Americans are often ignorant about public policy, but they’re not stupid. They understand that if you want to extend health care to everyone, improve the system for people who already have coverage, and restrain costs over the long haul, somebody, somewhere, is going to have to give up something.
The Obama administration, however, has argued that the only people who really have to give up anything are the wealthy, who will pay somewhat higher taxes. Everybody else will only have to give up things that aren’t doing them any good anyway, or give up things with one hand but get a lot more back in the other.
As I said, the American people aren’t stupid, so they’re not buying this.
There’s a message, though, that the president hasn’t tried. It would go like this: “Here’s what you’ll have to give up. Here’s what you’ll get in return–but by ‘you’ I don’t just mean you personally, but you, your community, your kids and grandkids, the country as a whole. In other words, I really mean ‘we,’ or ‘us.’ Are you willing to make that trade-off, or are you only willing to give up something if you see a direct, personal benefit?”
The closest he came to trying this approach was when a reporter asked him if taxing the wealthy to pay for health care for the poor was not somehow un-American. Obama’s answer, paraphrased, went more or less like this: “No, I don’t think so. I think that if you’ve been fortunate enough to be among the top five percent of income earners in this country, you’re probably willing to share some of your good fortune with others. That’s what it means to be part of a community.”
Maybe he’s wrong about that “community” message. I hope not. I’d really like to find out, though.
More specifically, I’d like to see the president cast the health care issue in terms of individual sacrifice for collective purposes. I’d like to see him ask the AARP, for example, either figuratively or literally, “Would you be willing to see a small reduction in Medicare benefits in order to extend insurance coverage to everyone and secure the fiscal future of the country? Keep in mind, you wouldn’t be doing this alone. Everybody would have to give up something. Your part, though, would come out of what we spend on Medicare.”
If the AARP were to say, “No, we’re not willing to see our benefits cut in order to preserve the country’s fiscal future and extend coverage to the uninsured,” then I think we could declare health care reform dead, and the country essentially ungovernable.
When we get to the point that major groups, whether organized or not, are unwilling to relinquish a sliver of their self-interest in order to secure the collective good, then we’re pretty much back to the state of nature, the “war of all against all.” Then it’s time to knock down the civil structure we’ve built and start over again.
Footnote: Under this AARP scenario, though, I think you’d see dramatically increased enthusiasm for the end-of-life care provisions in the House legislation–maybe even for death panels!
Anklenote: I remember a while back that somebody proposed a hypothetical bargain to the head of one of the two teacher unions, either the AFT or the AEA. Here was the bargain: “If you guys will permit school choice, we’ll guarantee public funding of $15,000 per year for every student who remains in the public school system.” Here was the answer: “No.” Follow-up: “How about $20,000?” Answer: “No.” Follow-up: “How about $50,000?” Answer: “No.” Follow-up: “How about a million?” Answer: “No.”
Translation of all those “no” responses: “We are unwilling to accept any threat to our self-interest, even if it might result in a significant public good.” It seems ridiculous, but there it is.
I wonder, then, whether the AARP–and lots of other well-heeled, well-organized groups, not to mention the disorganized mass of average Americans–is prepared to say, “There are no circumstances under which we are willing to support a health care reform that requires any sacrifice from us.”