Daniel Eran Dilger
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What Obama could learn from Apple… on Health Care

Daniel Eran Dilger

Before President Obama was elected, I compared him to Steve Jobs on the threshold of Apple in 1996, challenged with the task of rebuilding a failed enterprise and charting out a new future for it. How well is Obama doing in his role as a Jobsian CEO of America? Well, he could use some Apple-style marketing.

“Once he took over the reins at Apple,” I wrote, “Jobs immediately worked to slash pointless spending, restore confidence in the company, end a costly war with Microsoft, and set up new regulations outlining how new products would be created and financed.”

In some ways, Obama has it easy. In 1996, almost everyone was betting against Apple because few had any real interest in seeing the company prosper. Obama has millions of Americans rooting for him and maintains a celebrity status that Jobs had to earn through many keynotes of presenting one simple genius product after the next.

The other major difference, however, is that Jobs’ biggest fans supported his decisions as they grew bolder and gutsier, while Obama’s core supporters have grown increasingly irritated with his performance as it has watered down into compromise.

Imagine Steve Jobs for President

Obama vs Jobs.

Since taking office just a few months ago, Obama has turned the country around in many respects, from acting to protect our natural resources, insure children’s health, stop the most egregious torture programs operated by the Bush Administration, and reach out to our nation’s global neighbors to work to establish peace and security rather than following a religious crusade to assault, offend and alienate the rest of the world. Those things were all expected, so Obama got very little credit for pursuing any of them in his first days.

Obama now faces tougher decisions, and like Jobs, he’s being questioned and criticized at every step by observers on all sides. Jobs had the advantage of being able to direct Apple as an unchallenged dictator, killing off projects that made no sense (like the Newton Message Pad) and beginning new business that he hoped would succeed (like Mac OS X and the iPod).

Obama has to rely upon Congress to actually make laws and the Supreme Court to interpret them, thanks to a Constitutional mandate that checks and balances power, at least in years where Congress doesn’t weakly cower to the president’s decrees and the Supreme Court isn’t packed with activist conservatives who originally elected the president.

Today’s president isn’t wielding the near absolute power that Jobs could; instead, Obama has signaled that he plans to force Congress itself to hammer out its own compromises in areas like health care. Given the opportunity to replace a departing liberal on the Court, the president selected an experienced moderate in Sonia Sotomayor rather than a strongly progressive liberal justice. Obama seems to actually live in his idealistic fantasy where good prevails. This may be a mistake.

Obama’s Inheritance.

With his insistence upon actually acting within the role of a Constitutional US President rather than as a dictator that bullies Congress into the fear-based passage of trillions in spending on the Iraq War, massively expensive tax bailouts for the top 1% of the richest of the rich, and a series of hundreds of billions of failure bonuses paid out to banks and investment firms who made poor decisions with other people’s money, Obama must instead motivate Congress and the American people it represents to act intelligently and rationally using facts and science. This may be grossly naive.

America has fallen precipitously since the glory days of the 60s, when the country acted as a role model for the rest of the world, investing in the finest education for our children, acting aggressively to accord full civil rights to politically weak minorities, and hold scientific achievement in such high regard that our nation was first to set foot on the moon.

Today, the US ranks 18th out of 36 nations in education, is the only country among all advanced nations to fail to provide health care for its citizens, and has grown so skeptical of rational thought and science that entire states have traded away their credibility to cater to populist ignorance and fear.

Our nation has become so embarrassingly backward that we’re the only one left to have rejected the SI metric system for a nostalgic attachment to old English imperial measurements, resulting in our country also being the first nation to confuse measurements and subsequently waste millions in space on a satellite that doesn’t work.

Obama has inherited this country of increasingly uneducated, superstitious, and easily swayed mobs of angry and frustrated government haters, who also seem to think of themselves as deeply patriotic. Fixing the Beleaguered Apple of the mid 90s looks like a cake walk compared to the challenge ahead of Obama.

When the Going Gets Tough…

The good news for Obama is that the more difficult the problems are, the more qualified talent he can attract, as long as he doesn’t begin making easy choices that destroy the hope for change that he inspired in America prior to getting elected. The great difficulty of turning around Apple enabled Jobs to attract extremely talented people who were hungry for challenge and subsequently worked hard to achieve something meaningful and game changing in the tech world.

Obama seems to be surrounded by highly competent people. The president himself also offers little to assault in terms of talent and intelligence, forcing his critics to make up absurdist claims instead, ranging from branding him as “hating white people,” to being a secret operative for Islam, to being too physically fit, to being a radical Marxist with a weak spot for terrorism, to being just too educated and not religious enough.

However, Obama and his entourage of elite intellectuals, feared and loathed so much by the non-elites who closely follow their actually very racist, ignorant, hatred and violence-inciting pundits into the land of irrational superstition and credulity, seem to be so isolated within their bubble of well-meaning, good natured, can-do American idealism that I think they need to reappraise the task at hand, looking to Apple for some guidence.

How Obama Can Win Over Health Care Skeptics, Apple Style.

Issue 1: Obama’s effort to get Congress to fix the world’s most expensive but wildly ineffective and inefficient health care system appears to be facing massive push back, thanks to fearful and largely irrational panic induced by the powers who earn the most profits from inaction. This isn’t a political problem, its a marketing problem. Take a page from Apple: invent some brand names to use while you tell people why they need it. People don’t respond to intellectual discussion of complex details; cater to their simplistic grasp of basic ideas. Use graphics.

Medicare, the system passed by Democrats in 1965 and enacted over the angry protest of conservatives, is now being brilliantly used by Republicans to bash health care reform. They say any changes will hurt people on Medicare. They know this is a lie; many of them opposed and continue to oppose Medicare itself, only paying it lip service because America’s elderly intensely love being covered by the single payer, government health care system, completely unaware that Medicare is a single payer, government health care system.

In 1961, Ronald Reagan said “if you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” George HW Bush warned that Medicare was “socialized medicine” in 1964, and Bob Dole, in his failed run for president in 1996, bragged “I was there, fighting the fight, voting against Medicare . . . because we knew it wouldn’t work in 1965.” Medicare is a single payer, government health care system promoted by Democrats. When Republicans say they’re worried that Democrats will hurt old people by shutting it down or taking away their benefits, it mean they are liars, because Medicare stands for everything Republicans hate and Democrats seek to promote.

Solution 1: Obama shouldn’t be referring to generic “health care reform” or “health insurance reform.” He should be using the Democrat’s own brand name. This is “Medicare for America.” If that’s too hard to turn into a logo, then call it “Medicare II.” That will force Republicans to either admit that they are really against health care for anyone, turning the full rage of senior citizens against them where it belongs, or decide to actually support the system that anyone in America who can get it prefers to have over profiteering health care plans that exist to deny them coverage in exchange for profits.

So Obama and Madame Pelosi, name your damn bill Medicare II. Even Steve Jobs knew he had to rename OpenStep as Mac OS X in order to sell it to Mac users. It is borderline moronic that you are enabling your critics to name your bill for you, calling it ObamaCare as a way to incite personal and partisan hatred that has nothing to do with the merits of the bill.

