On September 19, Ezra Klein favored us with an analysis on health care reform in the WaPo. Coming off the results of the Kaiser Family Foundation’s 2009 Employer Benefits Survey, Ezra makes the following points:

”The truth is we all pay, and much more than we recognize, for health care. . . .”

” . . . Employers pay some, and so do individuals, and taxpayers. And some even hides [sic] behind the deficit. As such, few of us see the full picture. . . . ”

So, we, the people, don’t have a clear idea of the true cost of health care and the true magnitude of the national problem that faces us. But what is that cost? Ezra continues:

”The average health-care coverage for the average family now costs $13,375, according to Kaiser. Over the past decade, premiums have increased by 138 percent. And if the trend continues, by 2019 the average family plan will cost $30,083. . . . .

I have to say I wonder a bit about these numbers, the source of which is the Kaiser Family Foundation survey. As near as I’ve been able to estimate, US average costs per person for health care are now about $7500 per person. Indeed, this estimate may be a bit low. But assuming it is not, and that average family size is 3.1 persons (as indicated by US Census data), then US health care costs for the average family are running about $23,400 per year, or $10,000 higher than Kaiser’s estimate of average premium cost. What accounts for this discrepancy of $10,000 per family? We know that the health insurance companies are profitable, and are not losing $10,000 per family. So some thing’s wrong here somewhere. Again, Ezra continues:

”Those are numbers to marvel at. Those are numbers to fear. But they are not the numbers that loom in the minds of most Americans. And therein lies the problem for health-care reform.

”About 160 million Americans receive health coverage through their employers. In general, the employer picks up 73 percent of the tab. This seems like a good deal. In reality, that money comes out of wages. . . .

”Another 80 million Americans are on public plans, mainly Medicare and Medicaid. Those costs are paid by taxpayers. And about 46 million Americans are uninsured. The costs for their care are shifted to the insured: This raises premiums for the average family by $1,100 each year . . . . “

These numbers also seem a bit off. There are, according to the Census Bureau’s population clock, about 307.5 million Americans today. Ezra’s figures add up to 286 million. Are the remaining 21.5 million Americans all covered by individual private insurance policies? That seems unlikely. But, however many millions there are in this group, they do feel the burden of the full tab. Ezra goes on:

”That’s the dilemma for Washington wonks trying to fix this mess: They look at the numbers and see health-care costs crushing our economy, overwhelming our government, swallowing our wages. But the public isn’t feeling it. Virtually no one cuts a $13,375 check for health care. Most pay 27 percent of it, or even less. The surest way to cut health-care spending would be to make people shoulder more of the burden directly, as opposed to hiding it in taxes and lost wages. But that’s about as popular as a puppy pot roast. . . . “

There’s another discrepancy here, other than the amusing theory that any “Washington wonks” would ever even try to fix this mess, rather than just perpetuate it so that they could continue to practice their “wonkery.” What people pay in premiums is not what they pay for health care in toto. There are also co-pays, deductibles, what they pay for prescription drugs, and also whatever charges they pay for illnesses that their insurance companies end up refusing to cover. That amount is probably substantial, and may account for much of the $10,000 average annual discrepancy between premium costs and health care costs, I pointed to above. Also, is Ezra really advocating that we subject everyone to much more of the true cost of health care than they pay now, so that even fewer people will sign up for health insurance than now, and even more people will be going to the emergency rooms and increasing that burden on those who remain insured? Or is he suggesting that if people were subjected to the true costs, then all of us would, through new legislation and its effects, get the insurance companies and providers to completely overhaul the whole health care system to cut costs substantially? If everyone knew the real cost, what exactly would they do to see to it that costs were cut, and what effects could we expect from such action? Back again to Ezra:

”The problem for the White House has been that the proposed health reform policies meant to help the average American aren’t specific. They’re not a cash transfer or a new insurance card. These are the "curve benders," policies meant to cut long-term health-care costs. The problem is they’re abstract, speculative and, at times, even unpopular.

