Why The Health Care Debate Is So Contentious

Even prior to the abortion issue being pointlessly dragged into the debate over health care reform the issue has been one of the most contentious debates I have ever seen in politics.

The question quickly becomes: Why?

I feel I have an answer, and it mirrors the matter of the abortion debate as well.

It is simple:

Both sides view the other as disingenuous and downright evil.

From the perspective of the anti-reformists all support for this bill is a disguised effort to destroy capitalism and / or expand the federal government to an unreasonable size.

From the perspective of the pro-reformists all rejection of this bill is a disguised effort to spread hatred, intolerance, racism and violence under the banner of a “tea party” and / or purely strategic politics of conservatives seeking to undermine all bills proposed under President Obama.

(There is, of course, a great deal more complexity at play here in both positions.)

In a situation where both groups view the other as “liars” there is no debate to be had. No discussion that will bare fruits. None.

The fear and lies surrounding this health bill entirely native to the rightwing has no bartering point from which to start from. There is no common ground to find with a person who lies about the record and rejects all evidence that does not compliment their existing preconceptions.

Throughout this year long national debate I have strived to pull the emotions out and put the facts in their place, but such actions only serve a purpose when there remains holdouts on both sides. In the course of this I have seen new levels of hostility directed at me personally more so then ever before in my experience.

I have never “un-friended” and “blocked” so many people in my entire ten-plus years on the Internet.

The incitement toward violence, the death threats, the partisan hate; all existed prior to the matter becoming national in the death threats against Democrats post-HCR. All of this existed in the venom directed at health reform advocates on a daily basis from individuals of a very low moral fiber and very poor understanding of democracy.

In matters discussing life and death, I’d rather not see so many and myself give in to fear; but it truly doesn’t surprise me in the least to see this country explode in mindless paranoia. Big changes equates to big fears, bad economy equates to paranoia on the rise.

In the solid matter of facts, this health bill is a net-positive for America.

But this issue will not lose any of it’s contentious nature no matter how many facts are interjected in the mass spreading of paranoid myths. For too many Americans it is simply easier to believe the worst, and the biased conservative media is sure to provide them endless piles of red meat.

Urban Institute Overviews The Public Option

Ezra Klein of The Washington Post has called this the "best overview of the public option" he has read so far, and I concur:

Getting to a Public Option that Contains Costs: Negotiations, Opt-Outs and Triggers

Robert A. Berenson, John Holahan, Stephen Zuckerman

The debate over a public option has essentially become a debate over the size and role of government in the health care system. The central argument, as we see it, should be one of fiscal conservatism—that a public option should play a role in addressing the very serious problem of health care cost containment. The current debate between the left and the right on this issue is obscuring the fact that consolidation in both the insurance and provider markets is propelling a higher rate of growth in health care costs. The consolidation of power, particularly in provider markets, makes it extremely difficult for insurers to negotiate rates for their services and contributes to rapid growth in health care costs. A strong public option is one that ties provider rates in some way to Medicare rates (though set at likely higher levels), and that is open to any individual or firm regardless of firm size. It would thus provide countervailing power to providers and help control cost growth.

We argue that a strong version is necessary because there is little else in health reform that can be counted on to contribute significantly to cost containment in the short term. Capping tax-exempt employer contributions to health insurance has great support among many analysts (including us), but it faces considerable political opposition. Proposals such as comparative effectiveness research, new payment approaches, medical homes and accountable care organizations, all offer promise but could take years to provide savings. Thus, the use of a strong public option to reduce government subsidy costs and as a cost containment device should be an essential part of the health reform debate.

We recognize that there is opposition to a strong public option. Both the House and Senate proposals are considering relatively weak versions to make the public option more acceptable. Both proposals would have the public option negotiate rates with physicians and hospitals. We see two problems with this. One is that negotiating rates is not simple and it raises difficult implementation issues; for example, with whom would the government negotiate? Further, negotiations are most likely to be unsuccessful with providers who have substantial market power. Since this is at the heart of the cost problem, a strategy of negotiations seems unlikely to be effective, as has been affirmed by cost estimates from the Congressional Budget Office.

The Senate has proposed a public option with an opt-out provision. This has the advantage of recognizing regional diversity in political philosophy by allowing states to pass legislation to keep it from being offered in their states. A disadvantage of this proposal is that it would exclude many who would potentially benefit from a public option. The states likely to opt out are likely to be those with high shares of low-income people and many uninsured.

The other alternative is to establish a strong public option but not implement it unless a triggering event occurred. The goal would be to allow the private insurance system to prove that it can control costs with a new set of insurance rules and state exchanges. The triggering events could be the level of premiums exceeding a certain percentage of family incomes or the growth in health care spending exceeding certain benchmarks. Since the public option would only be triggered because of excessive costs, however measured, we assume that a relatively strong version of a public option would come into play.

We recognize that taking a strong public option off the table may be necessary to enact reform legislation. But this will mean, at a minimum, higher government subsidy costs by not permitting a payer with substantial market power to bring cost containment pressure on the system. The outcome is likely to be that costs will continue to spiral upward. In effect, the nation would be relying on the range of promising pilot approaches to cost containment that would take some time to be successful. If they are not, we may be left with increasingly regulatory approaches, such as rate setting or utilization controls that apply to all payers. This would mean much more government involvement than giving people a choice of a low-cost public option that would be required to compete with private insurers.

(Read entire paper in PDF)

The White House Blog: "On This Thanksgiving"

Posted by Macon Phillips on November 26, 2009 at 12:00 AM EST:

Happy Thanksgiving!

Given the holiday, we are releasing the President's weekly address today. In this video, President Obama calls to our attention the men and women in uniform who are away from home sacrificing time with family to protect our safety and freedom. He also talks about the progress of health care reform, the Recovery Act, and job creation to ensure that next Thanksgiving will be a brighter day.

And let's not forget that it was the American People themselves who put Barack Obama in office with our own donations and our own votes:

Obama's victory in the general election was aided by his tremendous fundraising success. Since the start of 2007, his campaign relied on bigger donors and smaller donors nearly equally, pulling in successive donations mostly over the Internet. After becoming his party's nominee, Obama declined public financing and the spending limits that came with it, making him the first major-party candidate since the system was created to reject taxpayers' money for the general election.

Source of Funds:

Individual contributions $656,357,572 88%

PAC contributions $1,830

Candidate self-financing $0

Federal Funds $0

Other $88,626,223 12%