And by the way, why haven’t I ever heard Obama or any Democrat say “the Medicare you enjoy and rely upon is a single payer, government health care system”? This should be repeated at least a dozen times daily on the news.

The Republican Death Panel

Issue 2: Republicans have begun coining coy slogans involving rationing and death panels to incite ignorant fear of change. Key to this campaign is a provision that enables Medicare II to pay for end of life counseling, so the people are informed of their options by their doctor, and can then choose whether they want to spend the last year or two of their life strapped to a hospital bed being kept alive artificially at great cost in the manner of Terri Schiavo, or allowed to spend their last days at home with their families and loved ones.

Individuals have either option under the plan; the only change is having the government pay doctors to provide patients with an outline of their options. There is no government involvement in the decision making process, and if anything, doctors might be biased toward talking terminal patients into spending hundreds of thousands extra to die in a sterile hospital, separated from their families.

Despite some Republicans’ mischaracterizations, the only real government intervention in health care in recent history was when Republicans sought to force Schiavo’s husband to keep his dead wife in suspended animation in perpetuity and at great cost following 15 years of her being in a persistent vegetative state following a tragic accident.

Somewhat ironically, while Republican leaders were catering to the Right-to-Life-as-long-as-you-don’t-enjoy-it crowd of family-meddling religious activists, they also began supporting the idea of enabling individuals to choose their own destiny using advanced care directives.

This legislation was supported by Republicans in Congress and later added to Medicare II by Republicans in the House, built using legislation drafted by Republicans pertaining to existing Medicare users. Now however, certain fringe Republicans have taken to calling this provision a “death panel” system, supposedly written by Obama himself, where citizens would beg government bureaucrats for coverage and likely be denied based on their value to society.

This disgusting mischaracterization is refuted as a “lie” and “nuts” even by moderate Republicans, including those Republicans in the House who originally wrote the language and put it into the Medicare II health care bill. That hasn’t stopped the media from repeating the phrase and taking it seriously as a matter of rational discourse.

It’s as if the Birther/Deather, Separatist/Patriot, Debtor/Conservatives are the only group that can create talking points and make up jingle slogans that the media will parrot. Why it that? Because Obama isn’t spoon feeding stupid Americans with the same level of baby food soft bits that Republican wonks have grown so skilled at doing. Time to catch up, Obama.

Solution 2: Nip this issue in the bud by calling the Death Panel Provision what it really is: “Republican-Sponsored End of Life Counseling.” No Democrat should ever miss an opportunity to call this spade a spade, while also praising it and the Republicans who wrote it for its being good legislation that is sensible, moral, intelligent and a potential source of cost savings and an important quality of life issue.

Instead, progressives are stopping to patiently explain how this works to an audience of old people only slightly more sentient than Schiavo was. Stop the madness Obama: stop explaining and start making sound bits to block the faux-outrage. You can’t negotiate with terrorists nor the persistently vegetative.

Obama, have the balls to tell America that Sarah Palin is flat out lying about Republican-Sponsored End of Life Counseling, and tell us about the Down Syndrome citizens that America’s single payer, government run health care systems, Medicare and Medicaid, already support. Then point out that Medicare II would have supported providing her family with birth control so that her unwed daughter wouldn’t be needing to give up her youth to raise a kid she didn’t plan on having, and that the girl’s now estranged boyfriend wouldn’t have needed to drop out of high school to get a manual labor job put on a morality play during Palin’s campaign just to create the illusion that the failure of “abstinence-only” policy has no real consequences as long as you can maintain a hypocritical show. Both kids could be in college.

Who Pays?

Obama has insisted all along that he wants Medicare II to be deficit neutral, believing that cost efficiencies and better bargaining with Medicare-abusing health industry profiteers will offset the majority of the cost of giving Americans the same access to preventive care that citizens of other advanced countries get, rather than telling the middle class to simply show up at the emergency room as President Bush suggested Americans could do.

Congress, pressed by the health industry’s lobbyists and the rabid crowds of old people terrified by the Republican’s unbelievably backward charge that Democrats are trying to take away their Medicare, has started threatening to water down Medicare II by taking away all the things that would make it work and throwing in things that would make it more expensive, such as Republican-Sponsored End of Life Counseling.

Republicans are working tirelessly to kill Medicare II because they know if it passes, it will be just as popular as the current Medicare system. They know they can’t stop anything at all from happening, so they’re banking on watering it down to the point where the system remains exploited by health care profiteers and becomes a failure.

Republicans want to do to healthcare what the Bush Administration did to FEMA: starve it into failure and assign inept management from a pool of incompetent friends. Then, when America depends upon their government, the government will fail and Republicans can point out that government is to be feared.

Never mind that we have plenty of successful examples of government, from the Interstate System to our National Parks to the EPA to OSHA to the FCC to the FAA; in fact, the American government works pretty damn well until Republicans destroy things in order to prove it doesn’t, such has been the case with, say, Amtrak, leaving the US without a competitive rail system in corridors where rail makes sense, and leaving the nation laughably behind the rest of the world.

McCain vs. Obama Presidential Pop Quiz: Socialism

This all has the media now saying that Obama is somehow probably not telling the truth when he says he wants Medicare II to be deficit neutral, or that it may not be realistic. A variety of solutions have been proposed by Congress, including the taxation of expensive benefits given to high earners and the restoration of taxes on the super rich that Bush cut for them, resulting in massive new deficits.

Nobody in Congress complained when Bush set in motion massive deficit spending designed to cause government starvation with his massive gift to the super rich. But now that the middle class stands to benefit from health care under Medicare II, Congress is suddenly worried about America’s debt levels, even though Medicare II wouldn’t have a substantial impact on the federal debt.

Here again is an opportunity for Apple-style branding that kills multiple birds with one stone. Americans are outraged over the massive bonuses being paid out by badly behaving banks that received huge, no questions asked bailouts from Bush as part of his closing act. They would also be outraged if they knew that people who make massive salaries are being given additional tax-free benefit packages that are larger than the average American’s entire salary.

Solution: Obama, stop talking about exploring the idea of “taxing benefits” and “new taxes on blah blah” and start announcing that you will pay for Medicare II by levying a new Bailout Bonus Penalty that will impact individuals that benefitted most from the Bush Bailouts: those making more than a quarter million in salaries, and those who get massive tax-free bonus benefits worth tens of thousands of dollars a year. This will indicate that you are aware of the anger of those who witnessed the massive redistribution of wealth from the public reserves of the government to the well connected douche bags on Wall Street, and that you have a righteous funding source for Medicare II.

Then assure Americans that their children and grandchildren will not being paying for their Medicare II benefits, but only Bush’s Iraq War and his massive tax holiday for the super rich. Given that massive debt burden, America’s next generations will need a health care system that enables them to stay productive and healthy as they compete globally against advanced nations who already have a functional health care system. What will do that Obama? Yes, Medicare II. Don’t forget to repeat that every day until America gets it.

