Health Care Bargains for Everyone on Your List

Dear Will,

This is powerful. I especially like the comparison between, on one hand, choosing between a TV or a grill, and on the other, not having a choice when one's health is concerned.

The dismantling of the economic arguments

i.e. there is no marginal utility when it comes to having a heart attack -- is also very useful and timely, and beyond the health care discussion, too.

This is definitely something to be thankful for. Regards,

Luis.

the poor the disabled should suffer the consequences of being unable and if it should so happen, die.
cheaper, easier.
saves taxes for me.

anyone who says that isn't the true nature of the beast is in denial.

ask most if they would agree to taxes to reinstitute cut social programs, for helping.
ask what their last purchase was and you'll get
no.
i need to live like a movie star.

let them eat (leftover) cake.

I like you approach to health care. However, the comparison with consumer goods gives away too much. All consumer goods should also be something good for us and something we are not being cheated by buying. The root cause of all of this needs to be addressed here. You have given us a shell game.

Mikuleck,

What are the values you like about Will's approach? Do you mean that a shell game is conservative? If so, what are the conservative values Will has promoted? I'm trying to understand your post. Thanks.

Sorry for being so unclear. The values he expressed about health care are all very positive and correct in my way of thinking. The shell game I am using as a metaphor is to contrast the good values with the marketing of commodities that are also a scam for the consumer. Both practices are the result of a common attitude in this country which sees the good of business AND services resting in their ability to serve CEOs and stockholders rather than consumers. Robert Reich's new book dances around this with some good critiques, but, as Tony Judt's review in the latest New York Review of Books points out, Reich's solutions fall short of the mark.

I think the problems with health care would be less even if the situation were improved to make health care a decent commodity. Were consumer goods sold to benefit consumers the model would certainly be less noxious. One danger of compartmentalizing issues this way is that the real cause of the problem often evaporates with the compartmentalization. To me, the root cause of all our problems is a badly misunderstood social contract. Were we to get to that root, much of the rest would follow. Compartmentalization is a sophisticated shell game. You are being distracted from the root cause by playing it.

"I would say we (at Rockridge) haven't really had a chance to evaluate capitalism qua capitalism yet."

Wow!!!!!

Then what are we talking about? How can hope to discuss politics in this country/world without first coming to grips with the role of capitalism? Maybe progressives really are as much a part of the problem as conservatives are? They just feel superior?

Reductionist thought and Lakoff's "direct causality" are basically the same thing. when you lapse into reductionist thinking and even seem to excuse it you are not very different from the conservatives who use direct cause all the time. I am finding that you folk are really not on top of what you claim to be talking about.

I really liked Will's blog entry. It creates crisp, clear images of the absurdity of the "free market" approach to health care.

In my view US health care is one of the most egregious examples of unregulated capitalism run amok with deadly consequences. I find it very helpful to carve out this example from the larger debate on the ills of capitalism/consumerism. I do not believe, as mikulik seems to, that making a much broader argument about capitalism will get us as far as making a clear stand on health care by itself, as a particularly inappropriate venue for unregulated capitalism. We need to make that broader argument as well, but when creating an effective message it helps to keep to a simple, clear, powerful point.

Messages that are complex are difficult to get across. Health care by itself is an extremely complex subject that is difficult to talk about without confusing people and putting them to sleep, especially those who have not already had first hand experience with the tragic impact the US health care mess can have on people's lives. Will has done a terrific job at getting to the heart of the moral debate on health care. Adding many much more complex points about capitalism overall to the discussion will only reduce the effectiveness of that message. I favor saving that for a separate message.

The attempt to carve out the health care issue from other capitalist endeavors as a public good may better assist in calling into question the validity of the free market belief system, than attacking it broadside. It is an "incrementalist" approach. Changing hearts and minds is often a slow and piecemeal project, and it is often more effective to build a case such as this one slowly. Fast change often leads to backlash and regression, while slow and solid change creates permanent progress. That is a strategy question we need to ask ourselves every step of the way, and one on which reasonable people may disagree.

Reductionist approaches always amaze me. The idea is that you isolate a topic and focus there. You pretend the links to the deeper problem do not exist. You believe that you can make gains this way. All I ask for is evidence for the idea that this strategy has ever worked. It certainly is loosing ground for every issue of importance that I know about, including health care,

Notice something. George Bush is still in control. He is there because he has a holistic strategy. He gives no ground, no matter what the issue, Meanwhile a congress elected to work on problems using your reductionist strategy is given even lower ratings by the public. I would say that your strategy will loose every time.

I disagree that what we are talking about here is a reductionist approach. In fact, in order to come to the conclusions Will has in his piece necessarily imply systemic thinking, and could not exist without it. Designing a message appropriate for the public is a different task than writing a blog entry for consumption by like-minded people, with it's own requirements.

I hope that your prediction of failure for this strategy and other disparaging characterizations of the efforts here do not serve to discourage further discussion.

