I finally understand why we are not going to get serious health reform. It will be defeated by our very love of "liberty and the pursuit of happiness" that is embodied in our founding document, the Declaration of Independence.
I finally figured it out thanks to Bill Galston, a former top domestic policy aide in the Clinton Administration who thinks a lot about America's social contract with itself. Bill was talking the other day about broader and somewhat different issues, but as I listened to him, I could not get health reform off my mind. In most of the world, universal medical care is accepted without a second thought thanks in part to that sense of community they call solidarity. Here, it is all about my freedom to get whatever medical care I want when I want it. The powerful evidence of the cost shifting that makes us all pay to care for the uninsured never cracks that wall of individual rights.
Interestingly, this view may be driving opposition to reform from both the left and right. For conservatives, it says no public insurance plan, limited subsidies for the uninsured, and more tax breaks for those who already can afford coverage. For liberals, it says pay for reform by taxing a handful of the uber-rich. For both, it means implacable opposition to efforts to curb care, even if those treatments are worthless or even dangerous. "Do you want some government bureaucrat telling you you can't get the care you need," asks the right. "Do you want some insurance company telling you you can't get the care you need," asks the left. It is, in the end, the same message: Medical care -- even bad medical care -- is your right and nobody can take it away from you.
Public opinion surveys deliver a consistent message: For many, health reform means more treatment at less cost. A June Kaiser Family Foundation poll reports that just 41% of those surveyed would be willing to pay more (either in tax or premiums) to cover the uninsured. Nearly two-thirds think reform can happen at no cost. This of course is impossible. But neither President Obama nor congressional leaders of either party want to say so.
It would be nice to conclude with a bromide like, "We won't get the health reform we need until public attitudes change." But they won't change. We are no more likely to develop a sense of European-style solidarity than we are to embrace futbol over football.
We are Americans. And, as Galston says, we believe down to our very guts in individual rights, not in our obligations to one another. That is the core American value. And it is why we are not going to get truly fundamental health reform. It says so right there in the Declaration of Independence.