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Healthcare Reform vs. The Surge
I’ve been pondering the common analogy between President Obama’s support for healthcare reform (HCR for short) and President Bush’s support for the surge in Iraq, both in the face of strong popular resistance. The political arguments for and against have been essentially the same, except with the parties reversed.
Three years ago, President Bush spoke of the need to do what is right for the nation, even though the public may not have agreed with him at time. Today, President Obama speaks of doing what is right without regard for what is popular. The opponents of both presidents criticized them relentlessly for ignoring the will of the people.
This analogy makes almost everyone uncomfortable, since almost no one who supported the surge in 2007 supports HCR now. The analogy forces both sides to look in the mirror and realize they are not that different from their opponents in certain regards. Yet both sides sense an inherent validity to the analogy’s logic.
In America politics, we often reserve our greatest praise for those who acted on principle in spite of the political cost, only to be proven right in the long run. Of course, such praise is offered mainly in hindsight. If the Redcoats prevailed in 1776, few of us would praise the principled courage of the Founding Fathers, assuming we knew who they were.
One of the hardest things to watch is one’s bitter opponents being praised for their farsighted commitment to principle. Today, many conservatives chafe at the popularity of Medicare and other entitlements, yet will not risk criticizing them openly. On the other side, President Obama personally knows the frustration of having to explain again and again and again, after the success of the surge, why he opposed it in the first place.
Now that the House has passed the Senate HCR bill, we may encounter another high-stakes test of the hypothesis that success can transform public opinion. Democrats seem confident that HCR will become the next Medicare, regardless of the price they pay at the polls this November. In spite of Republicans’ warnings that the bill will wreak havoc on our health care system and our entire economy, there is an undercurrent of anxiety that fears precisely what the Democrats hope for: the creation of another entitlement that is politically invulnerable. As Mark Steyn wrote earlier today,
[The Democrats] bet is that [HCR] can’t be undone, and that over time, as I’ve been saying for years now, governmentalized health care not only changes the relationship of the citizen to the state but the very character of the people.
Personally, I don’t consider the character of the American people to be all that malleable, although I think we may come to accept healthcare as an entitlement.
Of course, before we figure that out, we’ll have to see whether this round of reform can produce something as enduring as Medicare or Social Security.
18 Responses to “Healthcare Reform vs. The Surge”
“healthcare as an entitlement.” or a right…depending on your POV. We decide our legal rights.
I do like your point….two Presidents, yes I acknowledge that Bush was the final decider on the surge, had to make decisions that flew in the face of popular opinion, but I would also argue that popular opinion wasn't exactly well informed in either case and polling is always questionable, in order to do what they thought was best for the country.
also…
You just called me a no one…I'm like totally offended!
I supported the surge….the McCain sponsored surge that was first implemented locally by lower ranking officers in the military…long before McCain had heard about it. Bush jumped on board in a desperate attempt to save his legacy. I also support HCR…single payer, but I'll take any kind of reform over the status quo.
Interesting analogy and, in a way, although I think the current bill is likely to be a fiscal disaster, I have a renewed respect for President Obama (not so much for Pelosi but that's a different story).
The difference I think is going to be in assessing the effectiveness of the policy. In Iraq, it was relatively simple — did fewer people die and was security enhanced? In HCR, it is far less clear what objective metrics can be used to measure success. For some on the left, this doesn't matter because health care is a right and therefore its mere provision is success. For others, it's entirely unclear what metrics they would propose for us to judge the success of health care reform.
Even if we had metrics, the timeline is unclear. The surge was measured over the course of months. HCR will be years if we are lucky.
Very true….I think even those that feel that health care is right should be very concerned about costs and our deficit. Legal right or not, if this bill doesn't cut costs in comparison to what we think they would have been had we done nothing, then it is a failure.
Hopefully there will be some honest tweaking as time goes by.
Maybe we're arguing over semantics but I've always felt health care cannot be a right since it implies obtaining a service from another person. That person cannot be compelled to provide you that service without a breach of his or her own rights. Given that, health care has to be defined as a benefit or entitlement.
Shannon,
How will we know if the bill cuts costs? Which costs is it designed to cut? How will we measure it?
This is exactly my point. There is no agreed upon implicit or explicit set of metrics. Just take costs.
In the public sphere, would success for the bill consist of
1. Lowering total Federal health care spending?
2. Lowering the rate of growth of Federal health care spending from some counterfactual baseline?
3. Lowering the cost per covered individual?
4. Lowering the rate of growth in cost per covered individual?
In the broader market, you can have exactly the same conversation. This is exactly my point. There is no consensus on what “cutting costs” looks like in reality and, as a consequence, there will be no consensus on whether the bill has worked.
Take a silly example. Talk radio went to town when Dick Durbin said that insurance premiums in the private market were going to continue to increase and not decline. This seems blatantly obvious to me since the best that could be hoped for is a reduction in the rate of increase (of course we can't measure this because of the counterfactual problem). However, it may well be that in selling the bill, we've created the impression that HI premiums aren't going to rise and are going to come down. If so, the proponents of reform have a major problem since that just isn't going to happen.
