How I would prefer this health plan thing was done

I have said to lots of people that I support a public health care option of some sort. I am not too particular about its shape, so long as there is an insurance net that protects people who cannot afford health insurance. I also favor overall health care reform that gets costs under control and prevents the case where people's lives can be utterly destroyed by one massive medical bill.

But that doesn't mean I like how things are going in the current health care proposal - and my discontent is aimed at Democrats, Republicans and Mr. Obama. Here is my breakdown of things that I wish we would change.

1. Lose the antagonism
I agree with Obama's statement that the time for bickering is over. I wish that people would stop playing party wars and just work on the problem at hand.
I was quite upset, then, when in the middle of the speech Obama pulled out the "we said/you said" guns. He ripped at the Republicans for trying to privatize Medicare. He ripped at congress people, senators and a governor for promoting the death panel argument. He ripped at the previous administration for its spending practices.
And in the same speech he tries to position himself as the father figure coming in to tell the troops to behave. You lose a lot credibility on that stance when you immediately afterward: 1> pick a side, 2> start throwing the same tomatos.
I assume it is Obama's inner litigator getting the better of him. I get it - I do the same thing. When someone throws a line of bullcrap at you, bury them. In some venues it is almost a moral obligation to demonstrate that you don't take that sort of crap. In some venues.
The venue where it does not work is the one where you need the other guy to help solve the problem. If you just finished telling them they are liars, connivers, plotters and schemers (even if it is true) and then jump in and hurl jabs back, then you are going to lose them. It doesn't matter how reasonable your points are because you didn't lose on rationality. You lost by pure alienation and insult.
The President should have legitimately risen above the fray. Yes, he should have acknowledged the opposition, the attacks - but only so much as to give context to explain the counter argument. He should have ignored the insults like a bear ignoring bees. He should have focused more on laying out the mechanics of the plan, the options on the table and the means to solve the impasse so that the people in the room would be able to get to work. He should have left nobody any room to cry "foul" for him taking a partisan stance. I wish that had happened.

2. Lose the timeline urgency
I do not buy the argument that we need a full-packaged solution in place now. Human kind has lived for millenia with dreadful healthcare. Our healthcare has only reached humane proportions in the last century at best. The species knows how to continue its existence with misery, suffering and pain. I want a solution, but I would rather work on it slowly and get it right than rush it in. I believe rushing it in and getting it wrong will have worse impact than if we had not done it at all.
I am very cynical about the reason for the urgency. I believe the real reason for the urgency is because nobody wants "I voted yes on public health care" on the minds of the voters come next election. I suspect Obama knows this, and knows he won't get nearly as much participation from Democrat candidates if this goes on longer. They want this over and done with so they can put something else in recent memory to talk to their voters about. If this thing is all they have they are doomed at the polls and they know it.
This really makes me upset, because I believe we are going to lose the possibility of getting anything because of the rush. I want this to slow down. I want us to take longer thinking about how it should be done. I want us to... well... read the next section

3. Break the monolith into miniliths
Fixing health care actually has support from both sides. Disagreement is on exactly what to do and exactly what needs fixing. Maybe I think the wrong way for Congress, but that to me sounds like the type of thing you break into multiple bills which you vote on separately. Just a layman look, I would propose a couple: 1> health care insurance policy reform bill: this would cover all the "no pre-existing condition clause, no maximum lifetime cap... etc" stuff, 2> health care cost control reform bill: okay, I have no ideas on this, but the current bill seems to be rolling a bunch of stuff into it that proposes to reduce costs - so let's put those together, 3> public health care coverage bill: this is the one everyone is pissing in the wind about, so let's isolate it and have the vote on it so that it doesn't do collateral damage to other stuff people actually want...
Something like that. I am sure there are smarter ways.
I hear a lot of "If you don't keep clause , this all comes crashing down! You have to do !!!" I don't do economics, but I have been doing software testing for almost twenty years now, and I always cry "bullshit" on that. I hear it every time - some person become passionately enamored with a feature, and once they hear it is going to be cut declare the entire product unshippable without it. They have amazingly sound arguments... so compelling. Well, I have seen many features cut on a product line that makes billions of dollars a year... and I have seen many "critical" features kept (at high cost with added bugginess) that didn't matter two ounces to the customer. I suspect strongly the same thing goes with different aspects of any legislation - health care proposal included.
What I have learned from shipping software, though, is that you have to ship SOMETHING. Shipping late is bad, but not as bad as never shipping, and not nearly as bad as shipping something so dreadful and improperly built that you cannot sell or support it. It is better to cut in order to save the product. Yes, cutting is a risk - but let's remember what we are trying to accomplish here and not get so tied to our individual fixations.
And that is my proposal on the health care bill. One giant monolith, it is likely to die. Cut into pieces, the individual chunks may make it through. You also take the heat and controversy off the whole item - which means that you are far more likely to get comprose and less partisan bickering once people see parts of the problem they can actually work with.

