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Daily Howler: The ladies Dormady know about rationing. At the Times, Leonhardt does not
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IGNORING THE LADIES! The ladies Dormady know about rationing. At the Times, Leonhardt does not: // link // print // previous // next //
FRIDAY, JUNE 19, 2009

IGNORING THE LADIES: The ladies Dormady seem to know what the talk about “rationing” means.

The ladies sat with CNN’s John King as part of Sunday’s State of the Union. (They seem to be sisters. King didn’t explain. See THE DAILY HOWLER, 6/17/09.) At Junior’s Diner, over oatmeal with raisins, they kicked around their views on health care reform.

No, the ladies Dormady aren’t experts. But it wasn’t long before both ladies explained what decades of “rationing rhetoric” have been designed to convey:

KING (6/14/09): We went to Junior's Diner. It's in Orlando, Florida. We sat down. Everyone at the table agreed on the urgency—the urgency—of doing something about health care. But getting them to agree on just what, that is a whole other matter.

(BEGIN VIDEOTAPE)

KING: —with the way we do health care in this country now, if anything?

BLANCHE DORMADY: I think that depends on the person. I, I have—I don't like the insurance. The insurances decide what you're going to have and what you're not going to have. And I certainly don't want the—the government to have that ability. And I like it to be private.

KING: Well, are you , are you— Are you worried, though, that they will make it worse, the politicians will make it worse?

BLANCHE DORMADY: It will make it worse! But I'm not a worrier.

(LAUGHTER)

MARGARET DORMADY: I'm against health—national health care. I personally don't have health insurance, because it is too expensive. But I want to get for myself what I need. I— I don't want to be told what I can have and when I can have it.

The ladies Dormady aren’t health care experts. But it wasn’t long before they expressed the fears that have been driven by decades of talk about “health care rationing.” To wit:

When it comes to health care treatments, Blanche Dormady doesn’t want the government “decid[ing] what you’re going to have and what you’re not going to have.” Similarly, Margaret Dormady wants to get the health care treatments she needs for herself. She says the following, sounding like her apparent sister: “I don't want to be told what I can have and when I can have it.”

The ladies Dormady don’t want to be told what health care they can have. More specifically, they don’t want to be told by the federal government.

Essentially, these are the fears that get stirred, fairly or otherwise, by talk about health care rationing. The federal government will parcel out health care. Even if you can afford to pay for a treatment yourself, you will have to stand in a line, waiting for your chance. And of course, “the politicians” make everything worse. Blanche says this won’t be different.

These are the images and the fears that get conjured by talk about “rationing.” In 1993, the Clinton proposal was met by claims that care would be rationed—that you wouldn’t be able to buy the treatment you needed even if you could afford it. This talk about rationing has never died; like rust, conservative spin never sleeps. The fears it produces are still alive. On Sunday, the ladies expressed them.

The ladies Dormady aren’t health care experts—but they do know what talk about “rationing” means. By way of contrast, David Leonhardt is major cheese at the New York Times. And, to judge from Wednesday’s column, he has no earthly idea.

As we noted yesterday, Leonhardt started his piece like gang-busters, swearing he’d get to the heart of the problem (see THE DAILY HOWLER, 6/18/09). Spirits soared in our warren of study carrels as Leonhardt said he was going to lick every bit of spin in the house:

LEONHARDT (6/17/09): Rationing.

More to the point: Rationing!

As in: Wait, are you talking about rationing medical care? Access to medical care is a fundamental right. And rationing sounds like something out of the Soviet Union. Or at least Canada.

The r-word has become a rejoinder to anyone who says that this country must reduce its runaway health spending, especially anyone who favors cutting back on treatments that don’t have scientific evidence behind them. You can expect to hear a lot more about rationing as health care becomes the dominant issue in Washington this summer.

Today, I want to try to explain why the case against rationing isn’t really a substantive argument. It’s a clever set of buzzwords that tries to hide the fact that societies must make choices.

