There is no health care debate in the United States. There's not even a debate over principles. You'd think a nation intent on overhauling a broken system that presidents going back to Harry Truman have been trying to fix would want to openly discuss what it wants -- universal care? Single-payer? A private-public combination? Nationalized insurance? Nationalized care? All very different things. None is being aired in congressional hearings and town hall meetings, with one exception: Tinkering with more of the same.
When even Barack Obama -- the last great hope for reforming the West's trashiest health care system -- plays into the rhetorical ambushes of reform's enemies, it's clear that the debate has been hijacked by shams over the language of reform rather than its substance. Detractors can lob meaningless phrases like "government-run health care" and "socialized medicine" all day long, knowing that the diversion is enough to keep reform comatose. In an almost hour-long address to the American Medical Association on Monday, Obama couldn't bring himself even once to say universal health care.
He did want to bat off a "concern that's being put forward by those who are claiming that a public option is somehow a Trojan horse for a single-payer system. I'll be honest." Obama went on, "there are countries where a single-payer system works pretty well. But I believe -- and I've taken some flak from members of my own party for this belief -- that it's important for our reform efforts to build on our traditions here in the United States. So when you hear the naysayers claim that I'm trying to bring about government-run health care, know this: They're not telling the truth."
But Obama was as guilty as those naysayers for equating such things as "single-payer" with "government-run health care," instead of setting them straight. Medicare is a single-payer, public system. It's not government-run. It's nationalized insurance, but it enables private care. It's similar to what Germany, France and Japan provide all citizens, even (as in France) giving individuals full freedom to have supplemental, private insurance. As such, incidentally, Medicare is also more efficient, more fair, less wasteful, less bureaucratic and more choice-conscious than private insurers. Medicare is one of those "traditions" that work in the United States. Instead of presenting it as America's single-payer system, Obama chose to dismiss the single-payer approach, dishonestly and by association, as "government-run." He made the naysayers' day.
One man is particularly responsible for the successful hijacking of the debate: Frank Luntz, the Republican pollster. Euphemisms neuter language. Luntz makes you love the knife doing the neutering. He's the man who gave us the ClubMed-sounding "climate change" instead of "global warming," "opportunity scholarships" instead of "vouchers" (you know, private and religious schools' scheme to steal public education's dollars), "tax relief" instead of tax cuts." His latest, the 28-page "The Language of Health Care 2009," is a how-to manual for reactionaries looking to defeat reform before it's written. "Humanize your approach," accept that there's a crisis, you "MUST be vocally and passionately on the side of reform" -- but only to ride the Trojan horse of opposition to reform.
Here's one of his strategies: "Make no mistake: the high cost of healthcare is still public enemy number one on this issue - and why so many Americans (including Republicans and conservatives) think the Democrats can handle healthcare better than the GOP. You can't blame it on the lack of a private market; in case you missed it, capitalism isn't exactly in vogue these days. But you can and should blame it on the waste, fraud, and abuse that is rampant in anything and everything the government controls." (His italics.)
So it's clear that health care is too expensive, that most Americans know Democrats can be more trusted than Republicans to fix it, and that the free market failed the system -- but blame government for trying to fix it anyway (even though no one is talking about "government-run health care"), and do so by dishonestly portraying government with the very words that perfectly suit private-sector health care: waste, fraud and abuse. Not surprisingly, Luntz also is big on painting government as looking to rob patients of choice, impose delays on care or denying it outright, and running up costs -- again, precisely the sins of the current, private-insurance driven system. It's a matter of time before I call my insurer to get "permission" for a medical necessity only to hear some off-shored, slave-wage bloke in Toughluckistan tell me over a stuttering Internet line that my necessity isn't on the approved list, thank you very much.
No wonder the health care debate is flat-lining. Talking points like "The Language of Health Care" are as offensive -- and lethal -- as the prisonhouse of junk-rate care they aim to preserve. And for all his skills at countering the pimping of language to crooked uses, Obama is flirting with collaboration on this one.