Maybe I am naive, but I actually believe that if antagonism is dropped, the urgency removed, the timeline relaxed and the problem broken up into more workable chunks we would see both sides actually working on this issue in healthy debate. I wish Obama had seized the opportunity to work this way.

I've got your death panel right here...

We shouldn't have publicly funded health care.

Why?

Because, if we do, the government will need to manage the costs paid out to recipients. This will motivate them to adopt policies that will restrict care which could save people's lives. For example, they could have end of life counseling sessions where they recommend inexpensive pain treatments rather than more expensive life-sustaining treatment.

So, because of this possibility, we should not offer publicly funded health care?

Right.

What happens to people that need health care, then?

They get it covered by private insurance companies.

What if they cannot afford private insurance?

They will get it from their employer.

What if their employer doesn't offer it?

They will have to buy it themselves.

No... we already asserted they couldn't afford private insurance.

Oh, well they will pay for medical costs out of pocket, then.

The main purpose of insurance is to cover medical costs you cannot afford out of pocket, or at even at all. Yes, some plans offer more than that, but the primary service is to address the affordability problem by spreading the cost around. So, we are talking about expenses, which by definition, this person cannot pay for out of pocket - and in many cases could not pay for without completely losing everything in terms of their home, house, etc. Also, many medical situations make a person unable to work, further decreasing their ability to pay. How will they pay for the medical care then?

Um... well... you see because the taxpayers aren't paying for a public option...

You cannot use that because it hasn't happened yet, and we are talking about a realistic hypothetical example that happens now. If the taxpayer burden for public health care has not been imposed yet you cannot suddenly give all that money to our person needing care at this moment.

Well, I mean, isn't that their fault for not getting a better job?

Let's ignore the culpability of this individual for the moment. We'll get back to it.

Do you promise, because I really wanted to...

I know you did. I promise. But let's ask the question, what is going to happen to them?

I guess they just don't get the medical care they need.

Correct. Then what happens?

Well, I guess it depends on what they have.

Okay, so if you had Leukemia, what would probably happen if you didn't get treatment.

You would die.

Okay. So, a likely result is death, correct?

Yes.

All right, and this death happened because why?

The Leukemia.

Well, yes, you are correct, but why wasn't the Leukemia treated?

Really, isn't that their fault for not getting a better job?

Hold on. We aren't talking about culpability of the individual yet. I know you want to talk about that, but I promised we would get back to it. So, why didn't the Leukemia get treated?

Because the person didn't have the money.

Okay, and why didn't they have the money?

Well, their job... you see... and...

Okay, I know what you want to say. We will get to that. But, when they didn't have enough money on their own, did the government give them the money?

No.

Right. And would it be correct to say that the government didn't give them the money because, as policy, the government doesn't have a public health plan?

Yes.

So, in effect, this was a decision. This decision was that people are on their own to provide for their own medical insurance. If they cannot, the government will not help. Is it fair to say that this decision was driven by cost reasons?

Yes! Yes! Oh... yeah, now you get it!! You see, taxpayers people cannot be expected to pay for the health care of others who cannot afford it!!

Right. So cost reasons.

Oh, I am so glad we agree on that point! Now you are getting it!

I am glad too. Now, what was wrong with death panels? Why wouldn't they offer treatment to peopled needing health care?

It was because they would be motivated to control costs... um...

Yes?

Well...

You said "Motivated to control costs...", in other words because of cost reasons, correct?

Hey, um...

So, in effect, the decision not to provide publicly funded health care is really providing the same functional purpose as a death panel. It is making decisions, as a matter of policy, and independent of the decisions that a doctor and a patient make together in the best interests of the patient, what medicine to provide and what not to provide. All of these decisions are motivated purely by cost interests. So, by matter of definition, we have a death panel in place right now. Please remind me, is a death panel a good thing, or a bad thing?

Hey, wait - but this person... it's their fault! They should have worked harder, studied harder, got a better job, saved more money instead of spending it all on beer and donuts and getting a big fat ass and making me, a responsible taxpayer, cover their expenses.

Ah. You talk as if you know this person very well. Do you?

Well, no, but come on, look at most people, see how they behave! They don't deserve it! They're all a bunch of whiners.

Oh, statistics! You want to work with statistics!

Yes! I mean, it isn't morally right to have a bunch of lazy bums sap money from people who work hard.

Okay, so we should use statistics to determine who deserves health care.

Yes, let's be scientific.

Guess who else uses statistics to decide who deserves health care.

Rush Limbaugh?

I don't know. But I know who else. A death panel.

