In a recap of the second McCain-Obama debate, Joe Klein offers his thoughts on the role of government generally and in health care in particular. Excerpts and comments follow:
Obama began his response with a simple declarative sentence: "I believe that health care is a right for every American."
Health care is a bundle of goods and services. Treat health care like a "right," and watch it disappear.
The rest of his answer could be used as a template for how to deal with a complex issue in a town-hall debate. He began with a personal story: his mother, dying of cancer at age 53, having to fight her insurance company, trying to prove that her disease had not been a pre-existing condition.
Obama has said his mother "had been diagnosed just as she was transitioning between jobs." Neither candidate can claim that their health plan would have saved her life. But McCain can claim that the federal government created an employer-based health insurance system that routinely strips people of coverage right before and right after they get sick. In its attacks on McCain's health-insurance tax credit, I haven't once heard the Obama campaign acknowledge that McCain's plan would have spared Obama's mother that deathbed worry.
He broadened that into a general proposition about the proper role of government: "It is absolutely true that I think it is important for government to crack down on insurance companies that are cheating their customers."
Government should crack down on cheats. If an insurance company commits fraud or breaches its contracts, let 'em have it. One senses that Obama means something else, perhaps that insurance companies "cheat" any time they deny coverage for anything? Maybe because he thinks health care is a right?
And finally, he transformed the issue into a metaphor for the entire campaign: "That is a fundamental difference that I have with Senator McCain. He believes in deregulation in every circumstance. That's what we've been going through for the last eight years. It hasn't worked, and we need fundamental change."
Regarding Obama's silly attacks on McCain's proposal to deregulate health insurance, click here.
Obama's gamble is that the public — worried at the beginning of the campaign, terrified now — is ready for greater government support and regulation of the health-insurance system. That assumption has always been a sure loser in American politics. Republicans have perpetually and successfully waved the bloody flag of "socialized medicine." But the employer-provided-health-care system is fraying, costs to average families are rising, and almost everyone has a friend with a horror story.
Indeed. If only Klein and the Republicans recognized that socialized medicine is the root cause of those horror stories.
McCain's plan is a half-baked vestige of Reagan-era ideology: it tilts the incentives away from employer-provided health insurance and assumes that people will act in their enlightened self-interest if they are thrust out into a free market. That's absolutely true when it comes to buying refrigerators. But health insurance is complicated and scary; most people don't have the time or expertise necessary to make wise choices.
Health insurance is complicated; illness is scary. It would be nice if health insurers won customers by making health insurance simple and taking away patients' fears of illness and financial ruin (rather than focusing on employers' fears of absenteeism and rising labor costs). For that, the individual customer has to control the money.
They rely on their employers to make sure they're getting a good deal — and to fight for them if the insurance companies try to cheat them. And with many employers slouching away from that responsibility, the public seems ready to turn to the government for protection. In a collapsing economy, government regulation — forcing insurers to cover everyone at reasonable rates — sounds more comforting than stultifying.
Employers are shirking -- but the government won't? Even when Obama gives them a jillion more things to do than enforce contracts and prosecute fraud? And reasonable rates?? Does Klein know nothing about Medicare?