"Incremental" strategies are the main way that new policies and legislation are enacted in a republic such as ours', so specific messaging is essential to effect change. Washington gridlock prohibits major, systemic changes. If you examine the major changes that have occurred in the past 100 years you will see that each was achieved by many years of incremental advocacy, including all the major civil and human rights struggles. Often one single point of injustice is the entry point for what ultimately becomes radical and systemic equal rights legislation, which could not have been achieved without the introductory example. Fortunately, incremental, piecemeal strategies do work with regularity, but require patience.

Does anyone have any thoughts as to the ultimate outcome of any imposition of complex causation constructs on a public accustomed to simplistic causation- whether any significant segment of the population could be interested and persuaded to adopt more in depth analysis that systemic thinking implies? While it is a desirable goal I venture to think it might be too psychologically threatening to the basic assumptions and defenses of many, and may need to be accompanied by fear reduction strategies to reduce the anxiety they provoke. Time will tell.

I'm not sure I recognize the "holistic" strategy you cite on the part of George Bush, unless one considers persistent fear mongering and a proclivity for basing policy on deliberately deceptive and untrue data as holistic (I don't). I disagree that it is in any way superior to the thinking I see here on this site.

Some of the purported "success" of the Bush strategy may be due to their effective framing of 9-11 as a paradigm shifting event that opened the door to a series of radical policy changes that would otherwise have been completely unacceptable under any more normal conditions. Their use of "post 9-11 world" as a total reframe of politics and as usual disoriented the public and has temporarily allowed adoption of policies that are now in the process of being reversed, because they did not do the basic reframing required for their permanent establishment. The pushback following rapid, fundamentally unacceptable reasoning (e.g., rationale promoting the use of torture) is punishing, and can result in a net loss of position instead of gain. I fervently hope the Bush policies will be thoroughly repudiated, and we will see a return to our fundamental progressive morals and ethics.

That all sounds good. Yet I didn't get that when I read it. I'm not sure what is happening. I read the comments others write and am not sure they are getting that either.

There was a time when political discourse was very open about the central role the captialis system played in causing problems across the board. Reich's book on "supercapitalism" is the only thing I've seen lately that even comes close.

When Lakoff wrote about "direct cause" and "systemic cause" I became very hopeful that we getting back to core issues. I am one who was greatly influenced by Hutchins holistic approach when he became president of the University of Chicago at the age of 30. Hutchins believed that every issue and every category or topic is deeply imbedded in a cultural context. Art, science, religion, business, foreign affairs, politics, etc were all interlinked and to discuss any one in isolation from the others was to destroy important semantic content. I have been writing about this and trying to weave things back together. It is very hard to find a place today that tolerates holistic thinking. I think these blogs are inherently reductionist and tend to force us to speak in modified sound bites. What the Rockridge group seems to be doing is to try to make sure their approach and message is effective in that settinhg. What I fear is that even though you are aware of the need to tie things together and put them into context, the medium prohibits doing that in any effective way.

There is more to this than we see on the surface. The distinction between direct cause world views and systemic (complex) cause world views extends far beyond conservative vs progressive worldviews. It is basic in the distinction between reductionist/mechanistic science which is what the current establishment, insurance and drug industries use as their intellectual base. Hence the problem you address about health care is one which I, as a medical school faculty member, have been in the trenches with all my career. In the field of Health Care, direct cause thinking dominates and this thinking weaves a web of problems that may not be easily solved without tearing down the whole web.

For what ever this is worth, I hope to help us get where we want to go.

I don't know how else to do this...

I meant to say ...the distinction between reductionist/mechanistic science which is what ....use as their intellectual base and the science of complex, interacting systems.

 

We are the example of the idea we are discussing. Would we have reached this level of understanding together had we not both tried to recognize the importance of a holistic view and the practical problem of how to get to it without necessarily resorting to at least an entry level reduction?

Let me try to get to the idea another way. There is a mantra used in the study of complex systems: "The whole is more than the sum of its parts" If one really believes this, one is committing oneself to a very profound philosophical position. It is best seen in the realm of science where material things are being discussed, but certainly not limited to that realm.

If the whole is really more than the sum of its parts, then it has someting more than mere atoms and molecules making it up. Not only that but reducing the whole to its parts destroys this "something". It is then inescapable that the "something" has ontological staus equivalent to that of atoms and molecules.

If we look at language, for example, the relationship between syntax and symantics has metaphorical parallels to the material example.

Thus, the thing one needs to keep focused on with language is the potential loss of crucial meaning forced on one because of the limits of the nature of discussion. Without struggle and conscious effort one lapses into a linguistic mode or even a set of frames that one never intended to embrace.

I can make a very strong case that reduction and direct cause world views are very much the same thing.

My point is that as you struggle to frame or reframe ideas, you are forced to work with direct cause/reductionist methods. It takes a lot to get outside that box. I suspect that we fail on our attempts to reframe things into a systemic cause world view because we really don't know how to get at the holistic picture in any short, concise way. Am I making sunse?