Henry Fairlie, Health MavenFrom Grub Street, unexpectedly wise words about reforming health care.
Posted Friday, June 19, 2009, at 3:36 PM ET
PRINT
DISCUSS
E-MAIL
RSS
RECOMMEND...
Facebook
MySpace
Mixx
Digg
Reddit
del.icio.us
Furl
Ma.gnolia
Sphere
StumbleUponClick here for a guide to following the health care reform story online.
I never expected to receive sound advice about health care from Henry Fairlie. I knew Henry a little during the 1980s. He was a writer of elegant and somewhat cantankerous political essays for the New Republic, where I contributed pieces that were less elegant and less seasoned by human experience (of which I had none). Lately I've been reading the just-published Bite the Hand That Feeds You: Essays and Provocations, an engrossing anthology of Fairlie's best essays, edited by Jeremy McCarter.
That Henry would have anything to offer to the current health reform debate is a surprise for three reasons:
1) He died in 1990, one month after his 66th birthday (coincidentally, my 32nd, though the one time I mentioned this shared bond, he silenced me with a look of irritated bafflement that we might possibly have anything in common).
2) Henry's personal health was a disaster. Born with a cardiac defect ("I have a hole in my heart," he liked to say), he drank like a fish, smoked like a chimney, and in general indulged in behavior, as McCarter puts it in his introduction, that stood out "even in the louche world of Fleet Street" whence he came. Fairlie's fellow Briton (my Slate colleague) Christopher Hitchens wrote in a June 12 New York Times book review, "The word 'raffish' might have been coined for him," a judgment whose authority commands deference. (Christopher is sufficiently raffish that Vanity Fair achieved high comedy two years ago merely by sending him to a spa, but compared with Henry, he's Charles Atlas.)
3) Henry was a Tory, which is generally taken to mean a conservative.
Fairlie clarifies this last point in "In Defense of Big Government," a stirring and clear-headed essay the New Republic published in 1976 that I'd not previously read:
The characteristics of the Tory, which separate him from the conservative, may briefly be summarized: 1.) his almost passionate belief in strong central government, which has of course always been the symbolic importance to him of the monarchy; 2.) his detestation of "capitalism," of what Cardinal Newman and T.S. Eliot called "usury," of which he himself calls "trade"; and 3.) his trust in the ultimate good sense of the People, whom he capitalizes in this way, because the People are a real entity to him, beyond social and economic divisions, and whom he believes can be appealed to, and relied on, as the final repository of decency in a free nation. The King and the People, against the barons and the capitalists, is the motto of the Tory.
This description puts Tories well to the left of today's Democratic Party, particularly when it comes to health reform. Ezra Klein, the Washington Post's resourceful blogger on this and other economic topics, has posted an outline of the latest (tentative) iteration of the Senate finance committee's health care proposal. It appears designed to achieve two contradictory goals: to lower the bill's cost and to reassure the insurance lobby. These are achieved at the expense of extending and improving Americans' access to health care, which some might say is the whole point of passing a reform bill.
As Robert Pear reports in the New York Times, the Congressional Budget Office's latest 10-year cost estimate (well over the $1 trillion price tag President Obama envisions) scared the finance committee half to death, and now Chairman Max Baucus, D-Mont., has delayed introduction of its bill and begun frantically scaling it back. The public option, i.e., creation of a new government health insurer to compete with private insurers, is gone, at least for now. In its place is a publicly chartered health cooperative, proposed by Sen. Kent Conrad, D-N.D., that would lack the clout necessary to bring health costs down to the point where coverage could be extended in any meaningful way to the uninsured and the underinsured. (Berkeley political scientist Jacob Hacker, who devised the public option, explains why Conrad's idea is a poor substitute here.)
E-mail Timothy Noah at .
Most Fast Food Restaurants Thrived During the Recession. Not Arby's.
Did Anti-Communists Really End Communism? Two Historians Say No.
Dear Farhad: How Does Facebook Know I'm Gay?
What Ever Happened to Hood Ornaments?
Are Doctors Allowed To Say They're Sorry?
Hitchens: Let's Not Get Sentimental About Communism
The President says we have to take incremental steps. Medicare for All IS an incremental step. Step one was Medicare for the highest risk pool, old fogies like me. Step 2 is Medicare for everybody else which is actually easier because it does not cost any more (see below). Step 3 would be more efficient medical practice.
The main reason that it is far better to extend Medicare to everyone is cost. Private insurance companies waste about $400 Billion each year in high overhead and unnecessary requirements on physicians. There is another $100 Billion wasted on high drug prices to companies that spend 3 times as much on "marketing" as on R & D. This $500 Billion each year can be used to pay for the extension of Medicare to everyone. If you simply add a public plan, you are leaving the $500 billion on the table. You are simply adding cost. This is just stupid.
In addition, there are technical reasons just adding a public plan is foolish. If it has to take everyone while private companies can pick and choose, it will wind up with another high risk pool--the sick and the poor. While the idea of creating another pool is bad enough, if it is a high risk pool, it will be very expensive. The Republicans will seize on this and progress will halt. Also, if it covers preexisting conditions, then it will greatly expand the pool of the self insured which is terrible from an efficiency point of view. After all, why pay premiums when you are well?
Finally as to the attitudes of the public, Representative Anthony Weiner recently held a telephonic town meeting with 4,700 members of the public. He asked who preferred the public plan option and who preferred Medicare for All. Two thirds preferred Medicare for All. Then the Representative said the private insurance industry would never permit that option.
Who is running this country?
-- lensch
(To reply, click here)