  • Orenge

    The public overwhelmingly supports adding a public option alongside the corrupt existing companies. But it doesn’t matter, because Congress doesn’t do what’s best for the people. They do what’s best for those companies–and the river of cash flowing from them. Insurance companies want to keep screwing us over, and Congress will gladly take the bribe.

  • http://blogger.emailstar.com TheCrow

    Wow, what a stretch! You’re a much better writer when you stick close to the facts and skip all the opinions. Stop blaming Bush for every problem it’s grown old and tiresome. Was he a great president… no but Obama will have to be responsible for his own failures. In less than 6 months Obama has spent nearly as much Bush did during his entire presidency. And how any of this compares to Apple is a stretch beyond belief. Steve Jobs actually (and still is) made a difference!

    [The point of referencing Bush is that Obama spent most of that money BECAUSE of Bush’s failed 8 years of running the country into the ground. It’s best not to look at events in a vacuum. Steve Jobs similarly had to make a series of difficult decisions BECAUSE of what had happened at Apple over the previous decade. – Dan]

  • droughtquake

    The republicans have intentionally created a self-perpetuating phenomenon by starving education of funding (California’s Prop 13 is a prime example) which allows them to feed stupid marketing slogans (like suggesting Equal Rights is somehow ‘special rights’) to disinterested, uncurious drones who keep paying more so the rich can get richer.

  • samnberry

    As much as I think you should stick to just looking at mac stuff I think, you hit this on the head right on. It was a good analyses of the the way things are… It would be fun to see you on Rachel Madoow, keep up the good work

  • gus2000

    Well Daniel I’m glad to see you finally took all that technospeak out of your blog to delve deep into the subject of politics. I’m sure the rest of the commenters will be equally supportive!

  • http://jonnytilney.com Jon T

    Good stuff. But in Britain we have had 10 years of Tony Blair and Gordon Brown who have left us in the most god-almighty mess. They care(d) only for retaining power and used spin and ‘marketeering’ to hide the lack of worthwhile substance.

    And Dan, don’t you disparage Microsoft for their covering up of failure with their myriads of new brand names? I think you called it their “charade of renaming its failed products”. So their “new” search engine Bing, was just Live Search, or Windows Live Search, or MSN Search…

    I would say that the one thing Apple does NOT do, is use marketing to make up for other areas. It’s marketing is great, for great products, and it certainly doesn’t get changed for the sake of spin and misleading its customers…

  • http://www.roughlydrafted.com danieleran

    @ jon t – giving an idea a strong name for marketing reasons isn’t at all like furiously changing a failed product’s name.

    The problem I see with the bumbling democrats is that they’re ineffectially trying to explain complex features, allowing their product to be misrepresented by the party that did nothing to improve health care over the last decade of their control.

  • http://www.veo-design.com VeoSotano

    Well done, Daniel. I always loved your style of writing about the tech world, with deep analisys and logic-based conclusions. Now you’ve taken that to the area of politics and it works really well. In fact, much better than throwing in some politics into a tech article and mixing it all up.

    Well, that’s just my opinion, of course. Otherwise, keep up the good work!

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  • Lee

    Good article.

  • secondbassman

    Good read, Dan. BUT, as writer GK Chesterton observed, “The whole modern world has divided itself into Conservatives and Progressives. The business of Progressives is to go on making mistakes. The business of the Conservatives is to prevent the mistakes from being corrected.” And so, here we are, it seems…

    [Actually, the business of Progressives is to go on making *progress*. The business of the Conservatives is to prevent the progress from being made. Need some examples? Civil rights, health care, education, science, peace. Progressives push all of these, Conservatives are opposed to any progress being made and want to dial back the clock. Because they made more money a century or two ago in enslaving the poor, dumb and religious while using them to wage wars. That’s all they know. It’s true that progress sometimes involves mistakes, and conservatives are useful in preventing progress from being made too quickly, but conservatives must lose most of the time for humanity to continue to progress. – Dan]

  • http://twitter.com/NateTehGreat nat

    I think I’ll email this to Obama right now. Fantastic!

  • ChuckO

    C’mon neither Levy nor Palin’s kid have the cognitive capacity to attend college.

  • http://www.jphotog.com leicaman

    Would I want a government bureaucrat, whose job is to decide whether I get the treatment I need – without any concern for profit or money spent to keep me alive, or a business bureaucrat whose sole way of keeping his job is to keep costs down?

    You bet your sweet bippie!

  • worker201

    If sound bites, glossing-over, and Jedi mind trick hand-waving are preferable to honest explanation, then there is something very very wrong, and healthcare is the least of our worries.

    [They’re only preferable when your competition is doing nothing more than tweeting lies, fomenting revolutionary nutters with a history of violence (the “water the tree of liberty” guy protesting with a gun was wearing the same shirt Timothy McVeigh was after blowing up children in the Oklahoma City bombing) and going on TV to assure everyone that they are on the up-an-up, despite having no plan today nor any plan over the last decade.

    It’s we the people who are stupid and must be talked down to as children, because we allow this idiocy to continue while America fades into a third rate country while the media cheerleads the collapse of reason. – Dan ]

  • JohnWatkins

    Make sure that Nat in his letter reminds Obama that you think “[the middle of the United States] is backward and [sic] delusional and hesitant about making any progress” at all. That’ll impress Obama and all of us drooling, neanderthal, midwesterners!
    (I wonder why backward and delusional Iowa has affirmed gay marriage when California resoundingly rejected it? Iowans are so stupid and retrogressive!)

    [Middle America beings just east of Berkeley. There are massively backward throughout California, and plenty of reasonable intelligent people scattered across every city in America, even many in small towns like the one I came from. They’re just wildly outnumbered. Obama knows this, which is why he spoke of people clinging to their guns and religion. You’ll recall that made him Elitist throughout the election. But it was still true, quite obviously so by the level of nuttery that lines up with their guns to protest their fear of tyranny, apparently unaware of what it even is – Dan]

  • stefn

    Yes, let’s name the Republican party for what it is: anarchists in the service of plutocracy.

    Yes, stop chasing Republican votes and start supporting the President.

  • stefn

    Sent link to my Minnesota senators and rep.

  • SaneInSF

    Hilarious. You’re advocating putting lipstick on a pig. The first commenter saying that the majority of people want a public option? Whose crack are you smoking? The public *does not want a public option* — only the liberals and elitists want it, and not for themselves.

    The bills being considered do nothing for cost. The CBO, a *nonpartisan office* of congress called a spade a spade, to use your words — nothing being considered is budget neutral (and that’s a change in words — Obama earlier said that this would SAVE MONEY).

    Give me a break. Stick to Mac stuff. Your comprehension of healthcare economics is pretty lightweight, and partisan.

    [Please support your position with facts and reason. Surveys (despite the industry-seeded hysteria) do show Americans want reform and do favor a public option. The CBO only issued a report estimating that providing health care reform would cost less per year over the next decade than a few months of the Iraq War. Dan]

  • nelsonart

    As an independent that votes repub, I understand the power of taxes and incentives. You cannot simply hike taxes and expect treasury revenues to skyrocket. Some taxes are resilient, some are not. (See Clinton’s attempt to hike capital gains taxes and the resulting revenue decline.)

