"I don't want some government bureaucrats giving my money to someone else."
"I don't want my Medicare cut so that poor people and illegal aliens can have health care."
"I don't want the government death panels deciding what medicines I will get." "I want what's mine and I want it all."
This is the problem. According to the latest Rasmussen poll, 51% of voters say that passage of the congressional health plan, particularly with the public option, will make the cost of their health care go up, while 21% say it will make costs go down.
The good news is that these numbers were slightly worse for Obama in August; progress is being made, but slowly. The good news is that 54% believe that major changes are needed in health care. Sixty-eight percent say it's important for Congress to pass a bill this year.
Americans know by now that our current system is unfair, odious, and extremely wasteful. They know that the World Health Organization ranks the US 37th. They know that US life expectancy ranks 42nd in the world. (See: Cuba Has Better Health Care than the US.)
Voters know that they are getting fleeced by greedy insurance companies, doctors, pharmaceutical firms, and hospitals. An estimated $700 billion is being squandered annually according to a recent report by Thomson Reuters health care analytics. This amounts to one third of the nation's health care bill.
No wonder insurance payments have doubled in the last decade. Unless major changes are made, Medicare will go bankrupt in 20 years.
Voters want change. They hear the stories about people who don't have insurance and who have died because they did not get early medical treatment. They are afraid of losing their jobs and their health care -- and never getting it back.
They are worried that their insurance will not be enough -- won't cover everything and may have a cap. And they are worried about their pre-existing conditions.
They are worried about their children and grandchildren.
They are crippled with fear mongering from both sides.
But they also hear the stories about how the Obama health reform will cut into their present benefits and raise their taxes. And they are paralyzed with fear. Damned if they do and damned if they don't.
But 68% of voters have health insurance that they rate good or excellent.
It's OK for me now. Don't change anything.
Ninety percent of voters have some health insurance, and they will never support higher taxes to pay for medical care for the uninsured poor. Put this to a vote and it will lose every time.
They will not support any legislation that raises their taxes or lowers their entitlements, unless they are getting a piece of it. This is textbook Prisoner's Dilemma, each voter (prisoner) pursues his own self-interest (by ratting out the other guy) which leads everyone to be worse off than if they acted in interest of each other as a whole, by keeping quiet.
This is Democracy folks.
Voters are nasty, brutish, and selfish.
The question that Obama needs to answer for the large middle class is: What's in it for me? Maybe Obama should include a large, flat screen TV for every middle class family, as part of health care reform.
So far, the middle class voter with health insurance hasn't been given a good enough simple answer. No social program in American history -- Medicare, social security, rent control, public colleges and universities -- that aims to help the poor, can ever succeed without appealing to, and paying off, a broad middle class. If you are going to build parks in the ghettos, you have to build them in wealthy neighborhoods too.
Bottom line: In order to enact social programs for the poor, you have to buy off the middle class. That's why even the very wealthy are on Medicare and continue to collect social security payments and get unemployment checks -- monies they use for pocket change. And why some hedge fund honchos continue to live in rent-controlled apartments in New York City, while many young and poor pay inflated rental market rates.
This is the price that a democracy has to pay to help the disadvantaged.
Obama must apply game theory to this most complicated conundrum. Game theory assumes that voters are always rational and selfish -- always out to get what is best for themselves. Game theory is at the heart of the American democratic process. Candidates will inevitably keep shifting their positions -- "gravitational force" -- toward the middle to capture a consensus.
Republicans are playing to the worries of seniors who oppose health reform by a margin of 42% to 32%. Seniors, of course, are already covered by government-supported health care, Medicare.
I got mine, and I am not paying for yours.
Instead of letting this sentiment work against reform, how can Obama make it work to support his reforms? The President must pander to these worries and fears in a blatantly political way. He must fear monger just like the best of the right wingers. He is not going to be able to sell health care reform by pointing to the poor and the dying. Thirty-eight percent of Americans think that cost is the biggest problem with U.S. health care. Only 15% think that the 47 million uninsured is a bigger problem.
The Democrats must warn voters that Medicare will go broke ... that their private insurance rates will double again in the next decade, just as they did in the past decade. The insurance that most of us know, and like, won't be there for us unless urgent changes are made.
Obama must terrify insured workers about the possibility that they will lose their jobs, and their health care, about the real possibility that if they get sick, they will never be able to get insurance again. And that medical care as a percentage of GDP is likely to double again.
He must convince the middle class that the current system is unsustainable if we do nothing at all; that waste, fraud, and greed will mushroom into higher and higher prices. The free enterprise system has failed in protecting the public. It has not been allowed to work.
Often there is little choice. In 40 states the health care markets are effective monopolies, dominated by two or less companies. It's no surprise that our wasteful and unsustainable health care system costs more than twice as much, for worse outcomes, than in the other developed countries.
Insurance companies are particularly obscene in this regard. Instead of competing with lower prices and better service, there is a built-in motivation to make money by not covering the old and sick -- slicing out the young and healthy -- and by denying customer claims on technicalities and fine print.
Health care isn't too expensive; it's the profit and the waste that's too expensive. This is why the public option is so important. It will provide a low cost benchmark for private insurance to emulate.
The answer to the Whats in it for me? question is that what we have now is irrevocably broken. And the faux security some voters now feel will soon be gone. Health reform, with a public option, will bring health care costs in line with the rest of the world.
Ultimately, what's in it for the middle class is long term health care security in a world that has become increasingly scary.
write: jfleetwood@aol.com