Daily Archives: August 11, 2009

A civil exchange, at least. But not a very effective performance. He treated it as an election campaign event. The opening was thoroughly partisan: his first substantive remarks were an attack on the venality of the insurance companies, a theme to which he returned repeatedly. He banged the populist drum in other ways too. If this effort fails, he said, it will be because of the resistance of special interests. (Actually, it won’t.) They have blocked reform before, he said, and must not be allowed to do it again. To me, this is foolishly condescending to the voters who disagree with the proposed reforms on their merits: it says they are dupes.

Still, he successfully reset the message, as trailed earlier. He played down cost control, except when pressed by questioners to discuss the future of Medicare. (We will spend a lot less, he said, and get better results at the same time.) Moving the focus elsewhere is wise, since the bills have rather little to say on cost control, and this point is now well understood.

Instead, his main themes were the need to widen coverage and, especially, the benefits of reform for people who already have insurance–principally, that there will be new limits on out of pocket expenses (getting sick should not make you bankrupt) and that your coverage will not be denied in future because of pre-existing conditions. As I’ve mentioned before, this last point should have been front and centre from the start, but better late than never.

Unfortunately he’s still trying to argue that if you are happy with what you’ve got, nothing will change. This is neither true nor even plausible. For instance, services under Medicare would be affected by the new reimbursement regime. The public option would destabilise some private plans–and is intended to. People won’t just migrate at their own initiative to new plans because they find them preferable. Many will be migrated by their employers, whether they like it or not. This claim that nothing will change if you’re content has to go.

He was unusually clumsy now and then. What was he thinking, giving his second question to a child? And what was he thinking when he answered that question with a discussion of end-of-life counselling and an intended joke (I think) about switching off granny’s life support? I didn’t see many people in this overwhelmingly friendly audience laughing.

When he was asked about his earlier support in principle for single-payer, he said that the transitional difficulties would be too great. That seemed a tepid endorsement of the mostly private system that is actually being proposed. But of course the main problem is that he still cannot say with any precision what the plan is. He can assure the country of this and that, plausibly or otherwise, but there is still no finished plan to sell. Many of the questions were appeals for information. People are asking, what is going to happen? The president doesn’t know. He just knows he’s for it.

Democratic members of Congress are taking the case for health reform to a series of “town-hall meetings”. In many cases these have turned into brawls—and so far as most reporting is concerned, rage rather than the substance of the issues is now the story. Many protesters are hoping not to debate but to shut the meetings down. They carry posters of politicians with devils’ horns, or of Obama with a Hitler moustache. They claim the administration wants to bring in euthanasia, among other things. It is all very ugly.

There are valid and invalid criticisms of the protesters. A bogus criticism is the Democrats’ complaint that the protests are “orchestrated”. No doubt they often are. But what is wrong with that? Democrats have been known to orchestrate a thing or two. Progressive groups turn up for regular strategy consultations in the White House. What is that about, if not “orchestration”? Also, directed or not, the passion of the protesters is not synthetic. They are against these bills, and they are entitled to say so.

I’d go a little further in defending them. These town-halls are not really an exercise in consultation. The politicians are not asking their constituents, “What should we do about healthcare reform?” They are saying. “This is what we plan to do and why. Any questions?” The Democrats, after all, had hoped to get the whole thing done by now, no consultation required. This recess is an inconvenience not an opportunity. In that sense, the town halls are mainly for show. The politicians are not there to learn anything. I can understand the view that shouting at them is the only way to get their attention.

Of course, the notion that the administration plans euthanasia for sick retirees is insane—can anybody seriously believe this? And there are many other instances of deplorable and outlandish misinformation. But this does not mean that the proposed reforms give no grounds whatever for concern, as many liberals seem to believe.

In particular, the fear that standards of care for the elderly might fall has some justification. If stricter tests of cost effectiveness in health care are to be brought to bear—as they should be, in my view—spending unlimited sums on one or two low-quality end-of-life years will likely fail them. And the stricter rationing of treatments for the elderly is not a malicious fantasy of the conservative right. In systems like Britain’s NHS, it is standard operating procedure.

These are difficult issues. They have to be faced. What a pity this cannot be done in a civil way, with tolerance and mutual  respect. In the US today, this is asking the impossible. The two sides don’t just disagree. They loathe each other. They would literally wish to see each other destroyed. It is hard to see how you get from here to any kind of consensus.

Clive Crook’s blog

This blog is no longer updated but it remains open as an archive.

I have been the FT's Washington columnist since April 2007. I moved from Britain to the US in 2005 to write for the Atlantic Monthly and the National Journal after 20 years working at the Economist, most recently as deputy editor. I write mainly about the intersection of politics and economics.

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