At first, Leonhardt seemed to know whereof he spoke. “Rationing sounds like something out of the Soviet Union,” he said—seeming to know what was in the minds of the ladies Dormady. His reference conjured an uncaring bureaucrat, unfeelingly doling out access to care. And then, he said that he would “try to explain why the case against rationing isn’t really a substantive argument. It’s a clever set of buzzwords!”

Our analysts sat erect at their desks, eager to see what Leonhardt would say. But alas! Leonhardt wandered all over the countryside. It was all downhill from there.

The ladies Dormady seem to know what those “rationing” “buzzwords” mean. As usual, it seems the Times doesn’t.

Leonhardt’s ramble: Perhaps someone should have rationed Leonhardt’s word-count He was given more than 1200 words—quite a few by hard-copy standards. As a result, he rambled all over the countryside, speaking to this, that and more. But did the gentleman ever go where the rubber meets the road? The ladies Dormady had voiced the fears involved in decades of talk about “rationing.” Leonhardt rambled all over the world. But he ever get back to the fears expressed at Junior’s? To the big plates of unformed mush King politely described as “oatmeal?”

Frankly, we can’t really find the place where Leonhardt addressed the ladies’ concerns. (Go ahead. Search for yourselves.) That said, we can suggest a few ideas about how not to tangle with “buzzwords.”

First, if you going to tangle with decades of buzz, it’s best not to get highly theoretical. It’s probably best to avoid getting metaphoric. And it’s best not to argue ironically. The ladies had expressed a clear set of fears. As he continued, Leonhardt showcased his various skills—but where did he speak to their specific worries? We show you his paragraphs 6-10, in which he starts to wander:

LEONHARDT (continuing directly): In truth, rationing is an inescapable part of economic life. It is the process of allocating scarce resources. Even in the United States, the richest society in human history, we are constantly rationing. We ration spots in good public high schools. We ration lakefront homes. We ration the best cuts of steak and wild-caught salmon.

Health care, I realize, seems as if it should be different. But it isn't. Already, we cannot afford every form of medical care that we might like. So we ration.

We spend billions of dollars on operations, tests and drugs that haven't been proved to make people healthier. Yet we have not spent the money to install computerized medical records—and we suffer more medical errors than many other countries.

We underpay primary care doctors, relative to specialists, and they keep us stewing in waiting rooms while they try to see as many patients as possible. We don't reimburse different specialists for time spent collaborating with one another, and many hard-to-diagnose conditions go untreated. We don't pay nurses to counsel people on how to improve their diets or remember to take their pills, and manageable cases of diabetes and heart disease become fatal.

''Just because there isn't some government agency specifically telling you which treatments you can have based on cost-effectiveness,'' as Dr. Mark McClellan, head of Medicare in the Bush administration, says, ''that doesn't mean you aren't getting some treatments.”

Instantly, Leonhardt turns theoretical. “In truth, rationing is an inescapable part of economic life,” he offers, speaking from Olympian heights. We even “ration lakefront homes,” he is soon saying—although, in fact, we actually don’t, at least not in any way that’s relevant to the ladies’ concerns. In this country, if you want a lakefront home and you can afford it, you can damn straight go out any buy such a home. No government bureaucrat says you can’t. (So too with “the best cuts of steak.”)

The ladies Dormady are afraid it won’t work that way with health care.

The ladies Dormady are afraid it won’t work that way when it comes to medical services. Among other things, the ladies fear that you won’t be able to get a procedure even if you can afford to pay for it. This claim was made quite explicitly in the days of the pseudo-debate over the Clinton health care proposal. Leonhardt, in only his sixth paragraph, has wandered far away from the actual fears driven by actual buzzwords.

