On Christmas Eve I was a guest on POTUS, a political news station on XM/Sirius satellite radio, talking about the just-passed Senate health care reform legislation. My job was to offer political analysis of the bill, to talk about what happened in the Senate, what is likely to happen next, and what might happen after that. My job was not to promote or deride it. In an effort to steal ideas from friends and simultaneously plug myself, I posted my upcoming appearance on Facebook and asked for input.
The responses reminded me that that we are not having a debate about health care reform in this country; we are shouting our biases, anecdotes, fears, and hopes at each other.
None of my Facebook friends (who are also “real” friends) offered process thoughts. There was no, “the Kremlinesque line that the public option was just sick has finally given way to what everyone has known for months: it’s dead.” Instead there were a couple of suggestions on how to argue to make the bill more liberal, one suggestion on how to promote the bill, and one scathing attack. I mentioned “health care reform” and people immediately reached for their talking points and assumptions.
What makes this especially interesting is that other than one Facebook plug of a Paul Krugman column I don’t think I have publicly said what I think about the legislation (for the record, I agree with Krugman and Dionne).
A couple of observations based on this episode strike me as worth mentioning:
No one who has used the health care system likes it (the most vitriolic attacker in my Facebook page “discussion” and I exchanged a series of private emails that grew increasingly more balanced and respectful – he agrees the current government run systems, from which he benefits, are a mess and thinks that increased government attempts at solutions will only make it worse). People may like their doctor or hospital but the paperwork and bureaucracy involved in getting well are awful.
We don’t encounter or have opinions about the “health care system.” We see parts of it and extrapolate from those parts to the whole. The back and forth on my Facebook page covered a lot of ground and still left out Medicare Advantage, durable medical devices, the VA and Tri-Care, Indian Health, and countless other issues. Attempts to talk about the “system” are heard in the context of the piece or pieces the discussant knows about or is invested in. Those who rely on Medicare view system reform through the lens of impact on Medicare. Seen in this light, we are not having a debate about health care reform, we are instead throwing our personal interactions with small pieces of the massive pie at each other. The “system” is not discussed; the parts with which we individually interact are discussed, generally without consideration of the other parts. The individual or immediate element stands in for the whole. Immediate elements sail past each other, and a conversation about the whole is essentially impossible.
