• My answer to Harold Pollack’s question

    Harold Pollack asked a good question, which I posted earlier. I promised to come back and answer it. Here’s the question again:

    Over the past three years, we have experienced an amazing number of political, economic, and legislative trials. […]

    Anyone active and attentive should be thinking differently about something important after having witnessed so much history being made so quickly on so many different fronts. Tell me–Have your own views changed on any basic issues of domestic policy?

    My thinking on health care policy has changed in several ways. Here’s just one. As I’ve posted many times, the politics of cost control are hard, due to entrenched interests and posturing for short-term political gain. However, I’m now more willing to attribute one more cause to the difficulty: we’re generally not ready to face the issue.

    Collectively, if not individually, we’ve revealed by our action in the doctor’s office and the voting booth that we don’t want to control health care costs as much as we might say we do. Oh, we love to pay lip service to it, until it’s our health on the line. It’s not my utilization that’s wasteful, it’s all those other people who are duped by their doctor, who demand the latest and greatest, or think everything should be free and available.

    I’m skeptical. When faced with the health conditions and choices that the sickest among us face — those that account for the vast majority of spending — I am not at all convinced you or I would make decisions that save much money. We certainly wouldn’t welcome constraints that force us to. We don’t really want to be bound by the contract we seek to impose on others. Or, I don’t think so anyway.

    At a deep level we don’t want to change our health care spending habits. The day we really do, we’ll overcome the other political obstacles to doing so. On that day, many more of us will start to tune out the noise (“death panels,” “rationing”). On that day, we’ll stop believing that easy solutions will fix everything (high deductible health plans, the totally free market for insurance, Medicare for all).

    Today is not that day. Health care cost control is hard. It’s made harder by the fact that we aren’t serious about solving it, or not enough of us anyway. I’m beginning to think we like it that way. If so, we should embrace that fact, stop denying it. And then we should pay for what we use, rather than borrow our way into oblivion.

    • Austin
      I have been pondering this question all day.

      My answer is this:

      The response the public had to health reform in the summer of ’09. I agree with your perspective on the finances above, however, that was never in doubt from my vantage point, and that stems from my birds-eye of patients and their take on health care. Maybe it bubbled up for you during the reform debate, but for years your revelation was my constant reality.

      In my wildest dreams, I would never have thought that folks would invoke death panels, that states would rebel against a requirement to purchase insurance or pony up, or health care would be a wedge issue like guns, gays, gestation, or god.

      I badly misread the American public and how they would react, at least 40-50% of them. Just floored me.

      The other shocker for me is the traction someone like Sarah Palin achieved (and is now diminishing?). I say that not from a personal, or even ideological point of view (you might like what she advocates for??), but the thought that she has the capacity to be president is a sorry state. Reality TV and executive leadership is not what I thought we would lapse into.

      So again, my sense that there is a red, blue divide,–I do believe it is there–but this is something different–a “space” between me and my fellow citizens that 2-3 years ago I thought would never exist.