By paragraph seven, he has turned metaphorical. “Already, we cannot afford every form of medical care that we might like,” he says. “So we ration.” But he’s now speaking metaphorically—and the ladies Dormady aren’t. He’s talking about “rationing”—and they’ve heard about rationing. Real, flat-out, Soviet-style rationing. Rationing where a government bureaucrat says you can’t get that procedure.

They aren’t afraid of something that resembles rationing. They’re afraid of the real hard-core deal.

Before long, Leonhardt is waxing ironical. This is how he finishes the first half of his column:

LEONHARDT: On Wednesday, a bipartisan panel led by four former Senate majority leaders—Howard Baker, Tom Daschle, Bob Dole and George Mitchell—will release a solid proposal for health care reform. Among other things, it would call on the federal government to do more research on which treatments actually work. An ''independent health care council'' would also be established, charged with helping the government avoid unnecessary health costs. The Obama administration supports a similar approach.

And connecting the dots is easy enough. Armed with better information, Medicare could pay more for effective treatments—and no longer pay quite so much for health care that doesn't make people healthier.

Mr. Baker, Mr. Daschle, Mr. Dole and Mr. Mitchell: I accuse you of rationing.

Leonhardt is nicely ironical here. And the ladies Dormady, eating their oatmeal at Junior’s Diner, aren’t likely to give the first flying f*ck about a single word he has said.

In fairness to Leonhardt: In fairness to Leonhardt, he may not be discussing the way the “rationing” buzz can undermine hopes for health care reform. In our view, it never gets clear, at any point in this piece, just what he is discussing. When he opened his piece in the manner he did, he seemed to be addressing the ladies Dormady—and the millions of voters who share their fears. We thought he would address the fear that, after some sort of health care overhaul, the government would limit the kinds of health care a middle-class person might get.

And by the way, there’s a hidden aspect of the fear the ladies Dormady expressed. The ladies didn’t express this specific fear, and it may not be in their heads. But here it is: According to the “rationing” theory, a fully solvent, upper-end person might get denied some health care service because poor people are ahead of him or her in line. In today’s world, Margaret Dormady “can get for myself what I need;” if she has the money, she can buy the health care she wants. She fears that, in an overhauled world, she will have to stand in a very long line—even if she has the money to buy the service in question.

For some middle-class or upper-end people, they fear they’ll be stuck in line behind poor people—denied health services they can afford because such procedures will go to the poor.

What are the answers to such fears? We don’t have the foggiest! Like the ladies, we’re not experts. We don’t know what the answer would be if they went to the White House and presented these familiar fears to, let’s say, Kathleen Sebelius. But we see no place in Leonhardt’s column where he articulates these fears—or where he actually tries to address them. In the second half of his column, he lists “three main ways that the health care system already imposes rationing on us.” Everything he says makes sense (although his first form of “rationing” is absurdly metaphoric). But nowhere does he directly address the fears the ladies expressed.

Will they have to stand in a line? Even if they have the money? Leonhardt never quite says. And yes, those are the kinds of fears which derive from that “rationing rhetoric.”

Leonhardt’s column helps us see why health care reform won’t likely occur—certainly not the type of reform progressives would most prefer. Simply put, Leonhardt doesn’t seem to know what’s on the minds of average people. You can’t speak to average people’s fears if you don’t know what those fears really are. But conservative spin-tanks do know the fears of those average people. Sometimes using focus groups and polling, they craft “buzzwords”—skillful bits of rhetoric—which drive those fears along.

The ladies Dormady have heard such buzz all the years of their lives. They heard the buzz in 1993—and they’ve constantly heard it since then. Some of this buzz involves health care—and some of it simply involves “big government.” They constantly hear such buzz from the right. But what did they hear from the mainstream press all those years? What did they hear from the left?

For the most part, they heard very little—nothing relevant to their fears. In April, they heard a week of insults from Maddow and Olbermnan—the kinds of upper-class progressives who seem to enjoy mocking average people. (A guess: The ladies weren’t Rhodes Scholars.) In June, they got a long column from Leonhardt. But where did he speak to their fears?

