Friday, August 14, 2009

The debasement of public debate

Democracy is the worst form of government except for all the others, Churchill once supposedly remarked. One of democracy's virtues, at least as it is presented in civics books and the writings of some political theorists, is deliberation: the calm, reasoned, informed discussion of the pros and cons of alternative policies. Deliberation in the real world can never be purely disinterested: individuals and groups have economic and other interests and, in a capitalist democracy like that of the U.S., can be expected to organize to try to advance those interests in the public arena. But if deliberation cannot be disinterested -- if we cannot decide public policy questions behind a Rawlsian 'veil of ignorance' in which no one knows his or her particular socioeconomic position -- we nonetheless can, or at least we should, expect deliberation to adhere to certain minimal standards of civility and intelligence.

Public debate, of course, has often departed from such standards. To stick with the U.S. context, personal invective and ad hominem attacks have been a feature of American politics from the beginning. The Federalists and the anti-Federalists often attacked each other in the vilest terms imaginable, as did, especially somewhat later on, the proponents and opponents of slavery. The dispute over the Bank of the U.S. in Andrew Jackson's administration was hardly a model of temperate discussion. Many other examples could be given. Reasoned deliberation, purged of emotionalism and personal accusations, is a liberal ideal that is realized only very imperfectly in practice, when it's realized at all.

That said, it is nevertheless discouraging to observe the level and tone of debate now occurring on the subject of health care reform. The immediate occasion for this observation is my reading today of Charles Krauthammer's Wash Post op-ed and a few of the many reader comments on it. I disagree with Krauthammer's general opposition to any overhaul of the health-care system. But his specific point in this column, that prevention is not a 'magic bullet' when it comes to health care costs, is worth considering and debating on the merits. While some of the reader comments do address the merits, many others do not. Instead, they fling ad hominem charges -- a few go so far as to suggest that Krauthammer is endorsing human suffering, which he is not -- and they observe that Krauthammer has been wrong on other issues, such as the Iraq war.

Now it's true that Krauthammer was wrong on the Iraq war -- in my opinion he's been wrong on nearly every foreign policy issue of the last thirty years, or however long he's been writing his column. But that does not mean that he is necessarily wrong about the issue of prevention and costs. Some commenters point out that he underestimates the aggregate societal benefits of prevention, while others observe that his argument does not distinguish clearly between more-expensive and less-expensive types of prevention. Those commenters are contributing to reasoned debate. The commenters who hurl epithets -- "Nazi," "moron," "idiot" -- are not, any more than the people screaming and shouting at town meetings are.

The U.S. health care system, like the U.S. tax code and some other aspects of the American system, is byzantine, very wasteful, costly, inefficient. It produces excellent care for some while relegating others to second-tier treatment or none at all. As a 'developed' country with no universal or near-universal health insurance, the U.S. is an outlier. These are all obvious statements and they suggest that some kind of comprehensive reform is urgently required. I don't think myself competent to weigh in on the details of the current proposals, except to say that members of Congress should try to exercise the courage to admit that some taxes will probably have to be raised -- and not necessarily only on multimillionaires -- to fund the required reforms. Some savings can come from more administrative efficiency and competition (and maybe even from basic forms of prevention), but more taxes will still likely be necessary. I also tend to favor a public option. Beyond that, I can't contribute much to the substantive debate. But I feel that people committed to reasoned deliberation should speak up against the debased public discourse currently surrounding this issue.


hank_F_M said...


Yes just Who is a Fascist? :- )

There are two different items when dealing with cost. The government account and the total economy.

The government account will need more money than the current publically advertised plans allow for. But remember a $10 tax on the top one percent produces a lot less money than a $1 dollar tax on everybody. Something like the first can be sold as “tax the rich” plan but something like the second has to be hidden in the fine print or it won’t work. But the extra taxes would be an additional burden on the national economy and there is a recession.

The President is saying things like he wants to reduce the percent of the GPD (government and non-government) spent on health care by a third. Increased efficiencies, preventive care and what ever cannot do this. The only way is to reduce the amount of health care provided. This would also be a way to finance the government account health care.

This is one of the reasons there is opposition to plan The President own rhetoric implies it, though it may be poor word choice.

If he wants to sell the thing he needs to say how the plan can be implemented without reducing the amount of heath care delivered and still meet his other goals and a viable means of funding.

LFC said...

"The only way is to reduce the amount of health care provided."

Well, I believe a certain amount of the 'care' the system currently provides is duplicative or unnecessary (e.g., unnecessary tests, procedures, or surgery) but I don't know what the savings here would amount to, assuming better co-ordination among doctors could reduce some of this.

I will leave it to others who know more about these issues to debate the details of cost and funding.

The fact is there is going to be a bill almost certainly; the question is what the bill will contain. I hope it will contain, among other things, some mechanism that will help lower premiums in the insurance market and thus enable people who need to buy insurance (b/c they are not in the employer-covered system or for other reasons) to do so more easily. One reason a public option is attractive is that its premiums would presumably be more reasonable. The insurance companies don't like it b/c they want to cash in on the millions of currently uninsured people who presumably will be required to buy insurance under the bill. But the bill should not be a windfall for the insurance companies -- that's not the point.

LFC said...

Strike "that's not the point." It shouldn't be a windfall for the ins. cos., period.