Not long ago I wrote a blog entry here at Issue Oriented about how health care reform was about to become to a huge issue for the country. Though I was expecting an onslaught of misinformation and anger from the Right, I never thought things would develop quite like they have thus far.

First, a few facts about the issue: There is no “Obama plan”. Unlike the 1994-94 “Clinton health plan,” which famously turned Hillary Clinton into the caricature the Right loves to hate, President Obama made an early decision to leave the development of the plan’s specifics to Congress. Obama laid out what he wanted in health reform (a public plan, various new regulations on insurers, a new health care “exchange”, etc.), but rather than create a plan for which he would be directly accountable, he gave that responsibility to the House and Senate, many of whom are up for re-election next year. The result of that decision has been two separate bills that are different from each other in a number of ways – and a lot of back-and-forth on the financing and the reforms. The House plan is ready for a floor vote and (as of this blog) the Senate plan is still stuck in the Finance Committee.

On one side of this debate you have the opponents of health care reform. We have all seen them on tv and YouTube this past week, showing up at town hall meetings and turning discussions into rallies against reform. Though it is true that some of these folks are being turned out by the Republican establishment (conservative “tea party groups” and groups funded by insurance companies) most of the anger and fear being expressed at these town halls is genuine. Misinformation is being spread on talk radio, cable tv news shows and the internet; this bad info ranges from the ridiculous notion that the elderly will be forced to choose how to die, to the claim that liberty itself is at stake. Who wouldn’t be afraid of that if you didn’t know any better? With the government taking larger-than-usual steps to handle the financial and economic problems of the last year and getting little return, the public is offering a slimmer-than-usual margin of error on health care reform. Add in some horror stories about big government and “socialized medicine,” and you have a lot of genuine fear.

But just because something is genuine, doesn’t mean that it is legitimate. Let’s face it, health policy is very complicated and most people do not understand the basics of our health care system – not to mention the extent to which government is already involved in the system. This has been illustrated by a scenario which has played out at numerous town halls already – the senior citizen shouting that “the government needs to keep its hands off my Medicare.” (Medicare, of course, is a government insurance program that covers tens of millions of people.) For the members of Congress holding these town halls, it is a difficult challenge – how does one deal with a constituent who clearly does not understand the issue, but do so without coming off as an elitist?

The Republicans and conservative groups understand all this too well and are taking full advantage of it. And they are shameless in their spread of misinformation because the political stakes are so high. They know that if the Democrats win health care reform, it will be yet another nail in the Republican coffin. Though we Americans tend to pride ourselves on our “can do” spirit, deep down inside we want a safety net available for when we need it. Once it is provided, Washington dare not try to take it away. That is why even the most passionate conservative Republican in the House supports keeping Medicare in place – the seniors in their district would vote them out of office in a heartbeat if their Medicare was threatened, let alone taken away. When it comes to health care reform, the same principle holds true, and whichever party solves the health care crisis will enjoy decades of political dividends.

But this is not a war of ideas. The Republican solutions to health care are far out of the mainstream (i.e. weak insurance plans with $5,000+ deductibles and weak consumer protections), so the only thing they can do is drown out the debate with fear and anger, hoping to kill the bills. The same tactic worked for the Democrats and progressive groups back in 2005 when Bush proposed to turn part of Social Security over to Wall Street. The Dems did not have a solution to the Social Security solvency issue, so it made sense to focus on the risks Bush’s plan would create for retirees. Progressive groups – myself included at the time – ran town hall meetings, did district office visits with Congress members and organized press conferences to highlight the fears people had with the proposal. It was just a matter of time before Bush’s plan imploded. No alternative ideas were needed – all you need to do is rile people up, and organize them in a fashion that puts the proponents running for cover. It is a fairly simple concept that happens to work.

On the other side of the health care reform debate, there isn’t so much misinformation – but there is plenty of denial. President Obama is not calling for a Canadian-style single payer system – but he has called for a public plan that would compete with private insurers. Opponents of the public plan say that this is a trojan horse for single-payer -  and they’re correct. I worked for seven years for an organization that supports single-payer, and the public option was always understood to be a way to get your foot in the single payer door. This is supported by recent YouTube video clips of President Obama and Senator Barney Frank admitting that the public plan would eventually lead to the private insurers being forced out of the system and the evolution of a Medicare-style health insurance program that would take over. It is difficult if not impossible to honestly argue that you’re just looking for more “competition” by introducing a public plan in the face of video evidence like that, but yet that’s what the Dems are doing.

