironically. The ladies had expressed a clear set of fears. As he continued, Leonhardt showcased his various skillsbut where did he speak to their specific worries? We show you his paragraphs 6-10, in which he starts to wander:
LEONHARDT (continuing directly): In truth, rationing is an inescapable part of economic life. It is the process of allocating scarce resources. Even in the United States, the richest society in human history, we are constantly rationing. We ration spots in good public high schools. We ration lakefront homes. We ration the best cuts of steak and wild-caught salmon.
Health care, I realize, seems as if it should be different. But it isn't. Already, we cannot afford every form of medical care that we might like. So we ration.
We spend billions of dollars on operations, tests and drugs that haven't been proved to make people healthier. Yet we have not spent the money to install computerized medical recordsand we suffer more medical errors than many other countries.
We underpay primary care doctors, relative to specialists, and they keep us stewing in waiting rooms while they try to see as many patients as possible. We don't reimburse different specialists for time spent collaborating with one another, and many hard-to-diagnose conditions go untreated. We don't pay nurses to counsel people on how to improve their diets or remember to take their pills, and manageable cases of diabetes and heart disease become fatal.
''Just because there isn't some government agency specifically telling you which treatments you can have based on cost-effectiveness,'' as Dr. Mark McClellan, head of Medicare in the Bush administration, says, ''that doesn't mean you aren't getting some treatments.
Instantly, Leonhardt turns theoretical. In truth, rationing is an inescapable part of economic life, he offers, speaking from Olympian heights. We even ration lakefront homes, he is soon sayingalthough, in fact, we actually dont, at least not in any way thats relevant to the ladies concerns. In this country, if you want a lakefront home and you can afford it, you can damn straight go out any buy such a home. No government bureaucrat says you cant. (So too with the best cuts of steak.)
The ladies Dormady are afraid it wont work that way with health care.
The ladies Dormady are afraid it wont work that way when it comes to medical services. Among other things, the ladies fear that you wont be able to get a procedure even if you can afford to pay for it. This claim was made quite explicitly in the days of the pseudo-debate over the Clinton health care proposal. Leonhardt, in only his sixth paragraph, has wandered far away from the actual fears driven by actual buzzwords.
By paragraph seven, he has turned metaphorical. Already, we cannot afford every form of medical care that we might like, he says. So we ration. But hes now speaking metaphoricallyand the ladies Dormady arent. Hes talking about rationingand theyve heard about rationing. Real, flat-out, Soviet-style rationing. Rationing where a government bureaucrat says you cant get that procedure.
They arent afraid of something that resembles rationing. Theyre afraid of the real hard-core deal.
Before long, Leonhardt is waxing ironical. This is how he finishes the first half of his column:
LEONHARDT: On Wednesday, a bipartisan panel led by four former Senate majority leadersHoward Baker, Tom Daschle, Bob Dole and George Mitchellwill release a solid proposal for health care reform. Among other things, it would call on the federal government to do more research on which treatments actually work. An ''independent health care council'' would also be established, charged with helping the government avoid unnecessary health costs. The Obama administration supports a similar approach.
And connecting the dots is easy enough. Armed with better information, Medicare could pay more for effective treatmentsand no longer pay quite so much for health care that doesn't make people healthier.
Mr. Baker, Mr. Daschle, Mr. Dole and Mr. Mitchell: I accuse you of rationing.
Leonhardt is nicely ironical here. And the ladies Dormady, eating their oatmeal at Juniors Diner, arent likely to give the first flying f*ck about a single word he has said.
In fairness to Leonhardt: In fairness to Leonhardt, he may not be discussing the way the rationing buzz can undermine hopes for health care reform. In our view, it never gets clear, at any point in this piece, just what he is discussing. When he opened his piece in the manner he did, he seemed to be addressing the ladies Dormadyand the millions of voters who share their fears. We thought he would address the fear that, after some sort of health care overhaul, the government would limit the kinds of health care a middle-class person might get.
And by the way, theres a hidden aspect of the fear the ladies Dormady expressed. The ladies didnt express this specific fear, and it may not be in their heads. But here it is: According to the rationing theory, a fully solvent, upper-end person might get denied some health care service because poor people are ahead of him or her in line. In todays world, Margaret Dormady can get for myself what I need; if she has the money, she can buy the health care she wants. She fears that, in an overhauled world, she will have to stand in a very long lineeven if she has the money to buy the service in question.
For some middle-class or upper-end people, they fear theyll be stuck in line behind poor peopledenied health services they can afford because such procedures will go to the poor.
What are the answers to such fears? We dont have the foggiest! Like the ladies, were not experts. We dont know what the answer would be if they went to the White House and presented these familiar fears to, lets say, Kathleen Sebelius. But we see no place in Leonhardts column where he articulates these fearsor where he actually tries to address them. In the second half of his column, he lists three main ways that the health care system already imposes rationing on us. Everything he says makes sense (although his first form of rationing is absurdly metaphoric). But nowhere does he directly address the fears the ladies expressed.