Hubba... wha?

A death panel looks at demographics, behavior, cost of success of procedure and other factors and decides who gets treatment and who does not. You seem pretty ready to whip out statistics right now. How do you feel about a death panel telling you that you are a good person or a bad person, or that you deserve to die because the medical condition you have is something you brought on yourself.

I would be really upset... but...

So, if we have defacto implemented a death panel by not providing public health care, and if the proponents are justifying this decision, as you just did, by suggesting that people cannot afford medical coverage because of something they brought on themselves and therefore do not deserve it, well, it seems that the death panel is indeed doing that very thing. How does this make you feel.

You're a Liberal!

I am confused. Is that an actual response to the question?

Communist! You are a socialist pinko.

No, I don't think that was an actual answer. I think that was a personal attack. Our conversation is still incomplete without your answer...

You're a Nazi! You want to suck the pocket books of the people dry!!!!

Now you are confused. The Nazi movement was anti-Communist, so accusing me of being both doesn't really make sense.

His birth certificate is a fake!!!!

Okay, now you are just getting weird.

I don't think this is about health care...

The anger seems way out of proportion.

To every person I have had an argument with that has calmly present balanced, and well supported reasons and facts against the health care bill... this is not directed at you. But if you showed up at an Obama speech with an automatic rifle, or if you are in league with the birthers, or if you cannot talk about health care without passing out in fear from anxiety over death panels... you are it.

If this was really about where to put the tax dollars, then I would expect the debate to be far more reasoned. People may demonstrate some passion, and some excitement, but the anger seems far beyond just discussing budget allocations.

The debate seems to be about something far deeper. This debate is, I believe, showing something about our inner personality as a nation that we don't even consciously realize ourselves.

I believe that what is happening is that this debate is actually destabilizing things people very closely associate with their personal identity. I believe that people create a set of rules about how the world ought to be and look, and tie that in to their identity. To challenge the veracity of those rules is to invite an irrational debate, because they rules are not defended as a matter of a series of points and counter points to be considered, but instead are defended as a personal matter, because giving up on those rules means giving up on yourself - you have to become a different person to accept the challenge, and human beings do not like to give up on their definition of self.

I don't believe, however, that we clearly understand the rules we entangle with identity. I believe the rules are expressed at a subconscious level and that we post-hoc rationalize them with more palatable explanations.

Case in point - a couple of the individuals in my church that I attended as a child were racist. They would have never considered themselves racist, but just the fact that they tried to teach the kids in our Sunday school class that interracial couples should not marry was pretty solid proof to me. Their justification - "There are enough challenges keeping a marriage together and raising children without adding the extra burden that mixing the races will introduce" My suspicion of their inner reason that they wouldn't admit to was likely "Mixing white and black people is wrong because the one group is better than the other". Of course I don't know that, but come on. I am asserting, though, that for these specific people, they proposed a really weak argument against interracial marriage because they needed to supply something that sounded rational to explain a highly irrational position that their personal identity had been attached to a long time ago. It was part of their world order that white and black were different classes of species and they could not stand to see their world tossed out and redefined.

Back to health care... I completely respect the suggestion that a publicly provided health care option might not fix the problem. I completely respect the suggestion that there are better ways to use the money. I disagree, and in my disagreement admit that this is too complex for anybody to really be certain about - but still respect the opposing opinion when it is clear that the person is really just offering the counter proposal.

But there appears to be something else here. Shouting out town hall meetings? Death panel suggestions? Making up falsehoods about what the proposal suggests? No, there is more baggage here, and it is being driven by a highly irrational need to preserve personal identity.

I have my suspicions. I actually don't believe racism is the dominant motivation (although when I see more violent expression... like guns, Nazi references, etc. I start to suspect a deeper hatred because of race). My bigger suspicion is in an innate American hatred for poor people.

American tradition, American work ethic, as good as it is, is based largely on Calvinist doctrine. One of the aspects of Calvanism is the basic assertion that rich people are rich because they are good and industrious (hence God rewarded them) and poor people are poor because they are bad and lazy (hence God punishes). This definitely has some positive impact on society - it creates a culture that respects hard work, self-sufficiency, cleverness, etc. But it also releases people, and society at large, from an obligation to do anything about people that need help. It removes, completely, the possibility that people are victims of circumstances. It re-inforces the "this is mine, and you cannot have it!" not as selfishness, but as a virtue to be exalted and rewarded. This philosophy is wired deeply into the American ethic such that it defines a piece of personal identity for many people in America.

To admit that this view is wrong would mean admitting that you really ought not to get every last stitch of value from your hard work. It means that having more is not as good as giving more. It means admitting that you are no better than someone who is unable to pay for their home, their food, their health care. If you grew up believing to the contrary, then changing this means literally replacing your entire self-image with another. The walls will come up.

