American Attitude toward Reform Through the Eyes of David Brooks

In a tribute to Edward Kennedy, David Brooks, a columnist for the New York Times, wrote a column that I would call a short masterpiece. Below is a excerpt from it that focuses on the nature of our American society and our attitudes toward reform of any kind (see: The Great Gradualist). I will project his ideas later into the current dialogue about healthcare reform.

We in this country have a distinct sort of society. We Americans work longer hours than any other people on earth. We switch jobs much more frequently than Western Europeans or the Japanese. We have high marriage rates and high divorce rates. We move more, volunteer more and murder each other more.

Out of this dynamic but sometimes merciless culture, a distinct style of American capitalism has emerged. The American economy is flexible and productive. America’s G.D.P. per capita is nearly 50 percent higher than France’s. But the American system is also unforgiving. It produces its share of insecurity and misery.

This culture, this spirit, this system is not perfect, but it is our own. American voters welcome politicians who propose reforms that smooth the rough edges of the system. They do not welcome politicians and proposals that seek to contradict it. They do not welcome proposals that centralize power and substantially reduce individual choice. They resist proposals that put security above mobility and individual responsibility.

I would personally like to see some fundamental changes in our healthcare system, particularly modifications of the current fee-for-service approach that rewards unnecessary and inappropriate procedures. Such an approach is wasteful and can also harm patients. I now don't believe that such a change is going to happen. There's just too much money flowing into lobbying efforts from special interest groups representing insurance companies, big pharma, hospitals, and physicians to maintain the status quo.

One of the "rough edges" of our current system, to use Brooks' phrase, is the number of uninsured, which is estimated by the U.S. Census Bureau as 46 million under the age of 65. Under our current system with an emphasis on private insurance, I doubt that this problem can be addressed in a budget-neutral way. President Obama and the majority Democrats are saying: let's fix this problem of the uninsured now and find the offsetting savings later. The average American is deeply suspicious of this approach -- and with good reason. He or she understands that there are serious consequences if they manage their family budgets with a large deficit but the same rules don't apply at the federal level. My personal conclusion is that any serious attempt at healthcare reform in the current economic and political environment is doomed despite protests to the contrary from our politicians.

:: Update on September 3, 2009

See: Wrong Turns: How Obama's Health-Care Push Went Astray

Comments

[Health IT Nerd]

My analysis (http://healthitnerd.blogspot.com/2009/06/change-we-can-believe-in.html)

"USA is a country founded on a very different set of principles than other countries. Accordingly, it can't have the kind of healthcare system other countries can have, and comparisons with other countries are pointless and misleading. Because USA isn't ever going to achieve the outcomes other countries can - and neither can the other countries achieve what USA does. See, if you choose individual wealth over shared wellness, then that's what you're going to get."

But what's this about choice? He thinks you get less choice in France? Not so - you get a different set of choices that aren't available in USA and vice versa. It's all about money. So you're certainly right: there's no prospect of reform until the large corporates realise that they're the ones being done over by the healthcare lobbyists.