Bringing Civility Back

Barack Obama, discussing health care reform with Steve Kroft on 60 Minutes (September 13, 2009):

I will also say that in the era of 24-hour cable news cycles, that the loudest, shrillest voices get the most attention. I mean, let's take these town halls. As I've said, I had four of them. And there were people in there who disagreed with me. But all of them were courteous. All of them listened to each other. I kept on looking for somebody to yell at me, so that I could sort of sort of engage in these folks that you were seeing on TV. That wasn't our experience.

And if you go to a lot of members of Congress, and you ask them, "What was going on at some of these town hall meetings?" They'd say, "Eighty percent of the folks who were there were there to listen, to try to figure out how we can solve this problem." But you never saw those folks on TV, because it was boring.

And so, one of the things I'm trying to figure out is, how can we make sure that civility is interesting. Hopefully, I will be a good model for the fact that, you know, you don't have to yell and holler to make your point, and to be passionate about your position.

It's still a work in progress. No doubt about it.

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The Comforts of the Status Quo

From “Change We'd Rather Do Without,” by Michael Kinsley, The Washington Post (August 28, 2009):

The reason Americans have turned against health-care reform, after electing President Obama in part for promising it, is simple: Despite protestations to the contrary, Americans don't like change. You wouldn't know it, of course, if you listen to politicians in high-pander mode, or to talk radio hosts of the right or TV pundits of the left. Or, for that matter, if you listened to the president of the United States. You would think that while we might disagree about what kind of change we want, Americans are in total agreement that the current situation is intolerable in all areas and that change—big, immediate change—is essential. Americans do agree about this—in the abstract. But as soon as it seems that change might actually happen—as soon as we leave the abstract for the particular—we panic. We suddenly develop nostalgia for the comforts of the status quo. Sure, we want change—as long as everything can stay just as it is.

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Putting the Consumer at the Center of the System

Excerpts from “How American Health Care Killed My Father,” by David Goldhill, The Atlantic (September 2009)

A wasteful insurance system; distorted incentives; a bias toward treatment; moral hazard; hidden costs and a lack of transparency; curbed competition; service to the wrong customer. These are the problems at the foundation of our health-care system, resulting in a slow rot and requiring more and more money just to keep the system from collapsing.

How would the health-care reform that’s now taking shape solve these core problems? The Obama administration and Congress are still working out the details, but it looks like this generation of “comprehensive” reform will not address the underlying issues, any more than previous efforts did. Instead it will put yet more patches on the walls of an edifice that is fundamentally unsound—and then build that edifice higher. 

…I hope that whatever reform is finally enacted this fall works—preventing people from slipping through the cracks, raising the quality standard of the health-care industry, and delivering all this at acceptable cost. But looking at the big picture, I fear it won’t. So I think we should at least begin to debate and think about larger reforms, and a different direction—if not for this round of reform, then for the next one. Politics is, of course, the art of the possible. If our health-care crisis does not abate, the possibilities for reform may expand beyond their current, tight limits.

The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result.

A more consumer-centered health-care system would not rely on a single form of financing for health-care purchases; it would make use of different sorts of financing for different elements of care—with routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance.

A Context for Correcting Misinformation

Kathleen Hall Jamieson in conversation with Bill Moyers and Drew Altman on Bill Moyers Journal (8.14.09):

People who are angry and frustrated and not necessarily well informed in part driven by people who are on the other side of the reform effort. And it's driving into news evocative visuals that are leading the public, I think, to overgeneralize the extent to which there is principal, reasoned dissent from health care reform.

...But when people are shouting at each other, the answer doesn't get through. And when you're impugning the integrity of the person who's answering the questions, the member of Congress, that person's response isn't going to be believed if it is able to be articulated and isn't simply shouted down.

And so it's not creating context in which misinformation on both sides can be corrected. And that's the problem. We don't have a deliberative process here taking place in public to inform public opinion.

Instead, we're potentially distorting it.