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Henry Fairlie, Health MavenFrom Grub Street, unexpectedly wise words about reforming health care.

By Timothy NoahPosted Friday, June 19, 2009, at 3:36 PM ET

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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.

Bite the Hand That Feeds You: Essays and Provocations 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 66^th birthday (coincidentally, my 32^nd, 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.)

In the July 2 New York Review of Books, Arnold Relman writes, "Things will have to get still worse before major reform becomes politically possible. The legislation likely to emerge from this Congress will not control—and will probably even exacerbate—the inflation of costs." When I read these words earlier this week, I thought Relman, who's been advocating major health reform for decades, was writing off current efforts too hastily. Now I'm not so sure.

What's maddening is that it has always been obvious that any health reform bill worthy of the name would require altering the present arrangement with which health insurers, doctors, and hospitals all feel comfortable. What we call overspending they call income. Why is it a given that their financial concerns be heeded? What Relman calls the "medical-industrial complex" may oppose a robust public option, but (as Klein points out) the public supports it by a huge margin. A new NBC News/Wall Street Journal poll shows 76 percent agreeing that inclusion of a public option is either "extremely important" (41 percent) or "quite important" (35 percent). This in spite of the fact that nearly half (47 percent) believe its adoption would likely cause their employers to drop their coverage.

Fairlie's "In Defense of Big Government" was published not quite two years after Watergate forced President Richard Nixon out of office and less than one year after the fall of Saigon. Anti-Washington feeling was high, and it was bipartisan. Later that year it would usher Jimmy Carter, a relatively obscure ex-governor, into the White House. Even later it would elect Ronald Reagan, an outcome that took Fairlie by surprise (me, too). Fairlie had no idea, when he wrote this essay, how defining anti-government populism would be during the three decades that followed. But he did understand, as a Tory, how disruptive it could be to the commonweal:

[I]t is time that it was acknowledged that there are now only two choices: one can be either for strong government for the few and the rich, or for strong government for the unrich and the many. There is no longer a third way. This is what the American election this year is about: not whether there should be "big government" or not—that is a false issue—but whom the "big government" should serve.

The political vogue against big government, Fairlie wrote, misread the American mood, which opposed corrupt and "just plain lousy" government, of which it had recently experienced a bellyful, but not "big government" as such. "They need it, and they know they need it," Fairlie wrote. Given subsequent events, it was Fairlie, not anti-government rabble-rousers, who misread the public mood. But his words strike me as a fair description of the current public mood. "If one asks to be allowed to govern," he wrote, "one had better believe in government." Henry may have been inattentive to his personal health, but his understanding of the body politic reaches further today than it did in his own time. Sen. Baucus, take heed.

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Timothy Noah is a senior writer at Slate.

COMMENTS

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
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