Wednesday, August 19, 2009

A Question of Trust

Some people just don't trust the government.

That's not really too surprising. What interests me is that different people seem to trust or not trust the government to do certain things or to perform certain tasks. Conservatives, on one hand, seem to trust the executive branch to gather intelligence and to wage war. Liberals, on the other hand, sometimes do not, or at least not as much. When word leaked out that the government was listening in on international phone calls without a warrant (something that is not expressly prohibited by law, unlike domestic phone calls), many people screamed bloody murder about privacy violations. The government said that it was only listening in on known or suspected terrorists, but that wasn't good enough for many. As I said, some people just don't trust the government.

Interestingly, with a change in administration, the political sides' attitudes toward government snooping seem to have reversed. It was conservative Fox News that raised the alarm on the White House spamming people's email accounts, implementing tracking cookies on the White House web site for the first time and asking citizens to report "fishy" emails and other communications about healthcare reform. Liberal pundits couldn't understand what the fuss was about. If it had been the Bush administration doing the same in regards to, say, the Iraq War, things would of course have been different. Trust and distrust in the government seems to have a partisan element. Which is short-sighted. Because it is only a matter of time until the party you don't like is in charge of the government again.

Now the country is politically consumed with the topic of healthcare reform, and the political sides on government trust are reversed on this as well. One can debate the merits of the different voluminous bills working their way through Congress, but the simple fact is that, whatever bill emerges will only set in motion the new system. Many subsequent decisions will be taken up by functionaries and bureaucrats, as new agencies and mechanisms get set up. How it will all ultimately work out to the last detail is a great unknown. The most persuasive arguments by proponents of reform go something like this. A lot of people were scared about Social Security and Medicare when they were first being set up, but they turned okay and are quite popular. And this will turn out okay too, they say. Opponents of reform, at least as it currently seems to be proceeding, talk of spiralling costs, increased government debt, eroding personal choice in medical decisions and "death panels." There is absolutely no 100 percent certain way to know which vision will be closer to the truth. People who want reform are trusting the government to, at the least, not make things worse and, at the best, make things better. People showing up at town meetings and challenging their representatives do not have that trust in the government, at least as far as this particular task is concerned.

Proponents' trust in the worthiness of the undertaking clearly comes from a sincere desire to improve things. The country, they say, should at least try to solve the problems that many people encounter when dealing with the healthcare system. Opponents' distrust appears to stem from suspicions of the intent of the Democrats who control Congress and the White House. And they are correct that the ultimate goal of the strongest supporters of so-called ObamaCare is a single-payer system similar to what exists in Canada and various European countries. Skittish politicians may deny this, but activists are quite up front that this is what they want because, they believe, that would be much better than what we currently have. The president himself, albeit many months ago, has said that single-payer would be his preference.

And why do so many people oppose a single-payer system and, by extension, the bills working their way through Congress? Quite simply, they are afraid that it will make things worse and not better. They may have complaints about their insurance company or their HMO, but they think that, if they have to deal with the federal government, it will be even worse. And there is no way to prove whether they are right or wrong. A change like this involves a leap of faith.

Republicans may be thrilled by all of this because, at the moment, it is helping them politically. But they should be kicking themselves (or we should be kicking them) that they did not implement their own version of health care reform during all those years that they were in charge of Congress and the White House. But they didn't, and now the Democrats, having won big in last November's elections, are having their own go at it. As sure as Republicans are fighting against Democratic healthcare reform, Democrats would have derided Republican reform as inadequate. But a Republican version, if they had actually managed to get their act together, might have been closer to what most people actually want. People want something done about constantly rising medical costs. They want to be free of the fear of losing insurance coverage. And, I believe, most people would like to help people who do not have insurance. Now these are the very things that the president and other proponents of ObamaCare say their plan(s) would fix. But polls show that an increasing number of citizens think that Congress is currently on the road to do much more than just target these specific problems and perhaps bankrupt the country doing it.

In other words, a lot of people right now just don't trust the government.

Friday, August 14, 2009

That Brew-ha-ha

During all that fuss last month about the confrontation between Prof. Gates and Sgt. Crowley, many commentators took the opportunity to proclaim, aha, President Obama isn't so post-racial after all.

At the time, I tended to agree with them but, with the passage of time and a little perspective, it seems to me that the president may have been nearly the only person in the whole country who did not see the situation in racial terms. Henry Louis Gates is a friend of his, and he reacted the same way most of us tend to react when a friend gets into a conflict. We usually don't worry about the right or the wrong of the situation. We support our friend. And we call the person who upset our friend an idiot. Or, if we are trying to sound more reasonable, we might say that he acted stupidly.

What made the president's reaction remarkable is that, for such a political animal, it seemed not to occur to him that there would be a political dimension to his reaction. A few days later, he seemed genuinely surprised that anyone would have seen the situation any differently than himself. But almost everyone did, for the simple reason that most of us don't know Prof. Gates (or, for that matter, Sgt. Crowley) personally. It wasn't simply a case of being loyal to a friend for us in the masses. So it is strange that the president did not realize that much of the country would see the incident through a white-versus-black prism, just as Prof. Gates clearly did.

