Health care: are people just too far apart?

The health care debate is generating a lot more heat than light these days, and I’m somewhat puzzled as to why. Only somewhat puzzled, though, because much of what is going on was accurately predicted long before this issue even came up, and in fact has been the norm for years. What we are seeing is the consequence of events that happened thirty or forty years ago, still having a huge impact today. The sad result is that people are so far apart, it’s hard to know if that gap can even be bridged.

As a perfect example, when I first heard about the “end of life counseling” that was part of some of the health reform proposals out there, I didn’t hear many details. What I envisioned from the brief descriptions, though, was that it would involved helping people with issues like wills, health care directives, durable power of attorney, do-not-resuscitate orders, living wills, that kind of thing. Since everybody dies, and since I think everybody would prefer to avoid more Terri Schiavo-like incidents when the wishes of the patient are unclear and external parties fight over what the patient may have wanted, it seems to me fairly obvious that we should help people make these decisions before it is too late for them to do so. Of course, this is exactly what those counseling proposals entailed.

To others, though, they heard this and immediately jumped to “Death Panels”. What? Do people seriously think that health care reform would involve judging people’s worth and putting people to death? Medicare is single-payer health care for old people: does Medicare routinely murder patients that some arbitrary group of people thinks is “no longer worthy”? And worse, it wasn’t just the lunatic fringe that believed this, it was people that clearly know better. People who are now just cynically stoking the flames for their own political benefit.

The huge disparity undoubtedly comes at least partially from different worldviews. I think that government can do good things. I’m sure you’ve seen the emails that lay out, point by point, all of the things that government does on a daily basis that people take for granted, so I won’t repeat it. However, I will say that even though government has done horrible things, that doesn’t mean government is always, 100% wrong. You judge things individually as they come up, fix the bad things, keep the good. That’s my philosophy.

For an increasing number of conservatives, however, this is not how the world works. Government is always wrong, without fail. Believing that the government can do no right leads to such logical absurdities as people in their 70s screaming “Keep the government out of Medicare!” There is just no arguing with these people. They simply yell. Nothing the government can do is ever correct.

How did it get to be this way? The 1960s had a lot to do with it: civil rights, the Great Society, the Vietnam War…all of a sudden, especially in the South, the government was giving money to poor people who were not white, and even worse, was forcefully ending segregation. It’s hard to imagine now, but before that time, Republicans were about good government and actively supported some increases in government power. Comprehensive planning, for example, was supported by Republicans in many places as they realized that letting dozens of competing cities develop haphazardly and without regards to the needs of the region was detrimental to business. It was accepted that free markets and prosperity did not spring into existence without a governmental framework in place to help.

After the 60s, though, that kind of civic engagement started to change, especially south of the Mason-Dixon line. Nixon’s Southern Strategy turned resentment towards government actions into a political weapon, and the cycle continued until a huge group of people thought that government was the largest problem we face. These people elected leaders who vowed to dismantle government, but never did anything more than pick around the edges and complain about the government around election time to get more votes. Anti-government leaders had almost complete control of the government from 2001-2009, but in no way did government get smaller. It’s just an electoral ploy.

It’s also getting in the way of rational dialog. Personally, I support health care reform. We need to make major changes. There are a lot of things we can do, and I’d like to hear all of the options to think about them, determine the pros and cons, and hash it out with people. But the debate right now is being hijacked not by people with different ideas, but with people who think that any idea involving the government is a non-starter. It’s somewhat hard to talk about the government’s role in reform when one side thinks it shouldn’t have a role at all.

Maybe, like some people do, I’m romanticizing the past and clinging to incorrect beliefs that once upon a time, people could disagree but could also compromise. Right now, I’m seeing such a wide chasm regarding not only this issue, but so many other issues that it’s hard to see where to even start.