I was skimming through my usual RSS feeds and was pleasantly surprised to find this insightful article on The Corner blog. Mr. Finn, in his article, points out just how difficult a public debate on health care can be when the background knowledge required to fully understand the debate extends over so many fields of study. Here’s his main point:
What I’m most struck by, however, is the enormous amount of background knowledge — across multiple disciplines — that one must possess in order to understand this debate. It’s almost a litmus test of cultural literacy. Consider, for starters, just three short paragraphs from President Obama’s address to Congress last week:
I am not the first President to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.
Our collective failure to meet this challenge — year after year, decade after decade — has led us to a breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can’t get insurance on the job. Others are self-employed, and can’t afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or expensive to cover.
We are the only advanced democracy on Earth — the only wealthy nation — that allows such hardships for millions of its people. There are now more than thirty million American citizens who cannot get coverage. In just a two year period, one in every three Americans goes without health carecoverage at some point. And every day, 14,000 Americans lose their coverage. In other words, it can happen to anyone. [Emphasis added throughout.]
I’ve marked a few of the many terms, concepts, people, and formulations that demand background knowledge.
He goes on to ask several interesting questions to explain just why this statement is not quite as straightforward as one might expect:
- Who were Theodore Roosevelt and John Dingell Sr. (and Jr.), and what’s the relevance of their past experience to our present debate? How does the past shape the present?
- What are key differences between Democrats and Republicans? Why did Obama invoke both? Is it coincidental that he also named Roosevelt and Dingell?
- How does “insurance” work? What do insurance companies do? What do employers do in this realm? What does it mean to be “self-insured”? What is “coverage”? “Bankruptcy”?
- What’s an “advanced democracy”? How many are there? What are some others? What’s the point of Obama’s comparison of the U.S. with other countries?
- Some other essentials: What are Medicare and Medicaid? Where did they come from? How do they work? Who is covered by them?
- What’s the federal deficit, and why are some people concerned about its size?
- What is the congressional legislative process, and why is it unusually complex in this instance?
- What is “health care reform,” and what’s the significance of adding the word “comprehensive” to that phrase?
This post reminded me of a conversation I recently had with an old college friend of mine. We were having dinner and the conversation eventually landed on the topic of health care… and I asked my friends a question: Listening to Obama, do you think we have a health care problem or a health insurance problem? The reason I asked was because it seemed to me that nobody in washington really is able to explain which of these problems they are trying to solve. Obama speaks of both… but often without explaining the different policy prescriptions that are designed to address each specific problem. I argued that nearly everyone in this country gets basic care… and therefore it didn’t seem to me that we had much of a health CARE problem… but even in the above Obama quote, Obama still maintains that he is enacting health CARE reform… and is causing alot of un-necessary confusion in the process.
I hope this helps you understand just how difficult this debate can be… and why tensions are high.
via Health Care and an Educated Citizenry by Chester E. Finn Jr.