Monday, July 27, 2009

Should President Obama come out of the Closet on Rationing?

An editorial in yesterday's Washington Post challenges President Obama to come out of the closet about rationing and fess up to the American public about the need for limits and sacrifice. Here's the essence of the argument:
PRESIDENT OBAMA sometimes presents health-care reform as a pain-free proposition, as simple as choosing the red pill over the blue -- one that's no more effective but costs twice as much. Asked at his news conference whether "the American people are going to have to give anything up in order for this to happen," Mr. Obama's basic answer was no. "They're going to have to give up paying for things that don't make them healthier," he said...

But Mr. Obama's soothing bedside manner masks the reality that getting health costs under control will require making difficult choices about what procedures and medications to cover. It will require saying no, or having the patient pay more, at times when the extra expense is not justified by the marginal improvement in care. Mr. Obama is right that sticking with the status quo is a bad alternative, but he isn't leveling about the consequences of change...

The current system is untenable and getting worse, with employers dropping insurance and premiums rising for those who still have it. Reform is essential. But Mr. Obama does the public a disservice by acting as if it will not require anything from them in return.
Of course the editorial is correct about the need for rationing. But is its conclusion good advice for political leadership?

On May 13, 1940, Winston Churchill spoke to the British Parliament as the new Prime Minister. He didn't mince words about the need for sacrifice. Perhaps the Washington Post has Churchill in mind in their advice to President Obama:
I have nothing to offer but blood, toil, tears, and sweat. We have before us an ordeal of the most grievous kind. We have before us many, many months of struggle and suffering.

You ask, what is our policy? I say it is to wage war by land, sea, and air. War with all our might and with all the strength God has given us, and to wage war against a monstrous tyranny never surpassed in the dark and lamentable catalogue of human crime. That is our policy.

You ask, what is our aim? I can answer in one word. It is victory. Victory at all costs - Victory in spite of all terrors - Victory, however long and hard the road may be, for without victory there is no survival.

Let that be realized. No survival for the British Empire, no survival for all that the British Empire has stood for, no survival for the urge, the impulse of the ages, that mankind shall move forward toward his goal.
Metaphorically, the U.S. is facing the same situation the Brits were in 1940. Our public dream of a Garden of Eden in which all pain and illness can be banished is a "tyranny" that threatens the survival of the country as we know it. But the threat posed by an economic cancer does not galvanize society the way an external enemy does.

So how can the President align the ethics of honesty with the requirements of political effectiveness? If I were advising him I'd argue for statements like this:
My fellow Americans. Our country is facing a grave and devious threat in runaway health care costs. Health care costs are a form of virulent, but potentially treatable cancer. If we let the status quo continue health costs will strangle our economy and rob us of our strength. Al Qaeda's best strategy for weakening us would be to induce us to continue with the status quo...I know that many are afraid that change means rationing. They're 100% right to be concerned. Every other country in the world has chosen to ration health care. Unless we tackle avoidable waste we'll have to do the same thing. Making large changes can be frightening, but we have not been a nation of cowards...
President Obama needs to invoke an external enemy more effectively than he has done thus far. As wrong as they are, that enemy isn't the Republicans or the Blue Dog Democrats - it's the economic cancer of the status quo. His task is made difficult by the fact that the enemy isn't a foreign power - it's our own cowardice about facing facts in the arena of health care. As Pogo said in the 1950s - "We have met the enemy...and he is us!"

To move health care reform forward President Obama needs to channel Winston Churchill more effectively. If he doesn't create more of an external danger we'll just continue to fight with each other. That dynamic has scuttled every previous effort at meaningful reform.

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