Map of life expectancy at birth from Global Education Project.

Friday, January 21, 2005

It's Hard Work

No, I don't mean watching war on TV, or preznitin', though I'm sure those can both be quite challenging for a boy of very little brain. I'm talking about understanding our bizarre, Rube Golberg, byzantine, ramshackle, duct taped-together, accidental, incomprehensible health care system.

This is one of the biggest obstacles to advocating and organizing effectively for reform: the inevitable, eyeball glazing wonkishness of any attempt to explain just what in the delta quadrant of the galaxy you are talking about.

Most people don't know the difference between Medicaid and Medicare. If they do basically get that one is for poor people and one is for old people, they don't know about disabled people and they also don't know that a big chunk of Medicaid spending actually goes to people on Medicare, and if you tell them that, it doesn't make any sense to them and trying to explain why takes another 20 minutes. People don't understand the eligibility requirements, the benefits and limitations, how they are financed, state vs. federal administration . . .

And people don't understand very much about their employer-provided insurance either: how markets for health insurance work, what managed care is all about (what's left of it), how their doctors are paid, why it all costs what it does . . .

A while back I was involved in an organization working for a single payer plan in our state. We quickly realized that you can't put "single payer health care" on a bumper sticker. Nobody knows what that means, or why they should be for it, and if you try to explain it to them you've lost them after the first half hour or so. The main reason the Clinton plan went down in flames is that nobody could understand it -- including me, by the way. I had a number of questions that nobody could answer to my satisfaction, about people living in Rhode Island and working in Connecticut, flying up from Florida to Jackson Hole and breaking their leg there, who the hell was going to manage and figure out and supervise the spaghetti bowl of cash flows among all these hundreds of regional "alliances," how to stop the plans from cherry picking and all the other perverse incentives built into this gigantic junk pile.

Yes, we need universal, single payer national health care. But as soon as we make a serious proposal, Harry and Louise are going to be on TV making simple, straightforward and dishonest accusations about "rationing health care" (gasp! how immoral), and raising your taxes, and layers of bureaucracy, that it's going to take us six paragraphs of dense prose to refute.

So I'm having a bumper sticker contest. What are the slogans? What are the punchy, understandable messages that can beat Karl Rove at his own game?

Also, if there is popular demand, I will post a primer on the current system, but only if asked.