    There is demonizing on both sides. Reading the paragraph on FEMA is nearly as bad as listening to the senseless and uneducated rage that often appears in the town hall meetings on health care. I wouldn’t condemn one activity and then repeat it within the same article.

    Most sensible Americans support major components of health reform. Insurance companies have proven themselves to be adept at screwing Americans at every turn, denying coverage when we get sick and/or simply denying coverage at all for preexisting conditions.

    There is massive room for reform. Tort reform, insurance reform, best-practices analyses, consolidation of medical records. I’ve heard a lot of great ideas. I didn’t vote for Obama, but I give him much credit for having the brass balls to get this ball rolling. Something the republicans left alone for far too long.

    But for all the good ideas, Obama has not proven adept at explaining the costs or even the big ideas in a manner that people will trust and/or understand. The anger isn’t about taking away benefits and death panels. I think the anger is at endless govt. spending and deficits and debt.

    Medicare will be going broke. The unfunded liabilities are in the 10s of trillions. Obama is right in that it simply will not exist without reform. But think of logic of trying to explain how he wants an even larger version of Medicare, called Medicare on Steroids, and it’s to be mostly ‘funded’ by savings…. savings that come from wasteful spending, reckless abuse and corrupt practices from Medicare.

    Not very inspiring. The CBO doesn’t buy it. Neither do, appearently, a lot of angry Americans.

    I like the ideas presented here. I agree that Perot-style charts and graphs would be far more helpful. There has been a lot of demonizing of republicans even though Obama and the dems have the power in all three branches of govt.

    One thing the republicans understand is incentive. Bush cut taxes in 2003 and treasury revenue reversed and climbed aggressively as the economy recovered and new economic activity fueled govt. income. You might not believe in trickle down, but as an owner of a financial services firm, we are seeing the effects of the potential tax hikes already. When small business and successful individuals retrench into defensive positions, it’s not good for the economy. The tax hikes often bring in far less than predicted. And the savings from Medicare I could very well be lower than forecasted.

    We’ve seen it before and America is skeptical.

  • NormM

    I don’t know what might have been possible if this had all been handled differently, but at this point in the debate the goal should probably just be to get a bill that covers almost everyone. Rising medical insurance costs are unsustainable and so there will inevitably be changes to reign in the insurance companies — it isn’t all going to happen now and it doesn’t have to happen now. Maybe we should start by working hard to get a few more progressive Democrats into the senate and then revisit the public option.

  • http://benjamin-newton.com/ bhuot

    I think that it is so absurd that so many people think Obama is too liberal. I personally don’t think he is liberal enough – that is why I didn’t vote for him. And I don’t know how people ever got the idea that somehow conservatives are moral and liberals are not. I think that most our problems in America are that we are too ignorant of history, other cultures, and geography – that is about the only explanation for the war in the Middle East or our policies toward China. I remember republicans saying how the only way to make China democratic was to get our economies entwined. Basically they believed that the Chinese would buy more luxury goods from the United States than we would buy cheap stuff from them. I think the reason Obama didn’t get more votes is because people didn’t like him because he wasn’t white and because they wanted to buy more fully automatic machine guns for hunting and self defense.

  • ncmlist

    The trouble with Obama is that he is a normal, intelligent, informed adult trying to deal with a country with a far larger number of crazies than most advanced economy countries. All nations have their crazies, but the US seems to have a far larger percentage than most. When you consider flat-earthers, anti-darwinists, the percentage of people that don’t know that Hawaii is a state, etc. the mind boggles. No wonder so many people in the US regularly vote against their best interest. GOP congresspeople regularly state on Fox News that the US has the best healthcare system in the world. Reality puts it at 37 among the world’s nations. There is a lot of cognitive dissonance going on.

    Frankly, I don’t hold much hope for the country, given it’s proud ignorance. And the US corrupt system of people with the most money getting into Congress doesn’t help. Due to the current system, the only hope of getting re-elected is to cater to the largest donors to their re-election campaign, not the interests of their constituencies.

    If it wasn’t for the heavy hand of the US’s military might to influence world politics, I’d frankly say let them degenerate in their own juice. The US isn’t today the influence and leading nation it was back in the sixties. They aren’t going to seriously reform healthcare and take it to the place where all the other modern democracies are, they are still catering to the ignorant and the industries that profit from the deluded “patriotism” and ‘free market” ideologies of their often mistreated clients. Well, the insurance industry will continue to reap great profits off the backs of the dumb public. More power to them.

  • Etreiyu

    @ bhuot – “Fully automatic machine guns”? Aside from the redundancy, the simple fact is that NOTHING in this nation is as controlled as automatic weapons.

    Except perhaps Congresspersons on the payroll of industry, religion – or both.

  • brotherStefan

    The deficit was some $400 billion under President Bush and is projected to be about $2 trillion — $2 trillion — this year under President Obama. Those on the liberal left need to get over it — they won; with a legislative majority for over two years, and now the Presidency. After eight months, this economy is now his.

    [I don’t know what Right Wing website/AM Radio station you get your “fact substitutes” from, but:

    * The US public debt under Bush ballooned from 5.7 billion in 2001 to over 9.9 billion in 2009.
    * The interest alone on Bush’s debt in 2008 was $412 billion.
    * Bush’s administration did nothing to stop bad investment from destroying the economy over his 8 year term, and then lined up massive bank bailouts prior to Obama, leaving the next administration with few choices. The $700 billion Bush invested in failing banks is now costing another $350 billion because those investments have lost value along with the economy. Obama has since needed to pay out more billions to shore up the disaster Bush’s administration set in motion.
    * Bush spent $1.35 trillion (with a T!) on tax cuts for the super rich in 2001. That did little for the majority of citizens but cause the government to collapse under massive debt, and set up infrastructure, disaster relief, Medicare, and other services for subsequent failure.
    * Bush put Americans on the tab for what is now $915.1 billion in direct spending on the Iraq and Afghan wars, with most of that being spend in a muddled invasion of a country that had nothing to do with 9/11. The Iraq War was a fantasy crusade based upon extremist Christian mythology and expected to be paid for out of Iraqi oil, a plan that didn’t work out.
    * Obama has since allocated $787 billion in reinvestment spending. That’s nearly as much as Bush pumped into the middle east over his term. But Obama is investing in America itself, something Bush starved so the ultra rich could be slightly richer as they hide their money in offshore accounts.

    So yes, Obama has inherited a huge mess: a massive deficit, a public debt that is difficult to fathom, a destroyed economy, a national infrastructure in shambles, a population of zombies that follow hate radio terror mongers and uncritically repeat their bullshit. How about you do something to fix that last bit, the only part you have any ability to control? – Dan ]

  • Dov

    Dan – I always read your Mac posts with riveted attention, but I stopped reading this one as soon as I hit the phrase “activist conservatives” regarding Republican-nominated Supreme Court justices. I don’t understand who these mythical “activist conservatives” are, considering conservative justices are defined in terms of their restraint (a principal example being Antonin Scalia, who is renowned for deciding in favor of supporting the Constitution, even contrary to his own personal beliefs on a particular issue).

