The Old "Solidarity vs. Rugged Individualism" Diversion on Health Care

The elites continually try to give us phony political frames to divert the public from the real issues in politics. We have an excellent example of such an effort in the NYT's Economix blog where Uwe Reinhardt tells us that the health care debate is about "Solidarity vs. Rugged Individualism."

Reinhardt's story is that we have the solidaristic liberal types who think that everyone should be put in a single pool. If someone ends up getting really sick, then the healthy among us will pick up the tab. These are the supporters of Obamacare or other plans to extend health insurance coverage.

Then we have the rugged individualistic types who are willing to pay for their own care, but don't want to be stuck with the tab for others. Their philosophy is that if someone gets sick, then they should just get out of the way. There is no reason to stick everyone else with the tab.

That's a great way to frame the central issue in the debate, except of course that none of the leading opponents of Obamacare openly expouses anything like the rugged individualist view that Reinhardt wants to attribute to them. Instead they say things like they want to use market mechanisms to extend coverage. We can show that their approaches will not work, but that is not the same thing as espousing Reinhardt's rugged individualistic view that people just should not get care.

And, there is good reason to believe that very few people actually hold anything like the rugged individualist view that Reinhardt has outlined here. There is a little program called "Medicare" which operates in a way that is 180 degrees at odds with the rugged individualist view that Reinhardt has described. Incredibly, 70-80 percent of Republicans strongly support Medicare. In fact, 70-80 percent of self-identified Tea Party supporters strongly approve of Medicare.

This suggests that these people are not opposed to Obamacare because of their commitment to rugged individualism. It suggests that their opposition is gounded in something else -- perhaps confusion about the program, fear of a government mandate, perhaps dislike of the people who they see as the many beneficiaries -- but not a committment to rugged individualism.

If that is the case, the discussion of rugged individualism is a distraction from the real issues in the health care debate, perhaps front and center why health care in the United States costs twice as much as everywhere else. If the United States paid the same amount per person for its health care as Germany or Canada we would not be having a debate like this. Everyone would already be covered for less than we are now spending on Medicare, Medicaid and other government health care programs.

Where Was Reinhard$?
written by James, June 30, 2012 11:04

Individualism?

How about letting the TBTF largest financial institutions and companies go BK in 2008 and 2009? They should have fended for themselves, rigth? Instead, they got TARP, implicit gty, cheaper collateral % required by the FRB, Transaction Acct Gty by the FDIC, etc.

Yeah, individualism doesn't apply to the very powerful and politically connected, does it?

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written by MB, June 30, 2012 1:39

Hmm. I hear what you're saying and you're making good points. But I read UR's post as a challenge to a genuine, existing ideology that dominates the health-care debate more so than an attempt to divert the public away from the real issues and real solutions. Sometimes UR perplexes me because he's a deep expert on single payer but he does not recommend it as the first solution for the United States. At first I felt confused and a little bit angry that he signed a petition in support of ACA during its most controversial phase instead of standing up for single payer. But over time I feel like I can see his point of view, both in highlighting the shortcomings of single payer as well as in criticizing the ethical culture of America.

Even if the majority of Americans do not espouse libertarian ethos, the culture of the country has allowed those views to dominate. I agree that's mostly a consequence of confusions, fears, and prejudice (and other factors). But that's the narrative that has driven otherwise well-meaning people into apoplexy about death panels and government takeover's. So I see UR as a deep-thinking expert who is a force for good and not for evil. He really understands this issue and at a certain point I decided to trust that he is sincerely committed to influencing the country to the best workable solution.

Considering that most opponents to SP are poorly informed about it and considering that this country still needs to genuinely put the "universal" into universal healthcare, I think the single-payer movement should welcome a coherent, substantive debate with an expert like UR rather than have its most vocal opponent be soundbites from CNN & Fox.

It is a fact that American health care is enormously complex. Even though I support single payer and it sounds easy to just change out a few words and create Medicare for All, considering everything, I think it's possible that the worst thing that could happen to single payer would be enacting it immediately. The health system is a mess. There are very serious problems that need to be worked out and if SP was the law today, it would be blamed for every single one of those pre-existing problems. Now we can blame it on ACA. :-)

A very big question is, Does a nation need to satisfy certain pre-conditions for successfully implementing single-payer? My impression from reading UR is the answer is yes and that it's worth thinking and talking about those pre-conditions, which seem to include ethics such as social solidarity vs rugged individualism.

Plus it upsets me that two trusted blogging economists, who make such a tremendous effort to consistently clarify complex concepts for the common good of the general public, don't see eye to eye. It's like mommy and daddy are fighting. :-) [That's a joke btw, in case the emoticon wasn't clear.]

