Sunday, August 2, 2009

Republicans Propose Tearing Down Medicare

I'm worried about August. Opponents of health care reform are playing public fears very skillfully. The strongest volleys of sound bites are about evil bureaucrats who will deprive us of choice. The latest thrust is the assertion by Representative Virginia Foxx that the Republican version of the bill "is pro-life because it will not put seniors in a position of being put to death by their government." (see here.)

To my eye the administration is winning the health policy class but losing the political war. The opposition is using the Swift Boat technique - a steady drum of accusations. The response - "that's baloney" - may be accurate, but it's wimpy.

It seems to me that taken literally, the sound bite attacks on reform are an attack on Medicare. A single payer is "un American," "socialized medicine," and "takes away our choices." Medicare is a single payer system for the elderly. Logic tells us that the opponents of health care reform must be plotting to tear down Medicare.

The evil images in the sound bite war are "government bureaucrats" and "insurance company bureaucrats" who will seize on comparative effectiveness research to "come between you and your doctor." There's no better way to insure the demise of Medicare than by prohibiting thoughtful clinical management of the program. Without that the only cost containment measure is continued reduction of fees, which shifts costs to private insurance and perpetuates cost escalation throughout the system.

So my advice for the Democrats is to apply jiu jitsu. Don't just say that the opposition sound bites are false. Take them seriously, and trace out the consequences. This is the technique Socrates used as well. And when we trace out the implications of the opposition rhetoric we find an attack on the most popular component of our current health system.

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