    [Hi dov, glad you asked. Activist conservatives would be those that exist primarily to enact conservative politics, set aside the law and decree their own. The only SCOTUS issue that matters to fundamentalist conservatives is the prohibition of abortion. The conservative-activist court elected Bush, subverting the popular vote, in a bid to gain conservative power primarily with anti-abortion activism as the premise.

    What a terrible reign that resulted in: America became a war crimes nation, torturing people and indefinitely detaining people without charges and without trial (habeas corpus became a debated issue? really!), nearly two thousand Americans died due to FEMA’s mismanagement-by-design of Katrina, 4,300 Americans were killed in the Iraq war along with nearly a million casualties, and most idiotically, the whole blindly-activist abortion focus of Bush resulted in abortions going up dramatically under his watch, due to increased poverty, a lack of health care, and the failure of abstinence-only education.

    According to pro-life sources, “Abortion was decreasing. When President Bush took office, the nation’s abortion rates were at a 24-year low, after a 17.4% decline during the 1990s. This was an average decrease of 1.7% per year, mostly during the latter part of the decade. (This data comes from Minnesota Citizens Concerned for Life using the Guttmacher Institute’s studies).

    Enter George W. Bush in 2001. One would expect the abortion rate to continue its consistent course downward, if not plunge. Instead, the opposite happened. […] Under President Bush, the decade-long trend of declining abortion rates appears to have reversed. Given the trends of the 1990s, 52,000 more abortions occurred in the United States in 2002 than would have been expected before this change of direction.”

    So yes, the SCOTUS is packed with activist conservatives. They directly killed many thousands of Americans by acting to put a supposedly pro-life president in power, who then turned around and helped increase US abortions by tens of thousands per year (!), in addition to uncountable thousands more internationally, due to failed policy.

    So activist, but not really competent. – Dan ]

  • http://n/a patrickwilliamwalker

    Obama is, and always was, a fake. Many of us screamed loudly even as far back as February of 2008 that “black” + “educated” != “liberal”. For cripes sake, Obama is pro-death penalty, ironic coming from a black lawyer…

    Far from being liberal, Obama has been stalwart on some of the biggest problems of the Republican dominated years, even helping to cement the reality that Washington really is corporate-occupied territory (like one even needs proof to see how Wall Street owned the Democrats).

    He supported FISA and telco immunity (after he said he’d oppose it), he supported Cheney’s “Big Oil” bill, he supported the GOP push for “tort reform”, he criticized other Democrats for criticizing Bush SCOTUS picks, he pushed for lameduck corporate accountability with his “say on pay” measure, and he was for the expansion of Bush’s FBI (faith-based initiatives).

    He watered down nuclear regulations for campaign cash (google Excelon), he has not ended the practice of extraordinary rendition, and did he not go further than any other Jesusfreak in the GOP by stating, at an AIPAC conference in 2008 that Jerusalem was the undivided capital of Israel?

    But, worst of all, he supported the B.O.M.B. (Bush Obama McCain Bailout). Everything flows from the economic, and it’s quite clear at how nicely Obama has treated the criminals at Goldman Sachs and Bank of America, that he clearly isn’t the “One we’ve been waiting for.” Especially with the looming commercial real-estate disaster just over the horizon. You won’t be able to blame that one just on Bush and his merry cabal of scum. If you think things are any better, think again. Look at his economic advisory committee and his chief of staff…

    I take no joy in saying: “I told you so.” Obama doesn’t need more marketing. Far from it. He needs S-U-B-S-T-A-N-C-E. Why are people so surprised that Obama is acting the way he is? He had ZERO intention of allowing a public option, he just wants it to die so he can blame Republicans while not offending the big cash donors who gave to Obama nearly 2:1 than McCain (go to opensecrets.org).

    Neither McCain or Obama had the wellbeing of the average citizen in mind, but Obama was the one to fool everyone into thinking he did. And the scary thing is, the GOP could really do some electoral damage in 2010 if they weren’t having extramarital affairs and flying off to Argentina or wherever…

    So please, enough with the Obama boosterism and trying to equate Obama with Apple or Steve Jobs. Guilt by association

  • http://wanderbook.com eddieclay

    isn’t this the old “Medicare for all” idea? Just asking.

  • brotherStefan

    Dan wrote:
    “The US public debt under Bush ballooned from 5.7 billion in 2001 to over 9.9 billion in 2009.
    * The interest alone on Bush’s debt in 2008 was $412 billion.”

    Aside from you not knowing the difference between national debt and national deficit, your pontification is becoming absolutely rabid.

    $412 billion interest on on some debt number under $10 billion??? That’s quite some interest rate. But then YOU are the rational one.

  • davesmall

    I give Steve Jobs the highest rating for the job he’s done with Apple. I truly admire the man except for one thing. He put Al Gore on the Board of Directors. Steve’s a total winner. Al’s a total loser. Can’t comprehend that at all.

    I certainly don’t see Obama as a Steve Jobs clone. He might be a Scully clone though. He pushed out GW Bush just as Scully pushed out Steve Jobs. That’s a much better parallel.

  • bartfat

    Hey, so I sent this email to President Obama… hopefully he reads it. I might just as well send a letter (hopefully he reads that too). Well, here it is ;)

    Dear President Obama,

    I have a problem with the way you are communicating your health care plan to the US and Congress. Many have denounced your plan as part of a plan to “socialize” medicine and that somehow it will force Americans to pay higher prices, leave a budget deficit, and that it will be mandatory — all false, assuming the plan is similar to Medicare, except that it is providing public health care to everyone. In fact, you might as well name it Medicare for Everyone, like this article does.


    I completely agree with this writer, in that you have a branding problem. The Republicans have taken the airwaves and spread lots of bad information about this plan. It would be best if you had a public press statement discussing the system and why it matters so much… and throw out the statistics, such as showing that the US’s health care is the highest in cost and 37th in overall performance and 72nd in overall level of health. Stop trying to focus on the internet to spread policy updates — many Americans still get their news via the old-fashioned way, via radio or television. I’m not saying that the Internet isn’t a great tool, but it’s just one of them. In any case, you might also want some graphs and more hard numbers supporting your view that the U.S. needs health care reform, especially if you want to convince the population that your plan is the correct one. You can’t give up trying to push for this to pass, especially while Congress is out of session, since that’s when you or the opposition can determine what information people get to hear about the state of health care in the US.

    And please don’t water down the plan to appease the Republicans.. that hurts the people who will use the system in the future, and might even fail if the plan is too watered-down.

    Thanks and good luck,

    Any thoughts? I really do agree with Dan that it is a branding problem. And kudos to the fact that this time no one was claiming he was talking trash while not doing his research about politics — this time I didn’t see so much of a hint. Although that might be the case because all the people who might have gotten upset probably skipped reading the article and comments. But then again, no one (here anyway) seems to be able to deny that the US needs health care reform this time around ;)

  • http://www.tropicalspam.com macjojo


    As a Republican/Libertarian Machead who regularly reads your column, but who has lived in Europe and wholeheartedly agrees with the concept of socialized, single-payer medicine, I felt compelled to finally register (I am a longtime reader and fan) and comment.