Given the failure of private insurance over the decades to make quality coverage affordable (nearly 15,000 people lose their insurance every day), I personally think that real reform cannot happen without a public option of some sort. Health care is so expensive that much of the private coverage is already subsidized in one way or another. Employer-sponsored health insurance would not exist if the government did not help employers by giving them a generous tax break for doing so. “Medicare Advantage” plans (which are private plans) could not offer benefits without relying on taxpayer dollars. Even Mitt Romney’s so-called “free market” health reform in Massachusetts feeds heavily from the public trough. The “free market” people demanding that the “government should stay out of health care” do not know what they are talking about. It is as simple as that.

At the same time, the conservative critics are correct about the state of Medicare funding – it is in horrible shape, and needs to be addressed. Democrats and progressives keep punting the ball because the answer is going to have to involve some combination of raising taxes and cutting benefits, and that is poison even in a non-election year. The Democrats’ hope is to deal with this issue in part by passing health care reform. Include some changes to Medicare and raise some taxes as part of the overall package, and the blowback is muffled by the gains.

Given how things are going, what is likely to happen is that either health care reform will die a very public death or the public option is going to be dropped from the final bill. It currently does not exist within the Senate bill, and it is so controversial in the House that, if it were put to a vote today, it wouldn’t pass. But even if the public option is dropped it would still be an uphill battle for Democrats and other proponents, as the misinformation campaign of the Right has branded everything and all things “health care reform” as poison. Reform may be damaged goods at this point; and if entertainers like that idiot Glen Beck could convince people that the House plan mandated euthanasia for the elderly, then they can convince them of just about anything. Until the bill is finally dead.

We’re going to be hearing a lot about health care reform very soon. If you’ve never dug deep into this issue but consider yourself to be politically savvy, you’re about to find yourself completely lost very soon. I worked on health care reform as a political issue campaign, for several years, and it was some time before I knew up from down with any degree of confidence. Just when I thought I’d gotten a sense of it, I’d realize I had just hit the tip of the iceberg. So, when the tidal wave starts to hit in the coming days and weeks, and you realize you are lost, don’t feel bad; most people don’t know what they’re talking about when it comes to health care reform. Especially those on television and radio whom are paid to express opinions.

However, many people can understand the political implications of health care reform, because are much easier to follow. So for now, let’s keep it simple and limit this blog entry to politics and the very basics of health care.

Here is the general landscape: For Republicans and conservative interests, health care is a losing issue. In fact, it is lost. It is a lost issue because the only adequate answers to the challenges of health care require greater government involvement in one way or another. Conservative solutions like health savings accounts and plans with $5,000 deductibles require that health care be viewed as any other free market commodity – which it is not. Nor do consumers see health care this way. Think about it – who wants to go shopping for a “cheap” surgeon? Who is willing to forego medical treatment for their injured or sick child because of the costs? Who honestly thinks that a pre-tax savings account is a good deal compared to insurance that offers real coverage? This isn’t Blu-Ray vs HD DVD; this is healthy versus unhealthy, and everyone chooses the former.

Still, such is the mentality of those pushing so-called “consumer driven health care” concepts; the idea that people make health care choices like they make any other market choice. It’s ironic; conservatives claim the reason why health care is so expensive is because people use it “for every little thing” when a) high demand should theoretically drive competition to lower costs (which it has not done), and b) the opposite is actually true. One of the reasons why health care is so expensive is because Americans use health care too little, not too much. Preventive care – like getting checked out when you have a little problem – is much cheaper than waiting until that problem becomes a big and expensive. Catastrophic care is much more expensive than a check up, so if more people went to the doctor “for every little thing,” it would actually lower costs. This isn’t a theory; this is fact. This is how European countries and Canada – which have economies a fraction of the size of ours – can afford such huge national health care programs. They emphasize preventive care from child birth as a part of their culture. The result is less expensive health care and better health outcomes than ours.

