Thursday, June 16, 2011

Acting like citizens about health care

As the G.O.P.'s prospective candidates for president in 2012 slowly emerge out of the tea leaves, the national debate about health care policy gets weirder and weirder. What's a party whose raison d'ĂȘtre is to regain power to do (cf. Mitch McConnell)?

According to the Republican Party's playbook, trumpeting the signature achievement of a (currently) leading candidate when he served as a state governor is off the table. Why? Because Mitt Romney's signature achievement as governor of Massachusetts was signing a health care reform that was rational, pragmatic, economically viable, medically sound, and a boon to public health. Not perfect, to be sure. But better. Way better.

Oh, but wait ... it also served as a model for national health care reform signed into federal law by President Obama last year.

The story has been told, is being told, and will continue to be told, by talented professionals at greater length and in greater detail than you need to hear from me. Check out Ryan Lizza's story in the 13 June issue of The New Yorker for a comprehensive analysis, Romney's Dilemma, available from your local public library if you don't subscribe to the magazine. For a shorter survey that isn't limited to subscribers, try Dr. Aaron Carroll, Associate Professor of Pediatrics at Indiana University, via his piece on, Romney's contortions on health care.

Let's take a small step to the side and have a look at what Michael Specter has to say on controversies over vaccination in the 30 May issue of The New Yorker. In the article, Specter gives an airing to reservations & resistance to government-mandated vaccination, making clear in this specific aspect of public health policy the issues that are currently shaping the larger national debate on health care -- specifically, the tension between individual liberty and responsibility to community. Here's how Specter lands in his consideration of the topic:

But the social calculus of vaccination can never be reduced to the estimation of individual benefit. When most members of a community are vaccinated, they protect those who are not by eliminating the viral reservoirs in the population. The effect is known as herd immunity. Some people, because they are too young or have particularly weak immune systems owing to cancer or other illnesses, cannot be vaccinated. For them, herd immunity is the only defense. As long as the majority are vaccinated, then, a few can decline without courting harm, but when vaccination rates fall below a certain level this protection quickly begins to vanish. At that point, someone who refuses a vaccine imperils not only his own health but that of everyone he encounters.

Clear enough? Here he is again, reducing the issue to an even sharper point:

After all, what makes it easy to be a vaccine dissenter these days is the fact that most people aren’t. Because of routine vaccination, measles -- which kills at least a hundred and fifty thousand people in the developing world each year -- long ago ceased to be a significant threat in the United States. This creates a paradox. Public-health officials must struggle constantly with the consequences of their own success [...]

In this reader's opinion, that's just about the same point that Ryan Lizza makes in his article about Romney, here quoting Timothy Murphy on a requirement that individuals purchase health insurance. This so-called "individual mandate" is a key element of both Romney's and Obama's health care policy reforms. (Murphy served as one of several Romney advisers on health-care policy during his term as governor of Massachusetts.)

According to Murphy, Lischko, and Gruber, Romney believed that the logic in favor of a mandate was impeccable. Federal law requires emergency rooms to treat patients regardless of their ability to pay. "This is not Calcutta," Murphy said. "We don't let people go and die in the street. And then the question is, Who bears that cost? Those costs get paid by increased premiums for the people who do buy insurance, or they get paid for through socialized costs and claim our tax revenues and come at the expense of other things that people might want to do, like building roads and bridges. And in the Republican Party that I grew up in -- go back to the welfare debate, it's about personal responsibility -- that seems pretty reasonable."

Does individual liberty matter? Of course it does! But it's not the only variable in the equation. As individuals, we have ego and superego to balance id. As societies we have government, compromise, and rule of law to bound purely self-determined exercise of will and power. Where to draw the lines between individual liberty and social obligation will (I hope) be a topic of spirited disagreement and debate for centuries to come. But that's not the same thing as saying it would be okay to let Tea Party lunatics drive national policy.

In response to Congressman Paul Ryan's plan to gut Medicaid and Medicare, from which the party has been forced to beat a retreat for now, I wrote in early April: "Pander to the rich. Leave the poor to die in squalor. That's the cliff over which the G.O.P. wants to drive a nation they would rather damage than govern."

Mitt Romney, in his willingness to contort a once-pragmatic approach in order to align himself with extremists, seems well-qualified to hold the reins if the G.O.P. is successful in its bid to plunge the nation into an abyss.

Related posts on One Finger Typing:
G.O.P proposes a death panel plan for health care
Post-ideological health care

Thanks to DonkeyHotey for the caricature of G.O.P. presidential candidate and former Massachusetts governor Mitt Romney, via Flickr.


  1. I'm still reading New Yorkers from 2008.

    In the one I just started the Talk-of-the-Town writer foresees vigorous investigations of Wall St by whoever wins the White House; he even goes so far as to predict (his words) "witch hunts" against CEOs.

    Ha, ha. Good fun! (Not much of an Edgar Cayce he.)

  2. @Glenn -- Ha ha indeed. Are you suggesting I be fair and balanced in my blogging and mount an attack on the Democrat Party too? There's certainly plenty of fodder....

  3. You're welcome to use my line, Steve:

    Republicans appall. Democrats disappoint.

    ... Sadly, no matter how appalling Democrats get, Republicans will ever be so much more appalling that in relative terms, Democrats merely disappoint.