    Your article is insightful, and your comment about branding is clever and apt, given the current situation. While branding is an enormous issue, and your “Medicare II” brand is a stroke of genius, I believe that another hint the President should take from Apple is less (but simpler and better) choices in the health care plans. This entire deal with allowing congress to work the details out themselves is misguided.

    Make the choices easy (as you say, graphics, bulleted keynote presentations with the salient points. “This will make your life better by 1, 2, 3, and 4.” “What the Republicans are saying is wrong because of 1, 2, 3, and 4.” This is the most important issue of our lives, and to see it gt watered down and go down the drain, AGAIN, because of special interests, again, is nothing short of an American tragedy.

    Thank you for shedding some light on this. I’m a big big fan.

    Jesus Rodriguez, Esq.

  • stefn

    Daniel, think about redrafting this as an open letter and submitting to the NYT.

  • MipWrangler

    Thank you Dan for another thought provoking political article! I tend to disagree with you politically, indeed I am opposed to both of the currently proposed bills, but I always enjoy reading commentary from intelligent, well written folks like yourself, especially if they disagree with me. (BTW, I’m a long time reader.) You raise some very interesting points and I agree with you that one of the most frustrating aspects of this entire debate is how it’s being pitched by both the current administration and by the bills’ opponents. Two other points you made surprised me. Your suggested use of the name Medicare as good marketing for the _current_ bills and that you imply that most folks enrolled in Medicare are happy with it.

    “the Medicare you enjoy and rely upon…”

    I’d be interested in the statistics behind that claim. Not that I’m disputing it outright as I have no statistics of my own, but my experience with folks I know personally who have had to rely on Medicare would not claim to have enjoyed the experience. If a majority of Medicare enrollees do actually enjoy their coverage and experience then you are quite right that the Administration is not using those numbers to it’s advantage. I suspect this not to be the case however (though I’m interested to hear otherwise) based on personal accounts and also the House bill allotting considerable space to addressing the shortcomings of the Medicare and Medicaid programs (Division B, p215).

    What is most frustrating, and what you touched on, is that there doesn’t seem to be a clear case being made for: (1) what precisely are the problems we are trying to address, (2) all the details about how to address those issues, and why it is believed they will work (not just the favorable parts), and (3) a non-idealistic estimate of the costs, how specifically those funds would be raised, how it impacts taxpayers and for how long. Your imploring call for graphics is well warranted!

    The current versions of both House and Senate bills (I have read them both), propose the institution of a new government agency in addition to, not in place of, the current agencies that administer Medicare, Medicaid, and Social Security; all agencies synonymous, at least to the public, with bureaucratic bloat and inefficiency. What might be more marketable and arguably more “Jobsian” would be to actually combine the existing agencies, making meaningful cutbacks to reduce wasteful spending between them, then picking one or two of the biggest health care issues (“features”) to knock out of the park, and roll it all out under the name “Medicare II”; the remaining issues left to be added in future “releases” (even if they seem as essential as “cut,copy,paste”). Alas, the current proposals seem to come from more of a Microsoft-like play book rather than an Appleish one; if we must keep making analogies to consumer electronics that is. ;)

  • Dan Inouye

    Nothing progressive or liberating about ObamaCare. It’s a statist approach that even people in Canada are reconsidering: http://www.google.com/hostednews/canadianpress/article/ALeqM5jbjzPEY0Y3bvRD335rGu_Z3KXoQw. The money quote: “We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize,” Doing said in an interview with The Canadian Press.

    So, you and Obama want us to go backwards, using a system that even Canada finds unsustainable. What’s so progressive about that? With that in mind, Obama is like Microsoft where he is going where the puck was. Not like Apple where they try to consider where the puck will be… ;-)

    [The only similarity between what Obama’s planned Medicare II does and how Canada’s system works is that both relate to health care. Canada is a single payer insurance system with public/private hospitals, not a public/private insurance marketplace with private hospitals and doctors, as Medicare II outlines.

    Are you seriously suggesting that because Canada’s health care system has issues of its own to handle, that the US should be content with a clearly failed system that puts the USA dead last among wealthy nations? Because that would be rather silly.

    Also, just for the record, the planned US system has very little in common with how the UK works (UK hospitals are public and doctors are all government employees). So right wing comparisons to issues in the UK are at best specious misinformation. Still, the problems with the UK system are largely issues related to the government trying to impose corporate-style market incentives under conservative rule. Even so, I’d much rather go to the hospital/have cancer/have a baby/get old in the UK than here in the US. – Dan]

  • Dan Inouye

    Who said I was right wing?

  • Dan Inouye

    Anywhoo, got any word on iTunes Replay?

  • Pingback: Barack Obama News » Blog Archive » What Obama could learn from Apple… on Health Care – RoughlyDrafted …()

  • http://n/a patrickwilliamwalker

    Speaking as a Canadian, only certain elements inside the Canadian Medical Association (basically, a union for doctors) are pushing for the end of single-payer in Canada because their rates are fixed at a certain rate. By getting rid of this limitation imposed by government and popular support, they actually believe that they can charge more and become fabulously wealthy as they see American doctors are.

    They’re in for a rude awakening.

    My parents, no bastions of leftwing thought have repeatedly said that they will not pay a single cent to a Canadian doctor and would fork out their own money and go to India for any serious treatment. Doctors here are even starting to charge “cancellation fees” if you do not appear for a scheduled appointment.

    The CMA, for the last 20 odd years, has gotten the medical schools in this country to restrict the number of applicants, thereby creating a “doctor shortage” which they try to indirectly blame on “government”, thereby implying that things need to change.

    The CMA used to be torn about 50/50 pro/con single payer, but all the older doctors, especially those that have no desire to return to being paid with pigs and chickens, are dying off, leaving the battlefield open to the other sociopaths who see the Canada Health Act as denying them the proper compensation which they think they deserve. These same people who are screaming about how the marketplace is more efficient has taken steps to distort this very same marketplace…

  • http://n/a patrickwilliamwalker

    What I should say simply is that the problems in the Canadian system are caused artificially. That is, there are elements inside the CMA and the government itself that wants to “kill it”. Governments don’t like the fact that money spent on health care cannot go towards corporate tax cuts, governments (*cough* Stephen Harper *cough*) don’t also like the fact that medicare in Canada actually works much, much better than the marketplace we had before.

    It’s also a captive market, so it wouldn’t surprise me if the provinces also wouldn’t like to carve up this captive market to connected friends in the private sector.

    I’m really upset by right-wing ideologues in the US basically misinform the problems with the Canadian system to scare Americans into revering a broken status quo.

  • Tardis


    Seriously, you should stand for US President in 2012.

    Sadly, I will be unable to vote for you. I come from a nation (Britain) that has, or had, a very good and cost-effective health-care system. I now live in a nation (Japan) that has a very good and even more cost-effective health-care system. When I lived in America, I was scared of catching a cold.