It's an interesting dilemma for supporters. Clarifying objectives means you can fail. On the other hand, not clarifying them leaves it up to all of us voters to set our own objectives.
That's because you aren't accustomed to thinking about affirmative rights. I don't think such things exist as a matter of philosophy but there are many people who believe they do
At a very micro level, you can measure costs per visit…illness…medicine…surgery…per individual. We'll have to cut medical profession salaries. Do things to help doctors and nurses on the education costs end. They will still make a lot of money…more than most doctors in other countries.
Call it the trickle up theory of savings.
I am not an economist, but I am sure there are plenty out there than can come up with some honest metrics.
I'm sure you're right that they could. I wish they would. Because so far, I have no idea how to know whether this is “working” and neither do I think does anyone else.
It's quite interesting to have such a massive change in policy without any real understanding of what cost control would actually look like.
As to medical salaries, I'll be you my traditional Chicago deep dish pizza that they don't decline materially over the next 10 years.
[...] Moderate Voice compares it to the Surge … no one liked it, but it ended up going down well. I dunno, the Surge took a bad situation and made it better, averting disaster. This thing takes a bad situation and makes it worse … and unlike the Surge, didn’t have to happen. [...]
Health care is not a right, of course. It never has been and never will be. Those who want it to be a “right” are seeking an entitlement and a claim on others.
It can be made a legal right, or entitlement, federal or state, depending on what the people want.
A more practical way to view it, not necessarily accurately, but better, is what someone posted on another thread: a necessity for many people. Think of it as a practical necessity when needed.
(It's not a right, and don't mis-call it a “human need,” either!)
Stop me!
“Stop me!
”
Department of Human Needs (or Rights)
Bureau of Income Security
Bureau of Health Security
Bureau of Food Security
Bureau of Housing Security
(How's that?)
Actually, Shannon, this whole health care issue involves people like you, who have been badly neglected in this debate. You are abroad, where you are a user of another nation's health care system, so you are a source on which to rely on learning what the other nation's public systems, that are entitlement-based in various ways, are really like. This has actually been something that has been badly neglected during the Dems' rush this past several months (they have lacked reason from the start). It even was neglected on lefty talk radio here in the States (not through any fault of the talk show hosts at all, but rather because they mainly were taking calls and callers here in the States, not elsewhere). There were rare callers from abroad or from people who were abroad who tried to excise various forms of myth and hype about foreign government health care systems, but it was an example of a badly neglected item in this debate. (In our case here,
we know that from the start what was sought was federal takeover of health care. The Dems settled for what they could get after public rejection of their early effort as well as of their behavior this past year.)
[...] Moderate Voice compares it to the Surge … no one liked it, but it ended up going down well. I dunno, the Surge took a bad situation and made it better, averting disaster. This thing takes a bad situation and makes it worse … and unlike the Surge, didn’t have to happen. (MV notes in a somewhat mystified tone that most of those who backed this thing opposed the Surge … what could that possibly mean?) [...]
[...] Healthcare Reform vs. The Surge (themoderatevoice.com) [...]
I have read a lot about the HCR bill today and this has to be the strangest comparison I have seen. The “Surge” was an inadequate troop escalation as a last ditch effort to salvage an incredibly screwed up invasion and occupation of a third-world country on the other side of the world that happened to have a lot of oil. Thanks to incredibly poor planning and inadequate resources the country was just winding down from an orgy of ethnic cleansing. Our military was already strained so we could only muster 20k troops to “surge” with. That was barely adequate to cover Baghdad. Bush was hoping the whole thing would go away. Don't try to call his decision a “brave” one in the face of public opposition. Today the country is in shambles, there are 2 million refugees and the political system is still dysfunctional. Sporadic violence continues.
Our health care problems were not caused by Obama. He did pledge to do something about it, though, and now he is making good on that. Perhaps in a few years HCR will turn ugly and Obama will pledge to send in 20k doctors to try and salvage it. Then you could compare the two situations. Right now it just looks like a pathetic attempt to take some of Obama's victory to make Bush look better. Give it up. Nothing will make Bush look better.
I've noticed an interesting parallel. This comment, from a Bush critic, suggests I was too kind to the surge and unfair to HCR. Elsewhere, Obama critic Jules Crittenden suggested I was too kind too HCR and unfair to the surge.
I think this pattern bolsters the argument that I made in my post — neither side is comfortable with the political parallels between HCR and the surge. We can argue all day about the merits of either. But the fact remains that both Bush and Obama spoke of the courage of defying public opinion, while their critics blasted them for ignoring the voice of the people.
The planning and execution of HCR by the Dems was done just as arrogantly and incompetently and the post war planning for Iraq.
Both failed miserably at first and then a later plan, not supported by the public, was put in place to fix the failures of the first.
Personally…I think the two are very much alike.
“The Dems settled for what they could get after public rejection of their early effort as well as of their behavior this past year.”
Sadly, this will not be the public record…especially not by Dems. Dems should be embarrassed by what had to take place in order to pass any kind of reform.