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Commented: The center cannot hold

Remember when the public option was the controversial part of the health-care bill? Now it's the Medicare reforms, which are far more modest than what the Republicans are proposing, and the individual mandate, which Chuck Grassley and Olympia Snowe and every co-sponsor of Wyden-Bennett supported before they decided to turn on the policy because doing so was politically convenient. Next week? Who knows? In comments, Theora Jones makes the case that it can, and will, be anything.

I was just at a health policy conference where wonks were talking about the "parts of the bill we all agree on," which were various demos and health delivery system change provisions.

And I was like … "we all agree" on these? Any one of these provisions could be controversial if someone thought it was in their interest to demagogue it. Heck, we could make medical education and licensure sound like a Stalinist plot if it suited our purposes ("the ONLY doctor you are allowed to see in America is a doctor who has attended a government-approved school, who has studied at a government-approved hospital training program, who has passed a government-approved test of how he will practice medicine, who can be reported anonymously to a panel of government-appointed bureaucrats and then have to justify to them the way he practices medicine, and who must by law prescribe ONLY government-approved medicines!").

The only reason we think we all "agree" on these things is because nobody except honest, informed, smart and well-intentioned wonks are paying attention to them!

You see this over and over again that people "from across the spectrum" "agree" on something until, you know, there's a possibility it will actually HAPPEN.

At which point people who would be losers start digging into the details of this policy so they can demagogue it, while at the same time people who have a political interest to see their opposition fail start trumpeting these demagogued points, and the bill is suddenly "controversial."

At which point someone "centrist" says, "Hey, why don't we do this other thing that none of you have paid much attention to? It seems so much less controversial ... " At which point people start digging into the new thing and demagoguing it and then it's lather, rinse, repeat until we decide that it's "too hard" to address this issue and oh it's so lamentable that "Washington" can't find a "common ground, common sense" solution which is somehow, magically, not offensive to anyone.

At a certain point, reporters and politicians and observers of DC need to grow up and realize that "moderate" does not mean "uncontroversial."

Especially when, for goodness' sake, organizations and parties have figured out that they can gin up controversy over anything!


By Ezra Klein  |  February 11, 2010; 5:21 PM ET
 
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Comments

There is a reason for this problem. None of these initiatives have been sufficiently explained and sold to the American people. The Democrats and left-leaning policy wonks never came out of their own echo chamber long enough to stop assuming that everyone already agreed with them on the key elements.

Case in point. Nobody, anywhere has made the case / connection between the individual mandate and the elimination of pre-existing conditions. The think-tankers just assume that the citizenry has a full appreciation of the free-rider problem. But I would venture that less than 10% of the population understands that you can't eliminate the pre-existing condition problem without having something like a mandate. As a result, the mandate gets demogouged.

Posted by: chris_rowen | February 11, 2010 5:40 PM | Report abuse

It goes back to Jon Chait's comments earlier this year: Any sweeping health care reform bill involves taking money out of one person's pockets, and putting them into someone else's pockets. The current health care reform bill, by having a community rating, an individual mandate, and a minimum benefits package, involves taking money out of the 27-year-old bachelor's pockets, and putting it into the 61-year-old's pockets. The idea John McCain proposed, by abandoning the community rating from our employer-based system, and moving to a system where everyone is charged based on their individual risk, and nobody is required to purchase any benefits, takes money out of the pockets of the 59-year-old diabetic accountant, and puts it in the pockets of the 25-year-old bachelor who plays shortstop on your office's softball team. There is no way around this.

As one of my friends has said, if you want health care reform, you'd better be willing to take intensely politically unpopular positions, or all you'll end up with is the status quo.

There is no such thing as "tacking left" or "tacking right" in health care reform: the policy has to be coherent, or it will do more harm than good, and because each part is so interdependent of the other parts, there is no middle ground to a coherent health care policy. You either believe in a tight community rating of some form, a strong individual mandate of some form, and a generous minimum benefits package, or you don't. Those three items are contained in every universal health insurance system -- be it single-payer, managed competition, or whatever. You either support all three items of this three-legged stool, or you don't. If you oppose even one of those three items, the whole thing falls apart.

Posted by: moronjim | February 11, 2010 5:50 PM | Report abuse

Case in point: IMAC, if it was doing its job, would likely rule cardiac stents not cost-effective. But can you imagine the outcry from wealthy interventional cardiologists and their Presidential patients? America is not ready for IMAC.