Conservatives are also at a serious disadvantage on the issue because competition in the health care marketplace has driven costs upward, not down. As opposed to DVD players and other traditional commodities, competition in health care has a way of making things more pricey. Competition in health care has created an environment where hospitals and clinics amass the most expensive treatments in order to get one step ahead of their competitors. The result is a flood of super-equipped hospitals and clinics with the most expensive equipment requiring the most expensive maintenance, training, operation and insurance. It is interesting to note that the state of Maine – hardly heavily populated – has more MRI machines than the entire country of Canada. The result is  over-treatment (i.e. getting an MRI for a twisted ankle). This system creates the most expensive care in the world, because someone has to pay for all of that overhead. As health care costs go up, insurers are more reluctant to pay out because they are not seeing profits like they used to. So they reimburse less to doctors and hospitals, which makes hospitals want to do more tests so they can build up the bill and get paid properly.  The insurers then deny coverage to policy holders more often, drop coverage for the “riskiest” patients who need it the most, and raise premiums. Employers can’t afford the rising premiums, so they cut benefits to their workers. Now the average worker with a family has zero or inadequate health insurance and can’t afford the $12,000 a year for a health plan on the individual market. That family also can’t qualify for Medicaid coverage because they make too much money. So they’re stuck, waiting for some kind of solution and praying that their child doesn’t get sick this winter.

There are other moving pieces that could be added to this equation; it is by no means a definitive explanation of the health care system in America. But it is one example illustrating why health care in America is out of control.

For most of the world, health care has been viewed more as a right than a privilege. In America, it is a mix. People understand instinctively that getting health care is not a choice someone makes – it is something they have to get when they need it. But America is also unlike any other country in the world in that our first cultural instinct with any problem is to find a market-based solution. We usually try this route before exploring any other option.  Government-sponsored health insurance is considered to be a lost opportunity for free-marketers, and so the business community puts up much resistance. They use fear tactics. They point to the former Soviet Union and paint an unpleasant picture of dirty doctor smocks, rusty scalpels and long lines at the clinic. But despite that rhetoric, the “fear” of national health care has very little to do with actual fears people have of “large government.” They don’t mind a large military, for example, which has been the one common characteristic of every dictatorship and empire in world history. What they do mind is incompetence and a lack of value – something for which government bureaucracies in America have typically been known; especially under Republicans who campaign saying that government can’t do anything right, and then govern with no political incentive to make government work at all.

Regardless, the Obama health plan is not socialism, as it will be called by many in the media in the coming days and weeks. Though it does call for a larger role for government to play – which in my opinion is necessary – it is a far throw from true “government health care” i.e. Canada or France. Obama’s plan builds off of the current private and public systems and infuses them with cash, while mandating certain administrative changes that aim to save money. The result will be that insurers will effectively be subsidized by the government so they can continue to make a profit and that more people will have coverage. If that is government health care, it is government working for the insurance industry, with the side effect of universal coverage for consumers.

I’m still a bit on the fence with this issue. On paper, a single-payer health care system makes the most sense. It is cheaper; you never see a bill; the country lives longer and healthier. But there are drawbacks. And despite the fact that in numerous decades the free market has not been able to create a sustainable, affordable, and functional health care system, part of me really wants to see us figure it out on our own. Don’t let anyone fool you: there is something unique about America. In few other places is the entrepreneurial spirit such a vital a part of the national fabric as it is here, and that is something that we need to appreciate, despite the abuses and callousness of the private market. Perhaps Obama has the same sense of appreciation I have, and that is why he is not calling for an all-out single-payer health plan, despite the time being as ripe as any. FDR was the same – that is why, despite the crunch of the Great Depression, he did not pursue a socialist route back then. Instead his greatest accomplishment remains Social Security, which entitles recipients to payments but only after they’ve paid into the system. Americans were willing to accept that, and it is why Social Security is seen as much more than just another government program today.

With health care, however, it seems inevitable that the whole thing is coming down. and that it needs to start over from scratch. So who the hell knows?