Over the past week, David Gratzer of the Manhattan Institute and Jonathan Cohn of the New Republic have been engaged in a fascinating debate over health care reform, hosted at TNR’s website. The two agree that American health care has serious problems, including a large uninsured population and very high costs. But they disagree about whether government-funded systems in other countries offer a model America should follow.
Their debate basically comes down to a disagreement about health-quality statistics. But both Cohn and Gratzer ignore almost entirely the attitude of the American public toward bureaucracy in health care. Recent experience suggests that Americans would be very unlikely to put up with even the modest constraints on doctors and patients in the French system that Cohn proposes as a model (let alone the overwhelmingly burdensome constraints employed in some other state-funded systems, like those in Canada and Britain).
The American public’s rejection of the HMO model of health insurance offers some evidence on this point. Health maintenance organizations try to contain costs by using case managers to review physician referrals and care decisions, and so to avoid unnecessary procedures and expenses. They work: during the HMO craze in the mid-1990’s, private health-care spending per capita grew by just 2 percent annually, while today it grows by nearly 10 percent.
But as HMO’s became more popular, resentment grew too, among both doctors and patients, about the way health decisions were being made by bureaucrats rather than doctors. HMO’s quickly became some of the most hated institutions in America, participation declined sharply, and today many plans that still call themselves HMO’s don’t actually follow the case-manager model.
Everything Americans didn’t like about HMO’s would be worse under the kind of government-funded system many other Western democracies have. Americans have far less patience for intrusion into health-care choices than Europeans seem to (a point that elicited some broader reflection on government and culture by Jonah Goldberg last week).
In response to this concern, advocates of state-funded care might make the perfectly serious point that covering the uninsured is more important than playing to the selfish whims of the American middle class. That’s how wonks should think. But it’s not how any politician could allow himself to think, and so it’s not how any practical and plausible reform of the system could work.
The fact is, the American middle class would hate—and rebel against—the kind of reform Cohn has in mind, and that in turn would take the political wind out of the effort to help the uninsured. That means health-care reform needs to work by addressing some of the concerns of the (insured) middle class—concerns about stability and portability—while building ways of insuring the uninsured.
That latter effort, though, can’t proceed by creating new, more powerful middle-class anxieties about who makes medical decisions and the freedom of doctors. This also means it can’t proceed by replacing our private insurance system with a public one. It needs, rather, to use public resources to help those who can’t afford private insurance obtain private insurance.
French health care works for the French. But for cultural reasons as much as economic ones, it’s very hard to see how it could work here.
Israel may win every battle, but it must also win the PR battle in order to win the war. Otherwise battles will keep coming, because the world will continue (wrongly) to regard the Palestinians as the oppressed inner-city minority poor who are suffering under the hands of the wealthy white bankers. Due to political correctness, whatever the oppressed minority does is presumed right, and whatever the wealthy majority does is presumed wrong. After all, who can blame the oppressed minority for throwing rocks (or rockets, whatever) at the bank? And isn’t it unjust of the bank owners to send their security guards wading into the crowd with guns?
As long as the west views the Palestinians as the oppressed minority, and thus restrains Israel and assists Palestine, we are going to have this problem. I’m glad the IDF is finally taking the PR battle seriously. It needs to do more. And the American President (ideally Obama, though I’m skeptical he would do such a thing) should help, by educating the west on the history of Israel, the history of Israeli and American services to the Palestinians, and the history of other Arab and Muslim nations preventing the Palestinians from assimilating and using the Israelis as scapegoats for all their problems. The average American and European knows next to nothing about these things, but it’s tougher now for pro-Palestinian governments to prevent the flow of information.
In the modern media frenzied environment it’s imperative that all Western Militaries have some sort of a PR or Media wing to supplant the anti-military bias in most Western Media. The US Iraqi model seems to have been a success. Despite Iraq being a woefully unpopular war good news did make it out and more than one side was heard. To be sure, improvements could be made, but this was a US success. It looks like the Israelis may be making some improvements as well.
This is good news.
The IDF is just starting to catch up. In fact, the U.S. has for years funded a program for Arab journalists and public relations personnel to effectively present their own views. But showing the effects of munitions may not be the kind of picture that the IDF needs to present. They need to demonstrate to the world what’s really happening in the other camp, extra-judicial killings, for instance.
Good for the IDF. Israel has reached the point where the IDF leaving press relations to the Foreign Ministry is much like the US DOD leaving press relations to the State Department. It will take some extra personnel for the IDF, to put out its own message. And it doesn’t always go like clockwork. But it’s worth it in the end.
The abused wife revels in the occasional signs of benevolence coming from her abuser.
Michael from Maine sees it clear, and states it succinctly.
Doesn’t matter though.
The wider PR battle has been well and truly lost.
The process whereby Israel is increasingly isolated proceeds apace.
As more and more mohammadens enter Europe, THERE’S NOTHING ISRAEL CAN DO TO ALTER the hardline that Europeans are going to take regarding Israel.
And the United States, increasingly reluctant, then ultimately unwilling to stand alone in support of Israel, is going to slowly but surely embrace the line of the Europeans.
It’s already happening.
The process is unstoppable.
The Left, the massive movement of mohammadens to the West and lastly the Democrats eagerness to court the black muslim vote, in lieu of their old Jewish constituency, ——————————- it’s a confluence of forces that all lead to Israel’s increased isolation.
Westerners began subscribing to the Arab narrative out of abject fear, fear of skyjackers, fear of terror, fear of seeing their cities detonated.
But now, out of fear and intellectual confusion, in some Stockholm syndrome kind of way, Westerners are actually espousing themselves to it.
We won’t have to wait very long now before we start seeing Westerners start to convert to islam.
Not long now.
Wait a minute. I thought all us JOOS controlled the media in the first place. Heads will roll.
All right, #7!