When I think about health reform in the United States, I usually think of words like impossible. When I stop to contemplate why it seems impossible, I usually focus my attention on the structure of our government, which is designed to resist change, and the disproportionate influence of wealthy organized interests on the political process. These things certainly play a role, but the more I think about it, the more I am convinced that the major barrier to meaningful health reform is public infighting. Typically, we hear about infighting in political parties. For instance, when Democrats stop bickering with Republicans and start bickering amongst themselves, that’s infighting. It’s a pretty self-defeating strategy, but the American people seem content to engage in it themselves.
As a nation, we can agree on a preferred outcome. It doesn’t take much effort to conclude that our country would benefit from everyone being healthier. Yet we can’t seem to agree on the path to that outcome. Here it comes down to the “haves” and the “have nots.” (My wife has me watching Big Brother if you can’t tell.) Quite simply, the “haves” are pleased with the world as they get to experience it. Just witness the latest Kaiser poll. These are the same people who say things like “We need to reform the health care system in this country, but I am extremely satisfied with my health insurance and my personal physician.” They also say things like “Congress is doing a terrible job. We need to vote them all out and start over. Except for my member of Congress. He/She is doing a pretty decent job.” Welcome to Lake Wobegon. When I snap my fingers you will wake up and realize that you can’t all be above average. Some of the haves have done this–and they’re the ones trying so diligently to reform the system for the better of the nation.
The “have nots” meanwhile, should be hacked off. Things clearly aren’t going their way. They should be totally supportive of health reform. Unfortunately, a recent poll shows that they don’t understand what “Obamacare” will do for them. They are disorganized and confused, but they are also proud and strive to be–however unsuccessfully–self-reliant. So they don’t want a handout, and they don’t want the government to get involved. Of course, this is a gross overgeneralization. There are plenty of uninsured who would welcome the help, and just don’t understand what sort of help they stand to get.
Still, at the end of the day, there are two groups of “haves” and two groups of “have nots” and these four groups are aligned two on each side: two for, and two against, health reform. That, I am convinced, is why we don’t see more meaningful health reform, why the states are not all making progress to implement the new law, and why our nation–and potentially our next GOP leader–faces a Sisyphean task.