Will they have to stand in a line? Even if they have the money? Leonhardt never quite says. And yes, those are the kinds of fears which derive from that rationing rhetoric.
Leonhardts column helps us see why health care reform wont likely occurcertainly not the type of reform progressives would most prefer. Simply put, Leonhardt doesnt seem to know whats on the minds of average people. You cant speak to average peoples fears if you dont know what those fears really are. But conservative spin-tanks do know the fears of those average people. Sometimes using focus groups and polling, they craft buzzwordsskillful bits of rhetoricwhich drive those fears along.
The ladies Dormady have heard such buzz all the years of their lives. They heard the buzz in 1993and theyve constantly heard it since then. Some of this buzz involves health careand some of it simply involves big government. They constantly hear such buzz from the right. But what did they hear from the mainstream press all those years? What did they hear from the left?
For the most part, they heard very littlenothing relevant to their fears. In April, they heard a week of insults from Maddow and Olbermnanthe kinds of upper-class progressives who seem to enjoy mocking average people. (A guess: The ladies werent Rhodes Scholars.) In June, they got a long column from Leonhardt. But where did he speak to their fears?
Why do they hear so little from the mainstream press, or from those on the left? Yesterday, Mark Halperin may have explained it. Weve said what he said for the past ten years, ever since the first Gore- Bradley debate in October 1999. (Gore and Bradley discussed health care, in detail. The press discussed Gores clothes.) Yesterday, Halperin said the same thing we said back then (just click here). And some liberals yelled at him for it:
HALPERIN'S TAKE: 5 reasons to bet AGAINST major health care reform passing this year.
- 1/6 of the economy can't be remade without genuine bipartisan support.
- The sticker shock threatens to whittle the thing down to something well short of universal coverage.
- The public is not demanding action.
- The upside doesn't seem big enough now to give congressional Democrats sufficient cover to vote for a tax increase.
- Most journalists still have health insurance.
He got yelled at for stating that fifth reason. Yet its probably part of the problemand he was cheeky to say it. In part, big journalists dont understand the concerns of the ladies Dormady because they have good health care themselves. Just a guess: Maddow and Olbermann dont discuss this issue for similar reasons.
Instead, they insult the average people who make Halperins third point true.
In 2003, the United States spent $5400 per person on health care. Finland was spending $2100. Career liberals didnt say boo about thathavent said much about this topic for the past fifteen years.
Why do you think that is? Well recommend Halperins fifth take.
In the past fifteen years, the buzz words from the right have continued. There has been little serious push from the left. For fifteen years, the fears of the ladies Dormady increased. Your side largely stared into air. But of course, your side also said nothing at all during the slanders of the 1990s. It was safer and easier not to complain. And your leaders had very good jobs.
Last night, Olbermnan played the fool in his closing segment in a truly stunning way. Do you really fail to understand why a man who gets paid $5 million would go on the air, on a national news show, and kill time in that embarrassing manner? (To watch what he did, just click here.)
We strongly suggest that you watch that segment. (And yes, it represents the latest case in which Olbermann indulged himself in the open ridicule of women. Ironically, Melissa Harris-Lacewell had appeared on the program earlier, explicitly praising KeithOs feminism. At the same time, Maddow was on Charlie Rose, endlessly kissing his keister. This is your movement on hustle and climb.)
No, it isnt Olbermanns fault that the left has failed to make a case about health care in the past fifteen yearseven though weve had the worlds most ridiculous set of facts to work with. (The UK: $2300!) But he was clowning hard last night, frying the brains of every viewer. And lets be honest: He and Maddow dont waste their time on such petty concerns as the health care fears of average people. The ladies Dormady arent their kind. For many in the progressive world, people like the ladies Dormady stand at the right hand of tea-baggers. Lets be candid: Its been that way on the left as long as weve been alive.
Their selection of topics is typically drawn from the upper-class end of the progressive palate. And, as Halperin accurately said: Upper-end people have health care.
Progressives say the darnedest things: Lets be clear: Maddow is much less foolish than Olbermann. In theory, she remains full or promise. But she can say the darnedest things.
Last night, when she wasnt kissing Charlies keister and ring (Gwen Ifill is one of her heroes/and she thinks Chris Matthews is brilliant), Maddow staged the kind of intelligent discussion that makes you mourn what her program frequently is. But near the end, she made one of her trademark, very-odd statements. We cant quote todayshe went on too long, and we werent taping. But she said she doesnt even know who her TV competitors are. She doesnt know whos on the other cable news channels at the same time shes on.
At 9 PM, Larry King is on CNN, Sean Hannity is on Fox. And Rachel Maddow doesnt know that? Its always possible thats true, of course. But could anyone really believe it? (Charlie of course played along.)
Maddow says such things a lot. We havent had time to fact-check.