Healthcare ideas losing out to ideology


The big mystery of the Democrats’ loss of the commanding heights in the national healthcare debate is how they managed to let ideologies trump ideas.

The difference between these two terms is crucial. Ideas arise from recognizing reality for what it is; ideologies attempt to impose themselves on the real world, whether or not they fit.

In this case, the Republican ideologies of limited government, of the free market as the cherished American way and the answer to most problems, have taken over the discussion.


Meanwhile, the search for ideas to solve a real American crisis is left gasping for life like a gaffed fish.

When President Obama speaks Wednesday to a joint session of Congress on the subject of healthcare reform, his main task must be to retrieve the issue from the clutches of ideology and restore the search for ideas to the forefront. Nothing is as important for the economic recovery and the competitiveness of American business.

He can start by reminding his audience of the reality of healthcare coverage in the U.S.

More than 45 million people are without health insurance. Nine million of them are children, and 31 million belong to families with one or two full-time workers. Minorities and the poor are overrepresented in the group. Blacks and Hispanics account for nearly half the uninsured, and members of families living at or below the federal poverty line for more than a third. (These figures come from a report by the Kaiser Family Foundation.)

Compared with covered individuals and families, the uninsured tend to get less preventive care, defer important treatments more often, skip medication more often and fall deeper in debt from medical expenses.

Millions more Americans have health coverage that hangs by a thread, dependent on their continued employment and their employers’ choice of what coverage to pay for or how much to subsidize it. Nor are those with insurance immune from the financial strain of medical costs: The UCLA Center for Health Policy Research reported last month that of the 2.2 million Californians who reported medical debts in 2007, two-thirds incurred that debt despite having insurance.

Commercial insurers deploy armies of clerks to find excuses for rejecting claims and weed out less-profitable customers. In a bold assertion of their power to dictate their own terms of business, a panel of health insurance chief executives appearing before Congress a few months ago flatly refused to disavow the practice of rescission, which means retroactively canceling policies of customers who had filed claims.

Those are the facts, and there’s nothing that ideology can do to change them.

Nevertheless, it’s ideology that has dominated this summer’s healthcare discussion, such as it is. Those people shrieking with fury at congressional town halls across the country aren’t putting forth ideas; they’re responding to a right-wing small-government ideology as though to a hallucination. They’re being goaded into speaking out against their own best interests, for who’s to say some of them won’t one day find themselves among the chronically ill uninsured or the unemployed, who are blackballed by our current system of healthcare.

The “death panel” fear-mongerers, among them a number of political leaders who have checked their intellectual self-respect at the door, are making no more of a contribution. They aim not to solve the problem but throttle the discussion at birth; their goal is raw political advantage, not the betterment of life in America.

Every time I write about healthcare reform, my in-box fills with responses in which the alpha and omega is anti-government ideology. A common trope is that “obtaining healthcare will be like service from the DMV,” as one e-mailer wrote.

These sound like the words of someone who isn’t bothering to think through what he’s saying. For one thing, it’s a facile rap on the Department of Motor Vehicles. In my experience, the California DMV manages my registration and license renewals with admirable efficiency: I pay online and the documents reliably arrive within days.

By contrast, I’ve wasted days at a time trying to extract treatment approvals from anonymous bureaucrats at my insurance carrier. I bet many of you have done the same.

Nor do DMV-bashers consider the logical corollary of their slogan. If their hypothetical DMV is emblematic of the inefficiency of government-managed healthcare, what’s the proper analogy for the “efficient” private sector? Enron? General Motors? AIG? The health insurance industry itself?

The exemplary ideological outburst of recent weeks is that of John Mackey, the CEO of Whole Foods Markets, whose op-ed in the Wall Street Journal against healthcare reform was cited in this column last week.

Mackey states outright that his program is based on the ideology of “less government control and more individual empowerment.” His prescription might be viewed as, in effect, removing government from the backs of the people so the big insurers can saddle up.

He proposes eliminating state health insurance regulations, although that would surely result in closing the private market to such unpalatable customers as women of childbearing age and sufferers of asthma and other chronic diseases. He has virtually nothing to say about how the indigent or people with preexisting conditions might obtain coverage, although he does suggest that if we become vegetarians we can live to 90 or beyond 100, “largely disease-free” -- absent actual clinical evidence, itself an ideological assertion.

He points to nostrums such as tort reform, as though malpractice lawsuits explain the nation’s sky-high per capita healthcare bill and its substandard health profile.

As it happens, California has had one of the nation’s strictest malpractice tort limits for 34 years. But it still boasts among the highest per capita ratios of uninsured residents in the nation. And don’t tell me that’s because of our illegal immigrants; UCLA’s figures show that if you factor out all uninsured residents lacking green cards (assuming they’re all here illegally), California would still rank in the bottom half of all states in this measure.

What’s surprising is that the White House and Democratic congressional leaders don’t seem to have seen the ideological attack coming. Yet it’s a familiar phenomenon.

The Republican Party’s attack on Social Security during the 1936 presidential campaign was, the historian Kenneth S. Davis wrote in 1986, “ruthlessly disregardful of truth and decency.” (Sound familiar?) GOP candidate Alf Landon suggested that enrollees might be fingerprinted, subjected to mug shots, or forced to wear dog tags.

On the eve of election day, the Hearst newspapers published a photo of a man wearing a tag on a chain under the headline: “Do You Want a Tag and a Number in the Name of False Security?”

That campaign had nothing to do with any debate over how best to support elderly Americans at a time of want. It was about fostering a particular ideology of government.

Ideologies aren’t always virulent. Sometimes they can help structure a consistent approach to economic or social conditions -- from either side of the political divide. But not when their purpose is merely to body check rational debate out of the arena. On such occasions, aggressive treatment is necessary. Will Wednesday’s operation on Capitol Hill set the patient on the path to recovery?


Michael Hiltzik’s column appears Mondays and Thursdays. Reach him at, read previous columns at, and follow @latimeshiltzik on Twitter.