Why do they hear so little from the mainstream press, or from those on the left? Yesterday, Mark Halperin may have explained it. We’ve said what he said for the past ten years, ever since the first Gore- Bradley debate in October 1999. (Gore and Bradley discussed health care, in detail. The “press” discussed Gore’s clothes.) Yesterday, Halperin said the same thing we said back then (just click here). And some liberals yelled at him for it:

HALPERIN'S TAKE: 5 reasons to bet AGAINST major health care reform passing this year.

  1. 1/6 of the economy can't be remade without genuine bipartisan support.
  2. The sticker shock threatens to whittle the thing down to something well short of universal coverage.
  3. The public is not demanding action.
  4. The upside doesn't seem big enough now to give congressional Democrats sufficient cover to vote for a tax increase.
  5. Most journalists still have health insurance.

He got yelled at for stating that fifth reason. Yet it’s probably part of the problem—and he was cheeky to say it. In part, big journalists don’t understand the concerns of the ladies Dormady because they have good health care themselves. Just a guess: Maddow and Olbermann don’t discuss this issue for similar reasons.

Instead, they insult the average people who make Halperin’s third point true.

In 2003, the United States spent $5400 per person on health care. Finland was spending $2100. Career liberals didn’t say boo about that—haven’t said much about this topic for the past fifteen years.

Why do you think that is? We’ll recommend Halperin’s fifth take.

In the past fifteen years, the “buzz words” from the right have continued. There has been little serious push from the left. For fifteen years, the fears of the ladies Dormady increased. Your side largely stared into air. But of course, your side also said nothing at all during the slanders of the 1990s. It was safer and easier not to complain. And your leaders had very good jobs.

Last night, Olbermnan played the fool in his closing segment in a truly stunning way. Do you really fail to understand why a man who gets paid $5 million would go on the air, on a national “news show,” and kill time in that embarrassing manner? (To watch what he did, just click here.)

We strongly suggest that you watch that segment. (And yes, it represents the latest case in which Olbermann indulged himself in the open ridicule of women. Ironically, Melissa Harris-Lacewell had appeared on the program earlier, explicitly praising KeithO’s feminism. At the same time, Maddow was on Charlie Rose, endlessly kissing his keister. This is your movement on hustle and climb.)

No, it isn’t Olbermann’s fault that the left has failed to make a case about health care in the past fifteen years—even though we’ve had the world’s most ridiculous set of facts to work with. (The UK: $2300!) But he was clowning hard last night, frying the brains of every viewer. And let’s be honest: He and Maddow don’t waste their time on such petty concerns as the health care fears of average people. The ladies Dormady aren’t their kind. For many in the “progressive” world, people like the ladies Dormady stand at the right hand of tea-baggers. Let’s be candid: It’s been that way on the left as long as we’ve been alive.

Their selection of topics is typically drawn from the upper-class end of the “progressive” palate. And, as Halperin accurately said: Upper-end people have health care.

Progressives say the darnedest things: Let’s be clear: Maddow is much less foolish than Olbermann. In theory, she remains full or promise. But she can say the darnedest things.

Last night, when she wasn’t kissing Charlie’s keister and ring (Gwen Ifill is one of her heroes/and she thinks Chris Matthews is brilliant), Maddow staged the kind of intelligent discussion that makes you mourn what her program frequently is. But near the end, she made one of her trademark, very-odd statements. We can’t quote today—she went on too long, and we weren’t taping. But she said she doesn’t even know who her TV competitors are. She doesn’t know who’s on the other cable news channels at the same time she’s on.

At 9 PM, Larry King is on CNN, Sean Hannity is on Fox. And Rachel Maddow doesn’t know that? It’s always possible that’s true, of course. But could anyone really believe it? (Charlie of course played along.)

Maddow says such things a lot. We haven’t had time to fact-check.