  • MipWrangler


    According to a 2004 report on the WHO website, the estimated deaths from cancer (per 100,000 population) in the UK was 33% higher than in the US for the same period (UK: 256.1, US: 191.9). Would you still prefer to get cancer care there?

  • Dan Inouye


    He said he would, just based on principle. I’m surprised after Dan’s glowing appraisal of their system, he didn’t buy his ticket to the U.K. yet.

  • shiver me timbers

    Daniel, I would like to offer you a different opinion from a different type of politician. No one would say that Ron Paul is a standard Republican. For example, Paul was the only 2008 Republican presidential candidate to have objected to and voted against the Iraq War Resolution and continues to oppose U.S. presence in Iraq, and his stance on foreign policy is one of consistent nonintervention which avoids war of aggression. He has also consistently voted against corporate bailouts.

    The National Journal labeled Paul’s overall foreign policies in 2006 as more conservative than 20% of the House and more liberal than 77% of the House. So, he is a free thinking Republican that votes on conviction, on what is Constitutional, and what is best for the the country, and does not just tow the party line.

    So, allow me to quote Ron Paul’s political position on health care from the Wikipedia:

    “Paul rejects universal health care, believing that the more government interferes in medicine, the higher prices rise and the less efficient care becomes. He points to how many people today are upset with the HMO system, but few people realize that HMOs came about because of a federal mandate in 1973. He also points to the 1974 ERISA law that grants tax benefits to employers for providing insurance but not individuals; he prefers a system which grants tax credits to individuals. He supports the U.S. converting to a free market health care system, saying in an interview on New Hampshire NPR that the present system is akin to a “corporatist-fascist” system which keeps prices high. He says that in industries with freer markets prices go down due to technological innovation, but because of the corporatist system, this is prevented from happening in health care. He opposes socialized health care promoted by Democrats as being harmful because they lead to bigger and less efficient government.

    Paul has said that although he prefers tax credits to socialized medicine, he would be willing to “prop up” the current systems of Medicare and Medicaid with money saved by bringing troops home from foreign bases in places such as those in South Korea.”

    Please watch this CNN interview with Ron Paul on 7/22/09:

    and watch this CCN interview with Ron Paul on health care reform:

    [Thanks for the comments. Ron Paul does say some interesting and provocative and thoughtful things, but where is there a workable model of providing health care for the nation using profit as a motive?

    The difference between health care and other business, say cars or computers or mobile phones, is that people can choose what level of luxury they want in a car, settling for a ten year old clunker or paying for a brand new, high end BMW. The market makes those options available, and rewards innovation, efficiency and design to an extent (note that without environmental regulations, car makers would dump toxins into the air until we all died of cancer, as they did up into the 70s, and resist putting in seat belts and crumple zones, etc).

    Health care is an entirely different business. If I don’t want to spend lots on health care, I can’t choose not to get sick, not to have an accident, not to have inherited a weakness, not to be poisoned by unregulated industry, etc. I might have health care bills equivalent to several high end luxury cars just dropped in my lap. As a consumer, I have few options for shopping around in a functional marketplace because once the sellers know I’m desperate for care, they can set prices however they like. My medical record exposes all of my buying history and future needs. There is no realistic potential for turning health care into a “free market” outside of providing insurance for very specific markets.

    Additionally, we have societal problems that make it essential that the public have coverage. I have little or no real impact from my neighbors choosing to buy a cheap car or to take the bus instead of buying a car. However, if they don’t have health care, they could be spreading diseases that would otherwise be treatable, and their untimely deaths will have an impact on my world in a way that their refusing to pay for a car does not.

    This makes health care a societal expense, not an individual expense. Rather than buying a car, its more like paying for roads. Does Ron Paul also advocate dismantling the Interstate System and leaving it up to individuals to pay for each stretch of private toll roads as they need them? That’s how you get around France, paying for a highway sticker and then stopping to pay tolls every few miles on top of $8/gallon gas. They drive less, and drive smaller cars. America doesn’t want that, it wants socialist highways that force everyone to pay for freeway maintenance from general taxes so that anyone can drive (gas taxes do not pay for all our roads, general taxes do). It benefits commerce and tourism and is corporate welfare for big shippers like Walmart.

    Once Americans realize how much public health care will benefit the middle class, they’ll support it too. The problem is that Republicans seem to worry that it will pay for poor people. That’s not the case at all. Those people already have health care — they just get carried into the hospital at great expense and then don’t pay. That’s part of why our health care is so crazy expensive. What we need is equitable, non-profit oriented health care. We have plenty of examples of this working both worldwide and in the US: public hospitals, the VA, Medicare, Medicaid.

    What we don’t have is any examples of excellent, affordable health care sprouting from a greed-centric system. That’s because there is little opportunity for real competition for services you don’t know you need, or can’t hide that you need, or can’t anticipate that you’ll need. Insurance is socialism, and health care in America desperately needs it.

    As much as I like free markets in areas where competition abounds, some markets don’t work like that.

    Also, Ron Paul last ran for president as part of the Constitution Party, an ironically named group of religious nuts who want to replace the government with a loosely Jesus-themed, Iran-style Sharia/Theocracy. The group’s platform hinges primarily on abortion prohibition, a failed policy that actually raised abortions under Bush. It also opposes “hate crime” legislation (they hate gays), public education (favoring home schooling by equally uneducated parents so that religion can flourish as it does in Iran), and an environmental policy that thanks God for the beautiful country while dismantling all the government agencies that have saved the wilderness from pillaging by the same nutters who want to rape the earth as much as they can before being whisked off to heaven during the Rapture.

    So no, I can’t take Dr. Paul’s health care fantasy very seriously. – Dan ]

  • nelsonart


    Fox News – specifically The Factor – has been beating the drums for simplification and honesty in the health care debate. I’ve heard a lot of discussion from both sides and watched this complicated issue often disintegrate into angry and unintelligent outcry.

    I don’t think I’ve listened to (or read) a stronger or more concise argument that your above reply.

    Had Obama read parts of this from a teleprompter during his prime time new conferences, I think the debate would have been far more intelligent.

    I don’t agree with your economic sensibilities at all, but this is one issue that you’re spot on with. And you seem to have the ability to lay out the reasons why it’s necessary.

    The only thing I’d add is Obama has to drop the notion that there doesn’t need to be any sacrifice. If we need to broaden the tax base so everyone pays (and not just ‘stick it to the rich’), then he has to be honest. Honesty in regards to how it’s going to be paid for is important.

    People are skeptical. Money is flying everywhere and people are still feeling the pain of the recession. Naturally, that creates an uphill battle for Obama to champion yet another expensive, complicated govt. program.

  • Dan Inouye


    As much as I disagree with you on this issue, your comment to shiver me timbers is your most thoughtful argument for socialized health care I’ve seen you make yet. You don’t come off as angry, but quite reasoned and knowledgeable in where you stand. You should try this approach more instead of the “Bush screwed us!”, “Republicans and conservatives are idiots!” rant you tend to use. The usual, angry method you employ tends to make you look like a loon at times.