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We Are Not Debating Libertarians
written by Dean, June 30, 2012 3:00

Folks,

I never accused Reinhardt of being a libertarian. I said that he set up a phoney debate. Almost no one on the other side is arguing the position that he sets out. He has fundamentally mis-characterized the key issues in the debate and that is a serious disservice.

Hide
written by MH M* m, June 30, 2012 9:37

Very glad to see how folks come here and lecture people must "at least know how to read and then comment." What a noble advice!

Loud enough to bold face to emphasize its importance.

Priceless!

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written by denim, July 01, 2012 5:28

I don't buy the rugged individualism premise. Anyone can choose to go into the woods and die alone. What Rinehart is covering up is cheapskatism. Public health is a society's issue. We really don't want typhoid Mary to resurface, do we? Or those homeless TB suffers. So pay up for what one really wants and gets...protection.

Canadian
written by Charles Johnson, July 01, 2012 8:52

If the United States paid the same amount per person for its health care as Germany or Canada we would not be having a debate like this.

WRONG!

If only Canadians could debate the cost of their Medicare programs and who should be covered. The federal government has just declared its plan to eliminate coverage for refugees from certain "safe" countries. Ontario has reduced the payments to some doctors for procedures that have become more efficient, such as cataract surgery. These were not debated; they were just implemented.

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Uwe is wrong, Forcing lower-income people pay for medical waste is not compassionate.
written by Rachel, July 01, 2012 10:26

I have a great deal of respect for the learned Uwe Reinhardt, who certainly knows that there is a great deal of waste, fraud and abuse in medicine. I am sure that he also knows that the ACA doesn't begin to address this problem (as Jonathan Oberlander and others have admitted recently).

Unfortunately, Uwe doesn't seem to have much experience of how badly many lower-income patients are treated in low-budget hospitals and HMOs. He doesn't seem to understand that it isn't just young and healthy lower-income (35k) people who are being taken from, in order to pay for the lavish feast (i.e. waste) being enjoyed in Big Medicine. So he doesn't understand that many caring people may find the ACA ill-informed and uncaring.

Or Reinhardt is just hoping to make the best of a bad situation (which situation includes some of his fellow Economix bloggers).

But I think it would be wisest and most compassionate if he were to simply continue trying to educate more people about the barriers and bad laws have created this health care crisis ... instead of promoting the redistribution of Big Medicine's excessive costs onto people who are not so well off, then blaming people who are not satisfied with this.

(Once again, I'm saying this with greatest respect for UR's intelligence, expertise, hard work, and public spirit. After all, we wouldn't want him to quit blogging in disgust.)

(And while I'm at it, equally greatest respect for Dean too. We don't want him to quit blogging either.)

Price Gougers
written by FoonTheElder, July 01, 2012 12:43

The health care debate is about how much big corporate health care price gougers can continue to have their unwarranted profits at the expense of the rest of America.

Neither Obamacare, Romneycare or Republicancare(the plan we've had for decades) will deal with the $1 trillion that is wasted each year under our current health care system compared to every other developed country ($3200 per year per American x 312m).

Obamacare takes us from 100 years behind the rest of the developed world up to 40 years behind the developed world. All these plans do is rearrange the deck chairs on the health care Titanic.

Germany has had universal health care for over 130 years. The U.S. won't solve its health care problems until there is a single payer plan that is not influenced by the medical price gougers.

The chance of that happening in our corporate owned government is near zero. At this rate, it will be another 60 years before we really fix the failed US healthcare system.

The "rugged individualist" view is quite openly espoused in editorial cartoons in the fly-over states.
written by H-Bob, July 02, 2012 1:19

maybe opponents of Obamacare don't openly espouse the rugged individualism view but it might be their actual view. Of course, they don't espouse that position for their own healthcare, hence "hands off my Medicare".

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written by evodevo, July 04, 2012 7:42

H-Bob has it right. Among my co-workers, hypocritical "rugged individualism" wins out hands down. They are terrified of ACA, without knowing anything about it except Fox memes; they pay cash for their current medical needs (ignoring the fact that they are under 40 and healthy, as are their kids) and see no reason why everyone can't also; vote as Tea Partiers, if they vote at all; and seem not to be saving for retirement or considering that they may get sicker as they age. Their parents are on SS and Medicare, but THAT isn't socialism, LOL. A young working class that is educated solely by Rush and Fox News is a tragedy waiting to happen.

The Old "Solidarity vs. Rugged Individualism" Diversion on Health Care

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