Dear George,
 I think your basic insight is sound.  However, I am less optimistic than you about reforming the underlying social ethos, the "hearts and minds" and therefore think that other, more nitty-gritty, aspects of the proposed reform that middle-class insured folks are being made to believe will personally hurt them, need to be addressed.
 
 Right now, most importantly, people need to know that the proposed reform is mostly about what kind of insurance options will be available and how insurance coverage for the currently un- or under-insured will be financed and that the provision of health care by physicians and hospitals (for those who currently have access through private insurance) will not change much, if at all. They also need to know that without reform their own employment-based insurance will become more expensive, less inclusive, and that their employers will undoubtedly shift more of the (direct) financial burden onto them.  They need to know that for them, and for their employers (particularly if they are small or middle sized businesses......including non-profits like colleges and universities) the public option could provide better coverage at lower cost.

 As a personal disclaimer re. where I stand politically:  I'm personally persuaded that we also need to reform the way health care providers are paid and the way health is delivered, but that isn't a major part of what is currently being debated, though it may be aided by a reform of the insurance system.  I've lived in the UK both as a grad. student and as a visiting professor with small children.  In both cases, my family and I had excellent health care from caring physicians.  But of course we were living in communities with university medical centers, which always helps!  So I'm one of those "political centrists" who, when it comes to health care, thinks that a single-payer system is fine and that allowing private supplementary health insurance is also probably necessary.   I also think that gradually moving to primarily salaried health care providers is fine.  But that requires us to figure out a way to train physicians without them ending up with the levels of personal debt which then become the justification for high-priced fee-for-service medical care. 

SJL

 
----- Original Message -----
From: George France <[log in to unmask]>
To: [log in to unmask]
Sent: Thu, 20 Aug 2009 12:43:26 -0400 (EDT)
Subject: Obama's moral sentiments

In an article by Jeff Zeleny and Carl Hulse in the electronic edition of the NYT of 20 August, President Obama is reported to have pleaded with a multi-denominational  assembly of religious leaders to support his health care plan, describing the debate as a "core ethical and moral obligation".

Comparing health care financing systems in mature federations, one reading of the evidence is that the principal independent variable contributing to explain America's problem of uninsurance and under-insurance may not be the specific character of its political and governmental/federal arrangements nor how powers are allocated there between governments nor even poorly specified citizens' rights to health care. Rather the root problem may be the "qualified" character of sentiments of social solidarity still held by Americans and their representatives. Citizens of other nations tend to be less begrudging and more consistent in how they treat their fellows while US society is still prisoner of the (19th century) logic of "deservingness". 

Referring to George W. Bush and his tax cuts,  Uwe Reinhardt wrote scathingly of the "leadership's moral sentiments regarding the plight of the uninsured". If social solidarity is an important policy variable, perhaps convincing a majority of citizens to share the moral sentiments of the Obama administration is crucial for the success of health care reform. 

Terms like "moral sentiment" and "social solidarity" are slippery and not very scientific, but in the last analysis they may be what the reform is about. If the President and his aides concentrate on tecnical questions in the public debate rather than on its ethical foundations, perhaps we shouldn't be surprised if the average man in his home entertainment room wearily switches off the news channel and reaches for a DVD and a six-pack. 

I think my point is that we tend  to appeal to ethics  and social justice at the very beginning of the policy design stage  and thereafter such considerations tend to be taken for granted. What do others think about this? Is there a change of strategy by Obama and even if there is, does it really matter? Or am I merely being simplistic here or stating the obvious? 

 

Best regards,

 

George France