  • twilightmoon

    “The republicans have intentionally created a self-perpetuating phenomenon by starving education of funding (California’s Prop 13 is a prime example) which allows them to feed stupid marketing slogans”

    You can believe that all you want but the sad truth is both parties benefit from an uneducated populace, both derive their power from propaganda and manipulation. The problems with education are at least as much if not more the fault of the Democrats who run the teachers unions which put keeping bad teachers employed and dumbing down the standards in front of what is best for children.

    Tell me which party is it that protects children from bullies and violence, and keeps the standards of education high, and rewards people that work hard? This is a cultural problem as much as it is political, our society has lowered its standards to the point where mediocrity seems like excellence. Patience is a thing of the past.

    “The point of referencing Bush is that Obama spent most of that money BECAUSE of Bush’s failed 8 years of running the country into the ground. ”

    The failures that Obama is “cleaning up” were as much a result of failed legislative leadership which was Democrat party primarily. Both parties created the mess, you can’t pin what happened on Republicans and Bush any more than I can pin it on Nancy Pelosi and Harry Reed. It was a tag team effort. I find it sad someone as intelligent as you is so easily manipulated by political figures. You see through bullshit in technology but have huge blinders on when it comes to political and cultural issues.

  • Oatworm

    I’ve been reading your blog for years and, after this post, finally got around to registering here. I have a feeling you’re getting a number of people doing the same.

    There is quite a bit I agree with you on with this post. Though I disagree with some of your issues regarding the previous Republican administration, I wasn’t a big fan of the GOP’s attempts to run existing government programs into the ground via mismanagement. I also agree that Obama has done a miserably poor job of “branding” his “product”, and you’re not the only one to notice this – in fact, Mickey Kaus on Slate has been pushing the same point for a month now. I also agree that our current health care “system” (using air quotes on that one) is deeply flawed.

    With all of that said, though, I have to disagree with you on the issue of government-run health care. More specifically, I have to disagree with you on the issue of US government-run health care.

    If the Federal government takes control of health care – this is the desired outcome of any progressive health care plan I’ve run across – here’s what would happen:

    One of these days, a dying grandmother is going to be faced with a choice. She can choose to continue treatment of her terminal illness, possibly extending her life by another six months, or she can refuse treatment and die quickly. Under significant pressure from her family, she will choose to continue treatment and tell the doctor as much. The doctor will then consult the government-run health care insurance program and ask for funding approval. Meanwhile, at the government-run insurance program, a computer program/government employee/pick something is going to do a little cost analysis – do we give this grandmother’s doctor $100,000 to keep her life going for another six months, or do we use that money to keep a premature baby on the other side of the country alive? Being a well-written computer program/well-trained government employee, the money will be allocated toward keeping the premature baby alive and the grandmother will be denied treatment.

    Now, at about this point, you’re thinking to yourself, “Ah ha! He’s talking about the death panels! I bet he listens to Limbaugh!” I don’t – can’t stand the guy. So, stay with me – you’ll like the ending.

    The family of the grandmother, upon hearing that the government insurance program has denied treatment, is distraught. They thought they would enjoy their grandmother’s company for another six years, but now some pencil-pushing bureaucrat/poorly designed Windows program (like there’s any other kind!) is saying she has to die?! That’s reprehensible! So, they contact their senator, their representative, the news – anybody that will listen – and they cry. They cry, they moan, and they kvetch to anyone and everyone that will give them a spec of airtime.

    This is the point where I explain why I don’t like the US government running health care.

    What happens next is that the opponent of the senator/representative/MSFoxNBC/whatever will say, “So, are you in favor of killing grandmothers?” All rational discourse on the merit of spending hundreds of thousands of taxpayer dollars to keep a person alive for another six months versus spending it on keeping premature babies alive will get lost. All that will be left will be emotion – raw, unadulterated, blind emotion. Once that happens, every single self-respecting senator/representative/news channel will do the only thing they can do:

    They cover the grandmother.

    Of course, they can’t revoke coverage from the premature baby – that’ll cause just as big of an uproar – so they just increase coverage across the board, increasing cost even further. Since the government-run health care plan will be seen as a bottomless pit of money (figures in the “billions” and “trillions” will do that to even the best educated people), people will find ways to be outraged that this expensive program isn’t covering X (X belonging to a set of treatments, many of which will either be pointlessly expensive, medically questionable, or worse) and demand that Congress do something about it. Since our political system is explicitly designed to reflect the will of the people, even when the people are being kind of stupid, Congress will cave each and every time. As a consequence, we’ll be buried up to our eyeballs in debt.

    This exact dynamic happened to the HMOs in the ’90s. It happens whenever defense spending comes up. It’ll get REALLY bad if the government does something stupid like revoking the “Public Option” and replacing it with a set of government-sponsored enterprises (think Fannie Mae/Freddie Mac) that can lobby Congress. To make a short story long, no, government-run health care isn’t bad, but US government-run health care would be an unmitigated disaster. In fact, I’d almost argue it already is.

    So, what do we do instead?

    Personally, I’d like to see all health care spending become tax deductible and put more emphasis behind health care spending accounts. Insurance companies regularly skim at least 15% to cover administration and profit – we’d be better off paying all of our health care bills with credit cards! Even a poorly run retirement account-style system would be better than what we’re doing; given a choice between taking a 20-40% hit every 8-10 years with compound interest growing the account in the meantime and taking a 15%+ hit every single month with no compound interest, I’ll take the compound interest without complaint. We could still keep high-deductible insurance plans for the big stuff, and probably find some way to subsidize health care for the poorest and oldest (kind of hard not to, electorally speaking).

  • Oatworm

    Oh, and, last but not least, I’d also like to see open pricing. When I go to a mechanic, buy a car, etc., there’s a price, I’m aware of it before I pay for it, and I have the opportunity to decline it or shop elsewhere if I’m so inclined. I don’t find out how much anything costs medically, though, until months after the fact. If we fix that, I think you’ll find that the free market suddenly doesn’t look so bad.

  • shiver me timbers

    Now, see Daniel. You have made a great factual error.

    You said:

    “Also, Ron Paul last ran for president as part of the Constitution Party, an ironically named group of religious nuts who want to replace the government with a loosely Jesus-themed, Iran-style Sharia/Theocracy.”

    That is patently false about Ron Paul. According to the Wikipedia:

    “Paul has run for President of the United States twice, first in 1988 as the nominee of the Libertarian Party and again in 2008 as a Republican.”

    Ron Paul never ran as a part of the Constitution Party. I knew that. And being the informed political essayist that you are, you should know that.

    While your rants against Microsoft as being evil on this site work for me (a devoted reader of your fantastic technology articles, by the way), when you go into a rant equating whom I believe to be the most honest politician in Washington who can’t be bought by any special interest, Ron Paul, as being almost evil, all based on an incredibly false assumption of yours, it makes me wonder what other political assumptions do you have that are patently false, where you have not checked on your facts but rather rely on inaccurate assumptions?

    When you start to spread misinformation, you do your political arguments a disservice, because it now brings into question: with what else you might you be in error?

    [For means of disclosure, I am not a Republican nor a Democrat but an Independent. I believe that both of our parties have gotten our country into serious trouble.]