Posted by: bmull | February 11, 2010 6:00 PM | Report abuse

at times like these I wish we had a responsible media

Posted by: Quant | February 11, 2010 6:02 PM | Report abuse

I agree with the other commenters. And there has to be a level of policy explanation (with which the president can address the public) which is between wonkism and platitude, substantive but not opaque, and which addresses valid concerns. It's tough to admit trade-offs and uncertainties when the other side speaks in absolutist terms, but I think the public would respect some honesty from their leaders. The president has the intelligence and communication skills to raise the level of debate.

Posted by: jduptonma | February 11, 2010 6:09 PM | Report abuse

>>>At which point people who would be losers start digging into the details of this policy so they can demagogue it, while at the same time people who have a political interest to see their opposition fail start trumpeting these demagogued points, and the bill is suddenly "controversial."

See McCaughey, Betsy

Posted by: TLM2 | February 11, 2010 6:26 PM | Report abuse

"There is a reason for this problem. None of these initiatives have been sufficiently explained and sold to the American people. The Democrats and left-leaning policy wonks never came out of their own echo chamber long enough to stop assuming that everyone already agreed with them on the key elements."

I think you're kind of on the right path, but not totally there. This stuff does get talked about, but in the following ways:

a. Singularly. In other words, it's brought up in an article here or an article there, but there isn't a continual focus on it. Which is a problem because:

b. People don't pay very close attention to politics. Or, if they do, they're not paying attention to the types of sites (like this one) that would continually cover health care in a sustained manner. A lot of people have largely opted out of the information stream (for a good book on the topic see Markus Prior's "Post-Broadcast Democracy"), and the stuff they do pay attention to isn't particularly edifying.

In other words, it's a systemic problem. The politicians aren't making a sustained case, but the media barely covers them when they do (horse-race, horse-race, horse-race!), and even when they do a great majority of people aren't paying close enough attention to receive the message (and that's before you get into the question of motivated reasoning processes leading those perceptions in particular ways, or issues of comprehension).

Posted by: y2josh_us | February 11, 2010 6:57 PM | Report abuse

At the same time, this argument makes the president and congress out to be passive victims of events, ignoring the fact that they can _drive_ events and the narrative if they try.

Posted by: tyromania | February 11, 2010 7:33 PM | Report abuse

"b. People don't pay very close attention to politics. Or, if they do, they're not paying attention to the types of sites (like this one) that would continually cover health care in a sustained manner. A lot of people have largely opted out of the information stream (for a good book on the topic see Markus Prior's "Post-Broadcast Democracy"), and the stuff they do pay attention to isn't particularly edifying."

And beyond the fact that they're not paying attention, policy is one of the few areas where there is no objective expertise on which people are content to rely, even when such expertise actually exists among the wonks and academics. People who are uninterested, or simply do not have the time to inform themselves about the arcane details of some area of human endeavor are content to rely on expert judgement in all sorts of milieu. Very few people worry about whether their doctor falls in the particular range of the medical philosophy spectrum they ascribe to, they just go with their expert judgment.

Anything associated with policy, however, inevitably has a political dimension to it. Conflicting messages are constructed, and people pick the set of "experts" they will believe based on their political leanings, regardless of whether these people have any expertise in an objective sense. For instance, I am utterly convinced that the reality of anthropogenic global warming would be considered an uncontroversial fact if there were no policy implications associated with it.

The percentage of people willing to take the time to inform themselves of the facts surrounding a complex policy issue and reach their own conclusions is tiny.
I'm pretty unconvinced there is some magical amount of sustained messaging by "real experts" that can counteract this dynamic, particularly when the issues are complex. There is a small population of persuadable individuals who are paying attention for whom this would make a difference, but I guess I'm pessimistic about it changing the landscape much. It's probably still worth making the effort, however.

Posted by: rayrick1 | February 11, 2010 8:09 PM | Report abuse

I appreciate the headline reference to Yeats' "The Second Coming." It's a poem that seems more and more apt these days for the state of things.

Posted by: sunnybeaches2 | February 11, 2010 8:30 PM | Report abuse

Since, gosh, it seems hard to agree on things, the Senate should just fold up its tent and go home.

Oh, wait, functionally, it already has. This shambles would be funny if it weren't so freakin' serious.