And then Ezra reviews these “curve benders.” According to him they include empirical evidence about which medical practices are most effective, followed by adoption of those practices; the public insurance option; taxing health care benefits; and popularizing high-deductible insurance plans. For each of these, he points out current political difficulties in getting them adopted, and tellingly, he also ignores the biggest “curve benders” of all, “Medicare for All,” single payer proposals like HR 676 and S 703. Then he really comes to the point of all this palaver:

”If Americans felt the full burden of health-care costs, they’d likely be clamoring for all these policies, and maybe more. They’d want transformational change. But they don’t feel those costs, and so they’re resistant to change. . . .”

The WaPo narrative which Ezra appears to share with other WaPo reporters is that it is a fact that Americans don’t want transformational change in the health insurance industry, and so are resistant to it. This fact then requires an explanation, a theory, that because Americans don’t experience the full costs of their health care, they are resistant to transformational change. So, if only they experienced the full burden of their health care, they’d be hell-bent on it. The truth, however, is that the fact Ezra assumes, the fact of widespread popular resistance to transformational change, is not a fact at all. Many surveys over the past 6 months have shown that the American people are in favor of either a single payer health care reform proposal, or one featuring a public option providing all Americans with a choice of a Medicare-like public plan; both pretty transformational compared to the present system. Some people are resistant to reforms like this, but they are a relatively small minority. They’ve been active in demonstrations throughout the summer, and the media have duly played up their actions. But they are far from either being the American people, or expressing their preferences.

Americans, in other words, in the heavy majority, are in support of transformational change in the health insurance system. Those who are not, the resistance which Ezra posits, are in the health insurance industry, or are politicians representing the industry who have received contributions from them, or are people who have been mobilized by lobbying organizations working for the industry, who make use of their anti-government, anti-modernist, anti-intellectual, anti-science, and other resentments, or are among the media who want to construct a narrative to absolve themselves of the uncomfortable responsibility of criticizing a system where congressional support has been plainly bought and paid for by the health insurance industry. It’s they who are blocking the transformational change, and not the American people.

I think that Ezra, and the WaPo more generally, are trying to create a fictional narrative to account for what they think will be the coming failure of health care reform. Instead of explaining that failure through reference to the Administration’s strategy, or the fecklessness of many progressive organizations, or the power of the insurance industry and its corruption of the legislative process; they are getting ready to ascribe what they think is the coming defeat to the American people, so they can absolve both themselves, and their fellow Washington DC villagers, for all they have done to thwart the clear desire of the American people for real change in the health insurance system.

To mask his own opposition to real health insurance reform, Ezra continues his analysis with some reasoning that is a perfect example of the resurrection of Clintonite policy wonkism, the view that while transformational changes may, through no fault of theirs, be politically impractical, they can reform things, and make a substantial improvement incrementally and cumulatively by “tinkering” with the details of the present system and introducing lots of small “tweaks.” He argues:

” . . . Obama continually promises that most Americans will notice no changes in their existing coverage, and all the bills reflect that vow. So what’s left? How do you reform a system you cannot change?”

”You ask the wonks. People often complain about the length of bills. But you don’t need many pages to explain a public plan, or set up a death panel (kidding!). Rather, the bulk of these bills amount to hundreds of small tweaks and fixes that make this corner of the health-care system a smidge more user-friendly, or that transaction a tad faster. Rather than saving hundreds of billions of dollars with a single dramatic intervention that transforms the system, they provide for the accretion of modest savings and small efficiencies. . . .

” . . . this is the quiet promise of health-care reform. The grand theories might fail. They often do. But making the system a bit better, a bit quicker and a bit more agile — we can do that. And until the stove gets hot enough, it may be all we can do.”

So, in effect, Ezra is saying don’t blame us DC villagers if health care reform fails, it’s really the fault of the people. They didn’t make “the stove” hot enough. They didn’t force us, Congress, and the Executive to pass reform. So never mind that our leadership was corrupt, our framing was consistently anti-reform, and our actions were opposed to real reform at every turn. After all, we have no leadership responsibility at all. It’s up to the people to make us do what ‘s right in spite of ourselves.

(Also posted at the Alllifeisproblemsolving blog where there may be more comments)