I believe there are other forces at work. Humans generally have a need to identify themselves as part of a group. Makes sense. Gorillas do it to, and we have continued it all the way through our evolution. Most of our existence was spent in village culture. It is only a small sliver of human existence where we have to exist in a non-village lifestyle, and it is no surprise that some part of ourselves has not really adapted to it.

I believe the same part of the brain that makes us need family, clan, village, etc. also makes us seek out other groupings of identity. Church. Club. Social peers. Work. Political party. Mobs. Protest rallies. Street gangs.

Once a person strongly ties themself to a group, it gets wired into personal identity. At that point, our protection of that association supercedes rationality. We almost don't care why, anymore, we are associated with a particular group - we just preserve that association.

This leads to actions in bulk. Democrats opposed Bush (1 & 2) for being Republican. Republicans opposed Clinton, and Obama for being Democrat. Most members of society even really understand the issues the different parties stand for, cannot articulate the goals or agenda of a given politician. People are really voting for the club. Why do they do that? They do it because the club they belong to is part of them.

It is the people who are very strongly tied to their party that will go nuts. Death panels freaks. Birthers. Swift boaters. People who assert the Pentagon wasn't struck by a plane.

There are other deeply rooted ethics. There is an American ethic of suppressed pride replaced with outer humility. Sounding "high and mighty" is frowned on in older, traditional American ethics. In the Puritan ethic, people were respected more for keeping their mouth shut than for speaking out. "It is better to be silent and thought a fool than to open one's mouth and prove the point." I love that quote, and probably should pay more attention to its advice, but in this case it leads a prejudice.

The prejudice is basically to distrust anybody who sounds smart. Use big words? You are an elitist. Use subtle arguments? You are shifty. You have an ivy league education with outstanding grades and a stellar reputation as a scholar? You are too big for your britches. Have a "C" in college, booze it up, speak with a limited vocabulary and make references that indicate you really don't understand anything about other nations and cultures - you are a "regular guy". People trust you.

This prejudice likewise ties in with identity. For one thing, it excuses the regular person for not being that very smart person. It provides justification for their envy and allows them to ignore their own feelings of insecurity. So what if they didn't get good grades, go to college? The guys that did - they cannot be trusted. They are unethical. There is something suspicious about them. This type of support and defense against personal insecurity is all wired in with who a person believes they are. The wiring is subconscious, because to be consciously aware of it would necessitate admitting that the person is really just covering up a sense of self doubt.

And, again, this sort of thing is defended with weak, strange, non-sequitir positions because the person cannot connect with their real reason. So many people say they don't trust Obama because he comes off as smug, too smart, elitist. What is wrong with elitist? We are talking running the most powerful country in the world! Heck yes, we need an elite leadership - so long as that elitism is based on intelligence, which is precisely the type of elitism that people seem to be complaining about. The fact is the only thing wrong with elitism is that it forces people to recognize that they are not that elite person, and that they feel inadequate about it.

I am offering my specific suspicions here - and I may be way off on the details. However, I am absolutely convinced that the notion of supporting inner subconscious motives that are intertwined with personal identity are really what is going on. All my examples have been about the current right wing attack on the health care proposal - but I believe that we have seen lots the same thing in the left movement as well. I believe the WTO riots (not necessarily the protests... the labor folks, for example, I think had a sensible statement to make) were really because there were people who had an inner need to throw rocks at the establishment because that was how they had identified themselves. This is a human phenomenon that hits us on all sides.

So, what to do? Will the problem ever go away? Can one propose controversial change without a public freakshow on the other side.

I am very skeptical and cynical about this. I had a discussion with someone once about gay rights. I suggested that the opposition was not going to come around with discussion. I suggested that what really needed to happen was for the opposition to get old and die. I personally believe that this is the heart of social change. New generations come about and their personal identity is molded based on the times that surround them. You don't get change by changing people's minds. You get change because the population supporting the previous opinion diminishes in size and is replaced by a population that supports the change. Young people are the only true hope of social change. Those in the generation ahead of them will always fight an uphill battle with their predecessors and peers. It is the young people, watching that battle, that eventually embrace the change and make it happen.

This means that the battle must always be waged. One must likely still strive for the dialogs as if minds would be changed, but this is for sake of showing the example to minds still forming. Racial acceptance, acceptance of gay lifestyle - to previous generations this was not just odd, it was morally wrong. To the young that are growing up today, most of them cannot even comprehend racial inequality (as opposed to my peers when I was young - I still remember the kids on my block telling me you had to hide whenever a car full of black people drove by - they used the N word, of course), and a growing number of them now and in the future will not understand inequality against gay people. This is in spite of a population of adults now who still do not see it this way.