But people across the country were seeing the incident through several different filters. Quite a few people specifically familiar with Cambridge and Harvard saw it through a local-police-versus-the-black-community prism. Others, who didn't want to go to the white-versus-black place, took an individual-citizen-in-his-own-home-versus-government-intrusion view. But what was interesting was how many people perceived the whole thing through a pointy-headed-elitist-academic-versus-a-working-class-man-just-doing-his-job filter. For them, the black-as-victim meme didn't quite work when it involved a world-famous academic at a prestigious university who calls the country's president a personal friend. And who wasn't picked up randomly on the street but was dealing with a cop responding to a report of a possible break-in.

The only generalization you can make about how the country reacted is that each news consumer slid the story into a template formed by their own experiences or the narratives of American society implanted on their consciousness. It wasn't so much the facts of the incident that got people's emotions going. It was the memories, personal or shared, that those facts evoked. Professional pundits and certain political operatives had a particular interest in fitting the story to a popular pre-existing narrative, which sometimes had strange results. The most surreal moment for me was watching CNN's very white Larry King more or less lecturing black libertarian guest pundit Larry Elder on not being sensitive enough to African-American history.

Let's hope that someday we finally get to the point where we can look at a situation like this and see it, like Barack Obama, as simply an incident involving two men. And let's hope that, in the meantime, Barack Obama can look at a situation like this and see it as a president.

Saturday, August 8, 2009

Drug Habits

People looking for encouraging precedents for heavy government involvement in health care may want to give Ireland a miss.

One of the big stories in the news, for more than a week now, is about a dispute between the government's health agency and the country's pharmacies, which has resulted a lot of pharmacies closing their doors, depriving people of medicines, even if they are willing to pay cash. A lot of people get their medicines paid for by the government, but because of the budget crisis spurred by the current recession, the government has slashed what it pays pharmacists to dispense the drugs. Irate, many pharmacists are refusing to dispense the drugs, and in some cases it is easier for them to close their doors altogether rather than deal with angry participants in various government drug plans.

It is a right mess and not at all encouraging for people who think that a "public option" will sort out the problem of health care costs. Of course, Ireland isn't a particularly useful case study for deciding what might happen in the U.S. because the countries are so different. Ireland is much smaller, culturally more homogenous and it has ceded its central banking powers to the European Union. It does not have the option of running up massive budget deficits, as the U.S. can and does, to get through tough times. But it can still give some insight as to the relative pros and cons of government programs versus free-market systems.

About a third of the Irish are government wards, for medical purposes. These include people who have what is called a full medical card (qualifying through unemployment or low income or other reasons), which pays all medical expenses, as well as people who have a GP visit card (with more liberal income limits), which is strictly for doctor visits. These programs equate more or less to a combination of the U.S. Medicare and Medicaid programs. The rough Irish equivalent of the "public option" would be VHI Healthcare, which is a government-owned insurance company, set up in 1957 as a monopoly. Interestingly, in recent years Irish politicians have nudged things in a direction completely opposite of that of today's political majorities in Washington. The insurance market was opened up to competition in 1996 with the idea that VHI might, at some point, be privatized, similar to what has happened to the government-owned telephone company (Eircom) and the government-owned airline (Aer Lingus).

Once you have a government monopoly, however, it can be hard to undo. The couple of private insurance companies that have entered the market have managed to offer lower premiums for their customers, partly through efficiencies and partly because they tend to attract a younger, healthier client base. When the government noticed this, it legislated a requirement that the private companies share some of their profits with VHI, in a plan called "risk equalization." The immediate result was that the main private company, the UK's Bupa Healthcare, immediately pulled out. Meanwhile, the premiums VHI charges have been reliably increasing from year to year. So much for a public option lowering costs.

Why would Ireland be trying to move toward less government involvement in health care anyway? Maybe it has something to do with an article last month in The Irish Independent, in which the paper detailed its own investigation into how the government health service was overpaying for drugs to the tune of 98 million euro per year. This doesn't really surprise Americans who have heard countless stories about, say, military orders for $640 toilet seats.

The basic problem is that any time large amounts of money are passing through large organizations, there is going to be a certain level of inefficiency and favoring. If the organization in question is a private company, one hopes that one or more government agencies might keep abuses to a minimum. When the organization in question actually is a government agency and subject to the whims of politicians, it gets harder. This is why, when the U.S. government decided to set up companies to be the ultimate housing lenders (Fannie Mae and Freddie Mac), they were essentially directed to make getting mortgages as easy as possible for people in the home districts, thereby contributing to the housing market meltdown. That is why, when the Pentagon says that it really doesn't need the F-22 stealth fighter plane, some politicians (like Pennsylvania military contractors' best friend John Murtha and my own senator Patty Murray) still fight tooth and nail to keep funding them because it helps, economically, folks back home and, indirectly, themselves. Can anybody doubt that, under a regime of greater government involvement in health care, there won't be members of Congress angling to get lucrative pharmaceutical contracts and other advantages for their constituents? To think otherwise represents a triumph of hope over experience.

Just as President Bush was silly to emphasize private accounts more than long-term solvency when he tried tackling Social Security, President Obama and his party are disingenuous to focus almost exclusively on insurance industry "reforms" and a public insurance option rather than actual, real ways to reign in healthcare costs, which is what most people actually care about.