Health Care Reform: Change or More of the Same?

Matt Yglesias’s comments on James Surowiecki on the health care reform debate triggered a few thoughts in my head.

First, Surowiecki (after describing how people fear reform because they tend to fear change):

Because it’s hard for individuals to get affordable health insurance, and most people are insured through work, keeping your insurance means keeping your job. But in today’s economy there’s obviously no guarantee that you can do that. On top of that, even if you have insurance there’s a small but meaningful chance that when you actually get sick you’ll find out that your insurance doesn’t cover what you thought it did (in the case of what’s called “rescission”). In other words, the endowment that insured people want to hold on to is much shakier than it appears. Changing the system so that individuals can get affordable health care, while banning bad behavior on the part of insurance companies, will actually make it more likely, not less, that people will get to preserve their current level of coverage.

This is basically what Simon and I argued in the Washington Post a couple weeks ago, and I’m glad that someone with a much bigger platform is saying it, too.

Surowiecki goes on, “The message, in other words, should be: if we want to protect the status quo, we need to reform it.” This reflects a disturbing trend I’ve been seeing lately, and that to a small extent I’ve participated in: supporters of health care reform talking about how the Obama Administration is fumbling the message. George Lakoff’s recent assault on “PolicySpeak” is one example. (I generally find Lakoff only half-convincing; I read Moral Politics, and while I thought his characterization of the conservative model was brilliant, I thought his attempt to create a liberal “equivalent” was an exercise in wishful thinking. I think conservatives just have it easier when it comes to this sort of thing.)

I don’t mean that Surowiecki shouldn’t be criticizing the messaging; I mean that it’s worrying that the administration’s communications problems have become the news – in part, of course, because the media find them more “newsworthy” than, say, the details of non-profit cooperatives. Remember, this was the team that ran the most praised presidential campaign in decades. If they can’t get it right, maybe the problem goes deeper.

And here’s Yglesias:

Insofar as people are already walking around filled with anxiety about loss of employer-provided coverage or rescission, then this kind of message will appeal to them. But if you run around trying to tell people they don’t have things as good as they think you do, will they embrace your policies or just decide you’re an unpleasant jerk?

According to the polls, many people are not walking around filled with anxiety. I guess I’m the unpleasant jerk in this scenario; our Post column was titled “Like Your Health Insurance? Maybe You Shouldn’t,” after all. My theory is that the only thing you can use to counter fear is fear; instead of being afraid of government death panels that don’t exist and won’t exist, people should fear losing their jobs and getting sick, which are real dangers. But curiously, we Americans seem to have this instinctive belief that we must have it good – we’re Americans, for God’s sake. And if that’s the case, then change – especially change that brings us marginally closer to the way every other advanced country provides health insurance – must be something to be afraid of.

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