Americans are, above all, supposed to be pragmatists. Their test for judging any existing system or proposed solution centers on its workability. If it is functional, if it serves its purpose, everything is fine. Of course, for the pragmatist, the corollary also holds true; a system that doesn’t meet people’s needs should be changed.
The present healthcare system in the United States fails every pragmatic test. It costs much more per capita than any other Western country, yet close to fifty million people in America have no coverage at all. Also, in the crucial litmus test areas of infant mortality and longevity, the statistics for other developed countries are better than in the United States.
Why does American pragmatism tolerate such poor performance in cost and delivery? The answer seems to be mainly ideological. Most Americans are suspicious of big government solutions. And lobbyists for the private healthcare industry spend hundreds of millions every year fostering this suspicion and opposing any major change, especially if it entails more involvement by Washington.
Central to President Obama’s thinking is what he calls a public option, a choice for people to avail of a Government-sponsored health care policy. This choice would be available not only to the millions of uninsured but to anybody who is dissatisfied with his or her present coverage, with no penalty or exclusion for pre-existing conditions.
Conservatives love to quote Thomas Paine who, famously, said that “the best government is the least government!” They mostly opposed the New Deal and Just Society programs of FDR and LBJ, both of which sought to use the Federal Government to provide a basic standard of living for all citizens. Republicans, most of whom define themselves as conservatives, opposed such landmark, progressive initiatives as Social Security to cushion the elderly from dire poverty and Medicaid, a nationwide program which provides healthcare for some poor families.
Instead, they favor the provision of all – or nearly all – services by private enterprise. They believe that healthy competition between private companies, competing for business, offers the best chance of meeting nearly all society’s needs, including in the area of healthcare.
Amazingly, the main argument used by opponents of the public option is that private companies, who cover most people at present, would not be able to compete with the new, proposed Government choice. Ironically, one of the main arguments being used by Republicans, who all oppose the Obama plan, is that vibrant competition, which is espoused as a sacred dogma by all conservatives, is unfair to the established private companies in the healthcare area.
Another core belief among conservatives is that Government, especially the central Government, is always inefficient and wasteful. They love to talk about "faceless bureaucrats" dictating to people about various entitlements. Yet, most people admit that the public option will involve far fewer employees – yes, bureaucrats - and cost less by comparison with the private companies.
Medicare, a federal program, which provides hospital and doctor services for the elderly, is considered much more cost-effective and efficient than similar programs provided by private companies. Yet, proponents of change, so far, have failed to get this crucial point across to the public. Instead, the media seem to concentrate on bogus arguments about incipient socialism and alleged long waiting lines in Britain and Canada.
The healthcare debate, which is dominating the public discourse this summer, is, without doubt, the most important domestic issue facing the American body politic for many years. Passing a bill along the lines of the Obama outline proposal, including a strong public option, would be a major success for the President. Failure to get the required number of votes for passage in either house of the Congress would greatly diminish and weaken Obama’s first term. The stakes are very high.
Can the strong pragmatic tendencies in American politics trump the deep suspicions of a “big” government solution? We will see before the year is out.