Posted by: RalfW | February 12, 2010 12:15 AM | Report abuse

It's because of the internet. Before this time, Theora Jones and the wonks would have watched the bills go up the Hill, get chopped into sausage, passed finally as a hollow core in a self-serving cloud of phony ideas, -- then shrugged their shoulders and said "If people only knew. Let's get 'em, next time!" Their wonkish plight would barely have made it to the morning daily newspapers. 8:09 pm

Instead, out in the hinterland, you would read in the newspaper something like "Moderates have proposed a compromise bill" and you would say to yourself, "Well that's good, because after all, we live in a Democracy!" (And chuckling to yourself like Gomer Pyle.)

A lot of the phrases in "quotes" in Theora's comment have been used by politicians as newspaper rhetoric for many decades. “agree, centrist, moderate, uncontroversial compromise, etc.” These actually mean, “We made a (sometimes crooked) deal.”

“Moderate” was rhetoric for “a deal was done.”

BUT: the new spread of detailed information on the internet is throwing a wrench into Washington's old style of dealmaking.

Now, anybody who wants to, can follow the proceedings closely, right down to the last closed door. And follow all the ideas too. Now, everybody sees moment-by-moment that it is beyond sausagemaking and that it is intellectually corrupt. The evidence is undeniable.

And in response, from Congress’ side, the old official rhetoric to shape it in the newspapers doesn’t work any more.

Posted by: Lee_A_Arnold | February 12, 2010 12:26 AM | Report abuse

And there’s another wrench: we’re interactive. Wonkish internetting improves the civil discourse, and looks at serious policy analysis, and faster than any politician can muster.

Speedy facts plus interactive discussion. Overall, what is happening is a change in the relationship of observant voters to the Congressional political process. Congress is being found to give unacceptable answers. It's the internet revolution, continuing.

Because it is beyond one person, or even one instituion, and you work for us.

This is upsetting several different applecarts and causing serious fall-out.

It's dangerous for the Republicans right now, because they actually don't have a very big backing from the U.S. voters against healthcare reform. They talk it up, but their numbers aren’t all over 50%. It’s unstable.

If the Dems get a legislative victory, they will easily reclaim some disaffected base to push them over the top again in many races.

Note: "Not compromising" is an untenable position, and the Repubs have now managed to link it to “not guaranteeing universal medical coverage.” --This is a devastating Achilles' heel, in the Republican future.

Also - the internet promotes total honesty and facts -- sooner or later. This is a real problem in Republican policy, which is based on some of the most fallacious reasoning which still exists in any advanced Western country, bar none. The Republicans are not terribly big on science or economics, the reasons behind climate or social safety-nets.

The success of Wikipedia is a testimony to the fact that a lot of people go interactive to disprove falsehoods, and the truth finally wins. So the Republicans are either going to have to join the real world, or invent an entire simulacrum of the universe on Fox, perhaps with more pharmaceutical commercials to subdue the Palinites medically.

Posted by: Lee_A_Arnold | February 12, 2010 12:28 AM | Report abuse

Meanwhile, the Dems are totally caught naked by their homies, because they're supposed to be the party of the people. Instead their crooks kowtowed to special interests and sank their own supermajority. Corrupt AND stupid! Beat that!

Both parties have lost control of their bases.

What neither party appears to understand is that the internet just changed the strategy of staying in office. They are trying to read our emotions, but they still think that their sausagemaking can channel these emotions into their next re-election.

They have to change to a method of open public discussion of technical issues. Special interests can show up -- but they have to identify themselves and speak all their reasons, publicly.

This public discussion has to be followed by a quick decision using bipartisan ideas (even if it is by reconciliation,) noting that when a law is passed, there can always be revisions in the future.

This is the only sort of process that people are going to accept in the future.

The Democrats are actually closer to this possibility at the moment. The only question is whether they can overcome their own special interests and inertia and chart the new course, first.

A quick decision, even if it is by reconciliation. Because if the opposition goes for non-compromise, they should forfeit until they learn some American manners.

Posted by: Lee_A_Arnold | February 12, 2010 12:30 AM | Report abuse

Ezra, as a totally separate thing, I think the recent increase in responding to comments has added to the blog. Since you don't participate much in the comments section, it goes a long way to making it feel more interactive.

Thanks!

Posted by: rpy1 | February 12, 2010 10:10 AM | Report abuse

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