Obama’s “Harry and Louise”

He’s making the honest case for health care reform: not that reform will make things better, but that it will control the processes that will otherwise make things worse.

Is Barack Obama about to turn the rhetorical tables on the health insurance industry? Chris Good thinks so.

Remember the “Harry and Louise” ads? They claimed that, if Hillarycare passed, your health care would be controlled, not by your doctor, but by some faceless bureaucrat.

The terrible thing is, that was the truth. The ads were dishonest primarily in what they didn’t say: that if Hillarycare didn’t pass, your health care would still be determined by a faceless bureaucrat, but the bureaucrat would be employed by an insurance company rather than the government and your rights of appeal would be limited. Those hundreds of pages of legislative language that made the bill seem so scary were designed in large part to build in some checks and balances to the cost-control process: checks and balances that private insurance largely lacks.

Part of the blame for the the industry’s capacity to bamboozle the public in that way falls on Bill Clinton. He desperately wanted health care to be the capstone of the New Deal; he fancied himself as the President who finally gave people “health care that can’t ever be taken away.” So he wanted to present Hillarycare as progress, as movement toward a desired goal.

But that was, at best, a half-truth. For those Americans – a majority – with decent health coverage, Hillarycare was going to be a step backwards. But that step backwards was inevitable. Rising health care costs made the then-existing fee-for-service model unsustainable; something was going to start to put some limits on costs, whether it was a public program or managed care. The honest claim for Hillarycare was that it would have made the transition somewhat less painful from the consumer viewpoint. That honest claim wasn’t enough to satisfy WJC’s grandiosity, so he made the larger, unjustified claim, and had HIAA ram it right down his throat.

Obama seems to have learned that lesson. During the campaign, he talked about health care finance reform in terms of covering the uninsured, and whatever plan emerges will do some of that. But now he’s talking about what he can actually deliver to the majority of voters: protection from evils that are on their way down the pike.

The more the debate over the next few months is about the details of the new system, the better it is for those opposed to any change. The more the debate is over people whose health insurance doesn’t insure them, people who have their health insurance taken away once they get sick, and companies increasingly unable to afford to offer decent coverage to their employees, the better it is for those who want to see the current, unsustainable system change in a direction somewhat less unfavorable to consumers (and businesses) than the natural course of events.

Many of you may be satisfied with your health care now. What you’ve got to do is project, if current trends continue, are you still going to be happy with your health care five years from now? Will you have health care five years from now?

There’s been a lot of liberal unhappiness about the performance of the Obama team over the past few months. But I don’t think betting on Obama to fail reflects prudent money management.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com